Managing Complications in Paediatric Anaesthesia

Martin Jöhr was the leader of Paediatric Anaesthesia at the Department of Anaesthesiology at the Luzerner Kantonsspital, Lucerne, Switzerland. With over forty years of hands-on experience, he is now dedicated to teaching and writing extensively on the topic of paediatric anaesthesia.

• Dedication; Acknowledgements; Abbreviations; 1. Introduction; 2. Concepts and strategy; 2.1. General safety rules: identification of the patient and the type of surgery; 2.2. Adequate anaesthetic plan; 2.3. Understanding the surgical procedure and the patient's physiology; 2.4. Organization and fasting times; 2.5. Anticipating massive bleeding; 2.6. Maintaining body temperature; 2.7. Unexpected laboratory results; 3. Airway related problems; 3.1. Breathing system; 3.2. Cannot intubate, cannot ventilate; 3.3. Can intubate, cannot ventilate; 3.4. Laryngospasm; 3.5. Size of the endotracheal tube; 3.6. Insertion depth of the endotracheal tube; 3.7. Laryngeal perforation; 3.8. Bronchial rupture; 3.9. Damage to teeth; 3.10. Damage related to a supraglottic airway; 3.11. Regurgitation during use of supraglottic airway; 3.12. Pneumothorax; 3.13. Pulmonary oedema e vacuo; 3.14. Pulmonary aspiration; 3.15. Bronchial foreign body; 3.16. Pharyngeal foreign body; 3.17. Oesophageal foreign body; 3.18. Un-anticipated tracheal stenosis; 3.19. Unknown pre-existing pathology; 3.20. Upper respiratory tract infection; 4. Vascular access; 4.1. Impossible venous access; 4.2. Paravasation; 4.3. Paravenous injection; 4.4. Intraarterial injection; 4.5. The 3-way stop cock phenomenon; 4.6. Vascular damage; 4.7. Malposition of the catheter tip; 4.8. Anomalies of the venous system; 4.9. Air embolism; 4.10. Venous thrombosis; 4.11. Ischaemic fingers; 5. Regional anaesthesia; 5.1. Wrong site block; 5.2. Inadequate technique; 5.3. Undesirable block extension; 5.4. Local anaesthetic toxicity; 5.5. Methaemoglobinaemia; 5.6. Total spinal anaesthesia; 5.7. Compartment syndrome; 5.8. Ischaemic extremity; 5.9. Needle damage; 5.10. Complications of caudal anaesthesia; 6. Medication related problems; 6.1. Medication error; 6.2. Drug overdose; 6.3. Inadvertent drug administration; 6.4. Drug administration during total intravenous anaesthesia; 6.5. Propofol infusion syndrome; 6.6. Systemic effect of local treatment (e.g. eye drops); 6.7. Hyponatraemia; 6.8. Hyperchloraemic acidosis; 6.9. Hyperkalaemia; 6.10. Prolonged paralysis; 6.11. Unexpected slow recovery; 6.12. Emergence delirium; 7. Pre-existing conditions; 7.1. Malignant hyperthermia; 7.2. Neuromuscular disease; 7.3. Down syndrome; 7.4. Oncologic disease; 7.5. The diabetic child; 7.6. Behavioural disorders; 7.7. Anaphylaxis; 7.8. Sepsis; 7.9. Pregnancy; 8. Miscellaneous; 8.1. Damage caused by pressure; 8.2. Damage related to positioning; 8.3. Iatrogenic burns; 8.4. Toxic skin necrosis; 8.5. Transfusion reaction.

'Whilst this book is aimed at consultant anaesthetists and trainees it is a valuable resource to all practitioners working in this area of practice and I would recommend its use in the perioperative department to support Operating Department Practitioners, Registered Nurses and other practitioners working in anaesthetics, surgery and post anaesthetic recovery units.' Lindsay Keeley, Journal of Perioperative Practice