Anesthesia for Pediatric Patients with Common Comorbidities Part II

In this chapter, we will discuss the perioperative anesthetic concerns of children with autism, attention-deficit hyperactivity disorder (ADHD), cystic fibrosis, epidermolysis bullosa, and von Willebrand disease. Children with autism and ADHD are at high risk for having severe anxiety and distress when undergoing anesthesia due to difficulty in adjusting to the changes in daily routine and new environment. Careful planning to limit waiting time in the preoperative area and appropriate premedication are critical to minimizing distress. Children with cystic fibrosis may have involvement of pulmonary, gastrointestinal, and pancreaticobiliary organ systems. Due to the increasing longevity of this population, both children and adults may present for a variety of surgical procedures; pulmonary status is a key concern when formulating an anesthetic plan. Children with epidermolysis bullosa present special challenges when undergoing anesthesia because both airway devices and the equipment used to monitor vital signs can cause serious postoperative complications. Von Willebrand disease is the most common congenital bleeding disorder encountered in pediatric anesthesia. Safe perioperative management requires interdisciplinary coordination to create a plan for prophylaxis prior to surgery, intraoperative and postoperative management to maintain hemostasis.