Induction, Maintenance, and Emergence

Induction of anesthesia in the pediatric population differs significantly compared to adult care. Many pediatric inductions are performed with a mask-only technique. Intravenous access is rapidly obtained prior to securing the airway in the majority of cases. Maintenance of anesthesia can be achieved via an inhalational agent, intravenous agent, or a combination of both. Fluid should be administered judiciously. Multimodal pain management is superior to an opioid-only technique. Premature or sick infants and neonates require added glucose to their fluids and frequent glucose checks. Additional intravenous access, arterial access, or foley should be obtained once the patient’s airway is secure and the patient is under a surgical plane of anesthesia. Emergence includes reversal agents if muscle relaxant was administered. Regardless of deep versus awake extubation, preparations for significant emergence delirium should be made for children aged 2-12 years. Common postoperative sequelae such as laryngospasm and emergence delirium are discussed.