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General anesthesia in neonates and children: Agents and techniques

Stephanie A Black, MD, EdM
Lynne G Maxwell, MD, FAAP
Section Editor
Lena S Sun, MD
Deputy Editor
Marianna Crowley, MD


Pediatric anesthesia differs in important ways from anesthesia for adults. This topic will discuss general principles of preanesthesia preparation, induction and maintenance of general anesthesia, and emergence from anesthesia for the healthy child undergoing routine surgery.

Induction and maintenance of general anesthesia for adults are discussed separately. (See "General anesthesia: Induction" and "General anesthesia: Maintenance and emergence".)


History and physical examination — All children should be evaluated with a preanesthesia medical history, review of systems, and an anesthesia directed physical examination. The preanesthesia evaluation is similar to that of an adult, with modifications appropriate for the child's stage of development, pediatric physiology, and family history. Important components of the preoperative history and physical examination for a child are shown in tables (table 1 and table 2).

A preanesthesia airway evaluation, including assessment of predictors of difficulty with airway management, should be performed in children, as it would be for adults, with particular attention to findings which may be associated with difficult intubation, such as reduced thyromental distance (micrognathia), decreased mouth opening, reduced neck mobility, or large tongue. The components of the airway examination for children are shown in a table (table 2). (See "Airway management for induction of general anesthesia", section on 'Airway assessment' and "Airway management for induction of general anesthesia", section on 'Prediction of the difficult airway'.)

Laboratory assessment — Preoperative laboratory testing should be individualized, based on patient factors and institutional norms. Routine laboratory studies are usually not required in healthy children.  

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Literature review current through: Dec 2017. | This topic last updated: Aug 29, 2017.
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