The very situation of the operating room itself scares the child. Venous access, necessary for both general and epidural anesthesia, can be long and painful — much more painful than the epidural blockade itself. Therefore, most children need deep sedation or superficial anesthesia, often for two operating rooms.
Intramuscular ketamine (4-5 mg / kg for young children), collected in the same syringe with atropine (0.01-0.02 mg / kg), and sometimes with diazepam (Sibazon), has the following advantages: (1 ) the possibility of induction without venous access; (2) hemodynamic stability; (3) preservation of spontaneous breathing and protective reflexes. Disadvantages: ( 1 ) the fairly high risk of laryngospasm (also a defensive reflex!), Especially in children, especially when the dose of atropine is too low (thick ketamine saliva, can cause laryngospasm); (2) without benzodiazepine in premedication — the possibility of frightening dreams (even long-term psychosis happens very rarely) and other psycho-damaging effects (3) in “former noobs” [Eng. ex-premies \ possibly apnea no less than with inhalation anesthesia.
For the latter reason, for infants of the first months of life who were born prematurely, weaker sedatives are used, for example, dimedrol (intravenously, 1-2 mg / kg).
Shedding for regional blockades
Ketamine 4-5 mg / kg + atropine 0.01 mg / kg i / m in children up to 6 months. Methohexital 15-20 mg / kg per rectum Fentanyl 1-2 mcg / kg + midazolam 0.05-0.1 mg / kg in / in older children Midazolam 0.2 mg / kg intranasal or 0.5 mg / kg per os
Diphenhydramine 1-2 mg / kg / in or chloral hydrate 20-30 mg / kg per os former not to d n of from.
After small outpatient operations, a rather long awakening after ketamine will delay discharge, therefore, for them, induction into superficial anesthesia with an inhalation anesthetic will be optimal.
Sedation during surgery can be supported by inhalation anesthetic, ketamine or propofol (Diprivan, Rekofol, Dipro foul), which has a quick and pleasant awakening and a unique anti-emetic effect. Another advantage of propofol when combined with epidural anesthesia is the ability of its minimal intravenous doses to eliminate the itching caused by epidural and spinal opioids. Children of the first months of life sometimes have enough nipples.