Equipment and monitoring in paediatric anaesthesia

Advances in paediatric anaesthetic equipment and monitoring continue to be made. While the mainstay of airway intubating equipment currently is the direct laryngoscope, video laryngoscopes and endoscopes are increasing in their use. These continue to evolve, generating better quality pictures, with more sophisticated yet easier to use equipment. Vascular access in paediatric anaesthesia can be challenging with an increasing number of patients presenting with difficult intravenous access. Ultrasound has become an integral piece of equipment in the management of these children. As the population increases in weight, so the management of the obese paediatric patient is now a reality. This requires thought and careful planning of their peri-operative care. Newer techniques such as high-flow nasal oxygen are useful both to prevent hypoxia at induction, but also to facilitate open airway surgery. Neurological monitoring in the form of near infrared spectroscopy and bispectral index are discussed with evidence relevant to paediatric practice. This article will discuss all of these devices and techniques with particular emphasis on paediatric anaesthetic practice.