New aspects in paediatric anesthesia - Role of new anesthetics and protocols

The paediatric anaesthetic management requires high standards of security. However, special considerations should be given to the psychological behaviour to provide an atraumatic and smooth transition to general anaesthesia. The pain from venipuncture will be diminished by lidocaine-prilocaine cream (EMLA). Because of its pleasant smell, the rapidity of induction, and the haemodynamic stability mask induction using sevoflurane is feasible and routinely used. The isomer S(+)-ketamine provides a relatively stable haemodynamic state during intramuscular induction. The newer intravenous anaesthetics propofol and remifentanil are well appreciated for paediatric anaesthesia using their potency of rapid induction and recovery. A recent study has challenged another myth of paediatric anaesthesia, that cuffed tubes must be avoided in infants and children.