[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anaesthesia and ICU](https://durgical.com/en/anaesthesia/) › [By patient and by surgery](https://durgical.com/en/anaesthesia/areas/by-patient/) › Paediatric anaesthesia

# Paediatric anaesthesia

- Patient and surgery

Anaesthesia for babies and children, whose airways, breathing and drug handling differ from adults and whose families need to be part of the plan.

Updated Nov 13, 2026

## Key points

- Children desaturate fast and respond to hypoxia with bradycardia: treat bradycardia first with oxygen and ventilation.
- Airway differences: large occiput and tongue, high anterior larynx, floppy epiglottis, short trachea; endobronchial intubation is easy.
- A recent upper respiratory infection raises the risk of laryngospasm, bronchospasm and desaturation; weigh postponing elective surgery.
- Ex-premature infants have a risk of apnoea after anaesthesia and need overnight monitoring.
- Caudal block is the most common paediatric regional block and is usually placed under general anaesthesia.

## What it is

Children are not small adults. Their airway has a large head and occiput, a relatively large tongue, a higher and more anterior larynx, a floppy epiglottis and a short trachea, so positioning differs and a tube easily slips into one bronchus. Oxygen consumption is high and reserve small, so they desaturate within seconds and the heart responds to hypoxia with bradycardia; cardiac output depends mainly on heart rate. Neonates and infants lose heat quickly through a large surface area, and their liver and kidneys handle drugs immaturely, so every drug and fluid is calculated by weight. Preoperative assessment looks for recent upper respiratory infection, which raises the risk of laryngospasm and bronchospasm, prematurity, which raises the risk of apnoea after anaesthesia in young infants, congenital heart disease, syndromes with difficult airways, and family history of anaesthetic problems such as malignant hyperthermia or undiagnosed muscle disease. Induction is often inhalational with a volatile agent, or intravenous after topical anaesthetic cream, with a parent present when appropriate and anxiolytic premedication when needed. Regional anaesthesia, most often a caudal block or ultrasound-guided peripheral block, is usually placed after the child is asleep and reduces opioid needs. The child gives assent where able, and the parents give consent.

## What changes in this patient

- Everything by weight: drugs, fluids, tube size and equipment are chosen for the child's weight and age.
- High oxygen consumption and small functional residual capacity: short apnoea tolerance.
- Heart rate drives cardiac output; bradycardia is usually hypoxia until proven otherwise.
- Large surface area and thin skin: rapid heat loss, especially in neonates.
- Immature liver and kidney function in neonates prolong the effect of many drugs; glucose stores are small.
- Anxiety and separation: preparation, play and parental presence shape the experience and later behaviour.

## Anaesthetic plan (and why)

- Assess age, weight, prematurity, recent colds, airway, heart and family history — these drive the main paediatric risks.
- Follow age-appropriate fasting in hours and encourage clear fluids until shortly before — less dehydration, less distress.
- Prepare equipment in several sizes and calculate drugs by weight before induction — no time to calculate in a crisis.
- Induce by inhalation or intravenously after topical anaesthetic, with a parent present when appropriate — calm and fast.
- Use a shoulder roll in infants and confirm tube position by listening to both sides and capnography — avoids one-lung intubation.
- Warm the room, fluids and child and monitor temperature — small children cool quickly.
- Add a caudal or peripheral block with ultrasound and a calculated local anaesthetic limit — less opioid, lower toxicity risk.
- Give multimodal analgesia and nausea prophylaxis and plan the emergence — limits pain, vomiting and emergence delirium.

## How the infant airway differs from the adult airway

| Feature | Infant | Practical consequence |
| --- | --- | --- |
| Head and occiput | Large | Neck flexes when supine: a roll under the shoulders aligns the airway |
| Tongue | Large for the mouth | Obstructs easily under sedation; an oral airway helps |
| Larynx | Higher and more anterior | A straight blade lifting the epiglottis is often easier |
| Epiglottis | Long, floppy, U-shaped | Harder to lift with a curved blade |
| Trachea | Short | A small movement of the head displaces the tube into a bronchus or out |

## Risks and complications

- Laryngospasm and bronchospasm, especially at induction or emergence and after recent respiratory infection.
- Hypoxaemia with bradycardia, which can progress quickly to cardiac arrest.
- Postoperative apnoea in ex-premature and young infants.
- Emergence delirium after volatile anaesthesia, and postoperative nausea and vomiting in older children.
- Hyperkalaemic arrest with suxamethonium or rhabdomyolysis with volatile agents in undiagnosed muscular dystrophy.
- Local anaesthetic toxicity from weight-based miscalculation, and dosing errors in general.

## Next step

- Recover in a child-friendly area with parents back early; monitor breathing, oxygen saturation, pain and nausea.
- Monitor ex-premature and young infants overnight with apnoea monitoring after anaesthesia.
- Call a senior anaesthetist for neonates, syndromes with difficult airways, congenital heart disease or any laryngospasm with desaturation.
- Give weight-based analgesia instructions for home and a contact number; check for sore throat, vomiting or behaviour change.
- Record any anaesthetic event clearly; refer suspected malignant hyperthermia or muscle disease for testing.

## Test yourself

Think of the answer, then tap the question to see it.

## Why does an infant become bradycardic quickly during an airway problem?

High oxygen consumption and a small reserve cause rapid hypoxaemia, and the infant heart responds to hypoxia with bradycardia; oxygenation and ventilation are the first treatment.

## Why is endobronchial intubation common in infants?

The trachea is short, so a small advancement of the tube or flexion of the head moves the tip into a main bronchus, usually the right.

## Why does a recent upper respiratory infection matter before paediatric anaesthesia?

The airway stays irritable for weeks, raising the risk of laryngospasm, bronchospasm and desaturation; elective surgery may be postponed if symptoms are significant.

## Which paediatric regional block is most commonly used and how is it usually placed?

The caudal block through the sacral hiatus, usually placed after induction of general anaesthesia, for surgery below the umbilicus.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anaesthesia/paediatric-anaesthesia/)

## Elsewhere in DurgiPedia

- [Newborn physiology and fetal maturation](https://durgical.com/en/physiology/newborn-physiology-and-fetal-maturation/)
- [Vital signs in children: how they change with age](https://durgical.com/en/clinical-exam/vital-signs-in-children-how-they-change-with-age/)
- [Pediatric history: perinatal, growth, development and vaccines](https://durgical.com/en/clinical-exam/pediatric-history-perinatal-growth-development-and-vaccines/)
- [Consent in minors: progressive autonomy in Colombian law](https://durgical.com/en/medical-ethics/consent-in-minors-progressive-autonomy-in-colombian-law/)

## Connections

## Related 8

- [How a child's airway differs](https://durgical.com/en/anaesthesia/how-a-child-s-airway-differs/)
- [Caudal block in children](https://durgical.com/en/anaesthesia/caudal-block-in-children/)
- [Peripheral nerve blocks in principle](https://durgical.com/en/anaesthesia/peripheral-nerve-blocks-in-principle/)
- [Preoperative fasting: what and why](https://durgical.com/en/anaesthesia/preoperative-fasting-what-and-why/)
- [Bronchospasm and laryngospasm](https://durgical.com/en/anaesthesia/bronchospasm-and-laryngospasm/)
- [Malignant hyperthermia](https://durgical.com/en/anaesthesia/malignant-hyperthermia/)
- [Neuromuscular disease and anaesthesia](https://durgical.com/en/anaesthesia/neuromuscular-disease-and-anaesthesia/)
- [Postoperative nausea and vomiting](https://durgical.com/en/anaesthesia/postoperative-nausea-and-vomiting/)

## Related conditions 6

- [Croup (laryngotracheobronchitis)](https://durgical.com/en/conditions/croup/)
- [Acute epiglottitis](https://durgical.com/en/conditions/acute-epiglottitis/)
- [Foreign body aspiration in children](https://durgical.com/en/conditions/foreign-body-aspiration-in-children/)
- [Bronchiolitis (RSV)](https://durgical.com/en/conditions/bronchiolitis/)
- [Down syndrome (trisomy 21)](https://durgical.com/en/conditions/down-syndrome/)
- [Malignant hyperthermia](https://durgical.com/en/conditions/malignant-hyperthermia/)

## In Pharmacology 10

- [Sevoflurane](https://durgical.com/en/pharmacology/sevoflurane/)
- [Propofol](https://durgical.com/en/pharmacology/propofol/)
- [Midazolam](https://durgical.com/en/pharmacology/midazolam/)
- [Dexmedetomidine](https://durgical.com/en/pharmacology/dexmedetomidine/)
- [Local anesthetics](https://durgical.com/en/pharmacology/classes/local-anesthetics/)
- [Bupivacaine](https://durgical.com/en/pharmacology/bupivacaine/)
- [Ropivacaine](https://durgical.com/en/pharmacology/ropivacaine/)
- [Paracetamol](https://durgical.com/en/pharmacology/paracetamol/)
- [Atropine](https://durgical.com/en/pharmacology/atropine/)
- [Suxamethonium](https://durgical.com/en/pharmacology/suxamethonium/)

[← All of anaesthesia](https://durgical.com/en/anaesthesia/)

Educational content; it does not replace supervised training, your institution's protocols or the anaesthetist's or intensivist's decision. It contains no doses and no ventilator or infusion settings.

Sources: [Pediatric Preoperative Anesthesia Evaluation and Management](https://www.ncbi.nlm.nih.gov/books/NBK559198/) (StatPearls (NCBI Bookshelf), 2026); [Pediatric Regional Anesthesia](https://www.ncbi.nlm.nih.gov/books/NBK572106/) (StatPearls (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anaesthesia/paediatric-anaesthesia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anaesthesia/paediatric-anaesthesia/