A one year child, preterm, low birth weight with delayed milestones is posted for elective hernia repair. Which of the following statement is true?
Correct Answer: Wait for complete neurological evaluation
Description: A i.e. Wait for complete neurological evaluationRef: Smith's Pediatric Anaesthesia, page 749 and Indian J Anaesth 2008;52, page 397Explanation:"A complete history and physical examination is essential before anaesthetizing these children. ""In the absence of a precise diagnosis, children presenting with an undiagnosed neuromusculardisease should not have elective surgery or anaesthesia other than as part of the diagnostic process.Ref: Vindra etal., Anaesthesia for Children with Neuromuscular Disease, Continuing Education in Anaesthesia Critical Care and Pain, Volume 10, Issue 5, 1 October2010, pages 143-147Inguinal hernia repair is the most common general surgical procedure performed by pediatric surgeons.Males are more frequently affected than females, and the incidence of inguinal hernia is highest in the first year of life.Right-sided hernias (60%) occur more frequently than left-sided (30%) and bilateral (10%) hernias.Risk factors associated with inguinal hernias are prematurity, chronic respiratory illness, and excessive intraperitoneal fluid (ventriculoperitoneal shunts, ascites, peritoneal dialysis).Anesthesia can be induced by mask inhalation of volatile agents or by IV or rectal technique.Endotracheal intubation is usually unnecessary for herniorrhaphy, except in infants younger than 1 year, in whom it may be difficult to maintain an adequate airway with bag and mask ventilation without distending the stomach.Premature infants have a particularly high incidence of inguinal hernias. In these infants, for whom an inhalation anesthetic may have increased risks, spinal anesthesia and caudal epidural anesthesia have been used successfully to avoid general anesthesia and endotracheal intubation.The history is compatible with cerebral palsy or congenital myopathies. Since this is an elective surgical repair, complete neurological workup and diagnosis is necessary before anesthetic risk can be assessed.These children are ideal for assessment by a multidisciplinary team which include anaesthesiologists and pediatrician. A complete history and physical examination is essential before anaesthetizing these children, including a discussion of postoperative pain management with the parents. Cognitive and communication problems may make preoperative assessment more difficult. Parents and caretakers are best to be involved during this period not only to gain information but also allay the fears of the child.Anesthetic Concern in Cerebral PalsyIntraoperative hypothermia and slow emergence.Suxamethonium does not cause hyperkalaemia in these patients, and a rapid sequence induction may be indicated.Anesthetic Concern in Neuromuscular DiseasesThe incidence of anaesthesia-induced rhabdomyolysis is significant.Succinylcholine and volatile agents should be avoided in at-risk children.
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Anaesthesia
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