الفهرس 
Anatomy of the AirwayOnly 14 pages are availabe for public view
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Abstract
Syndromic children or better speaking children with special needs have gained importance throughout the world. Furthermore, most countries provide services for them and now regional centers for their assessment and care are available worldwide.
Any anesthesiologist may encounter such patients and will have to manage them without having particular experience in this field. The anesthesiologist must therefore consider these children as potentially dangerous. They illustrate a number of difficulties that face the anesthesiologist who provides analgesia and anesthesia for them. Furthermore, there are many reports of difficulties encountered during anesthetizing these children. It can be seen that many of the difficulties have arisen as a result of either the diagnosis of these children not being made before operation or inexperience with dealing with them intra- or postoperatively.
These children must not be regarded as having a single disease entity. They are, in different types, many of which have specific implications for the anesthesiologist.
We have focused on the most common cases encountered by the anesthesiologist, especially neuromuscular diseases, airway abnormalities, congenital heart disease and dysmorphic facies. Other diseases, or better saying, syndromes, have also been described including examples of orthopedic, central nervous system, neurological and mental syndromes.
The pathophysiology and the frequently associated physiologic abnormalities of the respiratory, circulatory and neurologic systems of these children dictate, however, that from an anesthesiologist’s point of view, they must be considered different from the normal.
The pathophysiology of each disease entity was fully described, mentioning the unique features of each syndrome and its anesthetic implications.
The presentation and features of some of these children are described and their anesthetic management and the increased risks associated with anesthesia are considered.
Recently, it appears to be the safest to use a regional or local analgesic technique whenever possible for these children, as this is associated with lesser complications. However, some of these children present several problems for both general and regional (spinal and epidural) anesthesia owing to structural deformities, e.g. osteogenesis imperfecta. If general anesthesia is unavoidable, it should only be undertaken in a center able to provide postoperative support, i.e. ICU facilities should be available whenever these children are anesthetized.
Furthermore monitoring of these children was described, since they need meticulous monitoring intra- and postoperatively, since their postoperative period is also hazardous.