الفهرس 
Physiological and Anatomical considerationOnly 14 pages are availabe for public view
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Abstract
Trauma care is becoming an increasingly important part of modern medical practice as advances in care reduce the mortality from other diseases. Caring for pediatric patients with trauma is a complex and integrated process that requires knowledge of the special considerations of pediatric trauma patients and understanding of the pathophysiology and special requirements of the pediatric population.
The provision of safe anesthesia for the pediatric patient depends on a clear understanding of the anatomical, physiological and psychological differences between children and adults.
The infants have a proportionately larger head and tongue, narrow nasal passages, cephalad larynx, a long epiglottis, and a short trachea and neck, the subglottic area is the narrowest part of airway in children; these anatomic features make a challenge for anesthesiologist during intubation.
Physiological difference like renal function is markedly diminished in the neonate, complete maturation of renal function occurs by about 1 years of age, and the functional maturity of the liver is incomplete. Neonates have a limited capacity to maintain normal body temperature. In the setting of traumatic injury, children typically respond to hypovolemia differently to adults.
Several factors influence childhood injuries, including age, sex, behavior and environment; age and sex are the most important factors affecting the patterns of injury. Head injuries, either alone or in association with multiple system injuries, are the most severe and cause the most deaths.
The survival of children who sustain major or life-threatening trauma depends upon good prehospital care, appropriate triage, resuscitation by an experienced trauma team in an emergency center and effective emergent surgery. Physicians who are responsible for the care of a pediatric trauma patient, must be familiar with every tenet of modern trauma care (pediatric advanced life support course certification should be required).
The anesthesiologist should be present when the patient arrives in the emergency room, this will help to reduce the childhood mortality rate from trauma. The orderly progression of history, physical examination, diagnosis, and treatment must often be abandoned with trauma patients; because resuscitation has priority over the diagnosis. The goal of treatment is to provide cardiopulmonary cerebral resuscitation for the critically injured patient.
The patient must be regarded as having a full stomach and a potential injury to the cervical spine unless proved otherwise. The technique of intubation is rapid sequence induction and tracheal intubation with manual inline stabilization of the cervical spine.
There is no evidence that the choice of anesthetic agent affects survival; the safest course of action for the anesthetist is to use drugs with which he/she is most familiar.
Certain intraoperative problems may be occurring like prolonged anesthesia, hypothermia, hypoxia, massive transfusion and finally cardiac arrest.
Treatment of pain and suffering should be a priority for all clinicians especially anesthesiologist. Pain management in pediatric trauma patients are essential components of their management and may help not only to reduce pain but also improve cardio respiratory stability. Effective pain management can also allay fear and anxiety, prevent the development of procedure- phobia which frequently develops in these patients and reduce the incidence and severity of post-traumatic stress disorder and other psychological disturbances.
At the end of surgery; options for postoperative care include: return to the ward or shift to pediatric intensive care unit. There are criteria of extubation, Inability to meet these criteria immediately after surgery, mandates admission to a critical care unit; also there are criteria for discharge from intensive care unit.