ABSTRACT

Anaesthesia carries an increased risk of respiratory complications. An unexpected difficult airway is unusual in paediatric practice. It is very helpful to anticipate difficulty so that relevant equipment can be at hand. Local anaesthetic toxicity may follow accidental intravenous injection or systemic absorption, the latter being affected by total dose administered, site of injection and vasoconstrictor additives. It is due to a membrane-stabilising effect on other distant cells, especially heart and central nervous system. In an anaesthetised patient some of the early signs such as tingling around the mouth, agitation and tremor will be masked. Anaesthetic considerations include prematurity and associated concerns, effects of repeated aspiration and practical difficulties related to airway management. There is a risk of intubating the fistula but even if the tracheal tube is placed correctly, there is risk that gases will enter the stomach causing distension that impedes ventilation.