Anesthesia & Analgesia

Home > Subjects > Resuscitation > Pediatric Perioperative Life Support
Anesthesia & Analgesia:
doi: 10.1213/ANE.0b013e3182a1f3eb
Pediatric Anesthesiology: Special Article

Pediatric Perioperative Life Support

Shaffner, Donald H. MD*; Heitmiller, Eugenie S. MD*; Deshpande, Jayant K. MD, MPH

Continued Medical Education
Continuing Medical Education
Collapse Box


Pediatric advanced life support training and guidelines are typically designed for first-responders and out-of-hospital resuscitation. Guidelines and scenarios that are more applicable to the perioperative environment would be beneficial for anesthesiologists. The goal of this article is to review resuscitation of pediatric patients during the perioperative period. We use a format that focuses on preresuscitation preparation, resuscitation techniques, and postresuscitation management in the perioperative period. In an effort to provide information of maximum benefit to anesthesiologists, we include common pediatric perioperative arrest scenarios with detailed description of their management. We also provide a section on postresuscitation management and review the techniques for maintaining the child’s hemodynamic and metabolic stability. Finally, 3 appendices are included: an example of an intraoperative arrest record that provides feedback for interventions; a table of key medications for pediatric perioperative resuscitation; and a review of defibrillator use and simulation exercises to promote effective defibrillation.

1. Introduction

2. Preresuscitation Preparation/Prevention

a. Common etiologies of pediatric perioperative arrest

b. Categorization of risks and causes for pediatric perioperative arrest

c. Familiarization with resuscitation algorithms, skills, and equipment

d. Familiarization with resuscitation team, roles, and communication

3. Perioperative Resuscitation

a. Recognizing the need for resuscitation

b. Airway management

c. Circulation

d. Medication administration

e. Defibrillation and cardioversion

f. Monitoring the effectiveness of cardiopulmonary resuscitation

g. Open-chest cardiopulmonary resuscitation

h. Extracorporeal cardiac life support

i. Applying pediatric advanced life support assignments of team roles and responsibilities in the operating room

4. Treatment for Specific Pediatric Situations

a. Arrest during inhalational induction

b. Arrest in a child with a ventriculoperitoneal shunt malfunction

c. Posterior spinal fusion and craniofacial reconstruction surgeries

d. Transfusion-related hyperkalemia

e. Local anesthetic toxicity

f. Anaphylaxis

5. Postresuscitation Management

a. Maintain normotension

b. Temperature maintenance

c. Oxygen saturation maintenance

d. Avoid hyperventilation

e. Maintain normoglycemia

f. Breaking bad news to parents/families

g. Team debriefing

6. Summary

7. Acknowledgments

8. Tables and Figures

9. References

10. Appendices

1. Example of a Perioperative Arrest Record/Cognitive Aid (PARCA)

2. Medications for Perioperative Arrest: Pediatric Dosing

3. Defibrillator Key Points and Hands-On Simulation Exercises

© 2013 International Anesthesia Research Society

You currently do not have access to this article.

You may need to:

Note: If your society membership provides for full-access to this article, you may need to login on your society’s web site first.


Become a Society Member

Article Tools


Article Level Metrics