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Pediatric Perioperative Life Support

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

doi: 10.1213/ANE.0b013e3182a1f3eb
Pediatric Anesthesiology: Special Article
Continuing Medical Education

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

From the *Departments of Anesthesiology and Critical Care Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Departments of Anesthesiology and Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas.

Accepted for publication June 5, 2013.

Published ahead of print September 10, 2013

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Donald H. Shaffner, Bloomberg 6324, The Johns Hopkins Hospital, 1800 Orleans St., Baltimore, MD 21287. Address e-mail to

© 2013 International Anesthesia Research Society