Search

Safe and appropriate pharmacotherapy in children requires knowledge of age-group-specific features regarding pharmacology and drug dosing. In addition, aspects of medication safety must be considered. This review highlights basic principles and discusses key facts; further research in paediatric databases is recommended (www.kinderformularium.de).

Acute pain therapy in children is highly complex. Already preoperatively, the course for a successful therapy is set in the interaction with the child and parents. The goal of the treatment is a satisfied child. This means the use of empathy and therapy planning aimed at a balance between effect and side effect and functionality. Modern concepts are opioid-sparing and procedure-specific. Regional anaesthesia plays a major role, among other things due to excellent safety data. Knowledge of age- and block-specific local anaesthetic dosages is essential. Little is known about pharmacodynamic data of analgesics in children. Although knowledge about pharmacokinetic characteristics is increasing, off-label use of analgesics is inevitable. International databases such as the Kinderformularium provide up-to-date information. When using opioids, rules for safe handling must be followed both in terms of use and prescribing. Non-opioids and adjuvants - individually or in combination - have an established place in perioperative pain management. Non-pharmacological interventions can reduce anxiety and pain. Anxiety is one of the risk factors for chronic postsurgical pain.

The majority of professionals involved in pre-hospital emergency care do not have explicit paediatric training and have limited experience in the care of life-threatening paediatric emergencies. There is often a fear of being overwhelmed. However, no special paediatric expertise is primarily required to successfully perform resuscitation in children. In addition, the scope of the measures required for successful paediatric resuscitation is on average significantly smaller than for adults. It is essential to know clear and easy-to-implement courses of action, such as those provided by the resuscitation guidelines. For the technical implementation of airway protection, mask-bag ventilation and the laryngeal mask are essential, and for access to the venous system, the intraosseous needle is an aid that overcomes all difficulties almost without exception. With additional support from reference sources, calculation aids and length-related systems, a high level of drug therapy safety can be achieved. In summary, through thorough individual and institutional preparation for paediatric emergencies, safe primary care is feasible by emergency service personnel of any speciality.

Children and adolescents with disabilities have the right of full and effective participation and inclusion in society. Disability includes a wide range of long-term physical, mental, intellectual and sensory impairments for various reasons. In addition to the basic illness many children with disabilities have concomitant diseases. These diseases are decisive for the perioperative risk. Information from parents regarding their child's behavioural patterns and needs, signs of escalating anxiety and pain are important. Perioperative dialog with the parents is helpful and has positive effects also from parental point of view. Pharmacologic premedication is recommended. Induction of anaesthesia can be challenging and sometimes requires unconventional methods. Pain behaviour may be unusual. There are suitable scales that incorporate such behaviours.Die sichere anästhesiologische Versorgung von Kindern und Jugendlichen mit körperlichen oder geistigen Behinderungen ist zumeist zeitaufwendig und anspruchsvoll. In diesem Beitrag wollen wir auf Besonderheiten in der perioperativen Versorgung von behinderten Kindern und Jugendlichen hinweisen. Auf die Probleme bei der Anästhesie von Kindern mit Autismus-Spektrum-Störung, infantiler Zerebralparese und Trisomie 21 gehen wir im Anschluss näher ein.

Drug errors occur in all areas of care. Due to age-group-specific characteristics and the need for dose calculation, the probability of errors in children increases compared to adults. The recognition of the fallibility of every supplier and the acceptance of security structures are essential. The article describes a catalogue of measures for drug safety suitable for everyday use.Medikamentenfehler kommen in allen Versorgungsbereichen vor. Bei Kindern steigt die Fehlerwahrscheinlichkeit im Vergleich zu Erwachsenen aufgrund altersgruppenspezifischer Besonderheiten und der erforderlichen Dosisberechnung. Wesentliche Aspekte sind: die Erkenntnis, dass jeder Versorger fehlbar ist, und die Akzeptanz von Sicherheitsstrukturen. Dieser Beitrag beschreibt einen Katalog alltagstauglicher Maßnahmen zur Medikamentensicherheit.

Both ingestion and aspiration of foreign bodies are common events in children. If a child had something in his mouth and thereafter respiratory or swallowing complaints occur, both aspiration and ingestion are possible causes. Both events can be immediately life threatening or, if a direct threat is absent, cause significant long-term impairments for the children. Therefore, the identification of any possible threat is essential. This paper identifies the diagnostic and therapeutic options and needs that will ensure the best possible safety and the least possible consequential harm.Sowohl Ingestions- als auch Aspirationsunfälle sind häufige Ereignisse bei Kindern. Sie können unmittelbar lebensbedrohlich sein oder bei fehlender direkter Bedrohung dennoch erhebliche langfristige Beeinträchtigungen für die Kinder verursachen. Der Beitrag zeigt die diagnostischen und therapeutischen Möglichkeiten und Notwendigkeiten auf, durch die eine bestmögliche Sicherheit und möglichst geringe Folgeschäden zu gewährleisten sind.

A difficult airway in childhood is very uncommon. Therefore, it will always be an unfamiliar and menacing situation for most anaesthetists. Knowledge of the individual pathology, associated anaesthesiological problems and possible solutions provide the basis for successful airway management. Endoscopical techniques are essential for the process. The following article shows how a difficult airway in childhood can be recognized and which anaesthesiological options exist to handle such a situation.