Volatile or intravenous
Volatile agents give you an end-tidal number that correlates with depth, which is a real safety feature. Total intravenous anaesthesia gives a smoother emergence with less nausea and is mandatory in malignant hyperthermia susceptibility. Both are correct; the choice follows the patient and the case.
Minimum alveolar concentration
The end-tidal concentration at which half of patients do not move to a standard stimulus. It falls with age, opioids, nitrous oxide, hypothermia and illness, and rises in children and with chronic alcohol use. Age-adjusted MAC is the number that matters, not the textbook one.
Reading the patient, not the vaporiser
Tachycardia and hypertension during surgery may be light anaesthesia, inadequate analgesia, hypercapnia, hypovolaemia or a full bladder. The reflex to turn up the vapour treats one of five possibilities. Look at the capnograph, the surgical field and the fluid balance before you reach for the dial.
Awareness
Rare, and devastating when it happens. Risk concentrates in paralysed patients on light anaesthesia: cardiac surgery, obstetrics, trauma, and any total intravenous technique where the line tissues without anyone noticing. Depth monitoring is recommended for paralysed patients on intravenous anaesthesia, and a visible, running infusion site is worth more than any monitor.
Watch it done
Arterial line placement
Radial arterial cannulation, palpation and ultrasound, and the transducer set-up.
Source: OPENPediatrics · Watch on YouTube