Experience Summary

In this 360-degree video, observe anaesthetic induction of a paediatric patient prior to a tonsillectomy procedure.

Clinical Context

Anaesthetic induction in paediatric tonsillectomy is a critical phase of care that requires meticulous planning, clear communication, and an understanding of the unique physiological and emotional needs of children. Tonsillectomy is one of the most common paediatric surgical procedures, often performed for recurrent tonsillitis or obstructive sleep apnoea (OSA). Children undergoing this procedure present distinct challenges, making the induction period especially important for ensuring safety and setting the tone for the entire perioperative course.

The induction phase additionally sets the foundation for intraoperative stability. Ensuring reliable intravenous access, confirming airway security, and establishing an appropriate anaesthetic depth are prerequisites for safe tonsillectomy. Because these procedures involve shared airway access between surgeon and anaesthetist, stable induction facilitates efficient surgical preparation and reduces the risk of complications such as desaturation or aspiration.

Paediatric Considerations In Anaesthesia

A key consideration during induction is the high prevalence of airway abnormalities in this population. Many children presenting for tonsillectomy have OSA, enlarged tonsils, or adenoidal hypertrophy, all of which can contribute to airway obstruction before and during induction. These anatomical and functional airway constraints heighten the risks associated with administering anaesthesia, particularly at the point when protective airway reflexes are lost. Careful assessment, preparation of appropriately sized airway equipment, and anticipation of a potentially difficult airway are therefore essential. Smooth, controlled induction reduces the risk of hypoxia, laryngospasm, and difficult ventilation—complications that can escalate rapidly in paediatric patients.

Another important aspect is the choice between inhalational and intravenous induction. Children may be anxious, needle-averse, or developmentally unable to cooperate with cannulation while awake. Inhalational induction can provide a gentle transition into unconsciousness, allowing intravenous access to be secured once the child is asleep. However, in children with severe OSA, inhalational induction may worsen airway collapsibility, so the technique must be chosen deliberately and with adequate preparation. This decision-making illustrates how induction strategy must be tailored to the child’s clinical profile.

Anaesthetic induction also plays a key role in managing the emotional experience of both the child and their caregivers. Preoperative anxiety can lead to behavioural distress, more difficult inductions, and postoperative emergence agitation. Strategies such as parental presence, age-appropriate explanations, and premedication when indicated help create a calm environment. A smooth induction contributes to better overall cooperation and may improve postoperative recovery.

Learning Outcomes

1. Observe the anaesthetic induction of a paediatric patient.
2. Understand the key safety steps involved in anaesthetic induction.
3. Understand the particular anaesthetic considerations when operating on a paediatric patient.

External Resources

• British Association for Paediatric Otorhinolaryngology - Day Case Paediatric Adenotonsillectomy Consensus Guideline
• Association of Paediatric Anaesthetists of Great Britain and Ireland - Paediatric Anaesthesia For Beginners