Introduction to Pediatric Anesthesia Anesthesia Methods There are various routes of administration of pediatric anesthesia, including intravenous, inhalation, rectal, nasal, subcutaneous or intramuscular, and others (depending on the method of anesthesia) such as intrathecal (including sacral), subarachnoid, and neuraxial blockade (injection of drugs into the periphery of plexus), etc., among which intravenous and inhalation are more commonly used in pediatric anesthesia. Metabolism of anesthetic drugs Regarding the metabolism of anesthetic drugs. The biggest difference between an adult and a pediatric patient is “growth and development”, a process in which we can see a dramatic change in height and weight in the pediatric patient, as well as the growth and development of the enzymes that metabolize some of the drugs used for sedation and/or anesthesia. However, the metabolism of sedative and/or anesthetic drugs in children can not be generalized, children are not shrunken adults, the factors determining the effect of drugs in children are not only diversified but also complex, the absorption, distribution, metabolism and clearance of drugs may be different from that of adults; even if the concentration of drugs is the same, the intensity and nature of the pharmacological response may also be different; the types of diseases are also different, some diseases occur only in children, some diseases are not the same as adults, the course of disease is not the same as adults, the disease is not the same as adults, the disease is not the same as adults. course of the disease is different from that of adults, and the etiology of the disease is different. However, for different sedative and/or anesthetic drugs the metabolism of some drugs may be slowed in the pediatric population, but others may be enhanced due to differences in metabolic pathways and the development of enzymes that metabolize the drugs. Will anesthesia drugs affect a child’s intelligence The concern of many parents, “Will anesthesia drugs affect a child’s intelligence?” The initial origin of the matter is a paper published in 1999, which concluded that the use of NMDA receptor blockers (ketamine, commonly used in clinical practice, belongs to this type of drug) increased apoptosis in the brain cells of neonatal animals, and in turn affect the neurological occurrence; followed by 2003, another author found that after 6 hours of neonatal rats anesthetized with imidazole valium, nitrous oxide, and isoflurane (commonly known as a cocktail anesthesia), the hippocampus (a part of the brain) of the rat was affected by the anesthesia. impaired a physiological function of the hippocampus (a functional area of the brain associated with learning memory) and led to spatial cognitive deficits in rats at 4 weeks to 4 months. These and subsequent studies quickly generated strong interest in the anesthesiology community and society, is this really the case? Regarding animal experiments, there are a few points worth noting: ① the dosage used is often much larger than the clinical (human), for example, ketamine dosage of up to 20-100mg/kg, the clinical 2mg/kg; isoproterenol dosage of up to 10-60mg/kg, the clinical 1mg/kg; imipramine dosage of up to 9mg/kg or more, the clinical commonly used 0.1mg/kg. ② the anesthesia of animal experiments is a “bad” anesthesia, and it is a “bad” anesthesia. Anesthesia for animal experiments is a kind of “bad” anesthesia, after anesthesia, nearly half of the animals will die, and the animals that survive may experience a series of complications such as hypoxia and disturbance of the internal environment due to extremely deep anesthesia. (3) Neurogenesis in humans (mammals) is completed before birth, and only part of the brain is preserved for neural regeneration, and the hippocampus is one of them, which is related to learning and memory. However, apoptosis in them is part of normal physiological metabolism. To date, no causal relationship between sedation and/or anesthesia-induced apoptosis in the brain and learning and memory has been found to exist. Human learning, intelligence, etc., is influenced by a variety of factors, and the ability to learn is not just about learning math, languages, physics, etc. Furthermore, in general, twins live in almost identical environments, and it may be more convincing if one underwent anesthetic surgery and the other did not (although of course it is undeniable that even twins have their own learning abilities). Happily, retrospective analyses have confirmed the absence of effects of sedation and/or anesthesia. In 2007, an advisory committee to the U.S. Food and Drug Administration (FDA) concluded that “based on the available evidence, there is no need to change the status quo for clinical anesthesia”; in 2013, expert opinion concluded that “even if (and if) anesthesia has that much effect on the nervous system, there is no need to change the status quo. if) anesthesia has a small effect on the nervous system, changing a child’s current anesthesia technique or not doing anesthesia at all could lead to greater neurological harm”. Adverse effects after anesthesia Adverse effects that may occur after anesthesia include allergies, respiratory depression, nausea, vomiting, itching, irritability, and chills. When a child develops allergies and respiratory depression, the health care provider should be informed quickly; nausea and vomiting are also common after surgery, but most of them will subside with time. In severe cases (frequent vomiting or vomiting of the heart), it is necessary to bring to the attention of the health care provider to deal with the problem in a timely manner, and when the child vomits, attention should be paid to assisting him or her in tilting his or her head to the side, so as to expel vomitus, and extreme attention should be paid to avoiding misaspiration (into the lungs); itching can also accompany allergies. Itching can also be associated with allergies, and usually does not need to be treated if it is not severe; postoperative irritability is common, and children are often extremely uncooperative, but recover gradually over time; there has been much speculation as to the cause of irritability, but none of it has been confirmed. The transition from one state of consciousness to another is usually accompanied by a change in mood, for example, a child may have a tantrum when waking up in the morning, and the transition from sedation and/or anesthesia to awakening may be similar. Parental care should be taken to prevent the child from falling out of bed, which may cause further injury, and to keep the child warm during chills, although warmth does not necessarily eliminate the chills. It should be reminded that some children may undergo two surgeries, e.g., the left eye and the right eye are operated separately, and the adverse reactions after the two surgeries may be different, which may be related to the anesthesia medication, the surgical environment, the environment of the ward, the medication used, and the food ingested. In conclusion, postoperative care requires the joint efforts of parents and healthcare professionals. Children are our future and we should take good care of them together.