Fifty years of paediatric anaesthesia - newapproaches to an old technique

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2006

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South African Medical Journal

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University of Cape Town

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Abstract
The safety of paediatric anaesthesia has improved since Red Cross Children’s Hospital opened its doors 50 years ago. At that time routine surgical procedures were considered lifethreatening. To avoid the dangers of general anaesthesia some surgery was performed under local infiltration. However significant advances in virtually all aspects of paediatric anaesthesia have occurred over the past five decades. The perioperative well-being of all children has become an expectation. Economic pressures may have modified practice so that children after minor and some major surgical procedures can be discharged the same day. Peri-operative well-being is paramount. Improved outcome in children of all ages has become the focus of the modern paediatric anaesthesiologist. This has taken place in the face of improved surgical techniques and advances in neonatal care. More and more complex surgery, even in premature babies, who were not previously expected to survive, is being performed with good outcomes. Without the advances in anaesthesia, many of the surgical procedures performed at Red Cross Children’s Hospital could not be done. Computers and information technology have become an integral part of our lives. Evolution of this technology has influenced the way we conduct modern anaesthesia. Anaesthetic machines are self-calibrating with built-in safety checks to ensure safe delivery, fluid therapy and the infusion of intravenous agents can be tightly controlled and fine tuned, and ventilators and monitoring equipment have become highly sophisticated computer-controlled apparatus. Even anaesthetic record keeping can be automated. Some of the more important advances considered to have had the greatest impact on the safety of anaesthesia and the well-being of children undergoing surgery are highlighted.
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