Analysis of the main complications in pediatric anesthesia

Abstract

Introduction: Pediatric anesthesia presents unique challenges due to children's physiological characteristics, such as lower functional residual capacity and higher oxygen consumption, which increase the risk of respiratory and cardiovascular complications. Despite advancements, anesthesia in children can still lead to severe adverse events and raise concerns about its effects on neurodevelopment. Objective: To analyze the main complications in pediatric anesthesia. Methodology: This is a narrative review of the literature on complications in pediatric anesthesia, with a systematic search for articles in the BVS, SciELO, PubMed, and Google Scholar databases. The research was guided by the question: What are the main complications in pediatric anesthesia? and followed the PICOTS structure. Studies fully available in Portuguese or English, including randomized clinical trials, systematic reviews, meta-analyses, and observational studies, were included, with no temporal restrictions. Duplicated studies, those not focused on pediatric anesthesia, or those misaligned with the study objectives were excluded. Results and Discussion: Respiratory complications, such as laryngospasm and bronchospasm, are the most frequent and severe, contributing to up to 30% of perioperative cardiac arrests. Techniques such as THRIVE, which uses high-flow nasal cannulas to prolong oxygenation during apnea, have proven effective, especially in children with difficult airways. In cardiovascular terms, neonates are more vulnerable to bradycardia and hypotension due to their dependence on heart rate for cardiac output maintenance. Studies like GAS, PANDA, and MASK indicated that short exposures to general anesthesia before the age of 3 do not significantly increase the risk of cognitive deficits, but multiple exposures may impact specific neuropsychological domains, such as attention and learning. Additionally, adverse effects such as nausea, vomiting, and emergence delirium increase hospital costs and recovery time. Conclusion: The main complications of pediatric anesthesia involve respiratory events, cardiovascular issues, and adverse drug effects. Laryngospasm and oxygen desaturation are the most concerning respiratory risks, while bradycardia and hypotension are common due to neonatal cardiac immaturity. Adverse drug reactions, such as emergence delirium and nausea, are also frequent but can be reduced with appropriate protocols. Although there are indications of anesthesia-related impacts on children's neurodevelopment, the evidence remains inconclusive. The adoption of safety measures, such as rigorous monitoring and adjustment of anesthetic approaches, is essential to minimize risks and ensure safer anesthetic care.