Pediatric Anesthesia Digital Handbook
Department of Anesthesiology
Division of Pediatric Anesthesia
Tufts Medical Center
Boston, Massachusetts
United States of America

​
  • HOME
  • General
    • About
    • Pediatric Anesthesia Fellowship Program
    • Pediatric Anesthesia Resident Rotation - Goals and Objectives
    • Fellowship Orientation (password required)
    • Fellowship Goals and Objectives
    • GME Policies (password required)
    • Milestones
    • Revised Case Logs
    • Case Minimums
    • Fellow Index Cases
    • Pediatric Anesthesia Certification Examination
    • Fellow Lecture Schedule
  • Clinical Information
    • What makes Pediatric Anesthesia Different?
    • Pediatric OR Setup HOME >
      • STEP-2 PEDI OR SETUP - BREATHING CIRCUIT
      • STEP-3 PEDI OR SETUP - SUCTION
      • STEP-4- PEDI OR SETUP - OR TABLE AND PROPS
      • STEP-5- PEDI OR SETUP - MONITORS
      • STEP-6 PEDI OR SETUP - AIRWAY SETUP
      • STEP-7 PEDI OR SETUP - MEDICATION DESKTOP
      • STEP-8 PEDI OR SETUP - IV TRAY AND LINE
      • STEP-9 PEDI OR SETUP - ACCESSORIES
      • STEP-10 PEDI OR SETUP - SUMMARY
    • The Pediatric Anesthesia Cart
    • Pediatric Normal Parameters and Equipment
    • Premedication
    • Drug Library
    • Standard Drug Dilutions in the Pediatric OR
    • Pediatric Airway Management >
      • Positioning Infants and Children for Airway Management
      • Masking Technique
      • Upper Airway Obstruction During Anesthesia
      • LMA Techniques in Pediatrics
      • Atlas of Pediatric Intubation Technique
      • Pediatric Difficult Airway Algorithm
    • Pediatric IV Insertion Technique
    • Perioperative Fluid Therapy >
      • Fundamentals of Perioperative Fluid Therapy
      • The "4-2-1" Rule for Maintenance Fluid Therapy in Infants and Children
      • Glucose and Fluid Requirements for Neonates
      • Composition of Commonly Used IV Fluids
      • Estimating Circulating Blood Volume
      • Flow Rates Through Catheters
    • Blood Transfusion Therapy >
      • Normal Hemoglobin Values in Infants
      • Different Kinds of Blood Transfusion Filters
      • Transfusion Guidelines
    • Clinical Practice Guidelines
    • Single Lung Ventilation (SLV) Techniques
    • Regional Anesthesia >
      • Neuraxial Anesthesia >
        • Neuraxial Clinical Anatomy
        • Caudal Anesthesia
        • Epidural Anesthesia
        • Spinal Anesthesia
      • Peripheral Regional Anesthesia
  • PEDI STAT
    • PALS ALGORITHMS
    • Newborn Resuscitation Algorithm
    • PALS Cardiac Arrest
    • PALS Tachycardia with a pulse and poor perfusion
    • PALS Bradycardia with a pulse and poor perfusion
    • Cardioversion / Defibrillation
    • Laryngospasm
    • EZ-IO Intraosseous Infusion System
    • Hyperkalemia
    • Anaphylaxis
    • Malignant Hyperthermia
    • Society for Pediatric Anesthesia - Pedi Crisis® Critical Events Checklist
  • Case Primers
  • Multimedia Library
  • Pediatric Anesthesia Handicraft
  • Robert N Reynolds, MD Award
  • Disclosure Notice
  • COVID-19 RESOURCES
BACK
OR SETUP HOME
PROCEED TO STEP 5 - MONITORS

OR SETUP - STEP 4

Prepare the OR Table and Positioning Props

A. Prepare the OR Table

For neonates, infants, and children, a Baer Hugger / Mistral Air Forced Air Warming Underbody Blanket should be placed securely on the OR bed. These come in two sizes - Neonate Plus and Large Pediatric Underbody. For older children and young adults, a regular upper or lower body Baer Hugger blanket should be considered.

​The size of the operating bed may have to altered for neonates and infants. Communicate with your Attending Pediatric  Anesthesiologist before making any alterations.


B. Positioning Props

The classic sniffing position is an established standard across anesthesia practice. To bring children in the most optimal sniffing position, we must aim to align the External Auditory Meatus (EAM) in horizontal plane with the Suprasternal notch (SN). The Glabella - Chin face plane should also be near horizontal. 

In older children, a head rest (of variable height depending on size of patient) is generally sufficient to achieve optimal sniffing. Older obese children may require ramping similar to practice in adults. 

In infants and toddlers, a shoulder roll in combination with a head rest is recommended to optimally position  for airway management. In a small proportion of infants and toddlers, simple head extension without any props may be sufficient to bring the planes in horizontal alignment.

​Props can be created using different techniques and materials. the images below will demonstrate various common combinations.

Picture

Picture
Picture


PROCEED TO STEP 5

    COMMENTS / SUGGESTIONS

Submit

USEFUL LINKS

​Tufts Medical Center
Tufts Children's Hospital
​
TCH/BCH Transition Page
American Board of Anesthesiology (ABA)
American Society of Anesthesiologists (ASA)
Society for Pediatric Anesthesia (SPA)
Accreditation Council for Graduate Medical Education
ASA Guidelines, Statements and Practice Advisories
Malignant Hyperthermia Association of the United States
ERAS PDWS
AnesthesiaHub - The Central Resource of Anesthesiology

New Innovations Login
QGenda Login
Tufts Medical Center Webmail
​EVA log in
​EPIC Access
Tufts Hirsh Health Sciences Library


Copyright © 2014. Aman Kalra, MD. Clinical Associate Professor of Anesthesiology, Department of Anesthesiology and Perioperative Medicine (Author, Illustrator and Web Designer)
800 Washington Street, Box 298, Tufts Medical Center, Boston, MA 02111. USA
LAST UPDATED February 26th, 2022