In 1973, Winnie and co-workers stated that no technique could truly be called simple, safe and consistent until the anatomy has been closely examined. This is evident when looking at the literature where many anatomically based studies regarding regional techniques in adults have resulted in the improvement of known techniques, as well as the creation of safer and more efficient methods. Anaesthesiologists performing these procedures should have a clear understanding of the anatomy, the influence of age and size, and the potential complications and hazards of each procedure to achieve good results and avoid morbidity. A thorough knowledge of the anatomy of paediatric patients is also essential for successful nerve blocks, which cannot be substituted by probing the patient with a needle attached to a nerve stimulator. The anatomy described in adults is also not always applicable to children, as anatomical landmarks in children vary with growth. Bony landmarks are poorly developed in infants prior to weight bearing, and muscular and tendinous landmarks, commonly used in adults, tend to lack definition in young children. The aim of this research was therefore to study a sample of neonatal cadavers, as well as magnetic resonance images in order to describe the relevant anatomy associated with essential regional nerve blocks, commonly performed by anaesthesiologists in South African hospitals. This research has brought to light the differences between neonatal and adult anatomy, which is relevant since the majority of paediatric regional anaesthetic techniques were developed from studies originally conducted on adult patients. Current techniques were also analysed and where necessary new improvements, using easily identifiable and constant bony landmarks, are described for the safe and successful performance of these regional nerve blocks in paediatric patients. In conclusion a sound knowledge and understanding of anatomy is important for the success of any nerve blocks. This study showed that extrapolation of anatomical findings from adult studies and simply downscaling these findings in order to apply them to infants and children is inappropriate and could lead to failed blocks or severe complications. It would therefore be more beneficial to use the data obtained from dissection of neonatal cadavers. / Thesis (PhD)--University of Pretoria, 2010. / Anatomy / unrestricted

Bakgrund: Anestesiinduktion av barn kräver särskild kompetens hos anestesisjuksköterskan. Trygghet och tillit behöver skapas i mötet med barnet, vilket kan utgöra en utmaning om mötet är kort och intensivt. Barns förmåga att samarbeta och delta i förberedelser och vid anestesiinduktionen påverkas av barnets ålder och utvecklingsnivå. Bristande följsamhet och samarbetsvilja hos barnet kan leda till att tvång tillämpas i samband med induktionen, vilket kan väcka varierande tankar och känslor hos anestesisjuksköterskan. Tidigare forskning fokuserar främst på barn och föräldrars upplevelse av anestesiinduktionen. Genom att beskriva anestesisjuksköterskans upplevelse kan ett bredare perspektiv på fenomenet belysas och kunskapen inom barnanestesi fördjupas.Syfte: Syftet var att beskriva anestesisjuksköterskans upplevelse av att anestesiinducera barn.Metod: En kvalitativ metod med induktiv ansats har genomförts. Datainsamlingen bestod av semistrukturerade intervjuer och materialet analyserades enligt Graneheim och Lundmans (2004) kvalitativa innehållsanalys.Resultat: Analysen resulterade i fem huvudkategorier med 10 underkategorier som formade två övergripande teman: att skapa goda förutsättningar inför anestesiinduktionen vilket innefattade att etablera kontakt, anpassa förberedelser samt att samverka med föräldrarna. Det andra temat var att möta och hantera utmaningar vilket innefattade handlingsberedskap och professionell utmaning.Slutsats: Att anestesiinducera barn kan vara både stimulerande och utmanande. Goda förutsättningar inför anestesiinduktionen främjas av en tillitsfull relation med barnet och föräldrarna, där leken utgör ett viktigt verktyg för att skapa delaktighet och lärande. Genom handlingsberedskap och strategier kan oron för komplikationer minskas. Anestesiinducering av barn kan ge upphov till etiska dilemman samt innebära en yrkesmässig påfrestning hos anestesisjuksköterskan. / Background: Anaesthesia induction of children requires special skills of the anaesthetic nurse, both physiological and emotional. The anaesthetic nurse needs to create security and trust in the meeting with the child, which can pose a challenge if the meeting is short and intense. Children's ability to cooperate and participate in preparations and in connection with the anesthesia is affected by the child's age, level of development and unique conditions. Lack of adherence and willingness to cooperate in the child can lead to the application of coercion in connection with the induction, which provokes different thoughts and feelings in the anesthesia nurse. Previous research focuses primarily on children and parents' experience of anaesthesia. By describing the anesthesia nurse's experience, a broader perspective on the phenomenon can be highlighted and knowledge in pediatric anesthesia increased.Aim: The aim of the study was to describe the anesthesia nurse's experience of anesthetize children.Method: To answer the purpose of the study, a qualitative method with an inductive approach was used. The data collection consisted of semi-structured interviews with 12 informants and the material was analyzed according to Graneheim and Lundman's (2004) qualitative content analysis.Results: The analysis resulted in five main categories with ten subcategories that shaped two overarching themes. The first theme was to create good conditions for the anesthesia induction, which included establishing a contact, adapting preparations and collaborating with the parents. The second theme was to meet and manage challenges, which included readiness to act and handling a professional challenge.Conclusion: Anesthetizing children can be both stimulating and challenging. Good conditions can be created through preparation, play and the establishment of contact with the child and its parents. The worry of complications can be reduced through readiness to act and strategies. Anesthetizing children can give rise to ethical dilemmas as well as involve a professional strain on the anaesthetic nurse.