Organisation de l'anesthésie pédiatrique : qui peut faire quoi et où peut-il le faire ?

Children present certain physiological and pharmacological characteristics, and their own pathologies, which require developing and maintaining specific knowledge and competences. The morbi-mortality of the youngest children, in particular those less than 1 year, and ASA > 3 is higher than that of older children. One of the most important risk factors of per-anaesthetic complications is the lack of experience and practice in paediatric anaesthesia (PA). However, as opposed to what one may observe in some other countries, in France PA is not a subspecialty and there is no ordinal qualification in PA, in contrast to paediatric surgery for example. On the other hand, each year of additional experience of the anaesthetist decreases the rate of perioperative cardiorespiratory complications of more than 2%. The maintenance of competences requires a regular weekly exercise of PA. According to the age, complexity of the surgical act and comorbidities of the child, one distinguishes several levels and thus health-care institutions, corresponding to proximity or specialised centres. These health care facilities have medical missions, medical competences (in particular anaesthetic), hospital environment and organisation of on-call time of different level. In the absence of specific paediatric facility, it is necessary to identify a specific sector of the operating suite and recovery room, to individualise a specific cart gathering all the equipment (adapted to the age and the weight of the children), and to dedicate at least one referring anaesthetist, who acquired the experiment and practical regularly the paediatric anaesthesia.