When assisting at paediatric surgical operations, it is important to remember from the outset, that the differences between adults and children are not only in their size, anatomy and physiology, but also in their psychology. In particular, it is important not to frighten children in the operating theatre.

This is for at least two reasons. Firstly, just as in adult surgery, it is simply more pleasant for the patient (and parents and staff) if he or she is relaxed. Secondly, but unlike in adult surgery, a frightened infant or child patient greatly increases the difficulties faced by the anaesthetist. This is because a different method is commonly used for induction of anaesthesia (‘going off to sleep’) in this age group.

Whereas in adults the usual method for induction of anaesthesia is by intravenous injection, in children, the preferred method is more often by slow inhalation of anaesthetic gases. The main reason for using this method, is that it avoids the need to insert an intravenous cannula while the child is awake–an event that most children find distressing. Thus, intravenous induction can be something of a last resort in elective paediatric surgery, to be used when dealing with a child ‘spooked’ by the theatre environment.

The willing compliance of the child is required for gaseous induction. Therefore, prior to the induction of anaesthesia, it is particularly important to provide an atmosphere which is quiet, gentle and safe, enabling the parent and child to relax. Do not underestimate the value of frequent reassuring smiles. Try not to trivialise the parent's anxieties and concerns.