During panendoscopy, the anesthesiologist and surgeon must share the airway, with different objectives. The anesthesiologist must deliver oxygen, remove carbon dioxide, provide anesthesia and protect the airway from soiling or aspiration. The surgeon requires an immobile, unobstructed surgical field and adequate time for diagnostic evaluation and intervention. Some patients requiring panendoscopy will present with critical airway obstruction and in these circumstances the safest approach is to proceed to elective tracheostomy under local anesthesia prior to any further endoscopic evaluation. Ventilation techniques can be considered in terms of open and closed systems. A closed system implies ventilation via a cuffed endotracheal tube (ETT). An open system without an ETT is more commonly used for panendoscopy. Panendoscopy is a brief yet highly stimulating procedure that requires deep anesthesia, obtunded hemodynamic reflexes, an immobile surgical field and rapid emergence with early return of protective airway reflexes.

Heart transplantation is considered emergency surgery, and there is often little time for extensive evaluation in the immediate preoperative period. This chapter covers the preoperative considerations and reviews the intraoperative management of heart transplant patients. Patients with severe heart failure are often on many drugs, including diuretics, angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists. Many of these drugs interact with anesthesia and should be taken into account. Following pre-anaesthetic assessment, induction of anesthesia should be performed after placement of essential monitoring. Initial pharmacological support is required during the period of weaning from cardiopulmonary bypass (CPB), and this initial management is described with ongoing support and choice of agent. After CPB, the transesophageal echocardiography (TEE) should focus on the ventricular function. Finally, there should be a careful and thorough handover to the team taking over the patient's care following transfer to the intensive care unit.

Pediatric surgical patients present special anesthetic challenges including induction without intravenous (IV) access, a higher incidence of airway complications, and a greater incidence of hemodynamic instability due to surgical blood loss. Supratentorial tumors are the second most common location and include low-grade astrocytoma, malignant and mixed glioma, ependymoma, ganglioglioma, oligodendroglioma, choroid plexus tumor, and meningioma. This chapter presents a case study of a 8-year-old child presented with partial complex seizures characterized by staring spells accompanied by oral and manual automatisms. Preoperative evaluation (magnetic resonance imaging) demonstrated a non-enhancing heterogeneous lesion in the mesial aspect of the right temporal lobe consistent with lowgrade glial neoplasm. A neurologic assessment was performed after extubation and it showed no neurologic deficits. Subsequently the patient was transported to the pediatric intensive care unit where his recovery was satisfactory. Anticonvulsant medications should be continued and administered the day of surgery to prevent intraoperative and postoperative seizures.