Paediatric orthopaedic surgery is wide-ranging in scope and complexity. Many patients have coexisting conditions, including cerebral palsy and neuromuscular diseases. Cerebral palsy presents a wide spectrum of motor dysfunction. Preoperative assessment must be guided by associated comorbidities and particularly evaluate respiratory function and any associated cardiac disease. Patients with muscular dystrophy presenting for major orthopaedic or spinal surgery have a high risk of morbidity and mortality, which must be discussed preoperatively; inhalational agents must be avoided due to the risk of rhabdomyolysis. Patients with conditions including osteogenesis imperfecta and arthrogryposis must be carefully managed and meticulously positioned for surgery. Major orthopaedic and spinal surgery can be accompanied by a significant risk of bleeding. Multimodal analgesic strategies, including the use of local anaesthetic blocks, should be used. Scoliosis may be congenital, acquired or idiopathic. Adolescent children with idiopathic scoliosis are often otherwise fit and healthy. In contrast, patients with acquired neuromuscular scoliosis often have significant comorbidities, particularly poor cardiorespiratory function, epilepsy and poor nutrition. Elective postoperative ventilation is frequently required. Intraoperative neuromonitoring is employed to detect and prevent potential spinal cord injury. Total intravenous anaesthesia is required for robust neuromonitoring of motor pathways, and muscle relaxation must be avoided intraoperatively.

Pediatric epilepsy is a broad topic with specific syndromes highlighted in this chapter. A thorough discussion for the evaluation and management of febrile seizures is first. The chapter then transitions to a discussion of high-yield epileptic and developmental encephalopathies. Examples include diagnoses like infantile spasms, Dravet syndrome, and FIRES (febrile infection-related epilepsy syndrome). The chapter than progresses toward the self-limiting epilepsy of childhoods and a discussion of clinical features, management, and long-term prognosis.The generalized epilepsies are then discussed since they commonly commence in the pediatric time period. High-yield EEG examples are provided as they so frequently confirm the diagnosis. Specific neurocutaneous syndromes are next reviewed in a concise table that defines key differences and diagnostic criteria.Lastly, the two diagnoses of Rasmussen’s encephalitis and hemimegaloencephaly that can benefit from early consideration of hemispherectomy are reviewed.

While the neurosurgical patient is not normally one junior prescribers should be caring for in a nonspecialist area, they may encounter them in the acute setting while a referral is being made. Readers are provided with key information on the management of subarachnoid haemorrhage, including how to manage blood pressure, prevent vasospasm and rebleeding. Adjuncts to reduce the chances of secondary brain injury, including steroids, mannitol and anticonvulsants, are also discussed, while the importance of good quality analgesia is also emphasised.