Seminars in pediatric surgery
-
Malignant hyperthermia is a rare disease triggered by succinylcholine and the volatile anesthetic agents in genetically predisposed individuals. Recent studies have implicated an abnormality in the calcium release channel of the sarcoplasmic reticulum in skeletal muscle as the likely etiology. Genetic studies have narrowed the search for the chromosomal abnormality to human chromosome 19. Although the mortality from this disorder has dramatically decreased in the past decade due to the discovery of dantrolene, elective diagnosis of the disorder is only now appearing on the horizon.
-
This article addresses the pertinent aspects of neonatal physiology and pharmacology, general considerations in the anesthetic care of surgical neonates, management details of selected neonatal surgical lesions, and anesthetic considerations for the ex-preterm infant.
-
Recent research into the mechanisms of pain and pain management and the development of new pharmacological agents have greatly increased the possibilities for preventing and treating postoperative pain in the pediatric patient. This article briefly reviews the physiology of pain and the measurement and assessment of pain, and then discusses in some detail the various modalities useful in treating pain in the pediatric patient during the perioperative period.
-
Optimal perioperative fluid management in pediatric patients entails a knowledge of the effects of preoperative fasting, perioperative third space losses, and hemorrhage on the patient's fluid compartments. We explain which of the various available intravenous fluids should be used to correct various fluid and electrolyte losses that may occur. The authors also review techniques for limiting homologous transfusion requirements and discuss certain complications associated with blood transfusion.
-
Semin. Pediatr. Surg. · Feb 1992
ReviewPreoperative evaluation and preparation of the pediatric patient.
A successful anesthetic is built on the foundation of the preoperative evaluation and preparation, six features of which will be discussed: (1) content and timing of the anesthesiologist's preoperative evaluation; (2) value of preoperative laboratory testing; (3) psychological effects of hospitalization and surgery; (4) approaches to psychological preparation; (5) pharmacological premedication (except for drugs designed to sedate or reduce anxiety, reviewed in the article by Bennie and McNiece); and (6) preoperative feeding schedules.