Seminars in pediatric surgery
-
Neonates with functional single ventricles have pulmonary and systemic circulations that are supplied in parallel, creating significant cyanosis and ventricular volume overload. The goal of palliative surgery, excluding transplantation, is to convert single-ventricle circulation from a parallel to a series arrangement. This will ultimately require a complete cavopulmonary anastomosis (Fontan-type procedure) in which vena caval blood is rerouted directly into the pulmonary circulation. ⋯ Patients who have undergone stage III surgery, the Fontan-type repair, vary in age from toddlers to adults, and in physical status from well-compensated to significantly debilitated. Fontan patients require thorough preoperative assessment when elective surgery is contemplated. Optimal communication between surgeons, anesthesiologists, and cardiologists is essential when caring for the patient with single-ventricle physiology.
-
At least 60% of all pediatric surgical procedures are performed as outpatients. Successful outpatient practice requires that both the patients and the procedures are appropriate for outpatient management. ⋯ Anesthesia must be managed with attention to the unique physiologic and psychological challenges of children. Anesthetic management of postoperative nausea and vomiting and provision of adequate postoperative analgesia, including regional techniques, are important elements of the care plan.