Seminars in pediatric surgery
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Semin. Pediatr. Surg. · Aug 2004
ReviewSedation and analgesia for procedures outside the operating room.
The volume of literature concerning sedation and analgesia for procedures outside the operating room has increased greatly over the past several years. Information relating to sedation risks and complications, the development of sedation guidelines, and now specific sedation techniques has appeared. ⋯ The risks and complications associated with sedation will be addressed and an approach to providing sedation and analgesia for procedures outside the operating room will be presented. The important characteristics of several common drugs used for sedation and analgesia will also be discussed.
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Semin. Pediatr. Surg. · Aug 2004
ReviewPostoperative neuraxial pain relief in the pediatric patient.
Pain serves as a useful warning function of potential tissue damage. The systemic response to pain is characterized by activation of the sympathetic nervous system. ⋯ When effective neuraxial anesthesia and analgesic techniques are employed, the surgical patient may benefit from decreases in morbidity, mortality, and prevention of subsequent development of chronic pain. The use of intrathecal and epidural techniques in the pediatric population is well established and allows these patients to benefit from superior pain relief and improved surgical outcomes.
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Good airway management technique is an essential skill for physicians in most specialties. This article begins with a review of basic airway anatomy and the physiology of the uninstrumented airway. This subject is of particular importance given the increasing use of procedural sedation and the increased recognition of sleep-disordered breathing in infants and children. ⋯ The fetus with the prenatal diagnosis of a lesion that predicts a difficult airway presents a particular challenge. The utilization of an ex-utero intrapartum treatment method is presented as an important approach for the delivery and airway management of these infants. This section closes with a discussion of the prehospital airway management of the pediatric patient.
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Pediatric surgical patients can present with a number of challenging common respiratory problems. This article reviews potential perioperative implications and anesthetic management of asthma, upper respiratory tract infections, bronchopulmonary dysplasia, and the effects of passive environmental smoke on children presenting for surgery.
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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.