Seminars in pediatric surgery
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Semin. Pediatr. Surg. · Feb 1999
Sharing the pediatric airway: issues between the surgeon and the anesthesiologist.
During surgical procedures, "ownership" of the patient's airway is often controversial. Communication between the anesthesiologist and the surgeon is critical. The author discusses several medical scenarios in which the anesthesiologist and surgeon must share the patient's airway. Strategies are outlined that can be used by both surgeon and anesthesiologist to ensure optimal outcome for patients.
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Semin. Pediatr. Surg. · Feb 1999
Assessment of pediatric patients for general anesthesia: the child with an upper respiratory infection and the ex-premature infant.
There are two types of patients that commonly lead surgeons and anesthesiologists into discussions relating to the possible cancellation or postponement of a minor pediatric surgical procedure; the child with a recent upper respiratory infection, and the patient who was born prematurely. Current opinion of the risks of anesthesia in such patients and the factors that influence perioperative course are reviewed, and a plan of management is suggested.
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Semin. Pediatr. Surg. · Feb 1999
Sedation and anesthesia outside the operating room: answers to common questions.
In recent years, practitioners have recognized the importance of providing comfort to children and have increased their use of analgesics and anxiolytics during painful medical procedures. In this article, the author reviews commonly asked questions regarding administering sedation to children for painful procedures outside the operating room. Current safety guidelines are reviewed, as well as qualifications of personnel performing sedations, contraindications to sedation, fasting guidelines before sedation, and common sedation techniques.
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There is increasing evidence that involvement of pediatric anesthesiologists in the perioperative care of infants and children can positively impact outcome. Considerable data have emerged in the past several years that clearly show that infants and small children experience untoward events at a much higher rate than do older children and adults. Herein the author presents some of this literature as well as data suggesting that anesthesiologists with interest and additional training in the care of infants and children can improve anesthesia outcomes. Even in these days of cost containment, it makes sense to provide the best pediatric team to care for the pediatric patient during the perioperative experience.
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Semin. Pediatr. Surg. · Nov 1996
ReviewExtracorporeal membrane oxygenation in patients with congenital diaphragmatic hernia.
Since the introduction of extracorporeal membrane oxygenation (ECMO) support for neonatal respiratory failure, the use of ECMO for infants with congenital diaphragmatic hernia has increased significantly. ECMO is offered to infants with a high risk of dying (with reported survival rates of 38% to 65%). Unstable infants can be placed on ECMO with subsequent repair on ECMO or after weaning from support. ⋯ Most centers use venoarterial ECMO in patients with congenital diaphragmatic hernia (CDH), but venovenous ECMO appears as effective. ECMO support appears to have improved the survival rate in high-risk infants with CDH, but because almost all studies are retrospective single institutional and have small numbers of patients, the true improvement in survival rate is difficult to quantitate. Further studies of the value of ECMO in patients with CDH are warranted.