Seminars in pediatric surgery
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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.
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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.
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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.
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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.
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Many new diagnostic and surgical procedures rely on immobile equipment such as computed tomography or magnetic resonance scanners, biplanar fluoroscopes, or radiotherapy units. To facilitate these procedures in infants and children, anesthesiologists must provide services in a variety of unique environments. This article reviews the anesthetic equipment and techniques that have been adapted to provide anesthesia for children outside the operating room.