Pediatric clinics of North America
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This article addresses the preoperative fast in the context of its historic background, the physiology of gastric emptying, and recent clinical studies. A rationale is developed for minimizing the traditional preoperative fasting interval for elective surgery. The timing and the necessity for patients to resume ingesting clear liquids in the postoperative period is also explored.
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Pediatr. Clin. North Am. · Feb 1994
ReviewAnesthetic implications of an upper respiratory infection in children.
Pediatricians and pediatric anesthesiologists are frequently confronted with the dilemma of a child scheduled for elective surgery with or recently recovered from an upper respiratory tract infection. Modifications of routine anesthetic practice may decrease but not eliminate risks of associated complications. Guidelines for the evaluation and triage of these children are presented.
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Neuromuscular blocking drugs are valuable adjuncts to the practice of pediatrics. Monitoring of drug effects is technically more difficult in the younger patient. Nevertheless, careful observation of drug effects will improve the usefulness of NMB and safeguard the patient from prolonged weakness. ⋯ The advantages of these long-acting drugs are minimal cardiovascular side effects (i.e., tachycardia or hypotension from histamine release) and longer dosing interval. In all children, the dosing interval should be adjusted to the needs of the individual. In children with renal insufficiency or in those receiving drugs which impair neuromuscular function (e.g., aminoglycosides), the interval at which supplemental doses are required is longer than normal.
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This article reviews specific considerations for greater anesthetic mortality in the first year of life as well as significant differences in pediatric anesthetic morbidity associated with routine anesthetic management. Clinical conditions such as upper respiratory tract infection, congenital heart disease, and muscle disease are addressed. Loss experience suggests a different profile for pediatric anesthesia.