Pediatric clinics of North America
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There has been a tremendous amount of progress in the perioperative approach to the child since Levy wrote "Psychic trauma of operations in children and a note on combat neurosis" nearly 50 years ago. Recognition of prolonged behavioral derangements following the anesthetic-surgical-hospital experience and the prominent role that the parent and physician play in modifying these have dramatically changed the contemporary pediatric perioperative care. Of paramount importance is the psychological preparation of family and child. With increasing outpatient or same-day admission surgery and free-standing surgical centers, preoperative preparation will, of necessity, increasingly become the responsibility of the pediatrician.
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Pediatr. Clin. North Am. · Feb 1994
ReviewAnesthesia and apnea. Perioperative considerations in the former preterm infant.
Former preterm infants younger than 44 weeks postconceptual age are at increased risk for developing postoperative apnea and PB. When surgery cannot be deferred until the infant is developmentally more mature, several measures should be taken to minimize the risk of ventilatory dysfunction. First, outpatient surgery is not advisable for infants younger than 44 weeks postconceptual age. ⋯ Infants with anemia of prematurity, generally a benign condition, are at increased risk for postoperative apnea. It is therefore preferable to delay elective surgery and supplement the feeds with iron until the Hct is above 30%. When surgery cannot be deferred, anemic infants must be observed and monitored carefully in the postoperative period.
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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.