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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Preoperative evaluation and preparation are directed toward minimizing the intrinsic risks of anesthesia and surgery by having the child in the healthiest possible condition prior to surgery. The pediatrician can contribute to this goal by understanding the effects of general anesthesia on the physiology of children. ⋯ The preoperative evaluation is designed to ensure that the child's preoperative needs may be met by providing the anesthesiologist both qualitative and quantitative information regarding the child's state of health and disease. The relationship between the child, parents, and pediatrician places the pediatrician in an ideal position to prepare families for their children's surgical experience.
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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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Appendicitis remains a common and morbid illness in children. The history, epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of acute appendicitis are discussed in this article.
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Detection of an abdominal mass in a child is an alarming finding for both parent and practitioner. Diagnostic studies including ultrasonography, computed tomography, and magnetic resonance imaging provide an accurate diagnosis in most cases. ⋯ Hepatoblastoma and neuroblastoma often present in an advanced stage and require preoperative chemotherapy before resection is attempted. Improved survival for children with these tumors awaits better detection, chemotherapy, and understanding of the biology of their growth.