Anesthesiology clinics of North America
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The demand for safe and effective procedural sedation for children is rapidly increasing because of the increased awareness about procedure-related anxiety even in young infants and children. The development of short-acting sedatives, improved monitoring, and new regulatory requirements have led to the evolution of new paradigms of safe, effective, and resource-efficient systems for providing procedural sedation outside the operating rooms by anesthesiologists and nonanesthesiologists.
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As the practice of pediatric cardiac anesthesia continues to grow, anesthesiologists now routinely care for patients ranging in size from less than 2 kg to more than 100 kg. New clinical and laboratory research has enhanced our understanding of the effects of anesthetic drugs on the pediatric myocardium, and improvements in survival statistics for even the smallest and sickest infants have shifted the emphasis to evaluation of quality of life and neurological outcome in pediatric cardiac patients. The use of circulatory support in infants and children, both for rapid resuscitation and for more chronic indications such as bridge to transplantation, also continues to evolve, with the recent introduction of pulsatile and axial pumps for pediatric use. This article reviews anesthetic agents, bleeding and coagulation, neurological monitoring, and mechanical circulatory support in the treatment of infants and children.
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The genetic evaluation of the ryanodine type one receptor (RYR1) gene is unlikely to be a useful screening test of malignant hyperthermia susceptibility. But when significant suspicion of malignant hyperthermia has been raised by well-documented clinical events or strong family history, the genetic evaluation of RYR1 could secure a diagnosis and indicate appropriate treatment for both the index patient and many relatives of all ages, including the youngest.
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Single-lung ventilation is requested for an increasing spectrum of surgical procedures in infants and children. A clear understanding of the physiology of single-lung ventilation, the techniques of lung separation, and the technical skill necessary to apply these techniques are essential for an anesthesiologist practicing thoracic anesthesia. This article focuses on various devices available for single-lung ventilation in the pediatric age group, the relevant respiratory physiology, and the strategies that optimize oxygenation during one-lung anesthesia.
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Anesthesiol Clin North America · Dec 2005
ReviewAnesthesia considerations for pediatric thoracic solid organ transplant.
This article discusses the indications, perioperative management, postoperative complications, and patient outcome of pediatric heart transplantation and pediatric lung transplantation. Special emphasis is placed on the anesthetic considerations relevant for children who are undergoing or have received a solid thoracic organ transplant.