The Surgical clinics of North America
-
This review aims at providing the pediatric surgeon with an update on the most important issues in pediatric anesthesia and the changes that have taken place over the last few years. Many practices, entrenched in tradition, are being modified in the light of research that has provided new knowledge, drugs, and techniques. Pediatric anesthesia requires dedication, a sense of anticipation, meticulous attention to detail, and an individual who derives enormous satisfaction from the pleasure to be had from dealing with these small patients and their families.
-
Surg. Clin. North Am. · Dec 1992
ReviewFluid and electrolyte management in the pediatric surgical patient.
The following is a quick guide to the perioperative fluid program discussed 1. Always assess the state of fluid repletion in any patient presenting for surgical management (Note: This does not necessarily mean operative management). 2. If the patient is hypovolemic or if there is the possibility of hypovolemia and you are uncertain, restore volumes equal to 25% of the patient's blood volume with a fluid push made up of an osmotically active electrolyte solution modified for the additional requirements of red cell carrying capacity or clotting factors. ⋯ Carefully monitor the patient's urine output. 6. Increase or decrease the fluid administration rate to bring the hourly urine output within the guidelines for the appropriate hourly urine output (milliliters) for the particular patient based on size (kilograms). 7. When the urine output falls within the appropriate range, maintain that rate of fluid administration, and recalculate the volumes required because of insensible loss, measured loss, and third-space shifts by subtracting the amount of fluid already administered from the volume that will be required in the remainder of the 24 hours; this will yield the volumes of additional maintenance, measured loss, and third-space fluids that will make up the remainder of the fluids needed for the 24 hours.(ABSTRACT TRUNCATED AT 400 WORDS)
-
Surg. Clin. North Am. · Dec 1992
ReviewVascular access techniques and devices in the pediatric patient.
Vascular access is a sine qua non in the management of pediatric surgical patients. The indications, as well as the number of available access routes, types of devices, and their use, have expanded over the last two decades. ⋯ Vascular access in children requires skill, time, patience, and the appropriate equipment. Fortunately, with attention to detail, most complications can be avoided.
-
Surg. Clin. North Am. · Dec 1992
ReviewCurrent surgical considerations in gastroesophageal reflux disease in infancy and childhood.
An understanding of gastroesophageal reflux disease in infants and children by the clinician requires a working knowledge of 18- to 24-hour esophageal pH monitoring and the motility disorders of the esophagus and stomach that may be associated with gastroesophageal reflux disease. The results of surgical therapy for childhood gastroesophageal reflux disease cannot be assessed accurately without this knowledge. ⋯ The presence of severe complications from gastroesophageal reflux disease in "asymptomatic" infants and children is a troublesome and not yet fully defined problem. Special areas include the documentation of gastroesophageal reflux disease as a cause of SIDS, the increased reporting of Barrett's esophagus and adenocarcinoma of the esophagus in childhood, and the effect of associated alimentary-tract motility disorders in children with CNS disease who have gastroesophageal reflux disease requiring surgical intervention.
-
Surg. Clin. North Am. · Aug 1992
Factors that influence the outcome of aortoiliac and femoropopliteal percutaneous transluminal angioplasty.
In the past, patients with peripheral arterial occlusive disease were managed by conservative treatment or by vascular reconstructive surgery. Now, percutaneous transluminal angioplasty and other endovascular methods provide an important alternative for managing selected patients with peripheral arterial occlusive disease. ⋯ In contrast, percutaneous transluminal angioplasty of the femoral and popliteal arteries has a relatively poor long-term success rate except for the treatment of patients with stenoses with good run-off. When the run-off is poor or an arterial occlusion is present, the role of femoropopliteal angioplasty is limited, and the procedure should be considered only for high-risk patients who do not have autogenous tissue for reconstructive surgery.