BOOK
A Practice of Anesthesia for Infants and Children E-Book
Charles J. Cote | Jerrold Lerman | I. David Todres
(2012)
Additional Information
Book Details
Abstract
Provide optimal anesthetic care to your young patients with A Practice of Anesthesia in Infants and Children, 5th Edition, by Drs. Charles J. Cote, Jerrold Lerman, and Brian J. Anderson. 110 experts representing 10 different countries on 6 continents bring you complete coverage of the safe, effective administration of general and regional anesthesia to infants and children - covering standard techniques as well as the very latest advances.
- Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located.
- Find authoritative answers on everything from preoperative evaluation through neonatal emergencies to the PACU.
- Get a free laminated pocket reference guide inside the book!
- Quickly review underlying scientific concepts and benefit from expert information on preoperative assessment and anesthesia management, postoperative care, emergencies, and special procedures.
- Stay on the cutting edge of management of emergence agitation, sleep-disordered breathing and postoperative vomiting; the use of new devices such as cuffed endotracheal tubes and new airway devices; and much more.
- Familiarize yourself with the full range of available new drugs, including those used for premedication and emergence from anesthesia.
- Benefit from numerous new figures and tables that facilitate easier retention of the material; new insights from neonatologists and neonatal pharmacologists; quick summaries of each chapter; and more than 1,000 illustrations that clarify key concepts.
- Access the entire text online, fully searchable, at www.expertconsult.com, plus an extensive video library covering simulation, pediatric airway management, burn injuries, ultra-sound guided regional anesthesia, and much more; and new online-only sections, tables and figures.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Expert Consult pin page | IFC2 | ||
| A Practice of Anesthesia for Infants and Children | i | ||
| Copyright page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xvii | ||
| Acknowledgments | xix | ||
| Table of Contents | xxi | ||
| Video Contents | xxiii | ||
| I Introduction | 1 | ||
| 1 The Practice of Pediatric Anesthesia | 1 | ||
| Preoperative Evaluation and Management | 1 | ||
| Parents and Child | 1 | ||
| The Anesthesiologist | 2 | ||
| Informed Consent | 3 | ||
| Operating Room and Monitoring | 3 | ||
| Induction and Maintenance of Anesthesia | 5 | ||
| Clinical Monitors | 5 | ||
| Sight | 5 | ||
| Hearing | 5 | ||
| Touch | 5 | ||
| Airway and Ventilation | 5 | ||
| Fluids and Perfusion | 5 | ||
| Conduct of the Anesthesia Team | 6 | ||
| The Postanesthesia Care Unit | 6 | ||
| Postoperative Visit | 6 | ||
| Summary | 6 | ||
| 2 Growth and Development | 7 | ||
| Normal and Abnormal Growth and Maturation | 7 | ||
| Gestational Age Assessment | 8 | ||
| Weight and Length | 8 | ||
| Head Circumference | 9 | ||
| Face | 10 | ||
| Teeth | 10 | ||
| Comportment and Behavior | 11 | ||
| Airway and Respiratory System | 11 | ||
| Upper Airway Development | 11 | ||
| Respiratory System Development | 12 | ||
| Transition to Air Breathing | 12 | ||
| Mechanics of Breathing | 12 | ||
| Chest Wall and Respiratory Muscles | 12 | ||
| Elastic Properties of the Lung | 12 | ||
| Static Lung Volumes | 12 | ||
| Total Lung Capacity | 12 | ||
| Functional Residual Capacity | 12 | ||
| Closing Capacity | 13 | ||
| Airway Dynamics | 14 | ||
| Resistance and Conductance | 14 | ||
| Distribution of Resistance | 14 | ||
| Inspiratory and Expiratory Flow Limitation | 14 | ||
| Regulation of Breathing | 14 | ||
| Cardiovascular System | 14 | ||
| Heart Rate | 14 | ||
| Blood Pressure | 15 | ||
| Cardiac Output | 15 | ||
| Normal Electrocardiographic Findings From Infancy to Adolescence | 15 | ||
| Renal System | 15 | ||
| Digestive and Endocrine System | 16 | ||
| Hepatic System | 16 | ||
| Physiologic Jaundice | 16 | ||
| Gastrointestinal Tract | 17 | ||
| Pancreas | 17 | ||
| Hematopoietic and Immunologic System | 18 | ||
| Hemoglobin | 18 | ||
| Leukocyte and Immunology | 18 | ||
| Platelets | 19 | ||
| Coagulation | 19 | ||
| Polycythemia | 19 | ||
| Neurologic Development and Cognitive Development Issues | 19 | ||
| Neurologic Development | 19 | ||
| Developmental Issues | 20 | ||
| Acknowledgment | 20 | ||
| References | 20.e1 | ||
| References | 20 | ||
| 3 Perioperative Behavioral Stress in Children | 21 | ||
| Developmental Issues | 21 | ||
| Cognitive Development and Understanding of Illness | 21 | ||
| Attachment | 21 | ||
| Temperament | 22 | ||
| Preoperative Anxiety | 22 | ||
| Risk Factors | 22 | ||
| Behavioral Interventions | 23 | ||
| Preoperative Preparation Programs | 23 | ||
| Parental Presence during Induction of Anesthesia | 24 | ||
| The Preoperative Interview | 25 | ||
| Health Care Provider Interventions | 26 | ||
| Pharmacologic Interventions | 27 | ||
| Pharmacologic Interventions Versus Behavioral Interventions | 27 | ||
| Postoperative Outcomes | 28 | ||
| Emergence Delirium | 28 | ||
| Sleep Changes | 28 | ||
| Other Behavioral Changes | 28 | ||
| Intraoperative Clinical Outcomes | 29 | ||
| Summary | 29 | ||
| Annotated References | 29 | ||
| References | 30.e1 | ||
| References | 30 | ||
| 4 Preoperative Evaluation, Premedication, and Induction of Anesthesia | 31 | ||
| Preparation of Children for Anesthesia | 31 | ||
| Fasting | 31 | ||
| Piercings | 32 | ||
| Primary and Secondary Smoking | 32 | ||
| Primary Smoking | 32 | ||
| Secondary Smoking | 33 | ||
| Psychological Preparation of Children for Surgery | 33 | ||
| Child Development and Behavior | 34 | ||
| Parental Presence during Induction | 35 | ||
| History of Present Illness | 36 | ||
| Past/Other Medical History | 36 | ||
| Herbal Remedies | 37 | ||
| Anesthesia and Vaccination | 37 | ||
| Allergies to Medications and Latex | 37 | ||
| Family History | 38 | ||
| Laboratory Data | 38 | ||
| Pregnancy Testing | 38 | ||
| Premedication and Induction Principles | 38 | ||
| General Principles | 38 | ||
| Medications | 39 | ||
| Tranquilizers | 39 | ||
| Benzodiazepines | 39 | ||
| Barbiturates | 41 | ||
| Nonbarbiturate Sedatives | 41 | ||
| Opioids | 41 | ||
| Ketamine | 42 | ||
| α2-Agonists | 43 | ||
| Antihistamines | 43 | ||
| Anticholinergic Drugs | 44 | ||
| Topical Anesthetics | 44 | ||
| Nonopioid Analgesics | 44 | ||
| Antiemetics | 47 | ||
| Corticosteroids | 47 | ||
| Insulin | 47 | ||
| Antibiotics | 47 | ||
| Antacids, H2 Antagonists, and Gastrointestinal Motility Drugs | 47 | ||
| Induction of Anesthesia | 48 | ||
| Preparation for Induction | 48 | ||
| Inhalation Induction | 48 | ||
| Inhalation with Sevoflurane | 48 | ||
| Inhalation Induction with Halothane | 49 | ||
| Inhalation Induction with Desflurane | 50 | ||
| Hypnotic Induction | 50 | ||
| Modified Single-Breath Induction | 50 | ||
| Intravenous Induction | 50 | ||
| Thiopental | 50 | ||
| Methohexital | 51 | ||
| Propofol | 51 | ||
| Etomidate | 52 | ||
| Ketamine | 52 | ||
| Intramuscular Induction | 52 | ||
| Rectal Induction | 52 | ||
| Full Stomach and Rapid-Sequence Induction | 52 | ||
| Special Problems | 54 | ||
| The Fearful Child | 54 | ||
| Autism | 54 | ||
| Anemia | 54 | ||
| Upper Respiratory Tract Infection | 55 | ||
| Obstructive Sleep Apnea Syndrome | 57 | ||
| Asymptomatic Cardiac Murmurs | 58 | ||
| Fever | 59 | ||
| Postanesthesia Apnea in Formerly Preterm Infants | 59 | ||
| Hyperalimentation | 61 | ||
| Diabetes | 61 | ||
| Bronchopulmonary Dysplasia | 62 | ||
| Seizure Disorder | 63 | ||
| Sickle Cell Disease | 63 | ||
| Acknowledgment | 63 | ||
| Annotated References | 63 | ||
| References | 63.e1 | ||
| References | 63 | ||
| 5 Ethical Issues in Pediatric Anesthesiology | 64 | ||
| Informed Consent | 64 | ||
| THE Informed Consent Process | 64 | ||
| Assent: The Role of the Patient | 64 | ||
| Informed Permission and the Best Interests Standard | 64 | ||
| Disclosure | 65 | ||
| Informed Refusal | 65 | ||
| Doctor, If This Were Your Child, What Would You Do? | 66 | ||
| Disclosure and Apology of Medical Errors | 66 | ||
| Special Situations in Pediatric Informed Consent | 66 | ||
| Confidentially for Adolescents | 66 | ||
| The Pregnant Adolescent | 66 | ||
| The Adolescent and Abortion | 67 | ||
| Children of Jehovah’s Witnesses | 67 | ||
| Emergency Care | 67 | ||
| The Impaired Parent | 68 | ||
| End-of-Life Issues | 68 | ||
| Forgoing Potentially Life-Sustaining Treatment | 68 | ||
| Perioperative Limitations on Life-Sustaining Medical Therapy | 68 | ||
| Barriers to Honoring Preferences for Resuscitation | 68 | ||
| Inadvisable Care | 69 | ||
| Improving Communication in Pediatric Intensive Care Units | 69 | ||
| Palliative Care | 69 | ||
| Euthanasia | 69 | ||
| Donation after Cardiac Death | 69 | ||
| Clinical and Academic Practice Issues | 70 | ||
| Pediatric Research | 70 | ||
| Minimal Risk | 70 | ||
| Minor Increase over Minimal Risk | 71 | ||
| Socioeconomic Concerns and Distribution of Risk | 72 | ||
| Imperative for Pharmacologic Research | 72 | ||
| Managing Potential Conflicts of Interest | 72 | ||
| Conducting Research | 72 | ||
| Interaction with Industry | 73 | ||
| Production Pressure | 73 | ||
| The Fetus | 73 | ||
| Physician Obligations, Advocacy, and Good Citizenship | 73 | ||
| Participating in Patient Safety Efforts | 74 | ||
| Treating Suffering | 74 | ||
| Suspicion of Child Abuse | 74 | ||
| The Ethics Consultation Service | 74 | ||
| Annotated References | 75 | ||
| References | 75.e1 | ||
| References | 75 | ||
| II Drug and Fluid Therapy | 77 | ||
| 6 Pharmacokinetics and Pharmacology of Drugs Used in Children | 77 | ||
| Pharmacokinetic Principles and Calculations | 78 | ||
| First-Order Kinetics | 78 | ||
| Half-Life | 79 | ||
| First-Order Single-Compartment Kinetics | 79 | ||
| First-Order Multiple-Compartment Kinetics | 79 | ||
| Zero-Order Kinetics | 80 | ||
| Apparent Volume of Distribution | 81 | ||
| Pharmacokinetic Example | 81 | ||
| Repetitive Dosing and Drug Accumulation | 81 | ||
| Steady State | 82 | ||
| Loading Dose | 82 | ||
| Population Modeling | 82 | ||
| Pediatric Pharmacokinetic Considerations | 82 | ||
| Size | 82 | ||
| Maturation | 83 | ||
| Organ Function | 83 | ||
| Pharmacodynamic Models | 83 | ||
| Sigmoid Emax Model | 83 | ||
| Quantal Effect Model | 84 | ||
| Logistic Regression Model | 84 | ||
| Linking Pharmacokinetics with Pharmacodynamics | 84 | ||
| Drug Distribution | 84 | ||
| Protein Binding | 84 | ||
| Body Composition | 85 | ||
| Absorption | 86 | ||
| Metabolism and Excretion | 86 | ||
| Hepatic Metabolism | 86 | ||
| Cytochromes P-450: Phase I Reactions | 87 | ||
| Developmental Changes of Specific Cytochromes | 87 | ||
| Phase II Reactions | 87 | ||
| Alterations in Biotransformation | 89 | ||
| Genotypic Variations in Drug Metabolism | 90 | ||
| Extrahepatic Routes of Metabolic Clearance | 90 | ||
| Renal Excretion | 90 | ||
| Central Nervous System Effects | 91 | ||
| Pharmacodynamics in Children | 91 | ||
| Measurement of Pharmacodynamic Endpoints | 92 | ||
| The Target Concentration Approach | 92 | ||
| Defining Target Concentration | 92 | ||
| Drug Interactions | 92 | ||
| The Drug Approval Process, the Package Insert, and Drug Labeling | 93 | ||
| Inhalation Anesthetic Agents | 94 | ||
| Physicochemical Properties | 94 | ||
| Pharmacokinetics of Inhaled Anesthetics | 95 | ||
| Factors Affecting Delivery of Anesthetics to the Lungs | 96 | ||
| Inspired Concentration | 96 | ||
| Alveolar Ventilation and Functional Residual Capacity | 96 | ||
| Factors Affecting the Uptake (Removal) of Anesthetics from the Lungs | 96 | ||
| Cardiac Output | 96 | ||
| Solubility | 96 | ||
| Alveolar to Venous Partial Pressure Gradient | 97 | ||
| Second Gas Effect | 97 | ||
| Induction | 98 | ||
| Control of Anesthetic Depth | 98 | ||
| Shunts | 99 | ||
| Washout and Emergence | 100 | ||
| Pharmacodynamics of Inhaled Anesthetics | 101 | ||
| Minimum Alveolar Concentration | 101 | ||
| Central Nervous System | 102 | ||
| Cardiovascular System | 103 | ||
| Respiratory System | 105 | ||
| Renal System | 106 | ||
| Hepatic System | 107 | ||
| Clinical Effects | 107 | ||
| Induction Techniques | 107 | ||
| Emergence | 109 | ||
| Emergence Delirium | 109 | ||
| Neuromuscular Junction | 110 | ||
| Malignant Hyperthermia | 110 | ||
| Stability and Toxicology of Breakdown Products | 110 | ||
| Nitrous Oxide | 111 | ||
| Environmental Impact | 112 | ||
| Oxygen | 112 | ||
| Intravenous Anesthetic Agents | 113 | ||
| Barbiturates | 113 | ||
| Methohexital | 113 | ||
| Thiopental | 113 | ||
| Propofol | 114 | ||
| Ketamine | 117 | ||
| Indications | 118 | ||
| Contraindications | 119 | ||
| Etomidate | 119 | ||
| Neuromuscular Blocking Drugs | 119 | ||
| Neuromuscular Monitoring | 119 | ||
| Neuromuscular Junction | 121 | ||
| Pharmacodynamics | 121 | ||
| Pharmacokinetics | 121 | ||
| Succinylcholine | 122 | ||
| Cholinesterase Deficiency | 122 | ||
| Adverse Effects of Succinylcholine | 123 | ||
| Temporomandibular Joint Stiffness | 123 | ||
| Arrhythmias | 123 | ||
| Hyperkalemia | 123 | ||
| Biochemical Changes | 124 | ||
| Rhabdomyolysis | 124 | ||
| Myoglobinemia | 124 | ||
| Fasciculations | 124 | ||
| Intraocular Pressure | 124 | ||
| Clinical Uses of Succinylcholine | 124 | ||
| Intermediate-Acting Nondepolarizing Relaxants | 125 | ||
| Atracurium | 125 | ||
| Cisatracurium | 125 | ||
| Vecuronium | 125 | ||
| Rocuronium | 126 | ||
| Clinical Implications When Using Short- and Intermediate-Acting Relaxants | 126 | ||
| Long-Acting Nondepolarizing Relaxants | 127 | ||
| Pancuronium | 127 | ||
| Antagonism of Muscle Relaxants | 127 | ||
| General Principles | 127 | ||
| Sugammadex | 128 | ||
| Relaxants in Special Situations | 129 | ||
| Opioids | 129 | ||
| Morphine | 129 | ||
| Meperidine | 131 | ||
| Hydromorphone | 131 | ||
| Oxycodone | 131 | ||
| Methadone | 132 | ||
| Fentanyl | 132 | ||
| Alfentanil | 134 | ||
| Sufentanil | 134 | ||
| Remifentanil | 134 | ||
| Butorphanol and Nalbuphine | 136 | ||
| Codeine | 137 | ||
| Tramadol | 138 | ||
| Acetaminophen | 138 | ||
| Nonsteroidal Antiinflammatory Agents | 139 | ||
| Ketorolac | 140 | ||
| Benzodiazepine Sedatives | 141 | ||
| Midazolam | 141 | ||
| Diazepam | 142 | ||
| Other Sedatives | 142 | ||
| Dexmedetomidine | 142 | ||
| Chloral Hydrate | 145 | ||
| Antihistamines | 145 | ||
| Diphenhydramine | 145 | ||
| Cimetidine, Ranitidine, and Famotidine | 145 | ||
| Antiemetics | 146 | ||
| Metoclopramide | 146 | ||
| 5-Hydroxytryptamine Type 3–Receptor Antagonists | 146 | ||
| Anticholinergics | 146 | ||
| Atropine and Scopolamine | 146 | ||
| Glycopyrrolate | 147 | ||
| Antagonists | 147 | ||
| Naloxone | 147 | ||
| Naltrexone | 148 | ||
| Methylnaltrexone | 148 | ||
| Flumazenil | 148 | ||
| Physostigmine | 148 | ||
| Drugs in the Pipeline | 148 | ||
| Etomidate Analogues | 148 | ||
| Butyfol | 149 | ||
| Benzodiazepine Derivatives | 149 | ||
| References | 149.e1 | ||
| References | 149 | ||
| 7 Total Intravenous Anesthesia and Target-Controlled Infusion | 150 | ||
| Total Intravenous Anesthesia | 150 | ||
| Indications | 150 | ||
| Drugs and Techniques | 150 | ||
| Principles | 150 | ||
| Fixed Infusion Rate and a Three-Compartment Model | 152 | ||
| Bolus and Variable Rate Infusion in a Three-Compartment Model | 152 | ||
| Manual Infusion Schemes | 157 | ||
| Propofol | 157 | ||
| Opioids | 157 | ||
| Ketamine | 158 | ||
| Midazolam | 158 | ||
| Target-Controlled Infusion | 158 | ||
| References | 160.e1 | ||
| References | 160 | ||
| 8 Fluid Management | 161 | ||
| Regulatory Mechanisms: Fluid Volume, Osmolality, and Arterial Pressure | 161 | ||
| Maturation of Fluid Compartments and Homeostatic Mechanisms | 163 | ||
| Body Water and Electrolyte Distribution | 163 | ||
| Circulating Blood Volume | 163 | ||
| Maturation of Homeostatic Mechanisms | 163 | ||
| Fluid and Electrolyte Requirements | 165 | ||
| Neonatal Fluid Management | 166 | ||
| Intraoperative Fluid Management | 167 | ||
| Intravenous Access and Fluid Administration Devices | 167 | ||
| Choice and Composition of Intravenous Fluids | 167 | ||
| Hyperalimentation | 168 | ||
| Fasting Recommendations | 169 | ||
| Assessment of Intravascular Volume | 169 | ||
| Ongoing Losses and Third-Spacing | 170 | ||
| Postoperative Fluid Management | 170 | ||
| General Approach | 170 | ||
| Postoperative Physiology and Hyponatremia | 170 | ||
| Postoperative Pulmonary Edema | 171 | ||
| Pathophysiologic States and Their Management | 171 | ||
| Fluid Overload and Edema | 171 | ||
| Dehydration States | 171 | ||
| Hypernatremia and Hyponatremia | 173 | ||
| Hypernatremia | 173 | ||
| Hyponatremia | 173 | ||
| Disorders of Potassium Homeostasis | 174 | ||
| Hyperkalemia | 174 | ||
| Hypokalemia | 175 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Secretion | 175 | ||
| Diabetes Insipidus | 176 | ||
| Hyperchloremic Acidosis | 176 | ||
| Hypochloremic Metabolic Alkalosis | 176 | ||
| Cerebral Salt Wasting | 177 | ||
| Acknowledgment | 177 | ||
| Annotated References | 177 | ||
| References | 177.e1 | ||
| References | 177 | ||
| 9 Essentials of Hematology | 178 | ||
| The Basics | 178 | ||
| Laboratory Values and Diagnostic Tests | 178 | ||
| Guidelines for Transfusion | 179 | ||
| Hemolytic Anemias | 180 | ||
| Hereditary Spherocytosis | 181 | ||
| Pathophysiology | 181 | ||
| Clinical and Laboratory Features | 181 | ||
| Perioperative Considerations | 181 | ||
| Glucose-6-Phosphate Dehydrogenase Deficiency | 182 | ||
| Pathophysiology | 182 | ||
| Clinical and Laboratory Features | 182 | ||
| Perioperative Considerations | 182 | ||
| Hemoglobinopathies | 183 | ||
| Sickle Cell Disease | 183 | ||
| Pathophysiology | 183 | ||
| Clinical and Laboratory Features and Treatment | 184 | ||
| Perioperative Considerations | 185 | ||
| Thalassemias | 187 | ||
| Pathophysiology | 187 | ||
| Clinical and Laboratory Features and Treatment | 187 | ||
| Perioperative Considerations | 187 | ||
| Thrombocytopenia | 188 | ||
| Platelet Disorders and Bleeding | 188 | ||
| Idiopathic Thrombocytopenic Purpura | 188 | ||
| Pathophysiology | 188 | ||
| Clinical and Laboratory Features and Treatment | 188 | ||
| Perioperative Considerations | 188 | ||
| Coagulation Disorders | 188 | ||
| Screening | 189 | ||
| Von Willebrand Disease | 189 | ||
| Pathophysiology and Classification | 189 | ||
| Clinical and Laboratory Features and Treatment | 190 | ||
| Perioperative Concerns | 190 | ||
| Hemophilia | 191 | ||
| Pathophysiology | 191 | ||
| Clinical and Laboratory Features and Treatment | 191 | ||
| Perioperative Concerns | 192 | ||
| Hypercoagulability | 192 | ||
| Cancer and Hematopoietic Stem Cell Transplantation | 192 | ||
| Cancer | 192 | ||
| Clinical and Laboratory Features and Treatment | 193 | ||
| Perioperative Considerations | 194 | ||
| Hematopoietic Stem Cell Transplantation | 195 | ||
| Clinical and Laboratory Features and Treatment | 196 | ||
| Perioperative Considerations | 197 | ||
| Annotated References | 197 | ||
| References | 197.e1 | ||
| References | 197 | ||
| 10 Strategies for Blood Product Management and Reducing Transfusions | 198 | ||
| Blood Volume | 198 | ||
| Blood Components and Alternatives | 200 | ||
| Red Blood Cell–Containing Components | 200 | ||
| Platelets | 201 | ||
| Special Processing of Cellular Blood Components | 202 | ||
| Fresh Frozen Plasma | 203 | ||
| Cryoprecipitate | 204 | ||
| Plasma-Derived and Recombinant Factor Concentrates | 204 | ||
| Desmopressin | 204 | ||
| Albumin, Dextrans, Starches, and Gelatins | 204 | ||
| Red Blood Cell Substitutes | 205 | ||
| Massive Blood Transfusion | 205 | ||
| Coagulopathy | 205 | ||
| Dilutional Thrombocytopenia | 207 | ||
| Factor Deficiency | 208 | ||
| Disseminated Intravascular Coagulation and Fibrinolysis | 210 | ||
| Hyperkalemia | 210 | ||
| Hypocalcemia and Citrate Toxicity | 211 | ||
| Acid–base Balance | 212 | ||
| Hypothermia | 213 | ||
| Monitoring during Massive Blood Transfusion | 213 | ||
| Infectious Disease Considerations | 214 | ||
| Methods to Reduce Exposure to Allogeneic Blood Components | 214 | ||
| Erythropoietin | 214 | ||
| Preoperative Autologous Blood Donation | 214 | ||
| Intraoperative Blood Recovery and Reinfusion: Autotransfusion | 215 | ||
| Indications | 215 | ||
| Contraindications | 215 | ||
| Controlled Hypotension | 215 | ||
| Physiology | 215 | ||
| Renal System | 216 | ||
| Pulmonary System | 216 | ||
| Hepatic System | 216 | ||
| Pharmacology | 216 | ||
| Sodium Nitroprusside | 216 | ||
| Dosage. | 216 | ||
| Toxicity. | 216 | ||
| Nitroglycerin | 217 | ||
| III The Chest | 221 | ||
| 11 Essentials of Pulmonology | 221 | ||
| Respiratory Physiology | 221 | ||
| Preoperative Assessment | 223 | ||
| Pulmonary Function Tests | 223 | ||
| Perioperative Etiology and Epidemiology | 225 | ||
| Upper Respiratory Tract Infection | 226 | ||
| Lower Airway Disease | 229 | ||
| Cystic Fibrosis | 233 | ||
| Sickle Cell Disease | 235 | ||
| Summary | 236 | ||
| Annotated References | 236 | ||
| References | 236.e1 | ||
| References | 236 | ||
| 12 The Pediatric Airway | 237 | ||
| Developmental Anatomy of the Airway | 237 | ||
| Tongue | 237 | ||
| Position of the Larynx | 237 | ||
| Epiglottis | 238 | ||
| Vocal Folds | 238 | ||
| Subglottis | 238 | ||
| The Larynx | 241 | ||
| Anatomy | 241 | ||
| Structure | 241 | ||
| Histology | 241 | ||
| Sensory and Motor Innervation | 242 | ||
| Blood Supply | 243 | ||
| Function | 243 | ||
| Inspiration | 243 | ||
| Expiration | 243 | ||
| Forced Glottic Closure and Laryngospasm | 243 | ||
| Swallowing | 243 | ||
| Phonation | 243 | ||
| Physiology of the Respiratory System | 243 | ||
| Obligate Nasal Breathing | 243 | ||
| Tracheal and Bronchial Function | 244 | ||
| Work of Breathing | 245 | ||
| Airway Obstruction during Anesthesia | 246 | ||
| Evaluation of the Airway | 246 | ||
| Clinical Evaluation | 246 | ||
| Diagnostic Testing | 247 | ||
| Airway Management: The Normal Airway | 247 | ||
| Mask Ventilation | 247 | ||
| Oropharyngeal Airways | 248 | ||
| Nasopharyngeal Airways | 249 | ||
| Tracheal Intubation | 249 | ||
| Technique | 249 | ||
| Selection of Laryngoscope Blade | 250 | ||
| Endotracheal Tubes | 250 | ||
| Endotracheal Tube Insertion Distance | 252 | ||
| Complications of Tracheal Intubation | 252 | ||
| Postintubation Croup | 252 | ||
| Laryngotracheal (Subglottic) Stenosis | 253 | ||
| Laryngeal Mask Airway | 253 | ||
| Other Supraglottic Airway Devices | 257 | ||
| The Laryngeal Tube | 257 | ||
| The Cobra Perilaryngeal Airway | 258 | ||
| The i-gel | 258 | ||
| Summary | 258 | ||
| Airway Management: The Abnormal Airway | 258 | ||
| Classifying the Abnormal Pediatric Airway | 258 | ||
| Management Principles | 259 | ||
| Documentation | 261 | ||
| The Unexpected Difficult Intubation | 263 | ||
| Extubation of the Child with the Difficult Airway | 264 | ||
| Special Techniques for Ventilation | 264 | ||
| Multi-handed Mask Ventilation Techniques | 264 | ||
| Laryngeal Mask Airway | 264 | ||
| Percutaneous Needle Cricothyroidotomy | 265 | ||
| Laryngeal Mask Airway versus Percutaneous Needle Cricothyroidotomy and Transtracheal Jet Ventilation | 267 | ||
| Surgical Airway | 267 | ||
| Anterior Commissure Scope and Rigid Ventilating Bronchoscope | 267 | ||
| Special Techniques for Intubation | 267 | ||
| Rigid Laryngoscopy | 267 | ||
| Optimal External Laryngeal Manipulation | 267 | ||
| Intubation Guides | 267 | ||
| Oxyscope | 268 | ||
| Dental Mirror | 268 | ||
| Retromolar, Paraglossal, or Lateral Approach using a Straight Blade | 268 | ||
| Fiberoptic Laryngoscopy | 269 | ||
| Equipment | 269 | ||
| Ancillary Equipment | 269 | ||
| Direct Technique | 269 | ||
| Staged Techniques | 270 | ||
| Lighted Stylet | 270 | ||
| Bullard Laryngoscope | 271 | ||
| Retrograde Wire-Guided Intubation | 271 | ||
| Video and Indirect Intubating Devices | 271 | ||
| Video Laryngoscopes | 271 | ||
| GlideScope. | 271 | ||
| Storz Video Laryngoscope. | 272 | ||
| MultiView Scope. | 272 | ||
| Optical Laryngoscopes | 272 | ||
| Airtraq. | 272 | ||
| Truview. | 273 | ||
| Optical Stylets | 273 | ||
| Shikani Optical Stylet. | 274 | ||
| Storz Bonfils Optical Stylet. | 274 | ||
| Shikani versus Storz Bonfils Optical Stylets. | 274 | ||
| Laryngeal Mask Airway as a Conduit for Intubation | 274 | ||
| The air-Q | 274 | ||
| Combined Techniques | 275 | ||
| Retrograde Wire and the Flexible Fiberoptic Bronchoscope | 275 | ||
| Rigid Laryngoscopy and the Flexible Fiberoptic Bronchoscope | 275 | ||
| Flexible Fiberoptic Bronchoscope Used in a Retrograde Manner | 275 | ||
| Acknowledgments | 275 | ||
| Annotated References | 276 | ||
| References | 276.e1 | ||
| References | 276 | ||
| 13 Anesthesia for Thoracic Surgery | 277 | ||
| General Perioperative Considerations | 277 | ||
| Ventilation and Perfusion during Thoracic Surgery | 277 | ||
| Thoracoscopy | 278 | ||
| Techniques for Single-Lung Ventilation in Infants and Children | 279 | ||
| Use of a Single-Lumen Endotracheal Tube | 279 | ||
| Use of Balloon-Tipped Bronchial Blockers | 280 | ||
| Use of a Univent Tube | 281 | ||
| Use of Double-Lumen Tubes | 282 | ||
| General Considerations in the Management of Single-Lung Ventilation | 283 | ||
| Surgical Lesions of the Chest | 284 | ||
| Neonates and Infants | 284 | ||
| Childhood | 288 | ||
| Summary | 289 | ||
| Annotated References | 290 | ||
| References | 290.e1 | ||
| References | 290 | ||
| IV The Heart | 291 | ||
| 14 Essentials of Cardiology | 291 | ||
| Congenital Heart Disease | 291 | ||
| Incidence | 291 | ||
| Segmental Approach to Diagnosis | 292 | ||
| Physiologic Classification of Defects | 293 | ||
| Volume Overload Lesions | 293 | ||
| Obstruction to Systemic Blood Flow | 293 | ||
| Obstruction to Pulmonary Blood Flow | 293 | ||
| Parallel Circulation | 294 | ||
| Single-Ventricle Lesions | 294 | ||
| Intrinsic Myocardial Disorders | 294 | ||
| Acquired Heart Disease | 294 | ||
| Cardiomyopathies | 294 | ||
| Myocarditis | 296 | ||
| Rheumatic Fever and Rheumatic Heart Disease | 297 | ||
| Infective Endocarditis | 298 | ||
| Causes and Treatment | 298 | ||
| Endocarditis Prophylaxis | 299 | ||
| Kawasaki Disease | 300 | ||
| Cardiac Tumors | 300 | ||
| Heart Failure in Children | 300 | ||
| Definition and Pathophysiology | 300 | ||
| Etiology and Clinical Features | 301 | ||
| Treatment Strategies | 301 | ||
| Anesthetic Considerations | 301 | ||
| Syndromes, Associations, and Systemic Disorders: Cardiovascular Disease and Anesthetic Implications | 301 | ||
| Chromosomal Syndromes | 301 | ||
| Trisomy 21 | 301 | ||
| Trisomy 18 | 301 | ||
| Trisomy 13 | 302 | ||
| Turner Syndrome | 302 | ||
| Gene Deletion Syndromes | 302 | ||
| Williams Syndrome | 302 | ||
| Chromosome 22q11.2 Deletion Syndrome: DiGeorge and Velocardiofacial Syndrome | 302 | ||
| Single-Gene Defects | 303 | ||
| Noonan Syndrome | 303 | ||
| Marfan Syndrome | 303 | ||
| Associations | 303 | ||
| Vater or VACTERL Association | 303 | ||
| CHARGE Association | 303 | ||
| Other Disorders | 304 | ||
| Selected Vascular Anomalies and Their Implications for Anesthesia | 304 | ||
| Aberrant Subclavian Arteries | 304 | ||
| Persistent Left Superior Vena Cava to the Coronary Sinus | 305 | ||
| Evaluation of the Child with a Cardiac Murmur | 305 | ||
| Basic Interpretation of the Electrocardiogram in Children | 306 | ||
| Essentials of Cardiac Rhythm Interpretation and Acute Arrhythmia Management in Children | 309 | ||
| Basic Rhythms | 311 | ||
| Sinus Rhythm | 311 | ||
| Sinus Arrhythmia | 311 | ||
| Sinus Bradycardia | 311 | ||
| Sinus Tachycardia | 311 | ||
| Junctional Rhythm | 311 | ||
| Conduction Disorders | 311 | ||
| Bundle Branch Block | 311 | ||
| Atrioventricular Block | 313 | ||
| First-Degree Atrioventricular Block | 313 | ||
| Second-Degree Atrioventricular Block | 313 | ||
| Third-Degree Atrioventricular Block | 313 | ||
| Cardiac Arrhythmias | 313 | ||
| Supraventricular Arrhythmias | 313 | ||
| Premature Atrial Contractions or Beats | 313 | ||
| Supraventricular Tachycardia | 313 | ||
| Ventricular Arrhythmias | 313 | ||
| Premature Ventricular Contractions or Beats | 313 | ||
| Ventricular Tachycardia | 314 | ||
| Long QT Syndrome | 314 | ||
| Ventricular Fibrillation | 316 | ||
| Pacemaker Therapy in the Pediatric Age Group | 316 | ||
| Pacemaker Nomenclature | 316 | ||
| Permanent Cardiac Pacing | 316 | ||
| Indications | 316 | ||
| Perioperative Considerations | 316 | ||
| Transcutaneous Pacing | 317 | ||
| Implantable Cardioverter-Defibrillators | 318 | ||
| Diagnostic Modalities in Pediatric Cardiology | 318 | ||
| Chest Radiography | 318 | ||
| Barium Esophagram | 318 | ||
| Echocardiography | 318 | ||
| Interpretation of an Echocardiographic Report | 320 | ||
| Measurements of Cardiac Chambers and Vessel Dimensions | 320 | ||
| Assessment of Ventricular Function | 320 | ||
| Estimation of Pressures | 320 | ||
| Evaluation of Gradients | 320 | ||
| Evaluation of Regurgitant Lesions | 320 | ||
| Magnetic Resonance Imaging | 320 | ||
| Computed Tomography | 321 | ||
| Cardiac Catheterization and Angiography | 321 | ||
| Interpretation of a Cardiac Catheterization Report | 322 | ||
| Pressure Data | 322 | ||
| Shunt Calculations | 324 | ||
| Cardiac Output Determinations | 324 | ||
| Vascular Resistances | 324 | ||
| Perioperative Considerations for Children with Cardiovascular Disease | 324 | ||
| General Issues | 324 | ||
| Clinical Condition and Status of Prior Repair | 324 | ||
| Summary | 326 | ||
| Acknowledgment | 326 | ||
| Annotated References | 326 | ||
| References | 326.e1 | ||
| References | 326 | ||
| 15 Anesthesia for Children Undergoing Heart Surgery | 327 | ||
| Preoperative Evaluation | 327 | ||
| The Preoperative Visit and Evaluation | 328 | ||
| Medical Assessment | 328 | ||
| Prescribing Premedication | 328 | ||
| Giving Information | 328 | ||
| Creating Rapport with the Child and Family | 328 | ||
| Formulating an Anesthetic Plan | 328 | ||
| Upper Respiratory Tract Infection and Cardiac Surgery | 328 | ||
| Perioperative Challenges in Pediatric Cardiac Anesthesia | 329 | ||
| Cyanosis | 329 | ||
| Intracardiac Shunting | 329 | ||
| Restrictive and Unrestrictive Shunts | 329 | ||
| Dependent Shunting during Anesthesia | 329 | ||
| Impaired Hemostasis | 329 | ||
| Strategies to Reduce Bleeding after Bypass | 330 | ||
| Antifibrinolytics | 330 | ||
| Topical Agents | 330 | ||
| Ultrafiltration | 331 | ||
| Desmopressin | 331 | ||
| Anesthesia Management for Surgery Requiring Cardiopulmonary Bypass | 331 | ||
| Monitoring | 331 | ||
| Transesophageal Echocardiography | 332 | ||
| Near-Infrared Spectroscopy | 332 | ||
| Induction of Anesthesia | 332 | ||
| Maintenance of Anesthesia | 333 | ||
| Institution and Separation from Bypass | 333 | ||
| Control of Systemic and Pulmonary Vascular Resistance during Anesthesia | 333 | ||
| Anesthetic Drugs Used in Pediatric Cardiac Anesthesia | 334 | ||
| Inhalational Agents | 334 | ||
| Sevoflurane | 334 | ||
| Isoflurane | 334 | ||
| Halothane | 334 | ||
| Nitrous Oxide | 334 | ||
| Intravenous Induction Agents | 335 | ||
| Ketamine | 335 | ||
| Etomidate | 335 | ||
| Propofol | 335 | ||
| Opioids | 335 | ||
| Fentanyl | 335 | ||
| Sufentanil | 335 | ||
| Remifentanil | 335 | ||
| Neuromuscular Blocking Drugs | 336 | ||
| Long-Term Neurocognitive-Developmental Outcomes Associated with Anesthesia | 336 | ||
| Regional Anesthesia | 336 | ||
| Fast Tracking | 336 | ||
| Cardiopulmonary Bypass | 337 | ||
| Stress Response to Cardiac Surgery | 337 | ||
| Reducing the Stress Response to Surgery and Bypass | 338 | ||
| Corticosteroids | 338 | ||
| Aprotinin | 338 | ||
| Allopurinol | 338 | ||
| Ischemic Preconditioning | 338 | ||
| Glucose-Insulin and Potassium | 338 | ||
| Anesthesia Considerations for Specific Cardiac Defects | 338 | ||
| Simple Left-to-Right Shunts | 338 | ||
| Atrial Septal Defect | 339 | ||
| V The Brain and Glands | 475 | ||
| 22 Essentials of Neurology and Neuromuscular Disorders | 475 | ||
| General Considerations | 475 | ||
| Static Neurologic Disorders | 476 | ||
| Cerebral Palsy | 476 | ||
| Multisystem Comorbidities | 477 | ||
| Anesthesia Considerations for Cerebral Palsy | 477 | ||
| Malformations of the Nervous System | 477 | ||
| Neural Tube Defects: Cranial and Spinal Dysraphism | 477 | ||
| Chiari Malformation | 478 | ||
| Syringomyelia | 479 | ||
| Hydrocephalus | 479 | ||
| Disorders of Ventral Induction | 479 | ||
| Disorders of Cortical Development | 479 | ||
| Progressive Neurologic Disorders | 479 | ||
| Primary Brain Tumors | 479 | ||
| Metabolic Disease | 480 | ||
| Anesthesia Considerations for Progressive Neurologic Disorders | 481 | ||
| Neuromuscular Disorders | 481 | ||
| Disorders of the Anterior Horn Cell | 481 | ||
| Spinal Muscular Atrophies | 481 | ||
| Anesthesia Considerations for Spinal Muscular Atrophies | 482 | ||
| Poliomyelitis | 482 | ||
| Axonal Disorders | 482 | ||
| Hereditary Neuropathies | 482 | ||
| Acquired Disorders of the Peripheral Nerves | 483 | ||
| Guillain-Barré Syndrome | 483 | ||
| Chronic Inflammatory Demyelinating Polyneuropathy | 483 | ||
| Nerve Palsies | 483 | ||
| Disorders of the Neuromuscular Junction | 483 | ||
| Myasthenia Gravis | 483 | ||
| Neonatal Transient Myasthenia Gravis | 484 | ||
| Congenital Myasthenic Syndromes | 484 | ||
| Juvenile Myasthenia Gravis | 484 | ||
| Anesthesia Considerations for Myasthenia Gravis | 484 | ||
| Myasthenia-like Syndrome | 484 | ||
| Disorders of Muscle Fibers | 484 | ||
| Myopathies | 484 | ||
| Congenital Myopathies | 484 | ||
| Metabolic Myopathies | 485 | ||
| Mitochondrial Disorders Underlying Myopathies | 485 | ||
| Anesthesia Considerations for Myopathies | 486 | ||
| Muscular Dystrophies | 487 | ||
| Myotonic Dystrophy | 487 | ||
| Dystrophinopathies | 488 | ||
| Anesthesia Considerations for Muscular Dystrophies | 489 | ||
| Undiagnosed Myopathy | 490 | ||
| Epilepsy | 490 | ||
| Summary | 490 | ||
| Annotated References | 491 | ||
| References | 491.e1 | ||
| References | 491 | ||
| 23 Surgery, Anesthesia, and the Immature Brain | 492 | ||
| Background | 492 | ||
| Normal Brain Development | 493 | ||
| Effects of Anesthetic Exposure on the Developing Brain | 494 | ||
| Apoptotic Cell Death | 494 | ||
| Long-Term Brain Cellular Viability, Neurologic Function, and Behavior | 496 | ||
| Effects on Neurogenesis and Gliogenesis | 496 | ||
| Alterations in Dendritic Architecture | 496 | ||
| Decrease in Trophic Factors | 497 | ||
| Degeneration of Mitochondria | 497 | ||
| Abnormal Reentry into Cell Cycle | 497 | ||
| Destabilization of The Cytoskeleton | 497 | ||
| Effects on the Developing Spinal Cord | 497 | ||
| Putative Mechanisms for Neurotoxicity | 497 | ||
| Specific Anesthetic and Sedative Agents | 498 | ||
| Ketamine | 498 | ||
| Inhalational Anesthetics | 499 | ||
| Nitrous Oxide | 499 | ||
| Xenon | 499 | ||
| Benzodiazepines | 499 | ||
| Chloral Hydrate | 500 | ||
| Barbiturates | 500 | ||
| Propofol | 500 | ||
| Dexmedetomidine | 500 | ||
| Opioid Analgesics | 500 | ||
| Exposure Time, Dose, and Anesthetic Combinations | 501 | ||
| Deleterious Effects of Untreated Pain and Stress | 501 | ||
| Potential Alleviating Strategies | 502 | ||
| Anesthetic Neuroprotection | 502 | ||
| Critical Evaluation of Animal Studies and Interspecies Comparisons | 502 | ||
| Duration of Exposure | 503 | ||
| Anesthetic Doses | 503 | ||
| Experimental Versus Clinical Conditions | 504 | ||
| Comparative Brain Development | 504 | ||
| Assessing Neurobehavioral or Cognitive Outcomes | 505 | ||
| Long-Term Outcome in Children Exposed to Anesthesia and Surgery | 505 | ||
| Outcome after Exposure to Anesthesia Outside of the Operating Room | 507 | ||
| Limitations of the Available Clinical Studies | 507 | ||
| Future Research | 508 | ||
| Recommendations for Clinical Practice | 509 | ||
| Annotated References | 509 | ||
| References | 509.e1 | ||
| References | 509 | ||
| 24 Pediatric Neurosurgical Anesthesia | 510 | ||
| Pathophysiology | 510 | ||
| Intracranial Compartments | 510 | ||
| Intracranial Pressure | 510 | ||
| Herniation Syndromes | 511 | ||
| Signs of Increased Intracranial Pressure | 511 | ||
| Monitoring Intracranial Pressure | 511 | ||
| Intracranial Compliance | 511 | ||
| Cerebral Blood Volume and Cerebral Blood Flow | 512 | ||
| Cerebral Perfusion Pressure | 512 | ||
| Cerebrovascular Autoregulation | 512 | ||
| Effects of Blood Pressure | 512 | ||
| Effects of Oxygen | 513 | ||
| Effects of Carbon Dioxide | 513 | ||
| Management of Anesthesia | 513 | ||
| Preoperative Evaluation | 513 | ||
| History | 513 | ||
| Physical Examination | 513 | ||
| Laboratory and Radiologic Evaluation | 513 | ||
| Premedication | 514 | ||
| Monitoring | 514 | ||
| Induction | 514 | ||
| Airway Management and Intubation | 515 | ||
| Neuromuscular Blocking Drugs | 515 | ||
| Positioning | 515 | ||
| Prone Position | 516 | ||
| Modified Lateral Position | 517 | ||
| Sitting Position | 517 | ||
| Local Anesthesia | 517 | ||
| Maintenance of General Anesthesia | 517 | ||
| Apoptotic Neurodegeneration | 518 | ||
| Blood and Fluid Management | 518 | ||
| Temperature Control | 519 | ||
| Venous Air Emboli | 519 | ||
| Emergence | 520 | ||
| Special Situations | 521 | ||
| Trauma | 521 | ||
| Head Injury | 521 | ||
| Scalp Injuries | 521 | ||
| Skull Fractures | 522 | ||
| Epidural Hematoma | 522 | ||
| Subdural Hematoma | 522 | ||
| Intracerebral Hematoma | 523 | ||
| Spinal Injury | 523 | ||
| Craniotomy | 524 | ||
| Tumors | 524 | ||
| Vascular Anomalies | 525 | ||
| Arteriovenous Malformations | 525 | ||
| Aneurysms | 525 | ||
| Moyamoya Disease | 525 | ||
| Seizure Surgery | 526 | ||
| Hydrocephalus | 527 | ||
| Congenital Anomalies | 528 | ||
| Encephalocele | 528 | ||
| Myelodysplasia | 528 | ||
| Chiari Malformations | 530 | ||
| Other Spinal Defects | 530 | ||
| Neuroradiologic Procedures | 530 | ||
| Acknowledgments | 532 | ||
| Annotated References | 532 | ||
| References | 532.e1 | ||
| References | 532 | ||
| 25 Essentials of Endocrinology | 533 | ||
| Diabetes Mellitus* | 533 | ||
| Classification and Epidemiology in Children | 533 | ||
| General Management Principles | 534 | ||
| Metabolic Response to Surgery | 535 | ||
| Metabolic Response to Anesthesia | 535 | ||
| Adverse Consequences of Hyperglycemia | 535 | ||
| Preoperative Assessment | 536 | ||
| Preoperative Management | 537 | ||
| Major Surgery and Intravenous Insulin Infusions | 538 | ||
| Special Considerations for Preoperative Management of Type 2 Diabetes | 539 | ||
| Intraoperative Management | 539 | ||
| Postoperative Management | 540 | ||
| Special Surgical Situations | 541 | ||
| Diabetes Insipidus | 541 | ||
| Diagnosis of Neurosurgical Diabetes Insipidus: The Triple-Phase Response | 544 | ||
| Perioperative Management of Minor Procedures | 544 | ||
| Perioperative Management of Major Procedures | 545 | ||
| New Perioperative Diagnosis | 545 | ||
| Postoperative Management | 545 | ||
| Post–intensive Care Unit Management | 546 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Secretion | 546 | ||
| Perioperative Management | 546 | ||
| Thyroid Disorders | 547 | ||
| Hypothyroidism | 547 | ||
| Classification and Epidemiology | 547 | ||
| Biochemical Tests of Thyroid Function | 547 | ||
| Clinical Manifestations | 547 | ||
| Neonatal Hypothyroidism | 547 | ||
| Treatment | 548 | ||
| Preoperative Management | 548 | ||
| Hyperthyroidism | 548 | ||
| Classification and Epidemiology | 548 | ||
| Graves Disease | 548 | ||
| Thyroiditis | 549 | ||
| Clinical Manifestations | 549 | ||
| Treatment | 549 | ||
| Perioperative Management | 549 | ||
| Parathyroid and Calcium Disorders | 550 | ||
| Physiology of Calcium Homeostasis | 550 | ||
| Hypocalcemia | 550 | ||
| Neonatal Hypocalcemia | 550 | ||
| Childhood Hypocalcemia | 551 | ||
| VI The Abdomen | 555 | ||
| 26 Essentials of Nephrology | 555 | ||
| Renal Physiology | 555 | ||
| Fluids and Electrolytes | 555 | ||
| Acid-Base Balance | 556 | ||
| Disease States | 556 | ||
| Acute Renal Failure and Acute Kidney Injury | 557 | ||
| Etiology and Pathophysiology | 557 | ||
| Diagnostic Procedures | 558 | ||
| Therapeutic Interventions | 559 | ||
| Hemodialysis | 560 | ||
| Peritoneal Dialysis | 560 | ||
| Chronic Renal Failure | 561 | ||
| Hematologic Problems | 562 | ||
| Cardiovascular Complications | 563 | ||
| Causes of Chronic Renal Failure | 563 | ||
| Preoperative Preparation of the Child with Renal Dysfunction | 564 | ||
| Preoperative Laboratory Evaluation | 564 | ||
| Perioperative Dialysis | 565 | ||
| Medications | 565 | ||
| Intraoperative Management | 565 | ||
| Special Considerations | 565 | ||
| Fluids and Blood Products | 565 | ||
| Anesthetic Agents | 566 | ||
| Postoperative Concerns | 567 | ||
| Annotated References | 568 | ||
| References | 568.e1 | ||
| Reference | 568 | ||
| 27 General Abdominal and Urologic Surgery | 569 | ||
| General Principles of Abdominal Surgery | 569 | ||
| “The Full Stomach”: the Risk for Pulmonary Aspiration of Gastric Contents | 569 | ||
| Rapid-Sequence Induction | 570 | ||
| Indications for Preoperative Nasogastric Tube Placement | 570 | ||
| Fluid Balance | 570 | ||
| Potential for Strangulated or Ischemic Bowel | 571 | ||
| Presence of Concomitant Septicemia | 571 | ||
| Presence of Abdominal Compartment Syndrome | 571 | ||
| Preoperative Laboratory Testing and Investigations | 571 | ||
| Monitoring Requirements | 571 | ||
| Choice of Anesthetic | 572 | ||
| General Principles of Urologic Surgery | 572 | ||
| Reduced Renal Function | 572 | ||
| Systemic Hypertension | 572 | ||
| Corticosteroid Medications | 573 | ||
| Infection or Sepsis | 573 | ||
| Monitoring Requirements | 573 | ||
| Laparoscopic Surgery | 573 | ||
| Pulmonary Effects | 575 | ||
| Cardiovascular Effects | 576 | ||
| Central Nervous System Effects | 577 | ||
| Renal Function and Fluid Requirements | 577 | ||
| Pain Management | 577 | ||
| Robot-Assisted Surgery | 577 | ||
| Specific General Surgical and Urologic Conditions | 578 | ||
| Nissen Fundoplication | 578 | ||
| Pectus Excavatum | 578 | ||
| Pheochromocytoma | 579 | ||
| Perioperative Evaluation | 580 | ||
| Laboratory Findings | 580 | ||
| Anesthetic Management | 581 | ||
| Potential Perioperative Problems | 582 | ||
| Circumcision | 582 | ||
| Hypospadias and Chordee | 582 | ||
| Cryptorchidism and Hernias: Inguinal and Umbilical | 583 | ||
| Torsion of the Testis | 584 | ||
| Posterior Urethral Valves | 584 | ||
| Prune-Belly Syndrome | 584 | ||
| Ureteral Reimplantation | 585 | ||
| Pyeloplasty | 586 | ||
| Nephrectomy | 586 | ||
| Neuroblastoma | 586 | ||
| Wilms Tumor | 587 | ||
| Bladder and Cloacal Exstrophy | 588 | ||
| Acknowledgment | 589 | ||
| Annotated References | 589 | ||
| References | 589.e1 | ||
| References | 589 | ||
| 28 Essentials of Hepatology | 590 | ||
| Anatomy | 590 | ||
| Principles of Hepatic Drug Metabolism | 590 | ||
| Phase I Reactions | 591 | ||
| Cytochrome P-450 Activity | 592 | ||
| Phase II Reactions | 592 | ||
| Anesthetic Agents | 593 | ||
| Inhalational Anesthetic Metabolism | 593 | ||
| Neuromuscular Blocking Drugs | 593 | ||
| Sedatives, Opioids, and Liver Disease | 593 | ||
| Anesthetic Effects on Hepatic Cellular Functions | 594 | ||
| Carbohydrates | 594 | ||
| Protein Synthesis | 594 | ||
| Bilirubin Metabolism | 594 | ||
| Hepatotoxicity | 594 | ||
| Perioperative Considerations in Liver Disease | 596 | ||
| Summary | 596 | ||
| Annotated References | 596 | ||
| References | 596.e1 | ||
| REFERENCE | 596 | ||
| 29 Organ Transplantation | 597 | ||
| Liver Transplantation | 597 | ||
| Demographics and Epidemiology | 598 | ||
| Pathophysiology of Liver Disease | 598 | ||
| Cardiac Manifestations | 598 | ||
| Pulmonary Manifestations | 599 | ||
| Neurologic Manifestations | 599 | ||
| Hematologic Manifestations | 600 | ||
| Renal Manifestations | 600 | ||
| Metabolic Manifestations | 601 | ||
| Preoperative Evaluation | 601 | ||
| Intraoperative Care | 602 | ||
| Surgical Technique | 603 | ||
| Hepatectomy (Stage 1) | 603 | ||
| Anhepatic Stage (Stage 2) | 604 | ||
| Reperfusion (Stage 3) | 604 | ||
| Biliary and Hepatic Artery Reconstruction (Stage 4) | 605 | ||
| Split Liver Techniques and Living Donor Liver Transplants | 605 | ||
| Outcomes | 605 | ||
| Immediate Postoperative Care | 606 | ||
| Long-Term Issues | 606 | ||
| Kidney Transplantation | 607 | ||
| Demographics and Epidemiology | 607 | ||
| Pathophysiology: Implications of the Patient in Renal Failure | 607 | ||
| Preoperative Evaluation | 608 | ||
| Surgical Technique | 608 | ||
| Children Weighing More Than 20 kg | 608 | ||
| Children Weighing Less Than 20 kg | 608 | ||
| Anesthetic Approach | 609 | ||
| Periinduction | 609 | ||
| Immunosuppressant Induction Therapy | 610 | ||
| Monitors and Vascular Access | 611 | ||
| Maintenance and Reperfusion | 611 | ||
| Immediate Postoperative Management | 611 | ||
| Long-Term Issues | 611 | ||
| Infection | 611 | ||
| Malignancy | 611 | ||
| Summary | 611 | ||
| Cardiac Transplantation | 612 | ||
| Demographics and Epidemiology | 612 | ||
| Pathophysiology of the Disease | 613 | ||
| Congenital Heart Disease | 613 | ||
| Dilated Cardiomyopathy | 614 | ||
| Restrictive Cardiomyopathy | 614 | ||
| Hypertrophic Cardiomyopathy | 614 | ||
| Other Conditions | 614 | ||
| Donor Selection | 614 | ||
| Preoperative Evaluation | 614 | ||
| Surgical Technique | 616 | ||
| Intraoperative Problems and Management | 616 | ||
| Immediate Postoperative Management | 617 | ||
| Long-Term Outcome and Quality of Life | 618 | ||
| Pediatric Heart-Lung and Lung Transplantation | 619 | ||
| Demographics and Epidemiology | 619 | ||
| Pathophysiology of the Disease | 620 | ||
| Preoperative Evaluation | 621 | ||
| Surgical Technique | 621 | ||
| Intraoperative Problems and Management | 621 | ||
| Immediate Postoperative Management | 623 | ||
| Long-Term Issues | 623 | ||
| Annotated References | 626 | ||
| References | 626.e1 | ||
| References | 626 | ||
| VII Other Surgeries | 627 | ||
| 30 Orthopedic and Spinal Surgery | 627 | ||
| Scoliosis Surgery | 628 | ||
| Terminology, History, and Surgical Development | 628 | ||
| Classification | 629 | ||
| Pathophysiology and Natural History | 630 | ||
| Congenital, Infantile, and Juvenile Scoliosis | 630 | ||
| Idiopathic Scoliosis | 631 | ||
| Neuromuscular Scoliosis | 632 | ||
| Risk Minimization and Improving Outcome from Surgical Intervention | 633 | ||
| Respiratory Function and Complications in the Early Postoperative Period | 633 | ||
| Long-Term Changes | 634 | ||
| Idiopathic Scoliosis | 634 | ||
| Neuromuscular Scoliosis | 635 | ||
| Spinal Cord Injury during Surgery | 635 | ||
| Etiology | 635 | ||
| Risk of Spinal Cord Injury and Spinal Cord Monitoring | 635 | ||
| Methods of Monitoring Spinal Cord Function | 636 | ||
| Wake-up Test | 636 | ||
| Ankle Clonus Test | 636 | ||
| Somatosensory Evoked Potentials | 636 | ||
| Motor Evoked Potentials | 637 | ||
| Triggered Electromyographic Techniques | 638 | ||
| Preoperative Assessment and Postoperative Planning | 638 | ||
| Respiratory Assessment and Planning FOR Postoperative Ventilatory Support | 638 | ||
| Cardiovascular Assessment | 638 | ||
| Postoperative Pain Management | 639 | ||
| Intraoperative Intrathecal and Intravenous Opioids | 639 | ||
| Nonsteroidal Antiinflammatory Drugs | 639 | ||
| Systemic Analgesics | 639 | ||
| Epidural Analgesia | 639 | ||
| Anesthetic and Intraoperative Management | 640 | ||
| Positioning and Related Issues | 640 | ||
| Temperature Regulation | 640 | ||
| Patient Monitoring | 640 | ||
| Minimizing Blood Loss and Decreasing Transfusion Requirements | 640 | ||
| Hypotensive Techniques | 641 | ||
| Hemodilution | 641 | ||
| Autologous Predonation | 641 | ||
| Antifibrinolytic Agents | 642 | ||
| Intraoperative Salvage of Shed Blood | 642 | ||
| Managing Blood Loss | 642 | ||
| Effects of Anesthetics on Somatosensory Evoked and Motor Evoked Potentials | 643 | ||
| Inhalational Anesthetics | 643 | ||
| Nitrous Oxide | 643 | ||
| Propofol | 643 | ||
| α2-Adrenoreceptor Agonists: Clonidine and Dexmedetomidine | 644 | ||
| Opioids | 644 | ||
| Ketamine and Etomidate | 644 | ||
| Midazolam | 644 | ||
| Neuromuscular Blockade | 644 | ||
| Choosing Anesthetic Drugs and Techniques | 644 | ||
| Tourniquets | 645 | ||
| Indications and Design | 645 | ||
| Physiology | 645 | ||
| Ischemia | 645 | ||
| Reperfusion | 645 | ||
| Ischemic Conditioning | 645 | ||
| Complications | 645 | ||
| Local Complications | 645 | ||
| Muscle Damage | 645 | ||
| Nerve Damage | 645 | ||
| Vascular Damage | 646 | ||
| Skin Safety | 646 | ||
| Tourniquet Pain | 646 | ||
| Systemic Complications | 646 | ||
| Temperature Regulation | 646 | ||
| Deep Vein Thrombosis and Emboli | 646 | ||
| Sickle Cell Disease | 646 | ||
| Drug Effects | 646 | ||
| Recommended Cuff Pressures | 646 | ||
| Acute Bone and Joint Infections | 646 | ||
| Pathophysiology | 646 | ||
| Clinical Presentation | 647 | ||
| Treatment Options | 647 | ||
| Anesthesia Considerations | 647 | ||
| Pain Management | 647 | ||
| Common Syndromes | 648 | ||
| Cerebral Palsy | 648 | ||
| VIII Emergencies | 733 | ||
| 35 The Extremely Premature Infant (Micropremie) | 733 | ||
| Physiology of Prematurity Related to Anesthesia | 733 | ||
| Respiratory System | 733 | ||
| Respiratory Control | 734 | ||
| Cardiovascular System | 735 | ||
| Neurologic Development | 736 | ||
| Long-Term Neurologic Complications of Prematurity | 736 | ||
| Intraventricular Hemorrhage | 736 | ||
| Retinopathy of Prematurity | 736 | ||
| Temperature Regulation | 737 | ||
| Renal and Metabolic Function | 737 | ||
| Glucose Regulation | 737 | ||
| Glucose and the Brain | 737 | ||
| Hepatic and Hematologic Function | 737 | ||
| Anesthetic Agents and the Micropremie | 738 | ||
| Anesthetics and the Immature Brain | 738 | ||
| Inhalation Anesthetic Agents | 738 | ||
| Intravenous Agents | 739 | ||
| Anesthetic Considerations for Surgical Procedures | 740 | ||
| Exploratory Laparotomy for Necrotizing Enterocolitis | 741 | ||
| Ligation of Patent Ductus Arteriosus | 742 | ||
| Inguinal Hernia Repair | 743 | ||
| Eye Surgery for Retinopathy of Prematurity | 744 | ||
| Anesthesia or Sedation for Radiologic Imaging | 744 | ||
| Annotated References | 745 | ||
| References | 745.e1 | ||
| References | 745 | ||
| 36 Neonatal Emergencies | 746 | ||
| Neonatal Physiology Related to Anesthesia | 746 | ||
| Cardiopulmonary | 746 | ||
| Oxygen Consumption | 746 | ||
| Pulmonary Gas Exchange | 746 | ||
| Oxygen Uptake and Circulation | 748 | ||
| Temperature Regulation | 750 | ||
| Renal and Metabolic Function | 750 | ||
| Renal Function | 750 | ||
| Fluid Management | 750 | ||
| Methods of Intravenous Access and Monitoring | 750 | ||
| Glucose Homeostasis | 751 | ||
| Calcium Homeostasis | 751 | ||
| Gastrointestinal and Hepatic Function | 752 | ||
| Neurologic Development | 752 | ||
| Preparation for Surgery | 752 | ||
| The Operating Room | 752 | ||
| The Family | 753 | ||
| Emergency Surgery | 753 | ||
| Respiratory Problems | 753 | ||
| Abnormalities of the Airway | 753 | ||
| Choanal Atresia and Stenosis | 753 | ||
| Laryngeal and Upper Tracheal Obstruction | 754 | ||
| Webs. | 755 | ||
| Congenital Subglottic Stenosis. | 755 | ||
| Subglottic Hemangioma. | 755 | ||
| Esophageal Atresia and Tracheoesophageal Fistula. | 755 | ||
| Diseases of the Lung Parenchyma | 756 | ||
| Specific Lesions | 756 | ||
| Congenital Diaphragmatic Hernia. | 756 | ||
| Congenital Bronchogenic and Pulmonary Cysts | 758 | ||
| Congenital Lobar Emphysema | 759 | ||
| Gastrointestinal Problems | 759 | ||
| Specific Lesions | 760 | ||
| Hypertrophic Pyloric Stenosis | 760 | ||
| Duodenal and Ileal Obstruction | 761 | ||
| Infantile Hernia | 761 | ||
| Imperforate Anus | 762 | ||
| Necrotizing Enterocolitis | 762 | ||
| Omphalocele and Gastroschisis | 762 | ||
| Malrotation and Midgut Volvulus | 764 | ||
| Hirschsprung Disease and Large-Bowel Obstruction | 764 | ||
| References | 765.e1 | ||
| References | 765 | ||
| 37 Fetal Intervention and the EXIT Procedure | 766 | ||
| A Range of Anesthetic Options for Mother and Fetus | 767 | ||
| Mother | 767 | ||
| Local Anesthesia | 767 | ||
| Monitored Anesthesia Care | 767 | ||
| Regional Neuraxial Blockade | 767 | ||
| Regional Neuraxial Blockade with Sedation | 767 | ||
| General Anesthesia | 767 | ||
| Combined Regional and General Anesthesia | 767 | ||
| Fetus | 767 | ||
| Transplacental Access | 767 | ||
| Intramuscular Access | 768 | ||
| Intravascular Access | 768 | ||
| Intraamniotic Access | 768 | ||
| Fetal Development | 768 | ||
| Pathologic Lung Development | 768 | ||
| FETAL Cardiovascular Development | 769 | ||
| FETAL Oxygenation | 770 | ||
| Central and Peripheral Nervous System Development | 771 | ||
| Programming Effects | 771 | ||
| Fetal Monitoring | 771 | ||
| Use of FETAL Heart Rate Monitoring for FETAL Interventions | 772 | ||
| Use of FETAL Blood Sampling during FETAL Interventions | 772 | ||
| FETAL Electrocardiography | 772 | ||
| FETAL Pulse Oximetry | 772 | ||
| FETAL Echocardiography | 772 | ||
| Doppler Ultrasonography of FETAL Cerebral Blood Flow | 773 | ||
| Physiologic Consequences of Pregnancy | 773 | ||
| Respiratory and Airway Considerations | 773 | ||
| Cardiovascular Considerations | 773 | ||
| Central and Peripheral Nervous Systems | 774 | ||
| Pharmacologic Consequences of Pregnancy | 774 | ||
| Induction | 774 | ||
| Neuromuscular Blocking Drugs | 774 | ||
| Inhalational Anesthetics | 774 | ||
| Fetal Preoperative Evaluation | 774 | ||
| Maternal Evaluation | 775 | ||
| Tocolysis and Tocolytic Agents | 775 | ||
| Hormonal Receptors in Labor | 775 | ||
| Treatment of Acute Preterm Labor | 775 | ||
| Nonsteroidal Antiinflammatory Drugs | 775 | ||
| β-Adrenergic–Mimetic Agents | 775 | ||
| Magnesium | 776 | ||
| Nitric Oxide Donors | 776 | ||
| Calcium-Channel Blockers | 776 | ||
| Pain Control | 776 | ||
| FETAL Complications of Tocolytic Therapy | 776 | ||
| Postoperative Pulmonary Edema | 777 | ||
| Congenital Cystic Adenomatoid Malformation: The Open Procedure | 777 | ||
| Congenital Cystic Adenomatoid Malformation of the Lung | 777 | ||
| Management | 778 | ||
| Operating Room Preparation | 778 | ||
| Induction | 778 | ||
| Maintenance | 778 | ||
| Intervention | 779 | ||
| Intraoperative Fetal Resuscitation | 779 | ||
| Closure | 780 | ||
| Postoperative Management | 780 | ||
| Other Diseases Eligible for Open Procedures | 780 | ||
| Pulmonary Sequestration | 780 | ||
| Bronchogenic Cysts and Mixed or Hybrid Pulmonary Lesions | 780 | ||
| Sacrococcygeal Teratoma | 781 | ||
| Hypoplastic Left Heart Syndrome: Percutaneous and Fetoscopic Procedures | 781 | ||
| Rationale for FETAL Cardiac Intervention | 781 | ||
| Defects Amenable to in-Utero Repair | 781 | ||
| Technical Aspects of FETAL Cardiac Interventions | 781 | ||
| Anesthetic Management for the Mother | 782 | ||
| Anesthetic Management for the Fetus | 782 | ||
| Intraoperative FETAL Resuscitation during Percutaneous Interventions | 783 | ||
| Postoperative Considerations | 783 | ||
| Other Diseases Eligible for Fetoscopic Procedures | 783 | ||
| TWIN–TWIN Transfusion Syndrome | 783 | ||
| Twin Reversed Arterial Perfusion Sequence | 784 | ||
| Needle Aspiration and Placement of Shunts | 784 | ||
| The EXIT Procedure | 784 | ||
| FETAL Diseases Eligible for the EXIT Procedure | 784 | ||
| Cervical Teratoma | 784 | ||
| Cystic Hygroma | 785 | ||
| Congenital High Airway Obstruction Syndrome | 785 | ||
| Congenital Goiter | 785 | ||
| EXIT to ECMO | 785 | ||
| Intraoperative Considerations | 786 | ||
| Uterine Relaxation and Perfusion | 786 | ||
| Surgical Procedure | 786 | ||
| Access to the FETAL Airway | 786 | ||
| Delivery of the Infant and Maternal Management | 786 | ||
| Postoperative Considerations | 787 | ||
| Movement toward Intervention for Non–Life-Threatening Diseases: Myelomeningocele | 787 | ||
| Future Considerations | 787 | ||
| Annotated References | 787 | ||
| References | 788.e1 | ||
| References | 788 | ||
| 38 Trauma | 789 | ||
| Epidemiology of Pediatric Trauma | 789 | ||
| Nonaccidental Trauma | 790 | ||
| Prehospital Care of the Pediatric Trauma Patient | 790 | ||
| Trauma Systems | 790 | ||
| Prehospital Airway Management | 792 | ||
| Emergency Department Evaluation and Management of the Pediatric Trauma Patient | 794 | ||
| Anesthesia Management of the Pediatric Trauma Patient | 795 | ||
| Preoperative Evaluation | 796 | ||
| Cervical Spine Evaluation | 797 | ||
| Airway Management | 797 | ||
| Cricoid Pressure | 800 | ||
| Volume Administration | 801 | ||
| Vascular Access | 802 | ||
| Damage Control Surgery | 802 | ||
| Pain Management | 802 | ||
| Future Directions in Pediatric Trauma | 803 | ||
| Summary | 803 | ||
| Acknowledgment | 803 | ||
| Annotated References | 803 | ||
| References | 803.e1 | ||
| References | 803 | ||
| 39 Cardiopulmonary Resuscitation | 804 | ||
| Historical Background | 804 | ||
| Epidemiology and Outcome of In-Hospital Cardiopulmonary Arrest | 804 | ||
| Diagnosis of Cardiac Arrest | 805 | ||
| Mechanics of Cardiopulmonary Resuscitation | 805 | ||
| Airway | 805 | ||
| Breathing | 805 | ||
| Circulation | 806 | ||
| Mechanisms of Blood Flow | 806 | ||
| Rate and Duty Cycle | 807 | ||
| Defibrillation and Cardioversion | 807 | ||
| Electric Countershock | 807 | ||
| Practical Aspects of Defibrillation in Children | 807 | ||
| Open-Chest Defibrillation | 809 | ||
| Automated External Defibrillation | 809 | ||
| Transcutaneous Cardiac Pacing | 809 | ||
| Vascular Access and Monitoring during Cardiopulmonary Resuscitation | 809 | ||
| Vascular Access and Fluid Administration | 809 | ||
| Intravenous Access | 809 | ||
| Intraosseous Access | 809 | ||
| Endotracheal Medication Administration | 810 | ||
| Monitoring During Cardiopulmonary Resuscitation | 810 | ||
| Medications Used during Cardiopulmonary Resuscitation | 810 | ||
| α- and β-Adrenergic Agonists | 810 | ||
| Epinephrine | 811 | ||
| Vasopressin | 811 | ||
| Atropine | 811 | ||
| Sodium Bicarbonate | 811 | ||
| Calcium | 812 | ||
| Glucose | 812 | ||
| Amiodarone | 813 | ||
| Lidocaine | 813 | ||
| Special Cardiac Arrest Situations | 814 | ||
| Perioperative Cardiac Arrest | 814 | ||
| Hyperkalemia | 814 | ||
| Anaphylaxis | 814 | ||
| Supraventricular Tachycardia | 814 | ||
| Pulseless Electrical Activity | 815 | ||
| Adjunctive Cardiopulmonary Resuscitation Techniques | 815 | ||
| Open-Chest Cardiopulmonary Resuscitation | 815 | ||
| Extracorporeal Membrane Oxygenation | 815 | ||
| Active Compression-Decompression | 815 | ||
| Postresuscitation Stabilization (Post–Cardiac Arrest Care) | 815 | ||
| References | 816.e1 | ||
| Annotated References | 816 | ||
| References | 816 | ||
| 40 Malignant Hyperthermia | 817 | ||
| Clinical Presentation | 818 | ||
| Patient Evaluation and Preparation | 820 | ||
| Monitoring | 821 | ||
| Diagnosis | 821 | ||
| Management, Susceptibility Screening, and Counseling | 822 | ||
| Treatment | 822 | ||
| Stress-Triggered Malignant Hyperthermia | 825 | ||
| Postepisode Counseling | 825 | ||
| Genetics | 826 | ||
| Physiology | 827 | ||
| Normal Skeletal Muscle: Excitation-Contraction Coupling | 827 | ||
| Pathophysiology of Malignant Hyperthermia | 827 | ||
| Molecular Mechanisms and Physiologic Effects of Dantrolene | 829 | ||
| Laboratory Diagnosis | 830 | ||
| Contracture Testing | 830 | ||
| Genetic Testing | 831 | ||
| Other Disorders and Malignant Hyperthermia | 832 | ||
| Myopathic Syndromes | 832 | ||
| Malignant Hyperthermia Mimics | 832 | ||
| Malignant Hyperthermia–like Syndrome in Pediatric Diabetes Mellitus | 832 | ||
| Disorders of Fatty Acid Metabolism | 832 | ||
| Neuroleptic Malignant Syndrome | 833 | ||
| Summary | 833 | ||
| Annotated References | 833 | ||
| References | 834.e1 | ||
| References | 834 | ||
| IX Pain | 835 | ||
| 41 Regional Anesthesia | 835 | ||
| Pharmacology and Pharmacokinetics of Local Anesthetics | 835 | ||
| Amides | 835 | ||
| Bupivacaine | 836 | ||
| Ropivacaine | 836 | ||
| Lidocaine | 837 | ||
| Esters | 837 | ||
| Toxicity of Local Anesthetics | 837 | ||
| Prevention of Toxicity | 839 | ||
| Total Drug Dose | 839 | ||
| Site of Injection | 839 | ||
| Rate of Uptake | 839 | ||
| Alteration in Toxic Threshold | 840 | ||
| Technique of Administration | 840 | ||
| Treatment of Toxic Reactions | 841 | ||
| Hypersensitivity to Local Anesthetics | 842 | ||
| Equipment | 842 | ||
| Use of Ultrasound | 842 | ||
| Use of a Nerve Stimulator | 842 | ||
| Specific Procedures | 843 | ||
| Central Neuraxial Blockade | 843 | ||
| Anatomic and Physiologic Considerations | 843 | ||
| Spinal Anesthesia | 844 | ||
| Technique | 845 | ||
| Selection of Drug | 847 | ||
| Neonates and Infants. | 847 | ||
| Children. | 847 | ||
| Complications | 847 | ||
| Epidural Anesthesia | 848 | ||
| Caudal Epidural Anesthesia | 848 | ||
| Technique. | 848 | ||
| Lumbar and Thoracic Epidural Anesthesia | 850 | ||
| Selection of Drug. | 851 | ||
| Continuous Epidural Infusions | 851 | ||
| Epidural Opioids | 851 | ||
| Adjunctive Drugs | 851 | ||
| Complications | 852 | ||
| Peripheral Nerve Blocks | 854 | ||
| Selection of a Local Anesthetic | 854 | ||
| Head and Neck Blocks | 854 | ||
| Supraorbital and Supratrochlear Nerve Block | 854 | ||
| Anatomy. | 854 | ||
| Technique. | 854 | ||
| X Special Topics | 963 | ||
| 45 Anesthesia Outside the Operating Room | 963 | ||
| Standards and Guidelines | 964 | ||
| Off-Site Anesthesia: Structure | 964 | ||
| Personnel Requirements | 964 | ||
| Specific Environmental Requirements | 965 | ||
| Quality Assurance of Anesthesia Services and Outcome in the Off-Site Areas | 966 | ||
| Anesthesia versus Sedation for Non–Operating Room Procedures and Tests in Children | 966 | ||
| Logistics of Managing Acute Emergencies and Cardiopulmonary Arrest Outside the Operating Room | 967 | ||
| Difficult Airway Management in the Non–Operating Room (Off-Site) Environment | 967 | ||
| Specific Locations for Non–Operating Room Anesthesia | 968 | ||
| Computed Tomography | 968 | ||
| Nuclear Medicine | 969 | ||
| Stereotactic Radiosurgery | 970 | ||
| Radiation Therapy | 970 | ||
| Magnetic Resonance Imaging | 971 | ||
| Interventional Radiology and Invasive Angiography | 974 | ||
| Intravascular Contrast Media | 978 | ||
| Endoscopic Procedures | 978 | ||
| Summary | 979 | ||
| Acknowledgment | 979 | ||
| Annotated References | 979 | ||
| References | 979.e1 | ||
| References | 979 | ||
| 46 The Postanesthesia Care Unit and Beyond | 980 | ||
| Perioperative Environment | 980 | ||
| Transport to the Care Unit | 981 | ||
| Arrival in the Care Unit | 982 | ||
| Central Nervous System | 982 | ||
| Pharmacodynamics of Emergence | 982 | ||
| Emergence Agitation or Delirium | 983 | ||
| Respiratory System | 984 | ||
| Criteria for Extubation | 984 | ||
| Extubation in the Operating Room or Postanesthesia Care Unit | 984 | ||
| Hypoxemia | 984 | ||
| Hypoventilation | 985 | ||
| Airway Obstruction | 985 | ||
| Respiratory Effort | 985 | ||
| Discharge of Preterm Infants from the Postanesthesia Care Unit | 986 | ||
| Cardiovascular System | 986 | ||
| Bradycardia | 986 | ||
| Tachycardia | 986 | ||
| Other Arrhythmias | 986 | ||
| Blood Pressure Control | 987 | ||
| Hypotension | 987 | ||
| Hypertension | 987 | ||
| Renal System | 987 | ||
| Gastrointestinal System | 987 | ||
| Incidence of Postoperative Nausea and Vomiting | 987 | ||
| Evidence-Based Consensus Management | 988 | ||
| Prophylactic Therapy | 988 | ||
| Rescue Therapy | 989 | ||
| Alternative Treatments | 989 | ||
| Postoperative Care and Discharge | 989 | ||
| Pain Management in the Postanesthesia Care Unit | 989 | ||
| Temperature Management | 990 | ||
| Discharge Criteria | 990 | ||
| Acknowledgment | 991 | ||
| Annotated References | 991 | ||
| References | 992.e1 | ||
| References | 992 | ||
| 47 Sedation for Diagnostic and Therapeutic Procedures Outside the Operating Room | 993 | ||
| Definition of Levels of Sedation | 994 | ||
| Goals of Sedation | 996 | ||
| Risks and Complications Associated with Sedation | 997 | ||
| Guidelines | 999 | ||
| Implementation of Sedation Guidelines | 1002 | ||
| Documentation | 1004 | ||
| Specific Sedation Techniques | 1005 | ||
| Local Anesthetics | 1005 | ||
| Anxiolytics and Sedatives | 1006 | ||
| Barbiturates | 1009 | ||
| Opioids | 1009 | ||
| α2-Adrenoceptor Agonist: Dexmedetomidine | 1010 | ||
| General Anesthetics | 1011 | ||
| Annotated References | 1013 | ||
| References | 1013.e1 | ||
| References | 1013 | ||
| 48 Procedures for Vascular Access | 1014 | ||
| Venous Cannulation | 1014 | ||
| Peripheral Intravenous Cannulation | 1014 | ||
| Indications | 1014 | ||
| Equipment | 1014 | ||
| Practical Suggestions | 1014 | ||
| Index | 1097 | ||
| A | 1097 | ||
| B | 1101 | ||
| C | 1104 | ||
| D | 1109 | ||
| E | 1111 | ||
| F | 1114 | ||
| G | 1115 | ||
| H | 1116 | ||
| I | 1118 | ||
| J | 1121 | ||
| K | 1121 | ||
| L | 1121 | ||
| M | 1123 | ||
| N | 1125 | ||
| O | 1127 | ||
| P | 1129 | ||
| Q | 1134 | ||
| R | 1134 | ||
| S | 1136 | ||
| T | 1138 | ||
| U | 1140 | ||
| V | 1141 | ||
| W | 1142 | ||
| X | 1142 | ||
| Z | 1142 | ||
| Inside back cover | ibc_i | ||
| Pocket Reference Guide | ibc_ii |