Additional Information
Book Details
Abstract
Now thoroughly up to date with new chapters, Smith’s Anesthesia for Infants and Children, 9th Edition, by Drs. Peter Davis and Franklyn Cladis, covers the information you need to provide effective perioperative care for any type of pediatric surgery. Leading experts in pediatric anesthesia bring you up to date with every aspect of both basic science and clinical practice, helping you incorporate the latest clinical guidelines and innovations in your practice.
- Quick-reference appendices : drug dosages, growth curves, normal values for pulmonary function tests, and a listing of common and uncommon syndromes.
- Outstanding visual guidance in full color throughout the book.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
- More than 100 video demonstrations , including new regional anesthesia videos, echocardiograms of congenital heart lesions, anatomic dissections of various congenital heart specimens with audio explanations, various pediatric surgical operative procedures, airway management, and much more.
- Table of Contents has been reorganized and new chapters added on statistics, sedation, pediatric obesity, and cardiac critical care pediatrics.
- A new chapter on regional anesthesia for pediatrics, including video and ultrasound demonstrations online.
- A new chapter on dermatology, specifically for the anesthesiologist, with more than 100 photos.
- A new chapter on medical missions to third-world countries, including what you should know before you go.
- A new Questions chapter provides opportunities for self-assessment.
- New coverage includes cardiac anesthesia for congenital heart disease, anesthesia outside the operating room, and a new neonatology primer for the pediatric anesthesiologist.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Endsheet 2 | IFC2 | ||
| Smith's Anesthesia for Infants and Children | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Preface | xii | ||
| Acknowledgments | xiv | ||
| Table Of Contents | xv | ||
| Video Contents | xvii | ||
| I Basic Principles and Physiology | 1 | ||
| 1 Special Characteristics of Pediatric Anesthesia | 2 | ||
| Outline | 2 | ||
| Introduction | 2 | ||
| Perioperative Monitoring | 2 | ||
| Anesthetic Agents | 3 | ||
| Airway Devices and Adjuncts | 4 | ||
| Intraoperative and Postoperative Analgesia in Neonates | 4 | ||
| Regional Analgesia in Infants and Children | 5 | ||
| Fundamental Differences in Infants and Children | 6 | ||
| Psychological Differences | 6 | ||
| Differences in Response to Pharmacologic Agents | 6 | ||
| Anatomic and Physiologic Differences | 6 | ||
| Body Size | 6 | ||
| Relative Size or Proportion | 8 | ||
| Central and Autonomic Nervous Systems | 8 | ||
| Respiratory System | 9 | ||
| Cardiovascular System | 9 | ||
| Fluid and Electrolyte Metabolism | 9 | ||
| Temperature Regulation | 9 | ||
| Summary | 9 | ||
| References | 9 | ||
| References | 9.e1 | ||
| 2 Behavioral Development | 10 | ||
| Outline | 10 | ||
| Introduction | 10 | ||
| Prenatal Growth | 11 | ||
| Postnatal Growth | 11 | ||
| Developmental Assessment | 11 | ||
| Motor Development | 12 | ||
| Primitive Reflexes | 12 | ||
| Gross Motor Skills | 13 | ||
| Fine Motor Development | 13 | ||
| Language Development | 13 | ||
| Cognitive Development | 13 | ||
| Clinical Relevance of Growth and Development in Pediatric Anesthesia | 18 | ||
| Neurodevelopmental Assessment After Anesthesia in Early Childhood | 18 | ||
| Investigations of Neurodevelopment After Early Anesthesia | 19 | ||
| Neuropsychological Testing as a Tool for Assessing the Neurodevelopmental Effects of Anesthesia | 19 | ||
| Developmental Considerations | 19 | ||
| Cognitive Domains and Associated Neuropsychological Instruments | 19 | ||
| Intelligence | 22 | ||
| Language | 22 | ||
| Learning and Memory | 22 | ||
| Visual-Spatial Skills | 22 | ||
| Attention and Executive Function | 22 | ||
| Motor and Psychomotor Abilities | 22 | ||
| Summary | 22 | ||
| References | 22 | ||
| References | 22.e1 | ||
| 3 Respiratory Physiology | 23 | ||
| Outline | 23 | ||
| Introduction | 23 | ||
| Development of the Respiratory System | 24 | ||
| Prenatal Development of the Lungs | 24 | ||
| Prenatal Development of Breathing | 26 | ||
| Neonatal Respiratory Adaptation | 26 | ||
| Postnatal Development of the Lungs and Thorax | 27 | ||
| Control of Breathing | 28 | ||
| Neural Control of Breathing | 28 | ||
| Dorsal Respiratory Group of Neurons | 29 | ||
| Ventral Respiratory Group of Neurons | 30 | ||
| Pontine Respiratory Group of Neurons | 30 | ||
| Respiratory Rhythm Generation | 30 | ||
| Airway and Pulmonary Receptors | 30 | ||
| Upper Airway Receptors | 30 | ||
| Tracheobronchial and Pulmonary Receptors | 31 | ||
| Slowly Adapting (Pulmonary Stretch) Receptors | 31 | ||
| Rapidly Adapting (Irritant) Receptors | 31 | ||
| C-Fiber Endings | 32 | ||
| Chest Wall Receptors | 32 | ||
| Chemical Control of Breathing | 32 | ||
| Central Chemoreceptors | 32 | ||
| Peripheral Chemoreceptors | 32 | ||
| Response to Carbon Dioxide | 33 | ||
| Control of Breathing in Neonates and Infants | 35 | ||
| Response to Hypoxemia in Infants | 35 | ||
| Response to Carbon Dioxide in Infants | 35 | ||
| Upper Airway Receptor Responses in the Neonatal Period | 36 | ||
| Active (REM) Versus Quiet (Non-REM) Sleep | 36 | ||
| Periodic Breathing | 36 | ||
| Apnea of Prematurity and Hypoxia | 36 | ||
| Postoperative Apnea | 37 | ||
| Maintenance of the Upper Airway and Airway Protective Reflexes | 37 | ||
| Pharyngeal Airway | 37 | ||
| Laryngeal Airway | 39 | ||
| Upper Airway Protective Reflexes | 39 | ||
| Anesthetic Effects on the Control of Breathing | 40 | ||
| Anesthetic Effects on Upper Airway Receptors | 40 | ||
| Anesthetic Effects on Upper Airway Muscles: Differential Sensitivity | 40 | ||
| Anesthetic Effects on Neural Control of Breathing | 41 | ||
| Anesthetic Effects on Chemical Control of Breathing | 41 | ||
| Summary | 42 | ||
| Lung Volumes | 42 | ||
| Postnatal Development of the Lungs | 42 | ||
| Pulmonary Hypoplasia | 42 | ||
| Functional Residual Capacity and Its Determinants | 43 | ||
| Mechanics of Breathing | 44 | ||
| Elastic Properties and Compliance | 44 | ||
| Compliance of the Lungs and Thorax | 44 | ||
| Developmental Changes in the Compliance of the Lungs and Thorax | 45 | ||
| Maintenance of Functional Residual Capacity in Infants | 45 | ||
| Effects of General Anesthesia on Functional Residual Capacity | 46 | ||
| Effect of Positive End-Expiratory Pressure in Anesthetized Children | 46 | ||
| Closing Volume and Closing Capacity | 48 | ||
| Dynamic Properties and Airway Resistance | 48 | ||
| Airway Resistance | 48 | ||
| Distribution of Airway Resistance | 49 | ||
| Upper Airway Resistance | 49 | ||
| Lower Airway Resistance | 50 | ||
| Tissue Viscoelastic Resistance | 50 | ||
| Time Constant of the Respiratory System | 50 | ||
| Flow Limitation and Maximum Expiratory Flow-Volume (MEFV) Curves | 50 | ||
| Distribution of Flow Resistance | 51 | ||
| Summary | 51 | ||
| ventilation | 52 | ||
| Dead Space and Alveolar Ventilation | 54 | ||
| Distribution of Ventilation | 54 | ||
| Clinical Implications | 54 | ||
| Summary | 55 | ||
| Gas Diffusion | 56 | ||
| Pulmonary Circulation | 56 | ||
| Perinatal Adaptation | 56 | ||
| Nitric Oxide and Postnatal Adaptation | 56 | ||
| Distribution of Pulmonary Perfusion | 57 | ||
| Ventilation/Perfusion Relationships | 57 | ||
| Low Ventilation/Perfusion Ratio and Lung Collapse While Breathing Oxygen | 59 | ||
| Oxygen Transport | 59 | ||
| Oxygen Affinity of Hemoglobin and P50 | 60 | ||
| Acceptable Hemoglobin Levels | 61 | ||
| Oxygen Saturation in Neonates and Infants | 62 | ||
| Surface Activity and Pulmonary Surfactant | 63 | ||
| Ciliary Activity | 64 | ||
| Measurement of Pulmonary Function in Infants and Children | 65 | ||
| Standard Tests of Pulmonary Function | 66 | ||
| Measurement of Lung Volumes | 67 | ||
| Flow Function with Spirometry | 67 | ||
| Measurement of Airway Resistance | 67 | ||
| Maximum Expiratory Flow-Volume Curves | 67 | ||
| Evaluation of Upper Airway Function | 68 | ||
| Airway Reactivity | 69 | ||
| Pulmonary Function Tests in Infants | 70 | ||
| Measurement of Dynamic Respiratory Mechanics | 70 | ||
| Maximum or partial expiratory flow-volume curves. | 70 | ||
| Measurement of Passive Respiratory Mechanics | 70 | ||
| Indications for and Interpretation of Pulmonary Function Tests | 71 | ||
| Special Considerations for Pediatric Pulmonary Disease | 72 | ||
| Special Considerations for Pediatric Lung Disease | 72 | ||
| Asthma | 72.e1 | ||
| Bronchopulmonary Dysplasia | 72.e3 | ||
| Chronic Aspiration | 72.e4 | ||
| Tracheomalacia and Bronchomalacia | 72.e4 | ||
| Cystic Fibrosis | 72.e4 | ||
| Duchenne’s Muscular Dystrophy and Other Congenital Disorders of Neuromuscular Weakness | 72.e5 | ||
| Summary | 72 | ||
| References | 72 | ||
| References | 72.e7 | ||
| 4 Cardiovascular Physiology* | 73 | ||
| Outline | 73 | ||
| Introduction | 73 | ||
| Fetal Circulation | 73 | ||
| Anatomy | 74 | ||
| Fetal Cardiac Output | 75 | ||
| Oxygen Delivery | 76 | ||
| Transitional Circulation | 77 | ||
| Pulmonary Blood Flow and Pulmonary Vascular Resistance | 78 | ||
| Myocardial Performance | 80 | ||
| Preload | 80 | ||
| Afterload | 83 | ||
| Contractility | 84 | ||
| Calcium and Diastolic Function | 85 | ||
| Heart Rate | 85 | ||
| Integrating Preload, Afterload, and Contractility | 86 | ||
| Developmental Aspects of Cardiomyocyte Structure and Function | 87 | ||
| Subcellular Structures | 87 | ||
| Sarcolemmal Ion Channels | 87 | ||
| Transverse Tubules | 88 | ||
| Mitochondria | 88 | ||
| Cytoskeleton | 88 | ||
| Sarcoplasmic Reticulum | 88 | ||
| Contractile Proteins | 88 | ||
| Myosin. | 88 | ||
| Actin. | 88 | ||
| Tropomyosin. | 88 | ||
| Troponins | 88 | ||
| Myocardial Energy | 89 | ||
| Electrophysiology | 89 | ||
| Central Nervous System Regulation of Cardiovascular Function | 89 | ||
| Pulmonary Vascular Development | 90 | ||
| Assessment of the Cardiovascular System | 92 | ||
| History | 92 | ||
| Physical Examination | 92 | ||
| Inspection | 92 | ||
| Palpation | 92 | ||
| Auscultation | 93 | ||
| Chest Radiograph | 93 | ||
| Electrocardiogram | 94 | ||
| Cardiac Catheterization | 94 | ||
| Hemodynamic Assessment | 95 | ||
| Pressure | 96 | ||
| Oxygen Content and Saturation | 96 | ||
| Oxygen Consumption | 96 | ||
| Cardiac Output | 96 | ||
| Shunts | 97 | ||
| Vascular Resistance | 98 | ||
| Echocardiography | 98 | ||
| Evaluation of Cardiac Function by Echocardiography | 99 | ||
| Preload. | 99 | ||
| Afterload. | 99 | ||
| Contractility. | 99 | ||
| Doppler Echocardiography Basics | 99 | ||
| Cardiac Magnetic Resonance Imaging | 100 | ||
| Effects of Anesthesia on the Cardiovascular System | 103 | ||
| Anesthetic Effects on Ion Currents | 103 | ||
| Anesthetic Effects on the Conduction System | 103 | ||
| Anesthetic Effects on Myocardial Metabolism | 104 | ||
| Anesthetic Effects on Systolic Function | 104 | ||
| Anesthetic Effects on Diastolic Function | 104 | ||
| Anesthetic Effects on Autonomic Control | 104 | ||
| Hemodynamic Effects of Specific Agents | 105 | ||
| Preanesthetic Medications | 105 | ||
| Inhalational Anesthetics | 105 | ||
| Opioids | 105 | ||
| Propofol | 105 | ||
| Ketamine | 106 | ||
| Etomidate | 106 | ||
| Dexmedetomidine | 106 | ||
| Regional Anesthetics | 106 | ||
| Summary (Box 4-1) | 106 | ||
| References | 107 | ||
| References | 107.e1 | ||
| 5 Regulation of Fluids and Electrolytes | 108 | ||
| Outline | 108 | ||
| Introduction | 108 | ||
| Overview of Anatomy and Physiology | 108 | ||
| Anatomy | 108 | ||
| Renal Blood Flow | 108 | ||
| Renal Physiology | 109 | ||
| Glomerular Filtration | 109 | ||
| Overview of Tubular Function | 111 | ||
| The Kidneys and Antidiuretic Hormone | 112 | ||
| Renin-Angiotensin-Aldosterone System | 113 | ||
| The Kidneys and Atrial Natriuretic Peptide | 113 | ||
| Body Fluid Compartments | 114 | ||
| Intracellular Fluid | 114 | ||
| Extracellular Fluid | 115 | ||
| Interstitial Fluid | 115 | ||
| Transcellular Fluid | 115 | ||
| Maturation of Renal Function | 115 | ||
| Fluid and Electrolyte Needs in Healthy Infants and Children | 116 | ||
| Parenteral and Oral Fluids and Electrolytes | 116 | ||
| Dehydration in Infants and Children | 117 | ||
| Evaluation and Management of Dehydration | 117 | ||
| Perioperative Parenteral Guidelines of Fluids and Electrolytes | 119 | ||
| Perioperative Fluid Management of Premature and Full-Term Neonates | 120 | ||
| Fluid Management of Children Undergoing Renal Transplantation | 120 | ||
| Disorders of Sodium Metabolism | 121 | ||
| Hyponatremia | 121 | ||
| Diagnostic Approach | 121 | ||
| Hospital-Acquired Hyponatremia and Its Prevention | 121 | ||
| Hyponatremic Encephalopathy | 121 | ||
| Clinical symptoms. | 121 | ||
| Neurogenic pulmonary edema. | 123 | ||
| Brains cell volume regulation. | 123 | ||
| Risk Factors for Developing Hyponatremic Encephalopathy | 123 | ||
| Age. | 123 | ||
| Hypoxia. | 123 | ||
| Syndrome of inappropriate vasopressin production. | 123 | ||
| Cerebral salt wasting (CSW). | 124 | ||
| Treatment of Hyponatremic Encephalopathy | 124 | ||
| Risk Factors for Developing Cerebral Demyelination | 124 | ||
| Hypernatremia | 125 | ||
| Pathogenesis | 125 | ||
| Diagnosis | 125 | ||
| Clinical Manifestations of Hypernatremia | 125 | ||
| Treatment | 126 | ||
| Central Diabetes Insipidus | 126 | ||
| Hypernatremia in the Edematous Patient | 126 | ||
| Disorders of Potassium Metabolism | 126 | ||
| Potassium Homeostasis | 127 | ||
| Hypokalemia | 127 | ||
| Hypokalemia Without Potassium Depletion | 127 | ||
| Potassium Depletion | 129 | ||
| Nutritional Causes | 129 | ||
| Extrarenal Causes | 129 | ||
| Renal Causes | 129 | ||
| Manifestations of Potassium Depletion | 129 | ||
| Diagnosis of Hypokalemia | 130 | ||
| Treatment of Hypokalemia | 130 | ||
| Hyperkalemia | 131 | ||
| Transcellular Shift | 131 | ||
| Pseudohyperkalemia | 131 | ||
| High Potassium Intake | 131 | ||
| Decreased Potassium Excretory Capacity | 132 | ||
| Manifestations of Hyperkalemia | 132 | ||
| Clinical Evaluation of Hyperkalemia | 133 | ||
| Treatment of Hyperkalemia | 133 | ||
| Diuretic Therapy | 134 | ||
| Classification of Diuretics and Site of Action | 134 | ||
| Proximal Tubule Diuretics | 134 | ||
| Mannitol. | 134 | ||
| Acetazolamide. | 135 | ||
| Loop diuretics. | 135 | ||
| Distal Convoluted Tubule Diuretics | 135 | ||
| Late Distal Tubule Diuretics | 136 | ||
| Anesthetic Agents and the Kidneys | 136 | ||
| Disorders of Divalent Ion Metabolism | 136 | ||
| Calcium | 136 | ||
| Calcium Homeostasis | 136 | ||
| Hypocalcemia | 137 | ||
| Manifestations of hypocalcemia. | 138 | ||
| Treatment of hypocalcemia. | 138 | ||
| Hypercalcemia | 139 | ||
| Manifestations of hypercalcemia. | 139 | ||
| Management of hypercalcemia. | 139 | ||
| Magnesium | 139 | ||
| Magnesium Homeostasis | 140 | ||
| Etiology and Manifestations of Dysmagnesemia | 140 | ||
| Hypomagnesemia. | 140 | ||
| Hypermagnesemia. | 141 | ||
| Phosphorus | 141 | ||
| Phosphorus Homeostasis | 142 | ||
| Hypophosphatemia | 142 | ||
| Hyperphosphatemia | 143 | ||
| Summary | 144 | ||
| References | 144 | ||
| References | 144.e1 | ||
| 6 Thermoregulation | 145 | ||
| Outline | 145 | ||
| Introduction | 145 | ||
| Temperature Monitoring | 146 | ||
| Physiology of Thermal Regulation | 147 | ||
| Afferent Thermal Sensing | 147 | ||
| Central Regulation | 148 | ||
| Efferent Response | 149 | ||
| The New Model of Thermoregulation | 149 | ||
| Heat-Loss Mechanisms | 150 | ||
| Conduction | 150 | ||
| Radiation | 151 | ||
| Convection | 151 | ||
| Evaporation | 151 | ||
| Heat Generation | 152 | ||
| Nonshivering Thermogenesis | 152 | ||
| Shivering Thermogenesis | 153 | ||
| Dietary Thermogenesis | 154 | ||
| Thermal Regulation in the Newborn | 154 | ||
| Effect of Anesthesia on Thermoregulation | 156 | ||
| Anesthesia and Hypothermia | 156 | ||
| Internal Redistribution | 157 | ||
| Thermal Imbalance | 157 | ||
| Thermal Steady State (Plateau or Rewarming Phase) | 158 | ||
| Anesthesia and Hyperthermia | 159 | ||
| Thermoregulation and General Anesthesia | 159 | ||
| Thermoregulation and Inhalational Anesthetics | 160 | ||
| Thermoregulation and Intravenous Agents | 161 | ||
| Thermoregulation and Regional Anesthesia | 162 | ||
| Adverse Effects of Hypothermia | 162 | ||
| Prevention of Hypothermia | 164 | ||
| Operating Room Temperature | 164 | ||
| Radiant Heaters | 164 | ||
| Reflecting Blankets | 164 | ||
| Skin-Warming Devices | 164 | ||
| Warming Mattresses | 165 | ||
| Warming of Intravenous Fluids | 165 | ||
| Humidified and Heated Gases | 165 | ||
| Transportation | 166 | ||
| Summary | 166 | ||
| References | 166 | ||
| References | 166.e1 | ||
| II Pharmacology | 167 | ||
| 7 Developmental Pharmacology | 168 | ||
| Outline | 168 | ||
| Introduction | 168 | ||
| Physiology and Development | 168 | ||
| Pharmacodynamics | 169 | ||
| Pharmacokinetic Parameters | 170 | ||
| Volume of Distribution | 170 | ||
| Clearance | 171 | ||
| Renal Clearance | 171 | ||
| Hepatic Clearance | 171 | ||
| Absorption | 172 | ||
| Distribution | 172 | ||
| Metabolism | 173 | ||
| Elimination | 175 | ||
| Transporter Proteins | 176 | ||
| Scaling Pediatric Dosing | 176 | ||
| Nonlinear Pharmacokinetics | 179 | ||
| Compartment Models | 179 | ||
| Context-Sensitive Half-Time | 181 | ||
| Population Pharmacokinetics | 183 | ||
| Body Size and Maturation Adjustments | 184 | ||
| Data Modeling | 184 | ||
| References | 185 | ||
| References | 185.e1 | ||
| 8 Intravenous Agents | 186 | ||
| Outline | 186 | ||
| Introduction | 186 | ||
| Barbiturates | 186 | ||
| Thiopental | 186 | ||
| Methohexital | 187 | ||
| Pentobarbital | 187 | ||
| Benzodiazepines and Antagonists | 188 | ||
| Diazepam | 188 | ||
| Midazolam | 188 | ||
| Flumazenil | 191 | ||
| Other Sedative Agents | 191 | ||
| Etomidate | 191 | ||
| Propofol | 192 | ||
| Ketamine | 194 | ||
| Clonidine | 196 | ||
| Dexmedetomidine | 197 | ||
| Summary | 199 | ||
| References | 199 | ||
| References | 199.e1 | ||
| 9 Inhaled Anesthetic Agents | 200 | ||
| Outline | 200 | ||
| Introduction | 200 | ||
| Properties of Specific Inhaled Agents | 200 | ||
| Physical Properties | 200 | ||
| Sevoflurane | 200 | ||
| Desflurane | 200 | ||
| Nitrous Oxide | 201 | ||
| Xenon | 201 | ||
| Pharmacokinetics | 201 | ||
| Wash-Out | 204 | ||
| Obesity | 204 | ||
| Receptor Binding | 205 | ||
| Pharmacodynamics | 205 | ||
| Potency | 205 | ||
| Cardiovascular Effects | 207 | ||
| Respiratory Effects | 207 | ||
| Apnea | 207 | ||
| Central Nervous System Effects | 209 | ||
| ICP and CPP | 209 | ||
| Neuroapoptosis | 209 | ||
| Emergence Agitation or Delirium | 211 | ||
| Metabolism and Toxicity | 211 | ||
| Malignant Hyperthermia | 212 | ||
| Nitrous Oxide Toxicity | 212 | ||
| Hepatotoxicity | 212 | ||
| Nephrotoxicity | 212 | ||
| Summary | 213 | ||
| References | 213 | ||
| References | 213.e1 | ||
| 10 Local Anesthetic Agents | 214 | ||
| Outline | 214 | ||
| Introduction | 214 | ||
| Physiochemical Properties | 214 | ||
| Mechanisms of Action | 215 | ||
| Systemic Absorption | 215 | ||
| Distribution | 216 | ||
| Protein Binding | 216 | ||
| Metabolism | 216 | ||
| Clearance | 216 | ||
| Lidocaine | 217 | ||
| Bupivacaine | 217 | ||
| Ropivacaine | 217 | ||
| Levobupivacaine | 217 | ||
| New Directions | 218 | ||
| References | 218 | ||
| References | 218.e1 | ||
| 11 Opioids | 219 | ||
| Outline | 219 | ||
| Introduction | 219 | ||
| Pharmacogenetics | 220 | ||
| Opioid Analgesics | 223 | ||
| Morphine | 224 | ||
| Meperidine | 226 | ||
| Fentanyl | 226 | ||
| Sufentanil | 228 | ||
| Alfentanil | 229 | ||
| Remifentanil | 231 | ||
| Methadone | 232 | ||
| Hydromorphone | 233 | ||
| Tramadol | 233 | ||
| Hydrocodone | 233 | ||
| Oxycodone | 234 | ||
| Codeine | 235 | ||
| Opioid Agonist-Antagonists | 236 | ||
| Nalbuphine | 236 | ||
| Opioid Antagonists | 236 | ||
| Abuse-Deterrent Formulations | 237 | ||
| Controlled-Release Oxycodone (Reformulation) | 238 | ||
| Morphine/Naltrexone (Embeda) | 238 | ||
| Acknowledgments | 238 | ||
| References | 238 | ||
| References | 238.e1 | ||
| 12 Neuromuscular Blocking Agents | 239 | ||
| Outline | 239 | ||
| Introduction | 239 | ||
| Neuromuscular Physiology and the Pharmacology of Neuromuscular Transmission | 239 | ||
| Neuromuscular Junction and Neuromuscular Transmission | 239 | ||
| Acetylcholine Receptors | 239 | ||
| Neuromuscular Transmission in the Neonate | 239 | ||
| Mechanism of Action of Depolarizing and Nondepolarizing Neuromuscular Blocking Agents | 240 | ||
| Basic Definitions and Pharmacology of Neuromuscular Blocking Agents | 241 | ||
| ED95 and Intubating Dose | 241 | ||
| Dose-response curves. | 241 | ||
| Relationship Between Potency and Intubating Dose of Neuromuscular Blocking Agent | 241 | ||
| Onset and Duration of Block, Maintenance Doses, and Recovery Index | 241 | ||
| Duration of Block in Infants | 243 | ||
| Pharmacologic Differences in Infants and Children: Sensitivity, Volume of Distribution, and Clearance | 243 | ||
| Monitoring Neuromuscular Block | 245 | ||
| Types of Monitoring: Peripheral Nerve Stimulation and Acceleromyography | 245 | ||
| Types of Stimuli | 245 | ||
| Neuromuscular Block Effects at Different Muscles | 246 | ||
| Posttetanic count. | 246 | ||
| Double burst stimulation. | 246 | ||
| Monitoring Recovery | 246 | ||
| Timing of antagonists. | 247 | ||
| Types of Neuromuscular Blocking Agents | 247 | ||
| Depolarizing Neuromuscular Relaxant: Succinylcholine | 247 | ||
| Dose, Onset, and Duration in Infants and Children | 248 | ||
| Side effects. | 248 | ||
| Cardiac arrest. | 248 | ||
| Dysrhythmias. | 248 | ||
| Intragastric pressure. | 248 | ||
| Intraocular pressure. | 249 | ||
| Increased intracranial pressure. | 249 | ||
| Hyperkalemia, myoglobinemia, and increase in creatine phosphokinase. | 249 | ||
| Masseter spasm and malignant hyperthermia. | 249 | ||
| Present Status of Succinylcholine Use in Infants and Children | 249 | ||
| Contraindications to Succinylcholine: Absolute and Relative | 249 | ||
| Nondepolarizing Neuromuscular Relaxants | 250 | ||
| Side Effects | 250 | ||
| Anaphylaxis. | 250 | ||
| Routes of Elimination of Nondepolarizing Agents | 250 | ||
| Classification of Nondepolarizing Blocking Drugs | 251 | ||
| Interactions with inhaled anesthetics. | 251 | ||
| Ultra-Short-Acting Agents | 251 | ||
| Gantacurium. | 251 | ||
| Short-Acting Agents | 251 | ||
| Mivacurium. | 251 | ||
| Rapacuronium. | 252 | ||
| Intermediate-Acting Agents | 252 | ||
| Atracurium. | 252 | ||
| Cisatracurium. | 252 | ||
| Dose, onset, and duration. | 252 | ||
| Cisatracurium infusions. | 253 | ||
| Vecuronium. | 253 | ||
| Dose, onset, and duration in children. | 253 | ||
| Duration of block in the infant and child. | 253 | ||
| Infants versus children infusions. | 253 | ||
| Children versus adults infusions. | 253 | ||
| Patients with organ failure. | 254 | ||
| Rocuronium | 254 | ||
| Dose, onset, intubating conditions, and recovery. | 254 | ||
| Recovery in infants. | 254 | ||
| Recovery in children versus adults. | 254 | ||
| Long-Acting Agents | 254 | ||
| Pancuronium. | 254 | ||
| Antagonists for Neuromuscular Blocking Agents: Anticholinesterases and Sugammadex | 255 | ||
| Mechanism of Action | 255 | ||
| Anticholinesterase Drugs | 255 | ||
| Infants and children. | 255 | ||
| Side effects of anticholinesterases. | 255 | ||
| Cardiovascular effects. | 255 | ||
| Gastrointestinal effects. | 255 | ||
| Sugammadex | 256 | ||
| Summary | 257 | ||
| Acknowledgment | 257 | ||
| References | 257 | ||
| References | 257.e1 | ||
| 13 Anesthetic Adjuncts | 258 | ||
| Outline | 258 | ||
| Introduction | 258 | ||
| Anticholinergic Agents | 258 | ||
| Atropine | 258 | ||
| Glycopyrrolate | 259 | ||
| Scopolamine | 259 | ||
| Adjunctive Pain Medications (Tables 13-2 and 13-3) | 259 | ||
| Ketorolac | 259 | ||
| Acetaminophen | 261 | ||
| Oral | 261 | ||
| Rectal | 261 | ||
| Intravenous | 261 | ||
| Antiemetics | 262 | ||
| Serotonin Antagonists | 262 | ||
| Ondansetron | 262 | ||
| Dolasetron | 262 | ||
| Granisetron | 263 | ||
| Palonosetron | 263 | ||
| Other Agents | 263 | ||
| Metoclopramide | 263 | ||
| Promethazine | 263 | ||
| Droperidol | 263 | ||
| Dexamethasone | 263 | ||
| Aprepitant | 264 | ||
| Antihistamines | 264 | ||
| Diphenhydramine | 264 | ||
| Dimenhydrinate | 264 | ||
| Summary | 264 | ||
| References | 264 | ||
| References | 264.e1 | ||
| III General Approach | 265 | ||
| 14 Psychological Aspects of Pediatric Anesthesia | 266 | ||
| Outline | 266 | ||
| Introduction | 266 | ||
| Psychological Preparation for Anesthesia and Surgery | 266 | ||
| Incidence and Definition | 266 | ||
| Identification of Children at Risk | 267 | ||
| Psychological Preparation Programs | 267 | ||
| Considerations in Choosing a Preparation Program | 268 | ||
| Parental Issues | 269 | ||
| Future of Preparation Programs | 269 | ||
| Intraoperative Considerations | 270 | ||
| Parental Presence | 270 | ||
| Parental Perspectives | 270 | ||
| Experimental Studies Involving Parental Presence | 270 | ||
| Satisfaction Issues | 272 | ||
| Postoperative Period: Parental Presence in the Recovery Room | 272 | ||
| Postoperative Period: Support for Parent Management of Recovery at Home | 273 | ||
| Health Care Provider Training | 273 | ||
| Behavioral Interventions | 273 | ||
| Family-Centered Preparation | 273 | ||
| Music | 273 | ||
| Acupuncture | 274 | ||
| Preoperative Interview | 275 | ||
| Postoperative Behavioral Changes | 275 | ||
| Epidemiology | 275 | ||
| Predictors | 276 | ||
| Interventions | 276 | ||
| Preparation Programs | 276 | ||
| Parental Presence | 276 | ||
| Sedatives | 276 | ||
| Clinical Outcomes | 277 | ||
| Summary | 277 | ||
| References | 278 | ||
| References | 278.e1 | ||
| 15 Preoperative Preparation | 279 | ||
| Outline | 279 | ||
| Introduction | 279 | ||
| Psychology of Hospitalization | 279 | ||
| Preoperative Medical Evaluation and Preparation | 279 | ||
| Prematurity | 280 | ||
| Apnea of Prematurity | 280 | ||
| Bronchopulmonary Dysplasia | 281 | ||
| Subglottic Stenosis | 281 | ||
| Airway | 281 | ||
| Cardiovascular | 282 | ||
| Murmurs | 282 | ||
| Subacute Bacterial Endocarditis | 282 | ||
| Respiratory | 283 | ||
| Asthma | 283 | ||
| Upper Respiratory Tract Infections | 284 | ||
| Obstructive Sleep Apnea | 285 | ||
| Central Nervous System | 286 | ||
| Autism | 286 | ||
| Attention Deficit Hyperactivity Disorder | 287 | ||
| Seizures | 287 | ||
| Musculoskeletal | 287 | ||
| Cerebral Palsy | 287 | ||
| Muscular Dystrophy | 287 | ||
| Hematology | 288 | ||
| Sickle Cell Disease | 288 | ||
| Oncology | 288 | ||
| Metabolic | 288 | ||
| Mitochondrial Myopathy | 288 | ||
| Endocrine | 289 | ||
| Adrenal Supression | 289 | ||
| Diabetes mellitus. | 289 | ||
| Anesthesia History | 290 | ||
| Medications | 290 | ||
| Allergies | 291 | ||
| Family History | 291 | ||
| Social History | 291 | ||
| Physical Exam | 292 | ||
| Preoperative Laboratory Data | 293 | ||
| Fasting Guidelines | 293 | ||
| Premedication | 294 | ||
| Anticholinergic Agents | 294 | ||
| Opioids | 294 | ||
| Benzodiazepines | 295 | ||
| Ketamine | 295 | ||
| Alpha-2-Adrenoreceptor Agonists | 295 | ||
| Dexmedetomidine | 296 | ||
| Legal and Ethical Guidelines | 296 | ||
| ASA Physical Status | 296 | ||
| Summary | 296 | ||
| References | 297 | ||
| References | 297.e1 | ||
| 16 Equipment | 298 | ||
| Outline | 298 | ||
| Introduction | 298 | ||
| Humidifiers | 298 | ||
| Anesthesia Breathing Systems | 299 | ||
| Nonrebreathing and Partial Rebreathing Systems | 299 | ||
| Mapleson A System | 299 | ||
| Mapleson D System | 299 | ||
| Bain Modification of Mapleson D | 301 | ||
| Circle Systems | 302 | ||
| Carbon Dioxide Absorbers | 302 | ||
| Anesthesia Machines | 302 | ||
| Gas and Anesthetic Vapor Delivery | 302 | ||
| Oxygen | 302 | ||
| Indications for Careful Control of Fio2 | 302 | ||
| Anesthetic Vapor Delivery | 304 | ||
| Anesthesia Machine Ventilators | 304 | ||
| Controlled Ventilation | 305 | ||
| Assisted Spontaneous Ventilation | 306 | ||
| Warming Devices | 307 | ||
| Circulating Water Devices | 307 | ||
| Forced-Warm-Air Devices | 308 | ||
| Resistive Polymer Warming Devices | 308 | ||
| Wrapping and Draping with Plastic Sheets | 308 | ||
| Humidification of Inspired Gases | 308 | ||
| Face Masks | 308 | ||
| Oral and Nasal Airway Devices | 309 | ||
| Tracheal Tubes | 310 | ||
| Double-Lumen Tracheal Tubes | 312 | ||
| Tracheal Tubes for One-Lung Ventilation | 313 | ||
| Univent Tracheal Tubes | 313 | ||
| Selective Endobronchial Intubation | 313 | ||
| Endobronchial Intubation with a Standard Tracheal Tube | 313 | ||
| Bronchial-Blocker Devices | 313 | ||
| Tracheostomy Tubes | 314 | ||
| Supralaryngeal Airways | 315 | ||
| Laryngeal Masks | 315 | ||
| Cobra Perilaryngeal Airway | 318 | ||
| Laryngeal Tube | 319 | ||
| Flexible Fiberoptic Bronchoscopy | 319 | ||
| Lighted Stylets | 320 | ||
| Optical Stylets | 320 | ||
| Retromolar Scope | 321 | ||
| Laryngoscopes | 321 | ||
| Video Laryngoscopes | 322 | ||
| Glidescope | 322 | ||
| Storz Video Laryngoscope | 323 | ||
| Optical Laryngoscope | 324 | ||
| Cricothyrotomy | 324 | ||
| Intravenous Equipment | 324 | ||
| Catheters | 324 | ||
| Near-Infrared Light Devices | 324 | ||
| Ultrasound Guidance for Peripheral Intravenous and Arterial Access | 325 | ||
| Intraosseous Access | 325 | ||
| Infusion Sets | 326 | ||
| Intravenous Fluid Warmers | 326 | ||
| Summary | 327 | ||
| References | 327 | ||
| References | 327.e1 | ||
| 17 Pediatric Anesthesia Monitoring | 328 | ||
| Outline | 328 | ||
| Basic Monitoring | 328 | ||
| Physical Examination | 329 | ||
| Observation | 329 | ||
| Auscultation | 329 | ||
| Electrocardiography | 329 | ||
| Systemic Arterial Pressure | 329 | ||
| Noninvasive Measurement | 329 | ||
| Direct Measurement | 330 | ||
| Systolic Pressure Variation | 331 | ||
| Central Venous Pressure | 332 | ||
| Mixed Venous Oxygenation and Monitoring | 333 | ||
| Pulmonary Artery Catheters | 333 | ||
| Transesophageal Echocardiography | 334 | ||
| Noninvasive Respiratory Gas Monitoring | 335 | ||
| Carbon Dioxide | 335 | ||
| Other Gases | 338 | ||
| Monitoring Oxygen and Carbon Dioxide | 338 | ||
| Cutaneous Oxygen Tension | 338 | ||
| Cutaneous Carbon Dioxide Tension | 338 | ||
| Pulse Oximetry | 338 | ||
| Multiple-Wavelength Pulse Oximetry | 340 | ||
| Plethysmographic Waveform Analysis | 340 | ||
| Temperature | 340 | ||
| Urine Output | 341 | ||
| Near-Infrared Spectroscopy | 341 | ||
| Cerebral Monitoring | 342 | ||
| Bispectral Index | 342 | ||
| Monitoring of Neuromuscular Blockade | 342 | ||
| Neurophysiologic Monitoring | 343 | ||
| Intraoperative Communication | 343 | ||
| Technical Considerations | 343 | ||
| Anesthetic Considerations | 344 | ||
| Maturational Changes | 344 | ||
| Intraoperative Monitoring Modalities and Applications | 344 | ||
| Electroencephalography | 345 | ||
| Somatosensory Evoked Potentials | 345 | ||
| Motor Evoked Potentials | 346 | ||
| Brainstem Auditory Evoked Potentials | 347 | ||
| Visual Evoked Potentials | 347 | ||
| Electromyography | 347 | ||
| Intraoperative Monitoring Summary | 348 | ||
| Summary | 348 | ||
| Acknowledgments | 348 | ||
| References | 348 | ||
| References | 348.e1 | ||
| 18 Airway Management | 349 | ||
| Outline | 349 | ||
| Introduction | 349 | ||
| Developmental Anatomy* | 349 | ||
| The Upper Airway | 349 | ||
| Formation of the Cranial Vault and Base | 349 | ||
| Clinical Correlation | 349 | ||
| Craniovertebral Development | 350 | ||
| Clinical Correlation | 351 | ||
| The Face | 351 | ||
| Clinical Correlation | 352 | ||
| Clinical Correlation | 353 | ||
| The Branchial Apparatus | 353 | ||
| Branchial arches. | 353 | ||
| Branchial Pouches | 354 | ||
| Branchial Clefts | 354 | ||
| Clinical Correlation | 354 | ||
| The Larynx | 355 | ||
| Developmental Physiology | 356 | ||
| The Upper Airway | 356 | ||
| Developmental Airway Physics | 357 | ||
| Laminar and Turbulent Flow | 357 | ||
| Clinical Correlation | 358 | ||
| Bubble Stability and Breathing: Laplace’s Law | 358 | ||
| IV Clinical Management of Specialized Surgical Problems | 512 | ||
| 23 Neonatology for Anesthesiologists | 513 | ||
| Outline | 513 | ||
| Introduction | 513 | ||
| Preoperative Evaluation | 514 | ||
| Development of the Fetus and the Intrauterine Environment | 514 | ||
| Labor and Delivery and Perinatal Events | 515 | ||
| Labor and Delivery | 516 | ||
| Neonatal Asphyxia | 516 | ||
| Metabolic Status in the Early Postnatal Period | 516 | ||
| Thermal Environment | 516 | ||
| Neonatal Requirements for Sodium, Calcium, and Glucose | 516 | ||
| Gestational Age and Birth Weight | 517 | ||
| Small-for-Gestational-Age Infants | 517 | ||
| Large-for-Gestational-Age Infants | 518 | ||
| Very Low-Birth-Weight and Extremely Low-Birth-Weight Infants | 518 | ||
| The Premature Infant | 518 | ||
| Late Preterm Infants (Born at 35 to 37 Weeks’ Gestation) | 518 | ||
| Infants Born at 30 to 34 Weeks’ Gestation | 518 | ||
| Infants Born at 27 to 29 Weeks’ Gestation | 519 | ||
| Infants Born at or Before 26 Weeks’ Gestation | 519 | ||
| Managing the Airway in Neonates | 519 | ||
| The Pulmonary System | 520 | ||
| Development | 520 | ||
| Pulmonary Blood Flow and Ventilation in the Early Postnatal Period | 521 | ||
| Pulmonary Blood Flow | 521 | ||
| Ventilation | 522 | ||
| Respiratory Distress Syndrome | 523 | ||
| Retinopathy of Prematurity | 524 | ||
| Bronchopulmonary Dysplasia | 524 | ||
| Preoperative Pulmonary Evaluation | 524 | ||
| The Cardiovascular System | 525 | ||
| Transitional Circulation | 525 | ||
| Nitric Oxide | 526 | ||
| Myocardial Ultrastructure | 527 | ||
| Force Generation | 527 | ||
| Myofibrils | 527 | ||
| Sarcomere | 527 | ||
| Contractile Proteins | 528 | ||
| Calcium Flux | 529 | ||
| Sarcolemma. | 529 | ||
| Sarcoplasmic Reticulum | 530 | ||
| Myocardial Compliance | 530 | ||
| Cytoskeleton | 530 | ||
| Sympathetic Innervation | 531 | ||
| Cardiovascular Function in Newborn Infants | 531 | ||
| Preoperative Cardiovascular Evaluation | 531 | ||
| The Central Nervous System | 531 | ||
| Embryologic Development and Abnormalities of the Central Nervous System | 531 | ||
| Growth of the Fetal Brain | 534 | ||
| Autoregulation of Cerebral Blood Flow in Newborn Infants | 534 | ||
| Unique and Vulnerable Cell Populations in the Brain of the Fetus and Premature Infant | 535 | ||
| Germinal Matrix–Intraventricular Hemorrhage and Periventricular Hemorrhagic Infarction | 535 | ||
| Periventricular Leukomalacia | 536 | ||
| Apgar Score | 536 | ||
| Hypoxic-Ischemic Injury | 537 | ||
| Perinatal Stroke | 537 | ||
| Preoperative Neurologic Evaluation | 537 | ||
| Postanesthetic Apnea | 538 | ||
| Thermoregulation | 539 | ||
| Hepatic Function | 539 | ||
| Glucose Metabolism | 540 | ||
| Hypoglycemia | 540 | ||
| Glucose Metabolism in the Fetus and Newborn | 541 | ||
| Perioperative Management of Hepatic Function | 541 | ||
| Biotransformation | 541 | ||
| Phase I: CYP450 | 542 | ||
| Phase II: UGT, SULT, NAT | 543 | ||
| Coagulation | 544 | ||
| Hyperbilirubinemia | 545 | ||
| Renal Function | 547 | ||
| Early Growth and Development of the Renal System | 547 | ||
| Distribution of Total Body Water | 548 | ||
| Glomerular Filtration Rate | 548 | ||
| Renal Tubular Function | 548 | ||
| Hormonal Control of Fluids and Electrolytes | 552 | ||
| Hematologic Function | 553 | ||
| Preoperative Hematologic Evaluation | 554 | ||
| Survival and Outcomes | 554 | ||
| Chronic Lung Disease and Bronchopulmonary Dysplasia | 556 | ||
| Mechanical Ventilation, CPAP, and Bronchopulmonary Dysplasia | 557 | ||
| Oxygen Therapy and Toxicity | 558 | ||
| Oxygen Therapy and Toxicity in Term Infants | 558 | ||
| Oxygen Therapy and Toxicity in Premature Infants | 558 | ||
| Outcomes of Ex-Premature Patients Who Have Had Pulmonary Dysfunction | 559 | ||
| Long-Term Outcomes in Adolescents and Adults | 560 | ||
| Bronchopulmonary Dysplasia, Corticosteroids, and Neurologic Outcomes | 562 | ||
| Outcomes of Ex-Premature Patients Who Have Had Neurologic Dysfunction | 564 | ||
| Bayley Assessment of Outcomes | 564 | ||
| Brain Injury | 564 | ||
| Brain Injury in Preterm Infants | 565 | ||
| Brain Injury and Clinical Outcomes in Expremature Patients | 566 | ||
| Neonatal Encephalopathy | 567 | ||
| Cerebral Palsy | 569 | ||
| Summary | 570 | ||
| References | 570 | ||
| References | 570.e1 | ||
| 24 Anesthesia for General Surgery in the Neonate | 571 | ||
| Outline | 571 | ||
| Introduction | 571 | ||
| Etiologies of Death in the Neonatal Intensive Care Unit | 571 | ||
| Anesthetic Pharmacology in the Neonate | 572 | ||
| Pharmacokinetics and Pharmacodynamics | 573 | ||
| Inhaled Anesthetic Agents | 573 | ||
| Intravenous Anesthetics and Analgesics | 574 | ||
| Muscle Relaxants | 576 | ||
| General Approach to Intraoperative Monitoring of the Neonate | 577 | ||
| Thermal Protection | 577 | ||
| Monitoring in the Operating Room | 577 | ||
| General Observation | 577 | ||
| Circulatory Monitoring | 577 | ||
| Ventilatory Monitoring | 579 | ||
| Monitoring of the Neuromuscular Junction | 579 | ||
| Monitoring Urine Output | 579 | ||
| Minimal-Access Surgery in the Neonate | 579 | ||
| Laparoscopy Background | 580 | ||
| Laparoscopy and Thoracoscopy in the Newborn | 581 | ||
| Specific Neonatal Surgical Lesions | 582 | ||
| Abdominal Wall Defects: Gastroschisis and Omphalocele | 582 | ||
| Embryology | 583 | ||
| Preoperative Management | 584 | ||
| Intraoperative Management | 584 | ||
| Postoperative Care | 585 | ||
| Outcome | 586 | ||
| Congenital Diaphragmatic Hernia | 586 | ||
| Embryology | 589 | ||
| Preoperative Management | 589 | ||
| Pathophysiology. | 589 | ||
| Prenatal Diagnosis and Treatment | 590 | ||
| Postnatal Diagnosis and Treatment | 590 | ||
| Clinical presentation. | 590 | ||
| Timing of surgery. | 591 | ||
| Nitric oxide. | 592 | ||
| Extracorporeal membrane oxygenation. | 593 | ||
| Intraoperative and postoperative management. | 594 | ||
| Outcomes | 595 | ||
| Pulmonary. | 595 | ||
| Musculoskeletal deformity. | 595 | ||
| Gastrointestinal. | 596 | ||
| Neurodevelopmental. | 596 | ||
| Tracheoesophageal Fistula and Esophageal Atresia | 597 | ||
| Embryology | 598 | ||
| Anatomy | 599 | ||
| Prenatal Diagnosis and Clinical Presentation | 599 | ||
| Preoperative Management | 600 | ||
| Intraoperative Management | 600 | ||
| Surgical technique. | 600 | ||
| Airway Management | 601 | ||
| Postoperative Management | 602 | ||
| Outcomes | 602 | ||
| Gastrointestinal. | 602 | ||
| Airway/Pulmonary. | 603 | ||
| Necrotizing Enterocolitis | 604 | ||
| Classic Necrotizing Eterocolitis | 604 | ||
| Pathophysiology | 605 | ||
| Ischemia/Disturbance in Microvascular Flow | 605 | ||
| Bacterial Colonization/Inflammation/Immune Responses | 605 | ||
| Immature Intestinal Barrier/Motility/Immunity | 606 | ||
| Genetics | 607 | ||
| Preoperative Management | 607 | ||
| Intraoperative Management | 609 | ||
| Postoperative Management | 610 | ||
| Outcome | 610 | ||
| Imperforate Anus (Anal Atresia) | 611 | ||
| Intraoperative Management | 611 | ||
| Postoperative Management | 612 | ||
| Outcome | 612 | ||
| Intestinal Obstruction | 612 | ||
| Duodenal Obstruction | 612 | ||
| Jejunoileal Atresia | 613 | ||
| Meconium Ileus | 613 | ||
| Malrotations and Volvulus | 614 | ||
| Sacrococcygeal Teratoma | 614 | ||
| Embryology and Diagnosis | 614 | ||
| Intraoperative Management | 615 | ||
| Outcome | 615 | ||
| Summary | 616 | ||
| References | 616 | ||
| References | 616.e1 | ||
| 25 Anesthesia for Fetal Surgery | 617 | ||
| Outline | 617 | ||
| Introduction | 617 | ||
| Diseases and Therapies | 617 | ||
| Complicated Multiple Gestations | 617 | ||
| Neurologic | 619 | ||
| Airway | 620 | ||
| Lung Lesions | 620 | ||
| Cardiac Disease | 622 | ||
| Bladder Outlet Obstruction | 622 | ||
| Sacrococcygeal Teratoma | 622 | ||
| Physiology | 623 | ||
| Maternal | 623 | ||
| Fetal | 624 | ||
| Uteroplacental Blood Flow | 625 | ||
| Placental Anatomy and Transport | 626 | ||
| Surgical Issues | 627 | ||
| Minimally Invasive Interventions | 627 | ||
| Open Midgestation Surgery | 628 | ||
| EXIT Procedure | 628 | ||
| Anesthetic Plan | 628 | ||
| Teamwork and Communication | 628 | ||
| Preoperative Preparation | 628 | ||
| Minimally Invasive Procedures | 629 | ||
| Open Midgestation Procedures | 629 | ||
| EXIT Procedure | 630 | ||
| Intraoperative Fetal Resuscitation | 631 | ||
| Summary | 631 | ||
| References | 632 | ||
| References | 632.e1 | ||
| 26 Anesthesia for Congenital Heart Surgery | 633 | ||
| Outline | 633 | ||
| Pathophysiology of Congenital Heart Disease | 635 | ||
| Shunting | 635 | ||
| Single-Ventricle Physiology | 635 | ||
| Intercirculatory Mixing | 636 | ||
| Fontan Physiology | 637 | ||
| General Approach to Anesthetic Management | 637 | ||
| Preparation for Anesthesia | 637 | ||
| Mask Induction | 638 | ||
| Intravenous Induction | 639 | ||
| Maintenance of Anesthesia | 639 | ||
| Specific Lesions | 639 | ||
| Atrial Septal Defect | 639 | ||
| Clinical Presentation | 640 | ||
| Management of Anesthesia | 640 | ||
| Ventricular Septal Defect | 640 | ||
| Clinical Presentation | 641 | ||
| V Systemic Disorders and Associated Problems | 1100 | ||
| 44 Endocrine Disorders | 1101 | ||
| Outline | 1101 | ||
| Diabetes Mellitus | 1101 | ||
| Preoperative Evaluation | 1102 | ||
| Perioperative Management | 1102 | ||
| Long-Acting Insulin Analogs and Subcutaneous Infusion Insulin Pumps | 1102 | ||
| Intravenous Insulin Infusion | 1103 | ||
| Classic Regimen | 1103 | ||
| Anesthetic Management | 1104 | ||
| Perioperative Management of Diabetic Ketoacidosis | 1104 | ||
| Diabetes Insipidus | 1104 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Secretion | 1106 | ||
| Adrenal Insufficiency | 1106 | ||
| Adrenal Insufficiency Due to Primary Abnormalities of the Hypothalamic-Pituitary-Adrenal Axis | 1106 | ||
| Perioperative Steroid Management | 1107 | ||
| Hypothalamic-Pituitary-Adrenal Axis Suppression Caused by Exogenous Steroid Therapy | 1108 | ||
| Thyroid Disorders | 1109 | ||
| Hypothyroidism | 1109 | ||
| Hyperthyroidism | 1110 | ||
| Congenital Hyperthyroidism | 1110 | ||
| Graves’ Disease | 1110 | ||
| Thyroid Storm | 1110 | ||
| Laboratory Evaluation | 1111 | ||
| Treatment | 1111 | ||
| Anesthetic Management | 1111 | ||
| Intraoperative Management of Patients for Thyroidectomy | 1111 | ||
| Postoperative Care | 1112 | ||
| Pheochromocytoma | 1112 | ||
| Diagnosis | 1112 | ||
| Preoperative Preparation and Evaluation | 1113 | ||
| Anesthetic Induction | 1113 | ||
| Intraoperative Management | 1113 | ||
| Postoperative Care | 1114 | ||
| Congenital Hyperinsulinism | 1114 | ||
| Management and Surgical Therapy | 1114 | ||
| Anesthetic Management of Pancreatectomy | 1114 | ||
| References | 1114 | ||
| References | 1114.e1 | ||
| 45 Respiratory Disorders | 1115 | ||
| Outline | 1115 | ||
| Asthma | 1115 | ||
| Epidemiology | 1115 | ||
| Pathophysiology | 1115 | ||
| Classification of Asthma Severity and Control | 1116 | ||
| Pharmacologic Therapy | 1117 | ||
| Preoperative Evaluation | 1119 | ||
| Anesthetic Considerations | 1120 | ||
| Perioperative Asthma Complications | 1120 | ||
| Cystic Fibrosis | 1121 | ||
| Clinical Spectrum | 1121 | ||
| Pulmonary Manifestations | 1121 | ||
| Upper-Airway Manifestations | 1123 | ||
| Gastrointestinal Manifestations | 1123 | ||
| Pancreatic Manifestations | 1123 | ||
| Hepatobiliary Manifestations | 1123 | ||
| Chronic Pain | 1123 | ||
| Anesthetic Considerations | 1123 | ||
| Nontransplant Anesthesia in Pediatric Lung Transplant Recipients | 1124 | ||
| Physiologic Features of the Transplanted Lung | 1124 | ||
| Common Indications for Lung Transplantation | 1124 | ||
| Complications Following Transplantation | 1124 | ||
| Anesthetic Considerations | 1125 | ||
| Bronchopulmonary Dysplasia | 1125 | ||
| Epidemiology | 1125 | ||
| Pathogenesis | 1125 | ||
| Old Versus New Bronchopulmonary Dysplasia | 1126 | ||
| Respiratory Function | 1126 | ||
| Cardiovascular Function | 1126 | ||
| Pharmacologic Interventions | 1126 | ||
| Anesthetic Considerations | 1127 | ||
| Upper-Respiratory Tract Infections | 1127 | ||
| Complicated Pneumonias Requiring Intervention | 1128 | ||
| Children on Home Ventilators | 1129 | ||
| References | 1130 | ||
| References | 1130.e1 | ||
| 46 Cardiovascular Disorders* | 1131 | ||
| Outline | 1131 | ||
| Introduction | 1131 | ||
| Anesthetic Management | 1131 | ||
| Preoperative Period | 1131 | ||
| Intraoperative Period | 1131 | ||
| Postoperative Period | 1133 | ||
| The Child with a Murmur and Possible Heart Disease | 1133 | ||
| Noncardiac Manifestations of Congenital Heart Disease | 1134 | ||
| Kawasaki Disease | 1134 | ||
| Takayasu Arteritis | 1135 | ||
| Inflammatory/Infectious/Postinfectious Diseases | 1136 | ||
| Hypertrophic Cardiomyopathy | 1137 | ||
| Dilated Cardiomyopathy | 1138 | ||
| Restrictive Cardiomyopathy | 1138 | ||
| Maternal/Intrauterine Disorders | 1138 | ||
| Genetic Diseases | 1139 | ||
| Toxins | 1139 | ||
| Trauma | 1139 | ||
| Summary | 1141 | ||
| References | 1141 | ||
| References | 1141.e1 | ||
| 47 Hematology and Coagulation Disorders | 1142 | ||
| Outline | 1142 | ||
| Introduction | 1142 | ||
| Overview of the Hemostatic System | 1142 | ||
| Mechanisms of Hemostasis | 1142 | ||
| Primary Hemostasis | 1142 | ||
| Secondary Hemostasis | 1143 | ||
| Teritary Hemostasis | 1143 | ||
| Maturation of Hemostasis | 1144 | ||
| Monitoring of Hemostasis | 1145 | ||
| Standard Coagulation Tests | 1146 | ||
| Viscoelastic Coagulation Tests | 1146 | ||
| Congenital Coagulation Abnormalities | 1147 | ||
| Von Willebrand Disease | 1147 | ||
| Hemophilia | 1148 | ||
| Inherited Platelet Disorders | 1150 | ||
| Immune Thrombocytopenia | 1150 | ||
| Thrombophilias | 1152 | ||
| Acquired Coagulation Abnormalities | 1153 | ||
| Acquired Coagulation Abnormalities of Primary Hemostasis | 1153 | ||
| Antiplatelet Drugs | 1153 | ||
| Thromboxane Inhibitors | 1153 | ||
| Platelet ADP Receptor Antagonists | 1153 | ||
| Platelet Glycoprotein IIb/IIIa Receptor Antagonists | 1154 | ||
| Phosphodiesterase Inhibitors | 1154 | ||
| Miscellaneous | 1154 | ||
| Acquired Coagulation Abnormalities of Secondary Hemostasis | 1154 | ||
| Anticoagulant Drugs | 1154 | ||
| Heparin. | 1154 | ||
| Warfarin. | 1155 | ||
| Low molecular weight heparins. | 1155 | ||
| Direct thrombin inhibitors. | 1155 | ||
| Factor Xa inhibitors. | 1156 | ||
| Acquired Coagulation Abnormalities of Tertiary Hemostasis | 1156 | ||
| Disseminated Intravascular Coagulation | 1156 | ||
| Other Acquired Coagulation Abnormalities | 1157 | ||
| Hepatic Dysfunction | 1157 | ||
| Dilutional/Transfusion Coagulopathy | 1158 | ||
| Red Blood Cell and Hemoglobin Abnormalities | 1159 | ||
| Glucose-6-Phosphate Dehydrogenase Deficiency | 1159 | ||
| Hemoglobin Abnormalities | 1160 | ||
| Thalassemias | 1160 | ||
| Sickle Cell Anemia | 1161 | ||
| Intraoperative Management of Coagulopathies | 1163 | ||
| Available Blood Products | 1163 | ||
| Whole Blood | 1163 | ||
| Packed Red Blood Cells | 1163 | ||
| Platelets | 1164 | ||
| Fresh Frozen Plasma | 1164 | ||
| Cryoprecipitate | 1164 | ||
| Pharmacologic and Procoagulant Agents | 1165 | ||
| Desmopressin Acetate | 1165 | ||
| Antifibrinolytic Drugs | 1165 | ||
| Recombinant Activated Factor VII | 1167 | ||
| Prothrombin Complex Concentrates | 1167 | ||
| Fibrinogen Concentrate | 1168 | ||
| References | 1168 | ||
| References | 1168.e1 | ||
| 48 Oncologic Disorders | 1169 | ||
| Outline | 1169 | ||
| Introduction | 1169 | ||
| Pediatric Acute Lymphoblastic Leukemia | 1169 | ||
| Central Nervous System: Medulloblastoma | 1171 | ||
| Abdomen: Neuroblastoma | 1172 | ||
| Hematopoietic Stem Cell Transplantation | 1174 | ||
| Anesthetic Management | 1175 | ||
| Pharmacologic and Physiologic Side Effects of Cancer Therapy | 1175 | ||
| Myelosuppression | 1175 | ||
| Cardiotoxicity | 1176 | ||
| Anthracycline Antibiotics | 1176 | ||
| Cyclophosphamide | 1176 | ||
| Radiation | 1176 | ||
| Pulmonary Toxicity | 1176 | ||
| Alkylating Agents | 1176 | ||
| Radiation | 1177 | ||
| Nerve Toxicity | 1177 | ||
| Summary | 1177 | ||
| References | 1177 | ||
| References | 1177.e1 | ||
| 49 Genetic Muscle Disorders | 1178 | ||
| Outline | 1178 | ||
| Overview | 1178 | ||
| Normal Skeletal Muscle Contraction | 1178 | ||
| Anesthetic Impact on Neuromuscular Physiology | 1179 | ||
| Myasthenic Syndromes | 1179 | ||
| Anesthetic Considerations | 1179 | ||
| Myotonias | 1180 | ||
| VI Critical Care in Pediatric Anesthesia | 1235 | ||
| 54 Cardiopulmonary Resuscitation | 1236 | ||
| Outline | 1236 | ||
| Cardiac Arrest During Anesthesia | 1236 | ||
| Incidence of Cardiac Arrest During Anesthesia | 1236 | ||
| Etiology of Cardiac Arrest During Anesthesia | 1238 | ||
| Outcomes From Cardiac Arrest During Anesthesia | 1241 | ||
| Cardiopulmonary Resuscitation | 1242 | ||
| Recognizing the Need for Cardiopulmonary Resuscitation | 1242 | ||
| Physiology of Cardiopulmonary Resuscitation: Reestablishment of Ventilation | 1243 | ||
| Physiology of Cardiopulmonary Resuscitation: Reestablishment of Circulation | 1245 | ||
| Mechanisms of Blood Flow During Cardiopulmonary Resuscitation | 1245 | ||
| Thoracic Pump Mechanism | 1246 | ||
| Cardiac Pump Mechanism | 1246 | ||
| Efficacy of Blood Flow During CPR | 1246 | ||
| Maintenance of Circulation | 1246 | ||
| Patient-related factors. | 1246 | ||
| Ventilation-related factors. | 1247 | ||
| Compression-related factors. | 1247 | ||
| Compression rate and duty cycle. | 1247 | ||
| Distribution of Blood Flow During CPR | 1248 | ||
| Monitoring the Effectiveness of Resuscitative Efforts | 1249 | ||
| Vascular Access for Medication and Fluid Administration | 1251 | ||
| Peripheral and Central Vascular Access | 1251 | ||
| Intraosseous Access | 1252 | ||
| Intratracheal Medication Administration | 1252 | ||
| Medications for Cardiopulmonary Resuscitation | 1253 | ||
| Vasoactive Medications | 1253 | ||
| Adrenergic Agonists | 1253 | ||
| Effects on coronary blood flow. | 1253 | ||
| Effects on cerebral blood flow. | 1253 | ||
| Outcome. | 1253 | ||
| Dosage. | 1253 | ||
| Other Adrenergic Agents | 1254 | ||
| Phosphodiesterase inhibitors. | 1254 | ||
| Vasopressin. | 1254 | ||
| Indication and dosage. | 1255 | ||
| Appendix A Pediatric Drug Dosages | e1 | ||
| Appendix B Growth Curves | e7 | ||
| Appendix C Normal Pulmonary Function Values | e15 | ||
| Appendix D Index of Syndromes and Their Pediatric Anesthetic Implications | e23 | ||
| Abbreviations | 1365 | ||
| Index | 1368 | ||
| A | 1368 | ||
| B | 1370 | ||
| C | 1372 | ||
| D | 1376 | ||
| E | 1377 | ||
| F | 1379 | ||
| G | 1379 | ||
| H | 1380 | ||
| I | 1382 | ||
| J | 1383 | ||
| K | 1383 | ||
| L | 1383 | ||
| M | 1384 | ||
| N | 1386 | ||
| O | 1388 | ||
| P | 1390 | ||
| Q | 1393 | ||
| R | 1393 | ||
| S | 1394 | ||
| T | 1397 | ||
| U | 1398 | ||
| V | 1399 | ||
| W | 1399 | ||
| X | 1399 | ||
| Y | 1399 | ||
| Z | 1399 | ||
| Endsheet 7 | IBC3 |