BOOK
A Practice of Anesthesia for Infants and Children E-Book
Charles J. Cote | Jerrold Lerman | I. David Todres
(2018)
Additional Information
Book Details
Abstract
Covering everything from preoperative evaluation to neonatal emergencies to the PACU, A Practice of Anesthesia in Infants and Children, 6th Edition, features state-of-the-art advice on the safe, effective administration of general and regional anesthesia to young patients. It reviews underlying scientific information, addresses preoperative assessment and anesthesia management in detail, and provides guidelines for postoperative care, emergencies, and special procedures. Comprehensive in scope and thoroughly up to date, this 6th Edition delivers unsurpassed coverage of every key aspect of pediatric anesthesia.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Endsheet 2 | IFC1 | ||
| 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 | 6 | ||
| Conduct of the Anesthesia Team | 6 | ||
| The Postanesthesia Care Unit | 6 | ||
| Postoperative Visit | 6 | ||
| Summary | 7 | ||
| 2 Growth and Development | 8 | ||
| Normal and Abnormal Growth and Maturation | 8 | ||
| Gestational Age Assessment | 9 | ||
| Weight and Length | 9 | ||
| Head Circumference | 13 | ||
| Face | 13 | ||
| Teeth | 14 | ||
| Airway and Respiratory System | 14 | ||
| Upper Airway Development | 14 | ||
| Respiratory System Development | 14 | ||
| Transition to Air Breathing | 14 | ||
| Mechanics of Breathing | 15 | ||
| Chest Wall and Respiratory Muscles | 15 | ||
| Elastic Properties of the Lung | 15 | ||
| Static Lung Volumes | 15 | ||
| Total Lung Capacity | 15 | ||
| Functional Residual Capacity | 16 | ||
| Closing Capacity | 17 | ||
| Airway Dynamics | 17 | ||
| Resistance and Conductance | 17 | ||
| Distribution of Resistance | 17 | ||
| Inspiratory and Expiratory Flow Limitation | 17 | ||
| Regulation of Breathing | 17 | ||
| Cardiovascular System | 18 | ||
| Heart Rate | 18 | ||
| Blood Pressure | 18 | ||
| Cardiac Output | 18 | ||
| Normal Electrocardiographic Findings | 19 | ||
| Renal System | 19 | ||
| Digestive and Endocrine System | 19 | ||
| Hepatic System | 19 | ||
| Physiologic Jaundice | 20 | ||
| Gastrointestinal Tract | 20 | ||
| Pancreas | 21 | ||
| Hematopoietic and Immunologic System | 21 | ||
| Hemoglobin | 21 | ||
| Leukocyte and Immunology | 22 | ||
| Platelets | 22 | ||
| Coagulation | 22 | ||
| Polycythemia | 22 | ||
| Neurologic Development and Cognitive Development Issues | 22 | ||
| Neurologic Development | 22 | ||
| Interactions With the External World During Growth and Development | 23 | ||
| Acknowledgment | 24 | ||
| Annotated References | 24 | ||
| References | 24.e1 | ||
| 3 Perioperative Behavioral Stress in Children | 25 | ||
| Developmental Issues | 25 | ||
| Cognitive Development and Understanding of Illness | 25 | ||
| Attachment | 25 | ||
| Temperament | 26 | ||
| Preoperative Anxiety | 26 | ||
| Risk Factors | 26 | ||
| Behavioral Interventions | 26 | ||
| Preoperative Preparation Programs | 27 | ||
| Parental Presence During Induction of Anesthesia | 28 | ||
| The Preoperative Interview | 29 | ||
| Health Care Provider Interventions | 30 | ||
| Pharmacologic Interventions | 31 | ||
| Pharmacologic Interventions Versus Behavioral Interventions | 31 | ||
| Postoperative Outcomes | 32 | ||
| Emergence Delirium | 32 | ||
| Sleep Changes | 32 | ||
| Other Behavioral Changes | 32 | ||
| Intraoperative Clinical Outcomes | 33 | ||
| Summary | 33 | ||
| Annotated References | 33 | ||
| References | 34.e1 | ||
| 4 Preoperative Evaluation, Premedication, and Induction of Anesthesia | 35 | ||
| Preparation of Children for Anesthesia | 35 | ||
| Fasting | 35 | ||
| Piercings | 36 | ||
| Primary and Secondary Smoking | 36 | ||
| Primary Smoking | 36 | ||
| Secondary Smoking | 37 | ||
| Psychological Preparation of Children for Surgery | 37 | ||
| Child Development and Behavior | 38 | ||
| Parental Presence During Induction | 39 | ||
| History of Present Illness | 39 | ||
| Past/Other Medical History | 40 | ||
| Herbal Remedies | 40 | ||
| Anesthesia and Vaccination | 41 | ||
| Allergies to Medications and Latex | 41 | ||
| Family History | 42 | ||
| Laboratory Data | 42 | ||
| Pregnancy Testing | 42 | ||
| Premedication and Induction Principles | 42 | ||
| General Principles | 42 | ||
| Medications | 43 | ||
| Tranquilizers | 43 | ||
| Benzodiazepines | 43 | ||
| Barbiturates | 44 | ||
| Nonbarbiturate Sedatives | 44 | ||
| Opioids | 44 | ||
| Ketamine | 45 | ||
| α2-Agonists | 46 | ||
| Antihistamines | 46 | ||
| Anticholinergic Drugs | 46 | ||
| Topical Anesthetics | 47 | ||
| Nonopioid Analgesics | 47 | ||
| Antiemetics | 49 | ||
| Corticosteroids | 49 | ||
| Insulin | 49 | ||
| Antibiotics | 49 | ||
| Antacids, H2-Receptor Antagonists, and Gastrointestinal Motility Drugs | 49 | ||
| Induction of Anesthesia | 50 | ||
| Preparation for Induction | 50 | ||
| Inhalation Induction | 51 | ||
| Inhalation With Sevoflurane | 51 | ||
| Inhalation Induction With Halothane | 52 | ||
| Inhalation Induction With Desflurane | 52 | ||
| Hypnotic Induction | 52 | ||
| Modified Single-Breath Induction | 53 | ||
| Intravenous Induction | 53 | ||
| Thiopental | 53 | ||
| Methohexital | 53 | ||
| Propofol | 53 | ||
| Etomidate | 54 | ||
| Ketamine | 54 | ||
| Intramuscular Induction | 55 | ||
| Rectal Induction | 55 | ||
| Full Stomach and Rapid-Sequence Induction | 55 | ||
| Special Problems | 57 | ||
| The Fearful Child | 57 | ||
| Autism | 57 | ||
| Anemia | 58 | ||
| Upper Respiratory Tract Infection | 58 | ||
| Obesity | 59 | ||
| Obstructive Sleep Apnea Syndrome | 61 | ||
| Asymptomatic Cardiac Murmurs | 62 | ||
| Fever | 63 | ||
| Postanesthesia Apnea in Former Preterm Infants | 64 | ||
| Hyperalimentation | 65 | ||
| Diabetes | 65 | ||
| Bronchopulmonary Dysplasia | 66 | ||
| Seizure Disorder | 67 | ||
| Sickle Cell Disease | 67 | ||
| Acknowledgment | 67 | ||
| Annotated References | 67 | ||
| References | 68.e1 | ||
| 5 Ethical Issues in Pediatric Anesthesiology | 69 | ||
| Informed Consent | 69 | ||
| The Informed Consent Process | 69 | ||
| Assent: The Role of the Patient | 69 | ||
| Informed Permission, the Best Interest Standard and the Harm Threshold Standard | 69 | ||
| Disclosure | 70 | ||
| Informed Refusal | 71 | ||
| “Doctor, If This Were Your Child, What Would You Do?” | 71 | ||
| Disclosure and Apology of Medical Errors | 71 | ||
| Special Situations in Pediatric Informed Consent | 72 | ||
| Confidentially for Adolescents | 72 | ||
| The Pregnant Adolescent | 72 | ||
| The Adolescent and Abortion | 72 | ||
| Children of Jehovah’s Witnesses | 72 | ||
| Emergency Care | 73 | ||
| The Impaired Parent | 73 | ||
| End-of-Life Issues | 73 | ||
| Forgoing Potentially Life-Sustaining Treatment | 73 | ||
| Perioperative Limitations on Life-Sustaining Treatment | 73 | ||
| Barriers to Honoring Preferences for Resuscitation | 74 | ||
| Physicians Orders for Life-Sustaining Treatment | 74 | ||
| Potentially Inappropriate Interventions | 74 | ||
| Improving Communication in Pediatric Intensive Care Units | 75 | ||
| Organ Donation After Cardiac Death | 76 | ||
| Clinical and Academic Practice Issues | 76 | ||
| Pediatric Research | 76 | ||
| Minimal Risk | 76 | ||
| Minor Increase Over Minimal Risk | 77 | ||
| Socioeconomic Concerns and Distribution of Risk | 77 | ||
| Imperative for Pharmacologic Research | 77 | ||
| Managing Potential Conflicts of Interest | 78 | ||
| Conducting Research | 78 | ||
| Interaction With Industry | 78 | ||
| Production Pressure | 79 | ||
| Physician Obligations, Advocacy, and Good Citizenship | 79 | ||
| Participating in Patient Safety Efforts | 79 | ||
| Treating Suffering | 79 | ||
| Suspicion of Child Maltreatment | 80 | ||
| The Ethics Consultation Service | 80 | ||
| Annotated References | 80 | ||
| References | 80.e1 | ||
| II Drug and Fluid Therapy | 81 | ||
| 6 Pharmacogenomics | 81 | ||
| Historical Perspectives | 82 | ||
| Basic Concepts and Nomenclature | 82 | ||
| Hepatic Metabolism and Developmental Pharmacogenetics | 83 | ||
| Cytochromes P-450: Phase I Reactions | 83 | ||
| Developmental Changes of Specific Cytochromes | 83 | ||
| Phase II Reactions | 86 | ||
| Alterations in Biotransformation at Birth | 86 | ||
| Genomics of Drug Metabolism, Exposure, and Effects | 86 | ||
| Pharmacogenomics of Pain and Analgesia | 87 | ||
| Pain Perception and Genetics | 89 | ||
| Genetic Variations Affecting Opioid Pharmacokinetics | 89 | ||
| Codeine | 89 | ||
| Tramadol | 91 | ||
| Hydrocodone | 91 | ||
| Oxycodone | 91 | ||
| Morphine | 91 | ||
| Methadone | 92 | ||
| Genetic Variations Affecting Opioid Pharmacodynamics | 92 | ||
| Opioid Receptor (OPRM1) | 92 | ||
| Blood-Brain Barrier Transporter (ABCB1) | 93 | ||
| Opioid-Cannabinoid System Interactions | 93 | ||
| Genes of Addiction | 93 | ||
| Nonsteroidal Antiinflammatory Drugs and Genetics | 94 | ||
| Acetaminophen and Genetics | 94 | ||
| Chronic Pain, Persistent Postoperative Pain, and Genetics | 94 | ||
| Pharmacogenomics Affecting Anesthesia | 95 | ||
| Intravenous Anesthetics | 95 | ||
| Propofol | 95 | ||
| Inhalational Anesthetics | 95 | ||
| Nitrous Oxide | 95 | ||
| Benzodiazepines | 96 | ||
| Neuromuscular Blocking Drugs | 96 | ||
| Local Anesthetics | 96 | ||
| Perioperative Outcomes | 96 | ||
| Postoperative Nausea and Vomiting | 96 | ||
| Perioperative Bleeding | 97 | ||
| Hemodynamic Response | 97 | ||
| Effect on Other Perioperative Outcomes | 97 | ||
| Ancestry/Race and Genetics | 97 | ||
| Pharmacogenomics Methods | 98 | ||
| Common Genotyping Methods | 98 | ||
| Common Limitations of Genetic Research Studies and Interpretation of Genetic Studies | 98 | ||
| Current Costs of Genotyping and Third-Party Coverage for Genotyping | 98 | ||
| Genetic Counseling | 98 | ||
| Clinical Translation: Bench to Bedside: Where Are We Now? | 98 | ||
| Conclusion | 98 | ||
| Annotated References | 99 | ||
| References | 99.e1 | ||
| 7 Pharmacokinetics and Pharmacology of Drugs Used in Children | 100 | ||
| Pharmacokinetic Principles and Calculations | 101 | ||
| First-Order Kinetics | 101 | ||
| Half-Life | 101 | ||
| First-Order Single-Compartment Kinetics | 102 | ||
| First-Order Multiple-Compartment Kinetics | 102 | ||
| Zero-Order Kinetics | 103 | ||
| Apparent Volume of Distribution | 103 | ||
| Pharmacokinetic Example | 104 | ||
| Repetitive Dosing and Drug Accumulation | 104 | ||
| Steady State | 104 | ||
| Loading Dose | 105 | ||
| Population Modeling | 105 | ||
| Pediatric Pharmacokinetic Considerations | 105 | ||
| Size | 105 | ||
| Maturation | 106 | ||
| Organ Function | 106 | ||
| Pharmacodynamic Models | 107 | ||
| Minimal Effective Concentration | 107 | ||
| Sigmoid Emax Model | 107 | ||
| Quantal Effect Model | 107 | ||
| Logistic Regression Model | 108 | ||
| Linking Pharmacokinetics With Pharmacodynamics | 108 | ||
| Drug Distribution | 108 | ||
| Protein Binding | 108 | ||
| Body Composition | 109 | ||
| Regional Blood Flows | 110 | ||
| Blood-Brain Barrier | 110 | ||
| Absorption | 110 | ||
| Enteral | 110 | ||
| Cutaneous | 110 | ||
| Intramuscular | 110 | ||
| Nasal | 110 | ||
| Bioavailability | 111 | ||
| Metabolism and Excretion | 111 | ||
| Hepatic Metabolism | 111 | ||
| Phase I Reactions: Cytochrome P-450 | 112 | ||
| Phase II Reactions | 113 | ||
| Alterations in Biotransformation | 113 | ||
| Extrahepatic Routes of Metabolic Clearance | 114 | ||
| Renal Excretion | 114 | ||
| Central Nervous System Effects | 115 | ||
| Pharmacodynamics in Children | 115 | ||
| Measurement of Pharmacodynamic Endpoints | 116 | ||
| The Target Concentration Approach | 116 | ||
| Defining Target Concentration | 116 | ||
| Drug Interactions | 117 | ||
| The Drug Approval Process, the Package Insert, and Drug Labeling | 117 | ||
| Inhalation Anesthetic Agents | 118 | ||
| Physicochemical Properties | 118 | ||
| Pharmacokinetics of Inhaled Anesthetics | 119 | ||
| Factors Affecting Delivery of Inhaled Anesthetics to the Lungs | 120 | ||
| Inspired Concentration | 120 | ||
| Alveolar Ventilation and Functional Residual Capacity | 120 | ||
| Factors Affecting the Uptake (Removal) of Inhaled Anesthetics From the Lungs | 120 | ||
| Cardiac Output | 120 | ||
| Solubility | 120 | ||
| Alveolar to Venous Partial Pressure Gradient | 121 | ||
| Second Gas Effect | 121 | ||
| Induction | 121 | ||
| Control of Anesthetic Depth | 122 | ||
| Shunts | 123 | ||
| Wash-Out and Emergence | 124 | ||
| Pharmacodynamics of Inhaled Anesthetics | 124 | ||
| Minimum Alveolar Concentration | 124 | ||
| Central Nervous System | 126 | ||
| Cardiovascular System | 127 | ||
| Respiratory System | 129 | ||
| Renal System | 130 | ||
| Hepatic System | 130 | ||
| Clinical Effects | 131 | ||
| Induction Techniques | 131 | ||
| Emergence | 132 | ||
| Emergence Delirium | 132 | ||
| Neuromuscular Junction | 133 | ||
| Malignant Hyperthermia | 133 | ||
| Stability and Toxicology of Breakdown Products | 133 | ||
| Nitrous Oxide | 134 | ||
| Environmental Impact | 135 | ||
| Oxygen | 135 | ||
| Intravenous Anesthetic Agents | 136 | ||
| Barbiturates | 136 | ||
| Methohexital | 136 | ||
| Thiopental | 136 | ||
| Propofol | 137 | ||
| Ketamine | 140 | ||
| Etomidate | 142 | ||
| Neuromuscular Blocking Drugs | 142 | ||
| Neuromuscular Monitoring | 142 | ||
| Neuromuscular Junction | 144 | ||
| Pharmacodynamics | 145 | ||
| Pharmacokinetics | 145 | ||
| Depolarizing Neuromuscular Blocking Drugs | 146 | ||
| Succinylcholine | 146 | ||
| Cholinesterase Deficiency | 146 | ||
| Adverse Effects of Succinylcholine | 147 | ||
| Temporomandibular Joint Stiffness | 147 | ||
| Arrhythmias | 147 | ||
| Hyperkalemia | 147 | ||
| Biochemical Changes | 148 | ||
| Rhabdomyolysis | 148 | ||
| Myoglobinemia | 148 | ||
| Fasciculations | 148 | ||
| Intraocular Pressure | 148 | ||
| Clinical Uses of Succinylcholine | 148 | ||
| Intermediate-Acting Nondepolarizing Neuromuscular Blocking Drugs | 149 | ||
| Atracurium | 149 | ||
| Cisatracurium | 149 | ||
| Vecuronium | 149 | ||
| Rocuronium | 150 | ||
| Clinical Implications When Using Short- and Intermediate-Acting Neuromuscular Blocking Drugs | 150 | ||
| Long-Acting Nondepolarizing Neuromuscular Blocking Drugs | 150 | ||
| Pancuronium | 150 | ||
| Antagonism of Neuromuscular Blocking Drugs | 151 | ||
| General Principles | 151 | ||
| Sugammadex | 152 | ||
| Neuromuscular Blocking Drugs in Special Situations | 152 | ||
| Opioids | 153 | ||
| Morphine | 153 | ||
| Pharmacodynamics | 153 | ||
| Pharmacokinetics | 153 | ||
| Routes of Administration | 154 | ||
| Adverse Effects | 154 | ||
| Meperidine | 155 | ||
| Hydromorphone | 155 | ||
| Oxycodone | 155 | ||
| Hydrocodone | 156 | ||
| Methadone | 156 | ||
| Fentanyl | 157 | ||
| Alfentanil | 159 | ||
| Sufentanil | 159 | ||
| Remifentanil | 160 | ||
| Butorphanol and Nalbuphine | 162 | ||
| Codeine | 162 | ||
| Tramadol | 163 | ||
| Tapentadol | 163 | ||
| Acetaminophen | 164 | ||
| Nonsteroidal Antiinflammatory Agents | 165 | ||
| Ketorolac | 166 | ||
| Benzodiazepine Sedatives | 167 | ||
| Midazolam | 167 | ||
| Diazepam | 169 | ||
| Other Sedatives | 169 | ||
| Clonidine | 169 | ||
| Dexmedetomidine | 170 | ||
| Chloral Hydrate | 172 | ||
| Antihistamines | 173 | ||
| Diphenhydramine | 173 | ||
| Cimetidine, Ranitidine, and Famotidine | 173 | ||
| Antiemetics | 173 | ||
| Metoclopramide | 173 | ||
| 5-Hydroxytryptamine Type 3–Receptor Antagonists | 173 | ||
| Neurokinin 1 and Other Antiemetics | 174 | ||
| Anticholinergics | 174 | ||
| Atropine and Scopolamine | 174 | ||
| Glycopyrrolate | 175 | ||
| Antagonists | 175 | ||
| Naloxone | 175 | ||
| Naltrexone | 175 | ||
| Methylnaltrexone | 176 | ||
| Flumazenil | 176 | ||
| Physostigmine | 176 | ||
| Annotated References | 176 | ||
| References | 176.e1 | ||
| 8 Total Intravenous Anesthesia and Target-Controlled Infusion | 177 | ||
| Pharmacokinetic and Pharmacodynamic Principles | 177 | ||
| Pediatric Pharmacokinetic Parameter Sets | 177 | ||
| The Target Concentration | 179 | ||
| Linking Pharmacokinetics With Pharmacodynamics | 179 | ||
| Pharmacodynamic Interaction Models | 180 | ||
| Traditional Methods | 180 | ||
| Response Surface Models | 181 | ||
| Depth of Anesthesia Monitoring | 182 | ||
| Common TIVA Drugs | 182 | ||
| Achieving the Target Concentration in a Multicompartment Model | 183 | ||
| Fixed Infusion Rate and a Three-Compartment Model | 184 | ||
| Bolus and Variable Rate Infusion in a Three-Compartment Model | 185 | ||
| The Target-Controlled Infusion | 189 | ||
| A Practical Approach in Children | 192 | ||
| Drug Delivery | 192 | ||
| Infusion Regimes | 193 | ||
| The Obese Child | 193 | ||
| Remifentanil as an Adjunct | 194 | ||
| Injection Pain With Propofol | 194 | ||
| Establishing TIVA After an Inhalational Induction | 194 | ||
| Practical Approaches for Some Clinical Scenarios | 194 | ||
| Spontaneously Breathing Diagnostic Procedures (Radiology Investigations) | 194 | ||
| Spontaneously Breathing Airway Procedures Without an Endotracheal Tube (Flexible Respiratory Bronchoscopy, Rigid Laryngobronchoscopy) | 195 | ||
| Spontaneously Breathing Procedures With an Endotracheal Tube (Adenotonsillectomy) | 195 | ||
| Spontaneously Breathing Surgical Procedures With an LMA (Orthopedic and Peripheral Surgical Procedures) | 195 | ||
| Major Invasive Procedures With Intubation (General, Thoracic, Neurosurgical, or Major Orthopedic Surgery (e.g., Posterior Spinal Fusion) | 195 | ||
| A Neonate Having Combined Anesthesia and Regional Blockade | 195 | ||
| Common Manual Propofol Infusion Schemes | 195 | ||
| Adults | 195 | ||
| Adolescents | 196 | ||
| Children | 196 | ||
| Infants | 196 | ||
| Common Manual Opioid Infusion Schemes | 197 | ||
| Ready Mixes | 197 | ||
| Acknowledgement | 197 | ||
| Annotated References | 198 | ||
| References | 198.e1 | ||
| Suggested Websites | 198.e3 | ||
| 9 Fluid Management | 199 | ||
| Regulatory Mechanisms: Fluid Volume, Osmolality, and Arterial Pressure | 199 | ||
| Maturation of Fluid Compartments and Homeostatic Mechanisms | 201 | ||
| Body Water and Electrolyte Distribution | 201 | ||
| Circulating Blood Volume | 201 | ||
| Maturation of Homeostatic Mechanisms | 202 | ||
| Fluid and Electrolyte Requirements | 203 | ||
| Neonatal Fluid Management | 204 | ||
| Intraoperative Fluid Management | 205 | ||
| Intravenous Access and Fluid Administration Devices | 205 | ||
| Choice and Composition of Intravenous Fluids | 206 | ||
| Hyperalimentation | 207 | ||
| Fasting Recommendations | 208 | ||
| Assessment of Intravascular Volume | 208 | ||
| Ongoing Losses and Third-Spacing | 208 | ||
| Postoperative Fluid Management | 209 | ||
| General Approach | 209 | ||
| Postoperative Physiology and Hyponatremia | 209 | ||
| Postoperative Pulmonary Edema | 209 | ||
| Pathophysiologic States and Their Management | 210 | ||
| Fluid Overload and Edema | 210 | ||
| Dehydration States | 210 | ||
| Septic Shock | 211 | ||
| Hypernatremia and Hyponatremia | 212 | ||
| Hypernatremia | 212 | ||
| Hyponatremia | 212 | ||
| Disorders of Potassium Homeostasis | 213 | ||
| Hyperkalemia | 213 | ||
| Hypokalemia | 214 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Secretion | 214 | ||
| Diabetes Insipidus | 215 | ||
| Hyperchloremic Acidosis | 215 | ||
| Hypochloremic Metabolic Alkalosis | 215 | ||
| Cerebral Salt Wasting | 216 | ||
| Acknowledgment | 216 | ||
| Annotated References | 216 | ||
| References | 216.e1 | ||
| 10 Essentials of Hematology | 217 | ||
| The Basics | 217 | ||
| Laboratory Values and Diagnostic Tests | 217 | ||
| Guidelines for Transfusion | 218 | ||
| Hemolytic Anemias | 219 | ||
| Hereditary Spherocytosis | 220 | ||
| Pathophysiology | 220 | ||
| Clinical and Laboratory Features | 220 | ||
| Perioperative Considerations | 221 | ||
| Glucose-6-Phosphate Dehydrogenase Deficiency | 221 | ||
| Pathophysiology | 221 | ||
| Clinical and Laboratory Features | 222 | ||
| Perioperative Considerations | 222 | ||
| Hemoglobinopathies | 222 | ||
| Sickle Cell Disease | 222 | ||
| Pathophysiology | 223 | ||
| Clinical and Laboratory Features and Treatment | 223 | ||
| Perioperative Considerations | 225 | ||
| Thalassemias | 226 | ||
| Pathophysiology | 226 | ||
| Clinical and Laboratory Features and Treatment | 227 | ||
| Perioperative Considerations | 227 | ||
| Thrombocytopenia | 227 | ||
| Platelet Disorders and Bleeding | 227 | ||
| Idiopathic Thrombocytopenic Purpura | 228 | ||
| Pathophysiology | 228 | ||
| Clinical and Laboratory Features and Treatment | 228 | ||
| Perioperative Considerations | 228 | ||
| Coagulation Disorders | 229 | ||
| Screening | 229 | ||
| Von Willebrand Disease | 229 | ||
| Pathophysiology and Classification | 229 | ||
| Clinical and Laboratory Features and Treatment | 230 | ||
| Perioperative Concerns | 230 | ||
| Hemophilia | 230 | ||
| Pathophysiology | 231 | ||
| Clinical and Laboratory Features and Treatment | 231 | ||
| Perioperative Concerns | 231 | ||
| Hypercoagulability | 232 | ||
| Hematologic Malignancies | 232 | ||
| Acute Lymphoblastic Leukemia | 233 | ||
| Pathophysiology | 233 | ||
| Clinical and Laboratory Features and Treatment | 234 | ||
| Perioperative Considerations | 234 | ||
| Acute Myelogenous Leukemia | 235 | ||
| Pathophysiology | 235 | ||
| Clinical and Laboratory Features and Treatment | 235 | ||
| Perioperative Considerations | 236 | ||
| Hodgkin Lymphoma | 236 | ||
| Pathophysiology | 236 | ||
| Clinical and Laboratory Features and Treatment | 236 | ||
| Perioperative Considerations | 237 | ||
| Non-Hodgkin Lymphoma | 237 | ||
| Pathophysiology | 237 | ||
| Clinical and Laboratory Features and Treatment | 237 | ||
| III The Chest | 281 | ||
| 13 Essentials of Pulmonology | 281 | ||
| Respiratory Physiology | 281 | ||
| Preoperative Assessment | 283 | ||
| Pulmonary Function Tests | 283 | ||
| Perioperative Etiology and Epidemiology | 285 | ||
| Upper Respiratory Tract Infection | 285 | ||
| Lower Airway Disease | 288 | ||
| Cystic Fibrosis | 292 | ||
| Sickle Cell Disease | 295 | ||
| Summary | 296 | ||
| Annotated References | 296 | ||
| References | 296.e1 | ||
| 14 The Pediatric Airway | 297 | ||
| Developmental Anatomy of the Airway | 297 | ||
| Tongue | 297 | ||
| Position of the Larynx | 297 | ||
| Epiglottis | 298 | ||
| Vocal Folds | 298 | ||
| Subglottis | 298 | ||
| The Larynx | 301 | ||
| Anatomy | 301 | ||
| Structure | 301 | ||
| Histology | 302 | ||
| Sensory and Motor Innervation | 302 | ||
| Blood Supply | 303 | ||
| Function | 303 | ||
| Inspiration | 303 | ||
| Expiration | 303 | ||
| Forced Glottic Closure and Laryngospasm | 303 | ||
| Swallowing | 303 | ||
| Phonation | 303 | ||
| Physiology of the Respiratory System | 303 | ||
| Obligate Nasal Breathing | 303 | ||
| Tracheal and Bronchial Function | 304 | ||
| Work of Breathing | 304 | ||
| Airway Obstruction During Anesthesia | 304 | ||
| Evaluation of the Airway | 306 | ||
| Clinical Evaluation | 306 | ||
| Medical History | 306 | ||
| Physical Examination | 307 | ||
| Diagnostic Testing | 307 | ||
| Airway Management: The Normal Airway | 307 | ||
| Mask Ventilation | 307 | ||
| Oropharyngeal Airways | 308 | ||
| Nasopharyngeal Airways | 308 | ||
| Tracheal Intubation | 308 | ||
| Technique | 308 | ||
| Selection of Laryngoscope Blade | 311 | ||
| Endotracheal Tubes | 311 | ||
| Endotracheal Tube Insertion Distance | 312 | ||
| Complications of Tracheal Intubation | 313 | ||
| Postintubation Croup | 313 | ||
| Laryngotracheal (Subglottic) Stenosis | 313 | ||
| Laryngeal Mask Airway | 314 | ||
| Other Supraglottic Airway Devices | 318 | ||
| The Laryngeal Tube | 318 | ||
| The Cobra Perilaryngeal Airway | 319 | ||
| The i-gel | 319 | ||
| Summary | 319 | ||
| Airway Management: The Abnormal Airway | 319 | ||
| Classifying the Abnormal Pediatric Airway | 319 | ||
| Management Principles | 320 | ||
| Documentation | 324 | ||
| The Unexpected Difficult Intubation | 325 | ||
| Extubation of the Child With the Difficult Airway | 326 | ||
| Special Techniques for Ventilation | 326 | ||
| Multi-Handed Mask Ventilation Techniques | 326 | ||
| Laryngeal Mask Airway | 326 | ||
| Percutaneous Needle Cricothyroidotomy | 326 | ||
| Laryngeal Mask Airway Versus Percutaneous Needle Cricothyroidotomy and Transtracheal Jet Ventilation | 329 | ||
| Surgical Airway | 329 | ||
| Anterior Commissure Scope and Rigid Ventilating Bronchoscope | 329 | ||
| Special Techniques for Intubation | 330 | ||
| Rigid Laryngoscopy | 330 | ||
| Optimal External Laryngeal Manipulation | 330 | ||
| Intubation Guides | 330 | ||
| Dental Mirror | 330 | ||
| Retromolar, Paraglossal, or Lateral Approach Using a Straight Blade | 330 | ||
| Fiberoptic Laryngoscopy | 330 | ||
| Equipment | 331 | ||
| Ancillary Equipment | 331 | ||
| Direct Technique | 332 | ||
| Staged Techniques | 332 | ||
| Lighted Stylet | 333 | ||
| Bullard Laryngoscope | 333 | ||
| Retrograde Wire-Guided Intubation | 333 | ||
| Video and Indirect Intubating Devices | 334 | ||
| Videolaryngoscopes | 334 | ||
| Optical Laryngoscopes | 335 | ||
| Optical Stylets | 336 | ||
| Shikani Optical Stylet. | 336 | ||
| Storz Bonfils Optical Stylet. | 337 | ||
| Shikani Versus Storz Bonfils Optical Stylets. | 337 | ||
| Laryngeal Mask Airway as a Conduit for Intubation | 337 | ||
| The air-Q | 337 | ||
| Combined Techniques | 338 | ||
| Retrograde Wire and the Flexible Fiberoptic Bronchoscope | 338 | ||
| Rigid Laryngoscopy and the Flexible Fiberoptic Bronchoscope | 338 | ||
| Flexible Fiberoptic Bronchoscope Used in a Retrograde Manner | 338 | ||
| Retrograde Light–Guided Laryngoscopy | 338 | ||
| Acknowledgments | 339 | ||
| Annotated References | 339 | ||
| References | 339.e1 | ||
| 15 Anesthesia for Thoracic Surgery | 340 | ||
| General Perioperative Considerations | 340 | ||
| Ventilation and Perfusion During Thoracic Surgery | 340 | ||
| Thoracoscopy | 341 | ||
| Techniques for Single-Lung Ventilation in Infants and Children | 342 | ||
| Use of a Single-Lumen Endotracheal Tube | 342 | ||
| Use of Balloon-Tipped Bronchial Blockers | 343 | ||
| Use of a Univent Tube | 344 | ||
| Use of Double-Lumen Tubes | 344 | ||
| General Considerations in the Management of Single-Lung Ventilation | 347 | ||
| Surgical Lesions of the Chest | 348 | ||
| Neonates and Infants | 348 | ||
| Childhood | 352 | ||
| Summary | 353 | ||
| Annotated References | 353 | ||
| References | 354.e1 | ||
| IV The Heart | 355 | ||
| 16 Essentials of Cardiology | 355 | ||
| Congenital Heart Disease | 355 | ||
| Incidence | 355 | ||
| Segmental Approach to Diagnosis | 356 | ||
| Physiologic Classification of Defects | 357 | ||
| Volume Overload Lesions | 357 | ||
| Obstruction to Systemic Blood Flow | 357 | ||
| Obstruction to Pulmonary Blood Flow | 358 | ||
| Parallel Circulation | 358 | ||
| Single-Ventricle Lesions | 358 | ||
| Intrinsic Myocardial Disorders | 358 | ||
| Acquired Heart Disease | 358 | ||
| Cardiomyopathies | 358 | ||
| Myocarditis | 360 | ||
| Rheumatic Fever and Rheumatic Heart Disease | 362 | ||
| Infective Endocarditis | 362 | ||
| Causes and Treatment | 362 | ||
| Endocarditis Prophylaxis | 363 | ||
| Kawasaki Disease | 363 | ||
| Cardiac Tumors | 364 | ||
| Heart Failure in Children | 364 | ||
| Definition and Pathophysiology | 364 | ||
| Etiology and Clinical Features | 364 | ||
| Treatment Strategies | 365 | ||
| Anesthetic Considerations | 365 | ||
| Syndromes, Associations, and Systemic Disorders: Cardiovascular Disease and Anesthetic Implications | 365 | ||
| Chromosomal Syndromes | 365 | ||
| Trisomy 21 | 365 | ||
| Trisomy 18 | 366 | ||
| Trisomy 13 | 366 | ||
| Turner Syndrome | 366 | ||
| Gene Deletion Syndromes | 366 | ||
| Williams Syndrome | 366 | ||
| Chromosome 22q11.2 Deletion Syndrome: DiGeorge and Velocardiofacial Syndrome | 367 | ||
| Single-Gene Defects | 367 | ||
| Noonan Syndrome | 367 | ||
| Marfan Syndrome | 367 | ||
| CHARGE Syndrome | 368 | ||
| Associations | 368 | ||
| VACTERL (or VATER) Association | 368 | ||
| Other Disorders | 368 | ||
| Selected Vascular Anomalies and Their Implications for Anesthesia | 369 | ||
| Aberrant Subclavian Artery | 369 | ||
| Persistent Left Superior Vena Cava to the Coronary Sinus | 370 | ||
| Evaluation of the Child With a Cardiac Murmur | 370 | ||
| Basic Interpretation of the Electrocardiogram in Children | 371 | ||
| Essentials of Cardiac Rhythm Interpretation and Acute Arrhythmia Management in Children | 374 | ||
| Basic Rhythms | 376 | ||
| Sinus Rhythm | 376 | ||
| Sinus Arrhythmia | 376 | ||
| Sinus Bradycardia | 376 | ||
| Sinus Tachycardia | 376 | ||
| Junctional Rhythm | 376 | ||
| Conduction Disorders | 377 | ||
| Bundle Branch Block | 377 | ||
| Atrioventricular Block | 377 | ||
| First-Degree Atrioventricular Block | 377 | ||
| Second-Degree Atrioventricular Block | 377 | ||
| Third-Degree Atrioventricular Block | 377 | ||
| Cardiac Arrhythmias | 377 | ||
| Supraventricular Arrhythmias | 377 | ||
| Premature Atrial Contractions or Beats | 377 | ||
| Supraventricular Tachycardia | 377 | ||
| Ventricular Arrhythmias | 379 | ||
| Premature Ventricular Contractions or Beats | 379 | ||
| Ventricular Tachycardia | 379 | ||
| Long QT Syndrome | 379 | ||
| Ventricular Fibrillation | 381 | ||
| Pacemaker and Defibrillator Therapy in the Pediatric Age Group | 382 | ||
| Pacemaker Nomenclature | 382 | ||
| Permanent Cardiac Pacing | 382 | ||
| Indications | 382 | ||
| Perioperative Considerations | 382 | ||
| Transcutaneous Pacing | 383 | ||
| Implantable Cardioverter-Defibrillators | 383 | ||
| Diagnostic Modalities in Pediatric Cardiology | 383 | ||
| Chest Radiography | 383 | ||
| Barium Esophagram | 383 | ||
| Echocardiography | 384 | ||
| Interpretation of an Echocardiographic Report | 384 | ||
| Measurements of Cardiac Chambers and Vessel Dimensions | 384 | ||
| Assessment of Ventricular Function | 385 | ||
| Estimation of Pressures | 385 | ||
| Evaluation of Gradients | 385 | ||
| Evaluation of Regurgitant Lesions | 386 | ||
| Magnetic Resonance Imaging | 386 | ||
| Computed Tomography | 386 | ||
| Cardiac Catheterization and Angiography | 387 | ||
| Interpretation of a Cardiac Catheterization Report | 389 | ||
| Pressure Data | 389 | ||
| Shunt Calculations | 389 | ||
| Cardiac Output Determinations | 389 | ||
| Vascular Resistances | 389 | ||
| Perioperative Considerations for Children With Cardiovascular Disease | 389 | ||
| General Issues | 389 | ||
| Clinical Condition and Status of Prior Repair | 391 | ||
| Summary | 391 | ||
| Acknowledgment | 392 | ||
| Annotated References | 392 | ||
| References | 392.e1 | ||
| 17 Anesthesia for Children Undergoing Heart Surgery | 393 | ||
| Preoperative Evaluation | 393 | ||
| The Preoperative Visit and Evaluation | 394 | ||
| Medical Assessment | 394 | ||
| Prescribing Premedication | 394 | ||
| Giving Information | 394 | ||
| Creating Rapport With the Child and Family | 395 | ||
| Formulating an Anesthetic Plan | 395 | ||
| Upper Respiratory Tract Infection and Cardiac Surgery | 395 | ||
| Perioperative Challenges in Pediatric Cardiac Anesthesia | 395 | ||
| Cyanosis | 395 | ||
| Intracardiac Shunting | 395 | ||
| Restrictive and Unrestrictive Shunts | 395 | ||
| Dependent Shunting During Anesthesia | 396 | ||
| Impaired Hemostasis | 396 | ||
| Strategies to Reduce Bleeding After Bypass | 396 | ||
| Antifibrinolytics | 397 | ||
| Topical Agents | 397 | ||
| Ultrafiltration | 397 | ||
| Desmopressin | 397 | ||
| Anesthesia Management for Surgery Requiring Cardiopulmonary Bypass | 398 | ||
| Monitoring | 398 | ||
| Transesophageal Echocardiography | 399 | ||
| Near-Infrared Spectroscopy | 399 | ||
| Induction of Anesthesia | 399 | ||
| Maintenance of Anesthesia | 400 | ||
| Institution and Separation From Bypass | 400 | ||
| Control of Systemic and Pulmonary Vascular Resistance During Anesthesia | 401 | ||
| Anesthetic Drugs Used in Pediatric Cardiac Anesthesia | 402 | ||
| Inhalational Agents | 402 | ||
| Sevoflurane | 402 | ||
| Isoflurane | 402 | ||
| Halothane | 402 | ||
| Nitrous Oxide | 402 | ||
| Intravenous Induction Agents | 403 | ||
| Ketamine | 403 | ||
| Etomidate | 403 | ||
| Propofol | 403 | ||
| Opioids | 403 | ||
| Fentanyl | 403 | ||
| Sufentanil | 404 | ||
| Remifentanil | 404 | ||
| Neuromuscular Blocking Drugs | 404 | ||
| Long-Term Neurocognitive-Developmental Outcomes Associated With Anesthesia | 404 | ||
| Regional Anesthesia | 404 | ||
| Fast Tracking | 405 | ||
| Cardiopulmonary Bypass | 405 | ||
| Stress Response to Cardiac Surgery | 405 | ||
| Reducing the Stress Response to Surgery and Bypass | 406 | ||
| Corticosteroids | 406 | ||
| Aprotinin | 406 | ||
| Allopurinol | 406 | ||
| Ischemic Preconditioning | 406 | ||
| Glucose-Insulin and Potassium | 407 | ||
| Anesthesia Considerations for Specific Cardiac Defects | 407 | ||
| Simple Left-to-Right Shunts | 407 | ||
| Atrial Septal Defect | 408 | ||
| V The Brain and Glands | 561 | ||
| 24 Essentials of Neurology and Neuromuscular Disorders | 561 | ||
| General Considerations | 561 | ||
| Static Neurologic Disorders | 562 | ||
| Cerebral Palsies | 562 | ||
| Multisystem Comorbidities | 562 | ||
| Anesthesia Considerations for Cerebral Palsies | 563 | ||
| Malformations of the Nervous System | 563 | ||
| Neural Tube Defects: Cranial and Spinal Dysraphism | 564 | ||
| Chiari Malformation | 564 | ||
| Syringomyelia | 565 | ||
| Hydrocephalus | 565 | ||
| Disorders of Ventral Induction | 566 | ||
| Disorders of Cortical Development | 566 | ||
| Progressive Neurologic Disorders | 566 | ||
| Primary Brain Tumors | 566 | ||
| Metabolic Disease | 567 | ||
| Anesthesia Considerations for Progressive Neurologic Disorders | 568 | ||
| Neuromuscular Disorders | 568 | ||
| Disorders of the Anterior Horn Cell | 568 | ||
| Spinal Muscular Atrophies | 568 | ||
| Anesthesia Considerations for Spinal Muscular Atrophies | 570 | ||
| Poliomyelitis | 570 | ||
| Axonal Disorders | 570 | ||
| Hereditary Neuropathies | 570 | ||
| Acquired Disorders of the Peripheral Nerves | 570 | ||
| Guillain-Barré Syndrome | 570 | ||
| Chronic Inflammatory Demyelinating Polyneuropathy | 571 | ||
| Nerve Palsies | 571 | ||
| Disorders of the Neuromuscular Junction | 571 | ||
| Myasthenia Gravis | 571 | ||
| Neonatal Transient Myasthenia Gravis | 572 | ||
| Congenital Myasthenic Syndromes | 572 | ||
| Anesthesia Considerations for Myasthenia Gravis | 572 | ||
| Myasthenia-Like Syndrome | 572 | ||
| Disorders of Muscle Fibers | 572 | ||
| Myopathies | 572 | ||
| Congenital Myopathies | 572 | ||
| Metabolic Myopathies | 573 | ||
| Mitochondrial Disorders Underlying Myopathies | 574 | ||
| Anesthesia Considerations for Myopathies | 574 | ||
| Muscular Dystrophies | 575 | ||
| Myotonic Dystrophy | 576 | ||
| Dystrophinopathies | 576 | ||
| Anesthesia Considerations for Muscular Dystrophies | 578 | ||
| Undiagnosed Myopathy | 578 | ||
| Epilepsy | 579 | ||
| Summary | 580 | ||
| Annotated References | 580 | ||
| References | 580.e1 | ||
| 25 Surgery, Anesthesia, and the Immature Brain | 581 | ||
| Background | 581 | ||
| Normal Brain Development | 582 | ||
| Effects of Anesthetic Exposure on the Developing Brain | 583 | ||
| Apoptotic Cell Death | 583 | ||
| Long-Term Brain Cellular Viability, Neurologic Function, and Behavior | 585 | ||
| Effects on Neurogenesis and Gliogenesis | 586 | ||
| Alterations in Dendritic Architecture | 586 | ||
| Decrease in Trophic Factors | 586 | ||
| Degeneration of Mitochondria | 586 | ||
| Abnormal Reentry Into Cell Cycle | 587 | ||
| Destabilization of the Cytoskeleton | 587 | ||
| Effects on the Developing Spinal Cord | 587 | ||
| Putative Mechanisms for Neurotoxicity | 587 | ||
| Specific Anesthetic and Sedative Agents | 588 | ||
| Ketamine | 588 | ||
| Inhalational Anesthetics | 588 | ||
| Nitrous Oxide | 589 | ||
| Xenon | 589 | ||
| Benzodiazepines | 589 | ||
| Chloral Hydrate | 589 | ||
| Barbiturates | 590 | ||
| Propofol | 590 | ||
| Dexmedetomidine | 590 | ||
| Opioid Analgesics | 590 | ||
| Exposure Time, Dose, and Anesthetic Combinations | 591 | ||
| Deleterious Effects of Untreated Pain and Stress | 591 | ||
| Potential Alleviating Strategies | 592 | ||
| Anesthetic Neuroprotection | 592 | ||
| Critical Evaluation of Animal Studies and Interspecies Comparisons | 593 | ||
| Duration of Exposure | 593 | ||
| Anesthetic Doses | 594 | ||
| Experimental Versus Clinical Conditions | 595 | ||
| Comparative Brain Development | 595 | ||
| Assessing Neurobehavioral or Cognitive Outcomes | 596 | ||
| Long-Term Outcome in Children Exposed to Anesthesia and Surgery | 596 | ||
| Outcome After Exposure to Anesthesia Outside of the Operating Room | 600 | ||
| Limitations of the Available Clinical Studies | 601 | ||
| Future Research | 602 | ||
| Recommendations for Clinical Practice | 602 | ||
| Annotated References | 603 | ||
| References | 603.e1 | ||
| 26 Pediatric Neurosurgical Anesthesia | 604 | ||
| Pathophysiology | 604 | ||
| Intracranial Compartments | 604 | ||
| Intracranial Pressure | 604 | ||
| Herniation Syndromes | 605 | ||
| Signs of Increased Intracranial Pressure | 605 | ||
| Monitoring Intracranial Pressure | 605 | ||
| Intracranial Compliance | 605 | ||
| Cerebral Blood Volume and Cerebral Blood Flow | 606 | ||
| Cerebral Perfusion Pressure | 606 | ||
| Cerebrovascular Autoregulation | 606 | ||
| Effects of Blood Pressure | 606 | ||
| Effects of Oxygen | 607 | ||
| Effects of Carbon Dioxide | 607 | ||
| Management of Anesthesia | 607 | ||
| Preoperative Evaluation | 607 | ||
| History | 607 | ||
| Physical Examination | 608 | ||
| Laboratory and Radiologic Evaluation | 608 | ||
| Premedication | 608 | ||
| Monitoring | 608 | ||
| Induction | 609 | ||
| Airway Management and Intubation | 609 | ||
| Neuromuscular Blocking Drugs | 609 | ||
| Positioning | 610 | ||
| Prone Position | 610 | ||
| Modified Lateral Position | 611 | ||
| Sitting Position | 611 | ||
| Local Anesthesia | 611 | ||
| Maintenance of General Anesthesia | 612 | ||
| Apoptotic Neurodegeneration | 613 | ||
| Blood and Fluid Management | 613 | ||
| Temperature Control | 614 | ||
| Venous Air Emboli | 614 | ||
| Emergence | 615 | ||
| Special Situations | 616 | ||
| Trauma | 616 | ||
| Head Injury | 616 | ||
| Scalp Injuries | 616 | ||
| Skull Fractures | 617 | ||
| Epidural Hematoma | 617 | ||
| Subdural Hematoma | 617 | ||
| Intracerebral Hematoma | 618 | ||
| Spinal Injury | 618 | ||
| Craniotomy | 619 | ||
| Tumors | 619 | ||
| Vascular Anomalies | 620 | ||
| Arteriovenous Malformations | 620 | ||
| Aneurysms | 620 | ||
| Moyamoya Disease | 621 | ||
| Seizure Surgery | 622 | ||
| Hydrocephalus | 623 | ||
| Congenital Anomalies | 625 | ||
| Encephalocele | 625 | ||
| Myelodysplasia | 625 | ||
| Chiari Malformations | 626 | ||
| Other Spinal Defects | 627 | ||
| Neuroradiologic Procedures | 627 | ||
| Acknowledgments | 627 | ||
| Annotated References | 628 | ||
| References | 628.e1 | ||
| 27 Essentials of Endocrinology | 629 | ||
| Diabetes Mellitus* | 629 | ||
| Classification and Epidemiology in Children | 629 | ||
| General Management Principles | 630 | ||
| Metabolic Response to Surgery | 631 | ||
| Metabolic Response to Anesthesia | 631 | ||
| Adverse Consequences of Hyperglycemia | 631 | ||
| Preoperative Assessment | 632 | ||
| Preoperative Management | 632 | ||
| Major Surgery and Intravenous Insulin Infusions | 634 | ||
| Special Considerations for Preoperative Management of Type 2 Diabetes | 634 | ||
| Intraoperative Management | 634 | ||
| Postoperative Management | 637 | ||
| Special Surgical Situations | 638 | ||
| Diabetes Insipidus | 641 | ||
| Diagnosis of Neurosurgical Diabetes Insipidus: The Triple-Phase Response | 641 | ||
| Perioperative Management of Minor Procedures | 642 | ||
| Perioperative Management of Major Procedures | 643 | ||
| New Perioperative Diagnosis | 643 | ||
| Postoperative Management | 643 | ||
| Post–Intensive Care Unit Management | 643 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Secretion | 643 | ||
| Perioperative Management | 644 | ||
| Thyroid Disorders | 644 | ||
| Hypothyroidism | 645 | ||
| Classification and Epidemiology | 645 | ||
| Biochemical Tests of Thyroid Function | 645 | ||
| Clinical Manifestations | 645 | ||
| Neonatal Hypothyroidism | 645 | ||
| Treatment | 645 | ||
| Preoperative Management | 646 | ||
| Sick Euthyroid Syndrome | 646 | ||
| Hyperthyroidism | 646 | ||
| Classification and Epidemiology | 646 | ||
| Graves Disease | 646 | ||
| Thyroiditis | 646 | ||
| Clinical Manifestations | 647 | ||
| Treatment | 647 | ||
| Perioperative Management | 647 | ||
| Parathyroid and Calcium Disorders | 648 | ||
| Physiology of Calcium Homeostasis | 648 | ||
| Hypocalcemia | 649 | ||
| Neonatal Hypocalcemia | 649 | ||
| Childhood Hypocalcemia | 649 | ||
| VI The Abdomen | 655 | ||
| 28 Essentials of Nephrology | 655 | ||
| Renal Physiology | 655 | ||
| Fluids and Electrolytes | 655 | ||
| Acid-Base Balance | 656 | ||
| Disease States | 657 | ||
| Acute Renal Failure and Acute Kidney Injury | 657 | ||
| Etiology and Pathophysiology | 657 | ||
| Diagnostic Procedures | 658 | ||
| Therapeutic Interventions | 659 | ||
| Hemodialysis | 660 | ||
| Peritoneal Dialysis | 661 | ||
| Chronic Renal Failure | 661 | ||
| Hematologic Problems | 662 | ||
| Cardiovascular Complications | 663 | ||
| Causes of Chronic Renal Failure | 663 | ||
| Preoperative Preparation of the Child With Renal Dysfunction | 663 | ||
| Preoperative Laboratory Evaluation | 664 | ||
| Perioperative Dialysis | 665 | ||
| Medications | 665 | ||
| Intraoperative Management | 665 | ||
| Strategies for Renal Protection | 665 | ||
| Vascular Access | 666 | ||
| Environment | 666 | ||
| Fluids and Blood Products | 666 | ||
| Anesthetic Agents | 666 | ||
| Postoperative Concerns | 668 | ||
| Annotated References | 668 | ||
| References | 668.e1 | ||
| 29 General Abdominal and Urologic Surgery | 669 | ||
| General Principles of Abdominal Surgery | 669 | ||
| “The Full Stomach”: The Risk for Pulmonary Aspiration of Gastric Contents | 669 | ||
| Rapid-Sequence Induction | 669 | ||
| Indications for Preoperative Nasogastric Tube Placement | 670 | ||
| Fluid Balance | 670 | ||
| Potential for Strangulated or Ischemic Bowel and Sepsis | 671 | ||
| Presence of Abdominal Compartment Syndrome | 671 | ||
| Preoperative Laboratory Testing and Investigations | 671 | ||
| Monitoring Requirements | 672 | ||
| Choice of Anesthetic | 672 | ||
| General Principles of Urologic Surgery | 672 | ||
| Reduced Renal Function | 672 | ||
| Systemic Arterial Hypertension | 673 | ||
| Corticosteroid Medications | 673 | ||
| Infection or Sepsis | 673 | ||
| Monitoring Requirements | 673 | ||
| Laparoscopic Surgery | 673 | ||
| Background | 673 | ||
| Adverse Effects of Pneumoperitoneum | 675 | ||
| Carbon Dioxide | 675 | ||
| Gas Emboli | 675 | ||
| Respiratory Effects | 676 | ||
| Cardiovascular Effects | 676 | ||
| Central Nervous System Effects | 677 | ||
| Renal Effects and Fluid Requirements | 677 | ||
| Pain Management | 678 | ||
| Robot-Assisted Surgery | 678 | ||
| Specific General Surgical and Urologic Conditions | 678 | ||
| Nissen Fundoplication | 678 | ||
| Pectus Excavatum | 679 | ||
| Circumcision | 679 | ||
| Hypospadias and Chordee | 679 | ||
| Cryptorchidism and Hernias: Inguinal and Umbilical | 680 | ||
| Torsion of the Testis | 681 | ||
| Posterior Urethral Valves | 681 | ||
| Prune-Belly Syndrome | 681 | ||
| Ureteral Reimplantation | 682 | ||
| Pyeloplasty | 682 | ||
| Nephrectomy | 683 | ||
| Neuroblastoma | 683 | ||
| Wilms Tumor | 684 | ||
| Bladder and Cloacal Exstrophy | 685 | ||
| Bariatric Surgery in Children | 686 | ||
| Multidisciplinary Approach to Bariatric Surgery in Adolescents | 687 | ||
| Anesthetic Implications of Obesity in Adolescents | 687 | ||
| Acknowledgments | 689 | ||
| Annotated References | 689 | ||
| References | 689.e1 | ||
| 30 Essentials of Hepatology | 690 | ||
| Anatomy | 690 | ||
| Principles of Hepatic Drug Metabolism | 690 | ||
| Phase I Reactions | 691 | ||
| Cytochrome P-450 Activity | 692 | ||
| Phase II Reactions | 692 | ||
| Anesthetic Agents | 693 | ||
| Inhalation Anesthestc Metabolism | 693 | ||
| Neuromuscular Blocking Drugs | 693 | ||
| Sedatives, Opioids, and Liver Disease | 693 | ||
| Anesthetic Effects on Hepatic Cellular Functions | 694 | ||
| Carbohydrates | 694 | ||
| Protein Synthesis | 694 | ||
| Bilirubin Metabolism | 694 | ||
| Hepatotoxicity | 694 | ||
| Perioperative Considerations in Liver Disease | 695 | ||
| Annotated References | 695 | ||
| References | 695.e1 | ||
| 31 Organ Transplantation | 696 | ||
| Liver Transplantation | 696 | ||
| Epidemiology and Demographics | 696 | ||
| Pathophysiology of Liver Disease | 698 | ||
| Cardiac Considerations | 698 | ||
| Pulmonary Considerations | 698 | ||
| Neurologic Considerations | 699 | ||
| Hematologic Considerations | 699 | ||
| Renal Manifestations | 700 | ||
| Metabolic Considerations | 700 | ||
| Preoperative Evaluation | 700 | ||
| Intraoperative Care | 701 | ||
| Surgical Technique | 702 | ||
| Hepatectomy (Stage 1) | 702 | ||
| Anhepatic Stage (Stage 2) | 703 | ||
| Reperfusion (Stage 3) | 704 | ||
| Biliary and Hepatic Artery Reconstruction (Stage 4) | 704 | ||
| Split Liver Techniques and Living Donor Liver Transplants | 704 | ||
| Outcomes | 705 | ||
| Immediate Postoperative Care | 705 | ||
| Long-Term Issues | 706 | ||
| Renal Transplantation | 706 | ||
| Pathophysiology | 706 | ||
| Surgical Technique | 708 | ||
| Anesthetic Management | 708 | ||
| Preoperative Evaluation | 708 | ||
| Anesthetic Induction | 708 | ||
| Monitors and Vascular Access | 709 | ||
| Maintenance of Anesthesia | 709 | ||
| Immediate Postoperative Management | 709 | ||
| Long-Term Issues | 709 | ||
| Infection | 709 | ||
| Malignancy | 709 | ||
| Summary | 709 | ||
| Cardiac Transplantation | 710 | ||
| Demographics and Epidemiology | 710 | ||
| Pathophysiology of the Disease | 710 | ||
| Congenital Heart Disease | 711 | ||
| Dilated Cardiomyopathy | 711 | ||
| Hypertrophic Cardiomyopathy | 711 | ||
| Restrictive Cardiomyopathy | 711 | ||
| Repeat Transplantation | 711 | ||
| Contraindications | 711 | ||
| Wait-List and Donor Selection | 711 | ||
| Preoperative Evaluation | 712 | ||
| Surgical Technique | 713 | ||
| Intraoperative Problems and Management | 714 | ||
| Immediate Postoperative Management | 715 | ||
| Survival and Quality of Life | 717 | ||
| Pediatric Lung and Heart-Lung Transplantation | 719 | ||
| Demographics and Epidemiology | 719 | ||
| Pathophysiology of the Disease | 719 | ||
| Preoperative Evaluation | 720 | ||
| Surgical Technique | 720 | ||
| Intraoperative Problems and Management | 721 | ||
| Immediate Postoperative Management | 722 | ||
| Long-Term Concerns | 723 | ||
| Annotated References | 725 | ||
| References | 726.e1 | ||
| VII Other Surgeries | 727 | ||
| 32 Orthopedic and Spine Surgery | 727 | ||
| Scoliosis Surgery | 728 | ||
| Terminology, History, and Surgical Development | 728 | ||
| Classification | 729 | ||
| Pathophysiology and Natural History | 730 | ||
| Congenital, Infantile, and Juvenile Scoliosis: Early-Onset Scoliosis | 730 | ||
| Idiopathic Scoliosis | 731 | ||
| Neuromuscular Scoliosis | 732 | ||
| Risk Minimization and Improving Outcome From Surgical Intervention | 733 | ||
| Respiratory Function and Other Complications in the Early Postoperative Period | 733 | ||
| Early-Onset Scoliosis | 734 | ||
| VIII Emergencies | 841 | ||
| 37 The Extremely Premature Infant (Micropremie) and Common Neonatal Emergencies | 841 | ||
| Physiology of Prematurity Related to Anesthesia | 841 | ||
| Respiratory System | 841 | ||
| Airway | 841 | ||
| Anatomic Differences and Work of Breathing | 841 | ||
| Lungs | 842 | ||
| Pulmonary Gas Exchange | 842 | ||
| Bronchopulmonary Dysplasia | 843 | ||
| Hyperoxia | 843 | ||
| Respiratory Control | 843 | ||
| Cardiovascular System | 845 | ||
| Immature Versus Adult Heart | 845 | ||
| Transition From Fetal to Neonatal Circulation | 845 | ||
| Patent Ductus Arteriosus | 845 | ||
| Persistent Pulmonary Hypertension and Inhaled Nitric Oxide | 845 | ||
| Neurologic Development | 846 | ||
| Immature Brain | 846 | ||
| Glucose and the Brain | 846 | ||
| Complications of Prematurity | 848 | ||
| Intraventricular Hemorrhage | 848 | ||
| Temperature Regulation | 848 | ||
| Renal and Metabolic Function | 849 | ||
| Renal Function | 849 | ||
| Fluid Management | 849 | ||
| Calcium Homeostasis | 849 | ||
| Glucose Homeostasis | 850 | ||
| Gastrointestinal and Hepatic Function | 850 | ||
| Hematologic Function | 851 | ||
| Anesthetics and the Neonate/Premature Infant | 851 | ||
| Anesthetics and the Immature Brain | 851 | ||
| Inhalational Anesthetics | 852 | ||
| Intravenous Anesthetics | 852 | ||
| Regional Anesthetics | 853 | ||
| Neonatal Surgical Emergencies | 853 | ||
| Preparation for Surgery | 853 | ||
| The “Urgent” Emergency | 853 | ||
| The Operating Room | 853 | ||
| Environment | 853 | ||
| Monitors | 854 | ||
| Oxygen Saturation | 854 | ||
| End-Tidal Carbon Dioxide | 854 | ||
| Invasive Monitors | 854 | ||
| Ventilator | 854 | ||
| Equipment Setup | 854 | ||
| Fluids and Medication | 854 | ||
| Bedside Procedures in the ICU | 855 | ||
| The Family | 856 | ||
| Emergency Surgery | 856 | ||
| Respiratory Pathology | 856 | ||
| Abnormalities of the Airway | 856 | ||
| Choanal Atresia | 856 | ||
| Laryngeal and Upper Tracheal Obstruction | 856 | ||
| Webs. | 856 | ||
| Congenital Subglottic Stenosis. | 857 | ||
| Subglottic Hemangioma. | 857 | ||
| Tracheoesophageal Fistula/Esophageal Atresia | 858 | ||
| Abnormalities of the Lung | 859 | ||
| Congenital Diaphragmatic Hernia | 859 | ||
| Congenital Lung Malformations | 860 | ||
| Congenital Bronchogenic and Pulmonary Cysts. | 860 | ||
| Congenital Lobar Emphysema. | 860 | ||
| Gastrointestinal Pathology | 861 | ||
| Obstructed Lesions | 861 | ||
| Hypertrophic Pyloric Stenosis | 861 | ||
| Duodenal Atresia and Meconium Ileus | 862 | ||
| Imperforate Anus | 863 | ||
| Compromised Intestinal Blood Supply | 863 | ||
| Inguinal Hernia | 863 | ||
| Necrotizing Enterocolitis | 863 | ||
| Omphalocele and Gastroschisis | 864 | ||
| Malrotation and Midgut Volvulus | 865 | ||
| Hirschsprung Disease | 866 | ||
| Ligation of Patent Ductus Arteriosus | 866 | ||
| Retinopathy of Prematurity | 866 | ||
| Annotated References | 867 | ||
| References | 867.e1 | ||
| 38 Fetal Intervention and the EXIT Procedure | 868 | ||
| A Range of Anesthetic Options for Mother and Fetus | 868 | ||
| Mother | 868 | ||
| Local Anesthesia (Field Block) | 869 | ||
| Monitored Anesthesia Care | 869 | ||
| Regional Neuraxial Blockade | 869 | ||
| Regional Neuraxial Blockade With Sedation | 869 | ||
| General Anesthesia | 869 | ||
| Combined Regional and General Anesthesia | 869 | ||
| Fetus | 869 | ||
| Transplacental Access | 869 | ||
| Intramuscular Access | 870 | ||
| Intravascular Access | 870 | ||
| Intraamniotic Access | 870 | ||
| Fetal Development | 870 | ||
| Pathologic Lung Development | 870 | ||
| Fetal Cardiovascular Development | 871 | ||
| Fetal Oxygenation | 871 | ||
| Central and Peripheral Nervous System Development | 873 | ||
| Programming Effects | 874 | ||
| Fetal Monitoring | 874 | ||
| Use of Fetal Heart Rate Monitoring for Fetal Interventions | 874 | ||
| Use of Fetal Blood Sampling During Fetal Interventions | 874 | ||
| Fetal Electrocardiography | 874 | ||
| Fetal Pulse Oximetry | 875 | ||
| Near-Infrared Spectroscopy | 875 | ||
| Fetal Echocardiography | 875 | ||
| Doppler Ultrasonography of Fetal Cerebral Blood Flow | 875 | ||
| Physiologic Consequences of Pregnancy | 875 | ||
| Respiratory and Airway Considerations | 875 | ||
| Cardiovascular Considerations | 876 | ||
| Central and Peripheral Nervous Systems | 876 | ||
| Pharmacologic Consequences of Pregnancy | 876 | ||
| Induction | 876 | ||
| Neuromuscular Blocking Drugs | 876 | ||
| Inhalational Anesthetics | 877 | ||
| Fetal Preoperative Evaluation | 877 | ||
| Maternal Evaluation | 877 | ||
| Tocolysis and Tocolytic Agents | 878 | ||
| Hormonal Receptors in Labor | 878 | ||
| Treatment of Acute Preterm Labor | 878 | ||
| Nonsteroidal Antiinflammatory Drugs | 878 | ||
| β-Adrenergic–Mimetic Agents | 878 | ||
| Magnesium | 878 | ||
| Nitric Oxide Donors | 879 | ||
| Calcium-Channel Blockers | 879 | ||
| Pain Control | 879 | ||
| Fetal Complications of Tocolytic Therapy | 879 | ||
| Postoperative Pulmonary Edema | 879 | ||
| Congenital Cystic Adenomatoid Malformation: the Open Procedure | 879 | ||
| Congenital Cystic Adenomatoid Malformation of the Lung | 879 | ||
| Management | 880 | ||
| Operating Room Preparation | 880 | ||
| Induction | 880 | ||
| Maintenance | 881 | ||
| Intervention | 881 | ||
| Intraoperative Fetal Resuscitation | 882 | ||
| Closure | 882 | ||
| Postoperative Management | 882 | ||
| Other Diseases Eligible for Open Procedures | 883 | ||
| Pulmonary Sequestration | 883 | ||
| Bronchogenic Cysts and Mixed or Hybrid Pulmonary Lesions | 883 | ||
| Sacrococcygeal Teratoma | 883 | ||
| Hypoplastic Left Heart Syndrome: Percutaneous and Fetoscopic Procedures | 883 | ||
| Rationale for Fetal Cardiac Intervention | 883 | ||
| Defects Amenable to In-Utero Repair | 884 | ||
| Technical Aspects of Fetal Cardiac Interventions | 884 | ||
| Anesthetic Management for the Mother | 884 | ||
| Anesthetic Management for the Fetus | 884 | ||
| Intraoperative Fetal Resuscitation During Percutaneous Interventions | 885 | ||
| Postoperative Considerations | 885 | ||
| Other Diseases Eligible for Fetoscopic Procedures | 885 | ||
| Twin–Twin Transfusion Syndrome | 885 | ||
| Twin Reversed Arterial Perfusion Sequence | 886 | ||
| Needle Aspiration and Placement of Shunts | 886 | ||
| The EXIT Procedure | 886 | ||
| Fetal Diseases Eligible for the Exit Procedure | 887 | ||
| Cervical Teratoma | 887 | ||
| Cystic Hygroma | 887 | ||
| Congenital High Airway Obstruction Syndrome | 888 | ||
| Congenital Goiter | 888 | ||
| Exit to ECMO | 888 | ||
| Intraoperative Considerations | 888 | ||
| Uterine Relaxation and Perfusion | 888 | ||
| Surgical Procedure | 888 | ||
| Access to the Fetal Airway | 888 | ||
| Delivery of the Infant and Maternal Management | 889 | ||
| Postoperative Considerations | 889 | ||
| Movement Toward Intervention for Non–Life-Threatening Diseases: Myelomeningocele | 889 | ||
| Future Considerations | 890 | ||
| Annotated References | 890 | ||
| References | 890.e1 | ||
| 39 Trauma | 891 | ||
| Epidemiology of Pediatric Trauma | 891 | ||
| Nonaccidental Trauma | 892 | ||
| Prehospital Care of the Pediatric Trauma Patient | 893 | ||
| Trauma Systems | 893 | ||
| Prehospital Airway Management | 895 | ||
| Emergency Department Evaluation and Management of the Pediatric Trauma Patient | 896 | ||
| Anesthesia Management of the Pediatric Trauma Patient | 897 | ||
| Preoperative Evaluation | 899 | ||
| Cervical Spine Evaluation | 900 | ||
| Airway Management | 901 | ||
| Cricoid Pressure | 904 | ||
| Volume Administration | 905 | ||
| Vascular Access | 906 | ||
| Damage Control Surgery | 906 | ||
| Pain Management | 906 | ||
| Future Directions in Pediatric Trauma | 907 | ||
| Summary | 907 | ||
| Acknowledgment | 907 | ||
| Annotated References | 907 | ||
| References | 907.e1 | ||
| 40 Cardiopulmonary Resuscitation | 908 | ||
| Historical Background | 908 | ||
| Epidemiology, Prevention, and Outcome of In-Hospital Cardiopulmonary Arrest | 909 | ||
| Diagnosis of Cardiac Arrest | 909 | ||
| Mechanics of Cardiopulmonary Resuscitation | 909 | ||
| Airway | 909 | ||
| Breathing | 910 | ||
| Circulation | 910 | ||
| Mechanisms of Blood Flow | 910 | ||
| Rate and Duty Cycle | 911 | ||
| Defibrillation and Cardioversion | 911 | ||
| Electric Countershock | 912 | ||
| Practical Aspects of Defibrillation in Children | 912 | ||
| Open-Chest Defibrillation | 913 | ||
| Automated External Defibrillation | 913 | ||
| Transcutaneous Cardiac Pacing | 913 | ||
| Vascular Access and Monitoring During Cardiopulmonary Resuscitation | 913 | ||
| Vascular Access and Fluid Administration | 913 | ||
| Intravenous Access | 913 | ||
| Intraosseous Access | 914 | ||
| Endotracheal Medication Administration | 914 | ||
| Monitoring During Cardiopulmonary Resuscitation | 914 | ||
| Medications Used During Cardiopulmonary Resuscitation | 915 | ||
| α- and β-Adrenergic Agonists | 915 | ||
| Epinephrine | 915 | ||
| Vasopressin | 915 | ||
| Atropine | 916 | ||
| Sodium Bicarbonate | 916 | ||
| Calcium | 916 | ||
| Glucose | 917 | ||
| Amiodarone | 917 | ||
| Lidocaine | 917 | ||
| Special Cardiac Arrest Situations | 918 | ||
| Perioperative Cardiac Arrest | 918 | ||
| Hyperkalemia | 918 | ||
| Anaphylaxis | 918 | ||
| Supraventricular Tachycardia | 919 | ||
| Pulseless Electrical Activity | 919 | ||
| Adjunctive Cardiopulmonary Resuscitation Techniques | 919 | ||
| Open-Chest Cardiopulmonary Resuscitation | 919 | ||
| Extracorporeal Membrane Oxygenation | 919 | ||
| Active Compression-Decompression | 919 | ||
| Postresuscitation Stabilization (Post–Cardiac Arrest Care) | 920 | ||
| The 2015 AHA Pediatric Advanced Life Support Guidelines Update | 920 | ||
| Annotated References | 920 | ||
| References | 920.e1 | ||
| 41 Malignant Hyperthermia | 921 | ||
| Clinical Presentation | 922 | ||
| Patient Evaluation and Preparation | 924 | ||
| Monitoring | 925 | ||
| Diagnosis | 925 | ||
| Management, Susceptibility Screening, and Counseling | 927 | ||
| Treatment | 927 | ||
| Stress-Triggered Malignant Hyperthermia | 930 | ||
| Postepisode Counseling | 930 | ||
| Genetics | 931 | ||
| Physiology | 932 | ||
| Normal Skeletal Muscle: Excitation-Contraction Coupling | 932 | ||
| Pathophysiology of Malignant Hyperthermia | 932 | ||
| Molecular Mechanisms and Physiologic Effects of Dantrolene | 935 | ||
| Laboratory Diagnosis | 936 | ||
| Contracture Testing | 936 | ||
| Genetic Testing | 937 | ||
| Other Disorders and Malignant Hyperthermia | 937 | ||
| Myopathic Syndromes | 937 | ||
| Malignant Hyperthermia Mimics | 937 | ||
| Malignant Hyperthermia–Like Syndrome in Pediatric Diabetes Mellitus | 937 | ||
| Disorders of Fatty Acid Metabolism | 938 | ||
| Neuroleptic Malignant Syndrome | 938 | ||
| Summary | 939 | ||
| Annotated References | 939 | ||
| References | 939.e1 | ||
| IX Pain | 941 | ||
| 42 Regional Anesthesia | 941 | ||
| Pharmacology and Pharmacokinetics of Local Anesthetics | 941 | ||
| Amides | 942 | ||
| Bupivacaine | 942 | ||
| Ropivacaine | 943 | ||
| Lidocaine | 943 | ||
| Esters | 943 | ||
| Toxicity of Local Anesthetics | 943 | ||
| Prevention of Toxicity | 945 | ||
| Total Drug Dose | 945 | ||
| Site of Injection | 945 | ||
| Rate of Uptake | 946 | ||
| Alteration in Toxic Threshold | 946 | ||
| Technique of Administration | 946 | ||
| Treatment of Local Anesthetic Systemic Toxicity | 947 | ||
| Hypersensitivity to Local Anesthetics | 948 | ||
| Placement of Blocks in Patients Under General Anesthesia | 948 | ||
| Equipment | 948 | ||
| Use of Ultrasound | 948 | ||
| Use of a Nerve Stimulator | 948 | ||
| Specific Procedures | 949 | ||
| Central Neuraxial Blockade | 949 | ||
| Anatomic and Physiologic Considerations | 949 | ||
| Spinal Anesthesia | 951 | ||
| Technique | 952 | ||
| Selection of Drug | 953 | ||
| Neonates and Infants. | 953 | ||
| Children. | 954 | ||
| Complications | 954 | ||
| Epidural Anesthesia | 954 | ||
| Caudal Epidural Anesthesia | 954 | ||
| Technique. | 954 | ||
| Lumbar and Thoracic Epidural Anesthesia | 957 | ||
| Selection of Drug. | 957 | ||
| Continuous Epidural Infusions | 957 | ||
| Epidural Opioids | 958 | ||
| Adjunctive Drugs | 958 | ||
| Complications | 958 | ||
| Peripheral Nerve Blocks | 960 | ||
| Selection of a Local Anesthetic | 960 | ||
| Head and Neck Blocks | 961 | ||
| Supraorbital and Supratrochlear Nerve Block | 961 | ||
| Anatomy. | 961 | ||
| Technique. | 961 | ||
| X Special Topics | 1077 | ||
| 46 Anesthesia Outside the Operating Room | 1077 | ||
| Standards and Guidelines | 1078 | ||
| Off-Site Anesthesia: Structure | 1078 | ||
| Personnel Requirements | 1078 | ||
| Specific Environmental Requirements | 1079 | ||
| Quality Assurance of Anesthesia Services and Outcome in the Off-Site Areas | 1080 | ||
| Anesthesia Versus Sedation for Non–Operating Room Procedures and Tests in Children | 1080 | ||
| Logistics of Managing Acute Emergencies and Cardiopulmonary Arrest Outside the Operating Room | 1081 | ||
| MRI Scanner | 1081 | ||
| Difficult Airway Management in the Non–Operating Room (Off-Site) Environment | 1081 | ||
| Specific Locations for Non–Operating Room Anesthesia | 1082 | ||
| Computed Tomography | 1082 | ||
| Nuclear Medicine | 1084 | ||
| Stereotactic Radiosurgery | 1084 | ||
| Radiation Therapy | 1085 | ||
| Magnetic Resonance Imaging | 1086 | ||
| Interventional Radiology | 1088 | ||
| Safety Radiation and Contrast Reactions | 1089 | ||
| Diagnostic Angiography | 1089 | ||
| Angiography With Embolization | 1090 | ||
| Sclerotherapy of Venous and Lymphatic Malformations | 1091 | ||
| Endoscopic Procedures | 1093 | ||
| Summary | 1093 | ||
| Acknowledgment | 1094 | ||
| Annotated References | 1094 | ||
| References | 1094.e1 | ||
| 47 The Postanesthesia Care Unit and Beyond | 1095 | ||
| Perioperative Environment | 1095 | ||
| Transport to the Care Unit | 1096 | ||
| Arrival in the Care Unit | 1097 | ||
| Central Nervous System | 1098 | ||
| Pharmacodynamics of EMERGENCE | 1098 | ||
| EMERGENCE Agitation or Delirium | 1098 | ||
| Respiratory System | 1100 | ||
| Criteria for Extubation | 1100 | ||
| Extubation in the Operating Room or Postanesthesia Care Unit | 1100 | ||
| Hypoxemia | 1100 | ||
| Hypoventilation | 1100 | ||
| Airway Obstruction | 1100 | ||
| Respiratory Effort | 1101 | ||
| Discharge of Preterm Infants FROM the Postanesthesia Care Unit | 1101 | ||
| Cardiovascular System | 1102 | ||
| Bradycardia | 1102 | ||
| Tachycardia | 1102 | ||
| Other Arrhythmias | 1102 | ||
| Blood Pressure Control | 1102 | ||
| Hypotension | 1102 | ||
| Hypertension | 1103 | ||
| Renal System | 1103 | ||
| Gastrointestinal System | 1103 | ||
| Postoperative Nausea and Vomiting | 1103 | ||
| Evidence-Based Consensus Management | 1103 | ||
| Prophylactic Therapy | 1103 | ||
| Alternative Treatments | 1104 | ||
| Postoperative Care and Discharge | 1104 | ||
| Pain Management in the Postanesthesia Care Unit | 1104 | ||
| Temperature Management | 1105 | ||
| Discharge Criteria | 1105 | ||
| Beyond PACU: Postoperative Monitoring in the General Care Setting | 1106 | ||
| Acknowledgment | 1107 | ||
| Annotated References | 1107 | ||
| References | 1108.e1 | ||
| 48 Sedation for Diagnostic and Therapeutic Procedures Outside the Operating Room | 1109 | ||
| The Evolution of Pediatric Sedation and the Anesthesiologist’s Role | 1109 | ||
| Sedation Depth | 1110 | ||
| The Concept of Levels of Sedation | 1110 | ||
| Sedation Scoring Systems | 1111 | ||
| Sedation Depth Versus Sedation Risk | 1113 | ||
| Guidelines | 1113 | ||
| Goals of Sedation | 1117 | ||
| The Concept of “Safety” | 1117 | ||
| Training and System Issues for Pediatric Procedural Sedation | 1119 | ||
| Documentation | 1119 | ||
| Specific Sedation Techniques | 1120 | ||
| Local Anesthetics | 1121 | ||
| Anxiolytics and Sedatives | 1122 | ||
| Barbiturates | 1124 | ||
| Opioids | 1124 | ||
| α2-Adrenoceptor Agonist: Dexmedetomidine | 1125 | ||
| Ketamine | 1126 | ||
| Summary and Future of Pediatric Sedation | 1127 | ||
| Annotated References | 1127 | ||
| References | 1128.e1 | ||
| 49 Procedures for Vascular Access | 1129 | ||
| Venous Cannulation | 1129 | ||
| Peripheral Intravenous Cannulation | 1129 | ||
| Indications | 1129 | ||
| Equipment | 1129 | ||
| Practical Suggestions | 1129 | ||
| Index | 1213 | ||
| A | 1213 | ||
| B | 1217 | ||
| C | 1219 | ||
| D | 1224 | ||
| E | 1226 | ||
| F | 1228 | ||
| G | 1229 | ||
| H | 1230 | ||
| I | 1233 | ||
| J | 1235 | ||
| K | 1235 | ||
| L | 1235 | ||
| M | 1237 | ||
| N | 1239 | ||
| O | 1241 | ||
| P | 1243 | ||
| Q | 1247 | ||
| R | 1247 | ||
| S | 1249 | ||
| T | 1251 | ||
| U | 1254 | ||
| V | 1255 | ||
| W | 1256 | ||
| X | 1256 | ||
| Y | 1256 | ||
| Z | 1256 | ||
| Endsheet 5 | IBC1 | ||
| Endsheet 6 | IBC2 | ||
| Endsheet 7 | IBC3 | ||
| A Practice of Anesthesia for Infants and Children | IBC4 |