Pediatric Anesthesia: A Guide for the Non-Pediatric Anesthesia Provider - Part I

Cover
Title
Copyright
End User License Agreement
Contents
Preface
WHO THIS BOOK IS WRITTEN FOR
WHO CONTRIBUTED TO THIS BOOK
WHAT IS IN THIS BOOK
THANKS
SUMMARY
List of Contributors
Anatomy and Physiology
Rachel Koehler1, Pravin Taneja2 and Nathalie Peiris3
AIRWAY
Respiratory Physiology
Cardiac Physiology
Renal Physiology
Hematologic Physiology
Gastrointestinal Physiology
Temperature Physiology
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENT
REFERENCES
Pediatric Pharmacology and Fluid Management
Shaharyar Ahmad1 and Grace Dippo1
PHARMACOKINETICS
Context-sensitive Half Time
Half Life and Volume of Distribution
Pediatric Pharmacokinetic Considerations
Administration, Absorption, and Distribution
Increased Total Body Water
Increased Permeability of the Blood-Brain Barrier
Clearance, Metabolism, Excretion
PHARMACODYNAMICS
Signal Transduction
Types of Agonists
Types of Receptors
Drug Effects
Drug-Drug Interactions
ANESTHETIC DRUGS & PHARMACOLOGY
Halothane
Sevoflurane
Desflurane
Isoflurane
Nitrous Oxide
Physiologic Properties of Volatile Anesthetics
Premedication
Intravenous Anesthetic Agents
Propofol
Ketamine
Etomidate
Clonidine
Dexmedetomidine
Barbiturates
IV Anesthetics
Neuromuscular Blockers
Succinylcholine
Nondepolarizing Neuromuscular Blockers (NDNMBs)
Reversal of Neuromuscular Blockade
Sugammadex
Acetylcholinesterase Inhibitors (AChEi)
Opioids
Opioid Agonist-Antagonist Nalbuphine
Opioid Antagonists
Naloxone
Naltrexone
Local Anesthetics
Benzodiazepines
Flumazenil
NSAIDS
Acetaminophen
Antiemetics
Anticholinergics
Atropine
Glycopyrrolate
Antihistamines
Dimenhydrinate
PHARMACOGENETIC VARIATIONS
Morphine
Codeine
Acetaminophen
FLUID AND ELECTROLYTE REQUIREMENTS IN HEALTHY CHILDREN
Fluid Compartments
Fluid and Electrolyte Requirements in Children and Infants
Homeostatic Mechanisms and Maturation
Maturation of Renal Function
PARENTERAL FLUIDS AND ELECTROLYTES
Choice of Fluids
Crystalloids
Glycemic Control
Colloids
Electrolyte Disturbances
Fluid Replacement
Maintenance Fluid
Fluid Deficit
Intraoperative Replacement of Insensible Loss
Dehydration
Electrolyte Disorders
Hyponatremia
Complications of Hyponatremia in Children
Hypernatremia
Diabetes Insipidus (DI)
Shock States
Blood Transfusion
Complications of PRBCs
Electrolyte Disorders
Potassium
Calcium
Magnesium
Phosphorus
Anesthetic Agents and the Kidneys
Postoperative Pulmonary Edema
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Pediatric Operating Room Setup
Bharathi Gourkanti1,*, Marlo DiDonna1 and Rosemary De La Cruz1
INTRODUCTION
Machine
Suction
Monitoring Equipment
Airway
Face Masks
Oropharyngeal and Nasopharyngeal Airways
Supraglottic Airway Devices
Laryngoscopy Equipment and Endotracheal Tubes
Laryngoscopes
Endotracheal Tubes
Difficult Airway
Laryngeal Mask Airways (LMA)
GlideScope
C-MAC Videolaryngoscope
Flexible Intubation Scopes/Fiberoptic Bronchoscopy Techniques
Nasal Cavity Block
Glossopharyngeal Nerve Block
Superior Laryngeal Nerve Block
Recurrent Laryngeal Nerve Block
IV and Blood Transfusion
Avoidance of Dehydration
Pediatric Blood Transfusion
Maximum Allowable Blood Loss (MABL)
Drug Therapy
Special Considerations
Environmental Conditions & Maintaining Normothermia in the Pediatric Patient
Handoff and Safe Transport of the Postoperative Child
Transporting to the Neonatal Intensive Care Unit
Special Setup/Unique Considerations
The Neonatal Intensive Care Unit (NICU) Baby
Intravenous Access
Airway Equipment
Fluid and Blood Product Management
Tracheostomy
Cleft Lip and Cleft Palate
Bleeding Tonsil
Epiglottitis
Obese Child
Sleep Apnea
Trauma
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Preoperative Evaluation and Planning
Fatimah Habib1 and Kathleen Kwiatt1
PREOPERATIVE EVALUATION
History and Physical Exam
NPO (Nil per os) Guidelines
Psychological Preparation
Obtaining Consent
Pregnancy Testing
Preoperative Intravenous Catheter (IV) Placement
Triaging the Patient
Expectations from Consultants
PREMEDICATION
Midazolam
Ketamine
Dexmedetomidine
Nonpharmacologic Preoperative Anxiety Reducing Strategies
III. INDUCTION PRINCIPLES
Inhalation Induction
Intravenous Induction
Parental Presence During Induction
IV. PLANNING FOR PATIENTS WITH SPECIAL CONSIDERATIONS
Full Stomach / Need for RSI
Recent Illness or Upper Respiratory Tract Infection (URI)
Autism
Special Needs: Mental Disability, Developmental Delay
The Premature Infant / Bronchopulmonary Dysplasia
Sickle Cell Disease
Obstructive Sleep Apnea (OSA)
Congenital Cardiac Anomalies
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Induction, Maintenance, and Emergence
Aysha Hasan1, Andrea Gomez-Morad2 and Arvind Chandrankantan3
INTRODUCTION
INDUCTION
Methods of Induction: Inhalational vs Intravenous
Parental Presence Induction
Rapid Sequence Intubation
Maintenance
Neurotoxicity Considerations with Anesthesia
Fluid Administration
Temperature Control
Emergence
Neuromuscular Reversal
Awake Versus Deep Extubation
Emergence Delirium
Pain
Temperature Instability
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
PACU Management and Emergence Delirium
Malgorzata Lutwin-Kawalec1, Sheaba Varghese1 and Dinesh K. Choudhry, FRCA2
PATIENT HANDOFF & RECOVERY ENVIRONMENT
GUIDELINES FOR DISCHARGE
EMERGENCE DELIRIUM
Prevention of ED
Treatment of ED
MALIGNANT HYPERTHERMIA
Signs and Symptoms
Triggers
Preparing for a Non-triggering Anesthetic
Treatment of an MH Episode
Testing
PERIOPERATIVE ADVERSE RESPIRATORY EVENTS
Hypoxemia
Laryngospasm
Prevention of Laryngospasm
Treatment of Laryngospasm
Postobstructive Pulmonary Edema
Bronchospasm
Treatment of Bronchospasm and Anaphylaxis
Postextubation Stridor
Postoperative Apnea
CARDIOVASCULAR EVENTS
Bradycardia
Narrow Complex Tachycardia
Premature Atrial Contractions
Hypotension
Cardiac Arrest
POSTOPERATIVE NAUSEA AND VOMITING (PONV)
Risk Assessment
Stepwise Approach to PONV Prophylaxis
3. Pharmacologic prophylaxis
Non-pharmacologic Prophylaxis
Failed Prophylaxis
CHILD LIFE SERVICES AND TEAM APPROACH TO PERIOPERATIVE CARE
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Emergency Intubation and Difficult Airway Management
Nathalie Peiris1 and Pravin Taneja2
INTRODUCTION
Preoperative Evaluation and Predictors of Difficult Airway
Advanced Tools for Difficult Airway
Video Laryngoscopes
Glidescope®
CMAC®
Supraglottic Airways
Flexible Fiberoptic Bronchoscope
Role of Passive Oxygenation
Anesthetizing Techniques for Difficult Airway
To Paralyze or not to Paralyze
Flexible Fiberoptic Bronchoscope Intubation Through SGA Technique
Steps to Intubation Through SGA
Glidescope® with Flexible Fiberoptic Technique
Anticipated Difficult Airway
Unanticipated Difficult Airway
Emergency Intubations Outside the Operating Room
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Pediatric Trauma Patient
Kathleen Kwiatt1 and Fatimah Habib1
INTRODUCTION
PRE-HOSPITAL PLANNING
PRIMARY SURVEY
SECONDARY SURVEY
AIRWAY MANAGEMENT
MANAGEMENT OF SHOCK: FLUIDS, BLOOD, AND TXA
PHARMACOTHERAPY
Induction
NEUROMUSCULAR BLOCKING AGENTS
REVERSAL
ADJUNCT MEDICATIONS
Opioids:
RESUSCITATIVE MEDICATIONS
MAINTENANCE OF ANESTHESIA
INTRAOPERATIVE MANAGEMENT MONITORING AND THERMOREGULATION
INJURY MANAGEMENT
POST-OPERATIVE CARE
CONCLUSION
ABBREVIATIONS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Pediatric and Neonatal Resuscitation
Melissa Lester1 and Grace Dippo1
CARDIOPULMONARY ARREST IN THE PEDIATRIC PATIENT
Epidemiology
ANESTHESIA-RELATED CARDIAC ARREST
DIAGNOSIS OF CARDIAC ARREST
CARDIOPULMONARY RESUSCITATION: MECHANISM OF ACTION
DEFIBRILLATION AND CARDIOVERSION
MONITORING DURING CPR
EMERGENCY VASCULAR ACCESS AND FLUID ADMINISTRATION
MEDICATIONS USED DURING CPR
ENDOTRACHEAL MEDICATION ADMINISTRATION
SPECIAL SITUATIONS
Anaphylaxis
Hs/Ts
POST-CARDIAC ARREST CARE AND STABILIZATION
2020 AHA PALS GUIDELINES UPDATE
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Pediatric Emergency Surgeries
Michael R. Schwartz1 and Yue Monica Li1
INTRA-ABDOMINAL EMERGENCIES
VOLVULUS
INTUSSUSCEPTION
APPENDICITIS
PREOPERATIVE EVALUATION
INTRAOPERATIVE MANAGEMENT
FOREIGN BODY ASPIRATION
PREOPERATIVE EVALUATION
INTRAOPERATIVE MANAGEMENT
POSTOPERATIVE MANAGEMENT
ESOPHAGEAL FOREIGN BODY
PREOPERATIVE EVALUATION
INTRAOPERATIVE MANAGEMENT
POSTOPERATIVE MANAGEMENT
EPIGLOTTITIS
PREOPERATIVE EVALUATION
INTRAOPERATIVE MANAGEMENT
POSTOPERATIVE MANAGEMENT
ACUTE HYDROCEPHALUS
PREOPERATIVE EVALUATION
INTRAOPERATIVE MANAGEMENT
POSTOPERATIVE MANAGEMENT
TONSILLAR HEMORRHAGE
PREOPERATIVE EVALUATION
INTRAOPERATIVE MANAGEMENT
POSTOPERATIVE MANAGEMENT
OPEN GLOBE INJURY
PREOPERATIVE EVALUATION
INTRAOPERATIVE MANAGEMENT
PEDIATRIC TRAUMA
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Neonatal Emergency Surgeries
Yue Monica Li1 and Michael Schwartz1
INTRODUCTION
NEONATAL PHYSIOLOGY
Respiratory and Airway Physiology
Pulmonary Development
Airway Anatomy
Apnea of Prematurity
Cardiac Physiology
Central Nervous System
Inhalational Anesthetic
Renal Physiology
Gastrointestinal Physiology
Thermoregulation
ANESTHESIA FOR SPECIFIC SURGERIES NECROTIZING ENTEROCOLITIS
Epidemiology
Pathophysiology
Diagnosis
Preoperative Management
Intraoperative Management
Postoperative Management
CONGENITAL ABDOMINAL WALL DEFECTS
Introduction
Preoperative Management
Intraoperative Management
Postoperative Management
CONGENITAL DIAPHRAGMATIC HERNIA
Introduction
Preoperative Management
Intraoperative Management
Postoperative Care and Outcomes
TRACHEOESOPHAGEAL FISTULA AND ESOPHAGEAL ATRESIA
Preoperative Management
Intraoperative Management
Postoperative Management
AIRWAY EMERGENCIES
General Considerations for Neonatal Airway Surgery
Specific Anomalies
Choanal Atresia
Pierre Robin Sequence
Subglottic stenosis
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Pediatric Ambulatory Anesthesia
Abraham G. Oommen1, Mark A. Dobish2 and Manish Purohit1
INTRODUCTION
Common Outpatient Procedures
NPO GUIDELINES
Preoperative Evaluation
Upper Respiratory Infections
Asthma & Reactive Airway Disease
Postoperative Apnea Risk Factors
Obstructive Sleep Apnea
Premedication
Midazolam
Dexmedetomidine and Ketamine
Parental Presence on Induction
Anesthetic Approach
Induction
Airway Utilization
Tracheal Extubation
Anesthetic Management of Common Procedures
Myringotomy and Ventilating Tubes
Adenotonsillectomy (T&A)
Herniorrhaphy, Umbilical Hernia, and Circumcision
Inguinal Hernia
Umbilical Hernia
Circumcision
Endoscopy
Imaging
Non-opioid Techniques
Postoperative Ambulatory Considerations
Deep Extubation
PONV
Pain Management
Oxygen Desaturation
Emergence Delirium
Unplanned Admission
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Non-operating Room Pediatric Anesthesia
Ian Brotman1 and Sindhu Samba1
INTRODUCTION
GENERAL DIFFICULTIES
NORA SETUP
NORA SITE CONSIDERATIONS
Radiology Suite: CT and MRI
Anesthetic Considerations for MRI
Interventional Radiology
Specific Considerations for Neuro-interventional Radiology
Nuclear Medicine
Oncology Suite
Endoscopy Suite
RECOVERY
NORA EMERGENCIES
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Anesthesia For Common Pediatric Surgical Procedures
Sabina DiCindio1 and Mary Theroux1
INTRODUCTION
Non-Pharmacological Interventions
Pharmacologic interventions
SURGERIES
Strabismus
Herniorrhaphy
Umbilical Hernia
Circumcision
Laparoscopic Surgery
Appendectomy
Pyloromyotomy
Tonsillectomy and Adenoidectomy (T&A)
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Subject Index