TY  - CHAP
M1  - Book, Section
TI  - Preoperative Assessment of Newborns and Children
A1  - Menser, Carrie Campbell McCoy
A1  - Hays, Stephen Robert
A2  - Longnecker, David E.
A2  - Mackey, Sean C.
A2  - Newman, Mark F.
A2  - Sandberg, Warren S.
A2  - Zapol, Warren M.
Y1  - 2017
N1  - 
T2  - Anesthesiology, 3e
AB  - KEY  POINTSChildren  of  all  ages  continuously  undergo  numerous  developmental  changes  affecting  all  aspects  of  anesthetic  care,  particularly  in  the  neonatal  period  when  caregiver  knowledge  of  physiologic  trajectories  and  patterns  of  malformation  is  essential.In  the  setting  of  acute  upper  respiratory  infection,  well-appearing  afebrile  children  at  their  baseline  activity  level  likely  have  minimally  increased  risk  of  perioperative  respiratory  complications  and  generally  do  not  merit  case  cancelation.Antibiotic  prophylaxis  for  endocarditis  is  recommended  only  for  patients  with  prosthetic  valve  material,  previous  endocarditis,  congenital  heart  disease  in  some  settings,  and  heart  transplant  with  valvulopathy;  only  invasive  dental  procedures,  respiratory  procedures  with  manipulation  of  mucosa,  and  procedures  on  infected  tissues  require  prophylaxis.Succinylcholine  may  induce  hyperkalemia  in  patients  at  risk  for  rhabdomyolysis  who  are  not  at  risk  for  malignant  hyperthermia  and  should  be  avoided  in  these  settings  but  may  generally  be  used  safely  in  most  other  patients  who  are  not  hyperkalemic.Data  increasingly  suggest  lack  of  harm  and  potential  benefit  from  restrictive  transfusion  strategies,  and  transfusion  should  generally  be  withheld  except  for  documented  or  reasonably  suspected  blood  product  deficiency  with  evidence  of  end-organ  dysfunction.Preoperative  fasting  intervals  for  all  patients  before  elective  procedures  requiring  sedation  or  anesthesia  are  2  hours  for  clear  liquids;  4  hours  for  breast  milk;  6  hours  for  light  meals,  including  nonhuman  milk  and  infant  formula;  and  8  hours  for  fried  or  fatty  foods  or  meat.Preoperative  pharmacologic  premedication  is  more  effective  than  nonpharmacologic  intervention  for  prophylaxis  of  postoperative  emergence  delirium,  which  is  associated  with  toddler  age,  male  sex,  certain  agents  and  procedures,  rapid  emergence,  and  parental  anxiety.Parental  presence  during  induction  of  anesthesia  does  not  significantly  reduce  patient  anxiety  in  most  settings  unless  anxious  patients  are  accompanied  by  calm  parents  and  may  be  counterproductive  when  calm  children  are  accompanied  by  anxious  parents.Developmental  differences  influence  pharmacology  in  pediatric  patients,  in  whom  doses  and  regimens  extrapolated  from  adult  practice  may  not  be  accurate  and  venous  access  may  not  be  readily  available.Animal  data  demonstrate  susceptibility  of  developing  brain  to  anesthetic  neurotoxicity  under  certain  conditions;  human  data  suggest  modestly  increased  risk  of  adverse  neurodevelopmental  outcomes  following  multiple  early  exposures  to  anesthesia  and  surgery  in  children;  the  extent  to  which  pediatric  anesthetic  exposure  itself  is  neurotoxic  remains  unknown.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1144111674
ER  -