TY  - CHAP
M1  - Book, Section
TI  - Chapter 64. Anesthesia for Children
A1  - Everett, Lucinda L.
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
Y1  - 2012
N1  - 
T2  - Anesthesiology, 2e
AB  - Overall,  pediatric  anesthesia  is  extremely  safe  in  the  hands  of  experienced  providers.  Factors  that  may  increase  risk  include  age  younger  than  1  year  and  coexisting  disease.  Careful  attention  to  maintenance  of  a  patent  airway  is  critical  to  the  safe  care  of  infants  and  children.One  of  the  challenges  of  pediatric  anesthesia  for  trainees  is  selecting  appropriately  sized  equipment  and  supplies.  Endotracheal  tubes  are  generally  selected  to  yield  a  leak  at  15  to  30  cm  H2O.  Cuffed  tubes  are  gaining  wider  use  in  young  children  as  well  as  those  older  than  8  years.  Straight  blades  are  most  commonly  used  for  intubation  in  infants,  with  the  usual  choices  being  Miller  0  for  neonates  and  Miller  1  for  infants.  A  Wis-Hipple  1.5  blade  is  often  used  in  toddlers,  with  progression  to  Macintosh  size  2  for  children  3  years  and  older.The  physiologic  and  psychological  contexts  must  be  considered  in  planning  an  anesthetic  for  any  child.  Premedication  and  parental  presence  may  be  appropriate  for  children.  Induction  of  anesthesia  for  elective  surgery  in  young  children  frequently  is  accomplished  by  inhalation  of  a  volatile  anesthetic.  Sevoflurane  is  the  most  common  choice  in  modern  practice  based  on  the  drug's  rapid  effect,  low  degree  of  airway  irritation,  and  cardiovascular  stability.Succinylcholine  is  no  longer  used  routinely  in  children  because  of  the  potential  for  hyperkalemia  in  undiagnosed  myopathy.  Succinylcholine  may  still  be  used  when  indicated  for  rapid-sequence  induction  or  treatment  of  laryngospasm.Regional  anesthesia  is  a  useful  adjunct  to  general  anesthesia  in  children  for  a  variety  of  procedures.  Surgery  with  a  regional  anesthetic  alone  is  uncommon  in  young  children;  one  exception  is  the  use  of  spinal  anesthesia  in  premature  infants  at  risk  for  postoperative  apnea.  For  common  outpatient  surgery  such  as  hernia  repair  or  orchidopexy,  caudal  blockade  with  a  local  anesthetic  such  as  ropivacaine  provides  good  intraoperative  and  postoperative  analgesia.  Epidural  catheters  also  may  be  placed  in  children  for  more  major  procedures  and  generally  are  placed  after  induction  of  general  anesthesia  in  children  who  are  too  young  to  cooperate.Selection  of  an  appropriate  plan  for  postoperative  analgesia  is  important  for  both  inpatient  and  outpatient  situations.  Adequate  doses  of  acetaminophen,  nonsteroidal  anti-inflammatory  drugs  when  not  contraindicated,  and  regional  anesthesia  may  be  appropriate  in  addition  to  or  in  place  of  opioid  analgesia,  depending  on  the  procedure.  Postoperative  vomiting  is  common  in  children  and  may  occur  more  frequently  during  certain  procedures,  such  as  strabismus  surgery,  and  in  patients  with  a  history  of  motion  sickness  or  postoperative  vomiting.  Prophylaxis  frequently  includes  use  of  a  5-hydroxytryptamine3  (5-HT3)  receptor  antagonist  or  a  steroid  such  as  dexamethasone.  Because  of  restrictions  on  the  use  of  droperidol,  5-HT3  receptor  antagonists  are  generally  used  as  first-line  treatment  of  postoperative  nausea  and  vomiting  in  children.Emergence  agitation  occurs  in  a  significant  number  of  toddlers  and  young  children,  particularly  after  use  of  a  volatile  anesthetic.  Appropriate  analgesia  and  possibly  supplemental  sedation  may  be  helpful.  The  results  in  the  literature  are  mixed  with  regard  to  links  with  specific  agents  (eg,  sevoflurane);  patient  and  parental  anxiety  may  contribute  to  the  development  of  agitation.Many  of  the  procedures  performed  in  children  involve  concepts  ...
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56648432
ER  -