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

Pediatric Anesthesia: A Guide for the Non-Pediatric Anesthesia is a comprehensive, contemporary reference that addresses all aspects of pediatric anesthesia. Both students and medical practitioners – novice and experienced - will find invaluable educational and practical information in this book. The book covers the subject in two parts. Part I covers basic information about pediatric and neonatal anatomy and physiology, pharmacology, emergency room and operating room procedures and surgery. Chapters on general anesthetic procedures in emergency rooms, operational theatres and common surgeries. Part II covers advanced topics for practicing healthcare professionals which include anesthesia for patients with a range of common and uncommon comorbidities, considerations for critically-ill patients, genetic disorders, pain management, COVID-19 guidelines for anesthesia, patient safety and research. Key features: - Basic and advanced information about pediatric and neonatal anesthesia covered in 25 chapters over two parts - Simple and organized presentation for learners - Contributions by expert clinicians and researchers - Special topics included such as considerations for patients with comorbidities and genetic disorders - References for further reading - Detailed illustrations and tables The text is an essential reference for scholars and professionals affiliated with general anesthesiology and surgery specialties at all levels who want to understand anesthesia for pediatric patients. 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