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

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 Foreword Preface WHO CONTRIBUTED TO THIS BOOK THANKS SUMMARY List of Contributors Anesthesia for Pediatric Patients with Common Comorbidities Part I Divya Dixit, M.D.1,* and Dinesh K. Choudhry2 UPPER RESPIRATORY TRACT INFECTION Introduction Perioperative Respiratory Adverse Events Risk Factors Preoperative Evaluation Investigations Postponement of Elective Surgery Perioperative Management Premedication Anesthetic Induction Airway Device Emergence ASTHMA Introduction Wheezing as a Risk Factor for PRAEs Preoperative Evaluation Investigations Perioperative Management Preoperative Premedication Anesthetic Induction Airway Device Ventilation Strategy During Anesthesia Intraoperative Bronchospasm Medications that may Precipitate Bronchospasm Emergence Conclusion DOWN SYNDROME Clinical Manifestations Craniofacial Features Neurological Features Respiratory System Musculoskeletal Cardiac Anomalies Behavioral Issues Other Conditions Preoperative Evaluation Cardiac Assessment Neurological Evaluation Airway Abnormalities Obstructive Sleep Apnea Perioperative Management Investigations and Premedication Anesthetic Induction Intubation Pulmonary Hypertension Positioning Pain Management Emergence Conclusion SICKLE CELL DISEASE Introduction Prevalence and Epidemiology Pathophysiology Clinical Features Cerebrovascular Acute Chest Syndrome Cardiovascular Aplastic Crisis Genitourinary Skeletal Complications Laboratory Findings Hemoglobin F and Hydroxyurea Perioperative Management Preoperative Red Blood Cell Transfusion Intraoperative Pain Management Postoperative Conclusion OBSTRUCTIVE SLEEP APNEA IN CHILDREN Introduction Central Sleep Apnea Obstructive Sleep Apnea Mixed Sleep Apnea Hypopnea Etiology Pathophysiology Clinical Features Investigations Perioperative Management Preoperative Intraoperative Postoperative Conclusion CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Anesthesia for Pediatric Patients with Common Comorbidities Part II Saranya Chinnappan1 and Monica Banerjee2,* AUTISM Introduction Preoperative Concerns and Premedication Intraoperative/Postoperative Management ATTENTION DEFICIT HYPERACTIVITY DISORDER Introduction Pharmacologic Interactions Perioperative Concerns Children with ADHD are more uncooperative during induction [8] so premedication will be essential. CYSTIC FIBROSIS Introduction Pathophysiology Perioperative Management EPIDERMOLYSIS BULLOSA Introduction Preoperative Evaluation Perioperative Management VON WILLEBRAND’S DISEASE Disease Classification and Management Perioperative Management Conclusion CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Anesthesia for Pediatric Patients with Common Comorbidities Part III Pravin Taneja1 and Nathalie Peiris2,* EX-PREMATURE PATIENTS Introduction Definitions Morbidity and Mortality Consequences of Prematurity Ex-Premature Infants and Children Respiratory and Airway Problems of the Ex-Premature Infant Apnea of Prematurity Neurologic Considerations Intraventricular Hemorrhage Cerebral Palsy Retinopathy of Prematurity Gastrointestinal Problems Anesthetic Considerations Pre-evaluation Perioperative Concerns Pain Control Diabetes Introduction Preoperative Evaluation Insulin Pump and Continuous Glucose Monitor Considerations Hypoglycemia Management Insulin Correction Factor Intraoperative Management Postoperative Management OBESITY Introduction Preoperative Assessment Intraoperative Management Drug Dosing Postoperative Management ONCOLOGY PATIENTS Introduction Anesthetic Implications Preoperative Evaluation PEDIATRIC MALIGNANCIES Leukemias Clinical Presentation Central Nervous System Tumors Clinical Presentation Lymphomas Clinical Presentation Intraoperative Considerations Airway Considerations Mediastinal Considerations Intracranial Considerations Systemic Effects of Malignancy Chemotherapy and Radiotherapy Considerations Myocardial Toxicity Pulmonary Toxicity Tumor Lysis Syndrome Summary POST CONGENITAL HEART DISEASE SURGERY PATIENTS FOR NON-CARDIAC SURGERY Introduction The Challenge A Simple Classification Preoperative Considerations Intraoperative Considerations A balanced Circulation Right to Left Shunt Left to Right Shunt Pulmonary Hypertension Single Ventricle Physiology Anesthesia Considerations in “Fontan Circulation” Infective Endocarditis Prophylaxis Summary CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Anesthetic Considerations for the Critically Ill Pediatric Patient Vincent Lau, D.O.1, Levi Mulladzhanov, M.D.1, Srikant Patel, D.O.1, Irwin Gratz, D.O.1 and Bharathi Gourkanti, M.D.1,* INTRODUCTION INFECTIOUS DISEASE Sepsis in Children Diagnosis Treatment of Shock Empiric Broad-spectrum Antimicrobial Therapy Invasive Ventilation Anesthetic Considerations Duration Endotracheal Intubation and General Sedation Goal-Directed Therapy Perioperative Considerations ENDOCRINE DISEASE Diabetic Ketoacidosis Diagnosis Management Propofol-Related Infusion Syndrome Management NEUROLOGIC DISEASE Cerebral Edema Status Epilepticus Treatment Perioperative Epilepsy Management HEMATOLOGIC DISEASE Sickle Cell Disease Preoperative Considerations Intraoperative Considerations Postoperative Considerations CONGENITAL HEART DISEASE Patent Ductus Arteriosus RESPIRATORY SYSTEM DISEASE Assessment Supplemental Oxygen Sources Asthma Acute Respiratory Distress Syndrome and Acute Lung Injury ARDS Treatment Modalities Surfactant Therapy Inhaled Nitric Oxide Corticosteroids High-Frequency Oscillatory Ventilation Tracheostomy Management During Respiratory Distress GASTROINTESTINAL SYSTEM - NUTRITION CONCLUSION CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Anesthesia-Related Genetic Disorders Ian Brotman, M.D.1,* and David Youssef, M.D.1 INTRODUCTION MALIGNANT HYPERTHERMIA Inheritance Clinical Features Management of an MH Crisis Anesthesia for High-Risk Malignant Hyperthermia Patients Malignant Hyperthermia Testing PSEUDOCHOLINESTERASE DEFICIENCY OPIOID USE IN PEDIATRICS CONCLUSION CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Pediatric Pain Management and Regional Anesthesia Dinesh K. Choudhry 1,* and Kesavan Sadacharam2 INTRODUCTION PATHOPHYSIOLOGY AND NEUROBIOLOGY DEVELOPMENTAL PHARMACOLOGY PAIN ASSESSMENT PAIN IN NEONATES APPROACH TO PAIN MANAGEMENT AND PHARMACOTHERAPY Opioids Non-opioid Medications MULTIMODAL APPROACH TO PAIN MANAGEMENT ENHANCED RECOVERY AFTER SURGERY OPIOID-INDUCED HYPERALGESIA REGIONAL ANALGESIA IN CHILDREN Upper Extremity Blocks Supraclavicular Approach Interscalene Approach Infraclavicular Approach Truncal Blocks Caudal Epidural Versus Truncal Blocks Rectus Sheath Block Quadratus Lumborum Block Transverse Abdominis Plane Block Ilioinguinal Block Lower Extremity Blocks Femoral Nerve Block Adductor Canal Block Fascia Iliaca Block Sciatic Nerve Block Lumbar Plexus Block Spinal Anesthesia CONCLUSION CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENT REFERENCES Research in Pediatric Anesthesia Noud van Helmond, M.D.1 and Bharathi Gourkanti, M.D.1,* INTRODUCTION IS IT IMPORTANT TO CONDUCT RESEARCH IN PEDIATRIC ANESTHESIOLOGY? Pediatric Anesthesiologists Cannot Extrapolate Findings from Adult Research to Children Scientists and physicians need to conduct research to increase safety and quality in pediatric anesthesiology Research is an essential part of anesthesiology training SPECIFIC CONSIDERATIONS FOR RESEARCH IN PEDIATRIC ANESTHESIA VS. RESEARCH IN ADULT ANESTHESIA Ethical Justification Minimizing Risk Study Procedure-related Distress Obtaining Assent and Consent Practical Considerations when Carrying out a Research Project CONCLUDING REMARKS CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENT REFERENCES Principles of Quality and Patient Safety in Pediatric Anesthesiology Keri Cronin1,* and Erin Pukenas1 INTRODUCTION FUNDAMENTALS OF PATIENT SAFETY Just Culture HIGH RELIABILITY ORGANIZATIONS (HROS) ERRORS IN PEDIATRIC ANESTHESIOLOGY Medication Errors Handoff Communication Use of Cognitive Aids to Enhance Patient Safety Reporting Adverse Events FUNDAMENTALS OF QUALITY IMPROVEMENT National/International Quality Improvement Programs Wake Up Safe (WUS) POCA Registry The American College of Surgeons Children’s Surgery Verification and Quality Improvement Program The Global Initiative for Children’s Surgery (GICS) Developing a Quality Improvement Program Quality Improvement in Developing Countries The Use of Simulation to support Patient Safety and Quality Improvement Efforts CONCLUDING REMARKS CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Anesthetic Considerations For Covid-19 (Year 2020) David Youssef, M.D.1,* and Bharathi Gourkanti, M.D.1 PREOPERATIVE CONSIDERATIONS AND SYMPTOMOLOGY COVID-19 TESTING Anesthesia Machine and Equipment Maintenance Laryngoscopy & Intubation in a COVID-19 Patient Ventilation Management Patient Transfer and Post-operative Care Regional Anesthesia SUMMARY CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Muscular Dystrophies and Mitochondrial Myopathies Divya Dixit, MD1,*, Dinesh K. Choudhry, MD2 and Kumar G. Belani3 MUSCULAR DYSTROPHIES DUCHENNE MUSCULAR DYSTROPHY Introduction Clinical Manifestations Cardiac Involvement Pulmonary Issues Gastrointestinal Issues Diagnosis Anesthetic Management Rhabdomyolysis Intraoperative Concerns Conclusion BECKER MUSCULAR DYSTROPHY LIMB-GIRDLE MUSCULAR DYSTROPHY EMERY-DREIFUSS MUSCULAR DYSTROPHY MYOTONIC MUSCULAR DYSTROPHY Introduction Types of Myotonic Muscular Dystrophy Congenital Myotonic Dystrophy Type 1 Childhood Onset of Myotonic Dystrophy Type 1 Classic Adult Onset of Myotonic Dystrophy Type 1 Clinical Manifestations Respiratory System Cardiovascular Musculature Perioperative Concerns Airway Management Anesthetic Induction Use of Muscle Relaxants Respiratory Issues Cardiac Issues Anesthetic Management Preoperative Intraoperative Postoperative Conclusion MITOCHONDRIAL MYOPATHIES Introduction Clinical Features Diagnostic Tests for Mitochondrial Myopathies Anesthetic Management Conclusion CEREBRAL PALSY Introduction Surgical Epidemiology Perioperative Concerns Neurologic Respiratory System Cardiovascular Gastrointestinal Fluids and Electrolytes Musculoskeletal Thermoregulatory Pharmacologic Positioning Anesthetic Management Preoperative Intraoperative Intrathecal Baclofen Pump Postoperative Conclusion CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Anesthesia for Uncommon Pediatric Diseases B. Randall Brenn1,2 and Dinesh K. Choudhry1,3 ANTERIOR MEDIASTINAL MASSES Introduction Prevalence Mediastinal Compartments Pathophysiology of AMM Airway Effects Systemic Venous System Heart and Great Vessels Risk Factors for Anesthesia Complications Preoperative Testing Risk Stratification Management CONCLUSION CONGENITAL PULMONARY AIRWAY MALFORMATION Introduction Etiopathogenesis Clinical Presentation Anesthetic Management Conclusion ARTHROGRYPOSIS MULTIPLEX CONGENITA Introduction Etiopathogenesis Classification Diagnostic Workup Perioperative Concerns ANESTHETIC MANAGEMENT PHEOCHROMOCYTOMA Introduction Epidemiology Pathophysiology Risks Assessment Preoperative Management Intraoperative Management Postoperative Management Conclusion CONSENT FOR PUBLICATION CONFLICT OF INTEREST ACKNOWLEDGEMENTS REFERENCES Subject Index 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 ndash; 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