Pediatric critical care medicine Volume 4. Peri-operative Care of the Critically Ill or Injured Child, 2nd Edition

The second edition of Pediatric Critical Care Medicine spans four volumes, with major sections dedicated to specific organ systems. Each major section consists of separate chapters dedicated to reviewing the specific disease processes affecting each organ system. Each chapter concludes with a comprehensive list of references, with brief, concise remarks denoting references of ‘special interest’ and ‘of interest’. Consequently, the books are unique in their comprehensive coverage of pediatric critical care and their ease of use and will be of value to those studying towards pediatric critical care examinations and those who are already qualified. Foreword to the First Edition Preface to the Second Edition Reference Preface to the First Edition Promises to Keep Acknowledgements Contents Contributors Part I: Anesthesia in the Critically Ill or Injured Child 1: Preparing the Critically Ill or Injured Child for Surgery Introduction Fasting Guidelines Systems-Based Approach to Preoperative Assessment Respiratory Cardiovascular Endocrine Hematologic Neurologic Preoperative Testing Vascular Access Preventing Surgical Site Infections Transportation of Critically Ill Patients Communication and Safe Hand-Off of Patient Care Conclusion References 2: Pharmacology of Inhalational and Intravenous Anesthetic Agents Introduction The Inhalational Anesthetic Agents Nitrous Oxide Volatile Anesthetics History of the Volatile Agents Chemical Structure and Physical Characteristics Uptake and Distribution of the Volatile Agents Minimum Alveolar Concentration of the Volatile Agents End-Organ Effects CNS Effects Cardiovascular Effects Respiratory Effects Hepatic Effects Renal Effects Malignant Hyperthermia Intravenous Anesthetic Agents Barbiturates Propofol Ketamine Etomidate Benzodiazepines Conclusion References 3: Sedation and Analgesia Introduction Agent, Route, and Mode of Administration Assessing the Depth of Sedation Agents for Sedation and Analgesia Inhalational Anesthetic Agents Benzodiazepines Etomidate Ketamine Propofol Barbiturates Opioids Phenothiazines and Butyrophenones Alpha 2 -Adrenergic Agonists Chloral Hydrate Conclusions References 4: Tolerance, Physical Dependency, and Withdrawal Introduction Tolerance, Physical Dependency and Withdrawal History Mechanisms of Tolerance Clinical Signs and Symptoms of Withdrawal Prevention of Tolerance Identification of the Group at Risk for Withdrawal Weaning Strategies and Treatment of Withdrawal Conclusion References 5: Neuromuscular Blockade Introduction Physiology of Neuromuscular Blocking Types and Classes of Neuromuscular Blocking Agents Depolarizing Neuromuscular Blocking Agents Succinylcholine Non-depolarizing Neuromuscular Blocking Agents Aminosteroid Compounds Pancuronium Vecuronium Pipecuronium Rocuronium Rapacuronium Benzylquinolinium Compounds D-tubocurarine Atracurium Cisatracurium Doxacurium Mivacurium Indications for Neuromuscular Blockade Short-Term Indications Long-Term Indications: Sustained Neuromuscular Blockade Current Treatment Strategies Monitoring Neuromuscular Blockade Reversal Anticholinesterases Cyclodextrins Side Effects and Complications Following Long-Term Use References 6: Procedural Sedation and Anesthesia in the PICU Introduction Definition of Procedural Sedation Preparation for Sedation Pre-procedural Assessment Fasting Guidelines Monitoring Complications Sedation Strategies Non-pharmacological Measures Pharmacological Agents Chloral Hydrate Benzodiazepines Propofol Ketamine Barbiturates Remifentanil Dexmedetomidine Inhalational Agents Comparative Studies Safety of the Clinical Setting References 7: Blood Conservation in the Perioperative Setting Introduction Risks of Transfusion and the Need for Blood Conservation Surgical Procedures and Patient Variables: Risk of Perioperative Transfusion Perioperative Blood Conservation Strategies Lowering Individual Transfusion Triggers Institutional Transfusion Guidelines Blood-Sparing Surgical Innovations: Minimally Invasive Craniosynostosis Surgery Antifibrinolytic Agents Epsilon Aminocaproic Acid (EACA) Tranexamic Acid (TXA) Preoperative Autologous Donation Cell Salvage Techniques Deliberate Hypotension Acute Normovolemic and Hypervolemic Hemodilution Preoperative Erythropoietin Administration Multimodal Blood Conservation References 8: Malignant Hyperthermia References Part II: General Principles of Peri-operative Care 9: Peri-operative Care of the General Pediatric Surgical Patient Introduction Thermoregulation in the Pediatric Surgical Patient Metabolic Changes from Surgical Stress Fluid and Electrolyte Balance Following Surgery General Principles of Resuscitation General Preoperative Preparation Special Considerations with Common Surgical Anomalies Gastroschisis Giant Omphalocele Esophageal Atresia with and Without Tracheoesophageal Fistula Congenital Diaphragmatic Hernia Necrotizing Enterocolitis Lymphatic Malformations Intestinal Obstruction Proximal Obstructions: Malrotation Proximal Obstructions: Duodenal Atresia, Stenosis, and Webs Proximal Obstructions: Jejuno-ileal Atresia Distal Obstructions: Hirschsprung’s Disease Distal Obstructions: Meconium Plug Syndrome Distal Obstructions: Meconium Ileus and Meconium Disease of the Preterm Infant Conclusion References 10: Perioperative Care of the Pediatric Neurosurgical Patient Introduction Developmental Physiology of the Nervous System Intracranial Pressure (ICP) Cerebral Blood Flow (CBF) Cerebral Metabolic Rate (CMR) CO 2 Reactivity Viscosity and CBF Cerebral Autoregulation Pharmacology of the Nervous System Propofol Barbiturates Opioids Etomidate Lidocaine Ketamine Dexmedetomidine Neuromuscular Blocking Agents Cerebral Vasodilators Fluids, Blood Products, and Electrolytes Electrolyte Disorders Preoperative Evaluation and Preparation Physical Examination Radiologic and Laboratory Evaluation Premedication General Principles of Intraoperative Management Induction Phase of Anesthesia Airway Management Vascular Access Maintenance Phase of Anesthesia Monitoring Advanced Neurophysiological Monitoring Cerebral Oxygenation Monitors Jugular Oximetry Cerebral Oximetry Brain Tissue Oxygenation (PbO 2) Anatomic Imaging and Cerebral Perfusion Emergence Phase of Anesthesia Special Considerations for Perioperative Management of Select Neurosurgical Diseases Congenital Anomalies Encephalocele Myelodysplasia and Spinal Cord Defects Chiari Malformations Tumors Hydrocephalus Craniosynostosis Epilepsy Vascular Malformations Neurotrauma Additional Considerations Neuroendoscopy Pain Management OR to ICU Handoffs and ICU Handoffs to OR Conclusion References 11: Perioperative Care of the Urology Patient Introduction General Perioperative Considerations Airway Management Fluid and Electrolyte Management Nutrition Drain Management Pain and Sedation Management Other Considerations Care of Patients with Neurogenic Bladder Intermittent Versus Indwelling Catheterization Antibiotic Use The Augmented or Neo-Bladder Catheter-Associated Urinary Tract Infection Prevention of CA-UTI References 12: Perioperative Care of the Orthopaedic Surgery Patient Introduction Pre-operative Management Pre-operative Evaluation Premedication Intra-operative Management Monitoring Anesthetic Management Positioning Visual Deficit After Prone Surgery Bleeding Spinal Cord Dysfunction Hypothermia Post-operative Management Cardiovascular and Hemodynamic Issues Respiratory Issues Pain Management Issues Electrolyte Abnormalities Conclusion References 13: Peri-operative Care of the ENT Patient Introduction Pre-operative Care Care of Specific Conditions Birth to 1 Year Infantile Hemangiomas Laryngotracheal Stenosis Toddler: 1–5 yo Epiglottitis Foreign Body Aspiration Croup/Spasmodic Croup Retropharyngeal Abscess Children to Adolescents Tonsillectomy and Adenoidectomy All Ages Inhalation Injuries/Burns and ENT Trauma Tracheotomy Post-operative Care Conclusion References Part III: Trauma 14: Head and Neck Trauma Introduction Head Trauma Epidemiology Pathophysiology Trauma Systems Initial Resuscitation ICP Monitoring Intracranial Hypertension Sedation, Analgesia and Neuromuscular Blockade CSF Drainage Hyperosmolar Therapy Hyperventilation Temperature Control Barbiturates Decompressive Craniectomy Corticosteroids Anti-convulsants Surgical Management Linear Skull Fractures Depressed Skull Fractures Compound Skull Fractures Epidural Hematomas Subdural Hematomas Cerebral Contusions and Intracerebral Hematomas Serial Imaging Additional Management Considerations Spinal Cord Injury Epidemiology Anatomic Considerations Clearing the Cervical Spine Spinal Cord Injury Without Radiographic Abnormalities (SCIWORA) Management Conclusion References 15: Craniofacial Trauma Introduction Epidemiology Anatomic and Physiologic Considerations in Pediatric Craniofacial Injuries Clinical Examination Imaging Studies Principle of Fracture Management Frontal Fractures Orbital Fractures Nasal Fractures Zygomaticomaxillary Complex Fractures Maxillary Fractures Mandibular Fractures Dentoalveolar Fractures Soft Tissue Injuries Conclusion References 16: Thoracic Trauma Incidence Anatomical and Physiological Considerations General Evaluation and Initial Treatment Specific Injuries Bony Injuries (Rib Fractures) Pulmonary Injuries Pulmonary Contusion Pneumothorax/Hemothorax Tracheobronchial Injury Traumatic Asphyxia Mediastinal Injuries Blunt Aortic Injury Blunt Cardiac Injury Commotio Cordis Esophageal Injuries Pneumomediastinum Diaphragm Emergency Room Thoracotomy Summary References 17: Abdominal Trauma Introduction Initial Evaluation of the Child with Suspected Abdominal Injury Imaging Specific Organ and Tissue Injuries Spleen Liver Pancreas Hollow Viscus Injuries Diaphragmatic Injury Abdominal Wall Injury Abdominal Compartment Syndrome Penetrating Trauma Conclusions References 18: Genitourinary Trauma Introduction Incidence Clinical Presentation Diagnosis Hematuria Radiographic Imaging Management of Renal Injury Complications Specific Types of GU Trauma Ureteral Trauma Diagnosis Management Bladder Trauma Diagnosis Management Urethral Trauma Diagnosis and Management Complications Scrotal and Testicular Trauma Diagnosis Management Female Genital Trauma Penile Trauma References 19: Pediatric Orthopaedic Trauma Introduction Pediatric Polytrauma Femur Fractures Pelvic Trauma Injuries to the Spinal Column Compartment Syndrome Open Fractures Orthovascular Trauma Clavicle Shaft Fractures and Rib Fractures Conclusion References 20: Pediatric Burns Introduction Classification of Burn Injuries Initial Management and Evaluation Hospital Admission Fluid Resuscitation Inhalation Injury Escharotomies and Fasciotomies Wound Care Topical Antimicrobial Agents Burn Excision and Closure Techniques Wound Closure Alternatives Nutritional Requirements After Burn Injury Complications Rehabilitation and Long Term Care Conclusion References Part IV: Cardiac Surgery and Critical Care 21: The Systemic Inflammatory Response to Cardiopulmonary Bypass: Pathophysiology and Treatment Introduction History Pathophysiology of the CPB-Induced Inflammatory Response Compensatory Anti-inflammatory Response Syndrome End Organ Injury and the Inflammatory Response to CPB Cerebral Injury Pulmonary Injury Cardiovascular Injury Renal Injury Mesenteric Injury Immunomodulatory Therapies Glucocorticoids Modified Ultrafiltration Heparin-Coated Circuits Conclusion References 22: Myocardial Protection Introduction Physiology of Immature Myocardium Physiologic Stresses Unique to Congenital Cardiac Disease Myocardial Protection Strategies Cardioplegia Crystalloid vs. Blood Cold vs. Warm Reperfusion Substrate and Electrolyte Enhancement Infusion Methods Reoxygenation Injury Conclusions References 23: Surgical Interventions for Congenital Heart Disease Introduction Two Ventricle Repairs Left-to-Right Shunt Lesions Atrial Septal Defect Timing of Surgery Method of Repair Follow-up Ventricular Septal Defect Timing of Surgery Method of Repair Follow-up Patent Ductus Arteriosus Timing of Surgery Method of Repair Follow-up Common Atrioventricular Canals Timing of Surgery Method of Repair Follow-up Aorticopulmonary Window Timing of Surgery Method of Repair Follow-up Mixing Lesions Truncus Arteriosus Timing of Surgery Method of Repair Follow-up Total and Partial Total Anomalous Pulmonary Venous Connection Timing of Surgery Method of Repair Follow-up D-Transposition of the Great Arteries Timing of Surgery Method of Repair Follow-up Congenitally Corrected Transposition of the Great Arteries Timing of Surgery Method of Repair Follow-up Left-Sided Obstructive Lesions Aortic Stenosis Timing of Surgery Method of Repair Follow-up Coarctation of the Aorta Timing of Surgery Method of Repair Follow-up Interrupted Aortic Arch Timing of Surgery Method of Repair Follow-up Mitral Stenosis and Cor Triatriatum Timing of Surgery Method of Repair Follow-up Right-Sided Obstructive Lesions Pulmonic Stenosis Timing of Surgery Method of Repair Follow-up Tetralogy of Fallot (TOF) Typical TOF Timing of Surgery Method of Repair Follow-up TOF with Pulmonary Atresia Timing of Surgery Method of Repair Follow-up TOF with Absent Pulmonary Valve Syndrome Timing of Surgery Method of Repair Follow-up Double Outlet Right Ventricle Ebstein’s Anomaly Timing of Surgery Method of Repair Follow-up Other Lesions Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) and Other Coronary Artery Anomalies Timing of Surgery Method of Repair Follow-up Vascular Rings and Slings Timing of Surgery Method of Repair Follow-up Single Ventricle Repairs Single Ventricle Surgical Procedures Systemic to Pulmonary Artery Shunt Pulmonary Artery Banding Pulmonary Artery-to-Aortic Anastamosis (Damus-Kaye-Stansel Procedure) Norwood Procedure Norwood with the Sano Modification Superior Cavopulmonary Connections and the Modified Fontan Operation Superior Cavopulmonary Connections Fontan Operation Common Lesions Receiving Single-Ventricle Palliation Hypoplastic Left Heart Syndrome Tricupsid Atresia Pulmonary Atresia with Intact Ventricular Septum Conclusion References 24: Palliative Procedures History Indications for Palliation Surgical Palliation to Supply Pulmonary Blood Flow Surgical Palliation to Control Pulmonary Blood Flow Catheter-Based Palliative Procedures Staged Hybrid Palliation Intraoperative Assessment of Palliative Procedures Post-procedure Management References 25: Peri-operative Care of the Child with Congenital Heart Disease Introduction Pre-operative Management Anatomy and Physiology Pre-operative Clinical State Pre-operative Cardiac Imaging and Hemodynamics Previous Cardiothoracic Surgery Intra-operative Course Procedure/Post-operative Hemodynamics Cardiopulmonary Bypass Cardioplegia and Myocardial Protection Modified Ultrafiltration Basic Principles of Post-operative Care General Principles Hemorrhage and Clotting Acid-Base Status Hemodynamic Assessment Oximetric Assessment Post-operative Intubation and Ventilation Arrhythmias Pacing Sedation, Analgesia and Muscle Relaxation Identification and Treatment of Low Cardiac Output Syndrome Acute Kidney Injury Diuretics Line and Tube Removal Mechanical Circulatory Support Lesion-Specific Post-operative Care Residual Left-to-Right Shunt Residual Systemic Ventricular Outflow Tract Obstruction Tricuspid or Mitral Valve Dysfunction Right or Left Ventricular Diastolic Dysfunction Pulmonary Hypertension Single Ventricle Lesions Conclusion References Part V: Critical Care of the Solid Organ Transplant Patient 26: Pharmacology of Immunosuppression Introduction Immunobiology of Transplantation and Graft Rejection Allorecognition Phase T-cell Activation Phase Commitment, Proliferation, and Differentiation Phase Effector Phase CD8 T-cell-Mediated Cytotoxicity DTH Response in Transplant Rejection Alloantibody Response in Transplant Rejection Adaptation of the Graft Following Transplantation General Concepts of Immunosuppression Drugs that Block the Signal Transduction Pathway of Activation in T Lymphocytes Cyclosporin A Sandimmune® Formulation: Pharmacologic Considerations Neoral® Formulation: Pharmacologic Considerations Drug Interactions Dose and Administration Drug Monitoring Adverse Effects and Toxicity Tacrolimus Pharmacologic Considerations Drug Interactions Dose and Administration Drug Monitoring Adverse Effects and Toxicity Sirolimus (Rapamycin) and Everolimus Pharmacologic Considerations Drug Interactions Dose and Administration Adverse Effects and Toxicity Sirolimus Efficacy Everolimus Efficacy Drugs that Block Proliferation and Differentiation Azathioprine Pharmacologic Considerations Drug Interactions Dose and Administration Drug Monitoring and Adverse Effects Mycophenolate Mofetil Pharmacologic Considerations Drug Interactions Dose and Administration Drug Monitoring Adverse Effects and Toxicity Leflunamide Mizoribine Drugs that Block or Inhibit Activation by Interfering with Cell Surface Interactions ATGAM Pharmacologic Considerations Dose and Administration Drug Monitoring Adverse Effects and Toxicity Thymoglobulin Pharmacologic Considerations Drug Interactions Dose and Administration Adverse Effects and Toxicity Alemtuzumab Pharmacologic Considerations Dose and Administration Adverse Effects and Toxicity Alemtuzumab Efficacy Non-depleting Antibodies: Daclizumab and Basiliximab Basiliximab Pharmacologic Considerations Dose and Administration Adverse Effects and Toxicity Efficacy Daclizumab Pharmacologic Considerations Dose and Administration Adverse Effects and Toxicity Efficacy Glucocorticoids Conclusion References 27: Heart Transplantation Introduction Identification and Evaluation of the Pre- Pre-transplant Evaluation Indications and Contraindications Psychosocial Factors Management of the Pre-transplant Candidate General Considerations Immunosuppression Induction Maintenance Immediate Post-operative Complications Primary Graft Failure Right Heart Failure Late Postoperative Complications Rejection Coronary Artery Vasculopathy Conclusion References 28: Pediatric Lung Transplantation Introduction Indications Cystic Fibrosis Surfactant Protein Abnormalities Pulmonary Vascular Disease Respiratory Failure Following Treatment for Malignancy Re-transplantation Contraindications to Lung Transplantation Post-operative Treatment Immediate Post-operative Management Immunosuppression Complications of Lung Transplantation Infection Graft Complications Primary Graft Dysfunction Rejection Airway Complications Vascular and Nerve Complications Other Complications Survival References 29: Pediatric Liver Transplantation Introduction Indications for Liver Transplantation Cholestatic Liver Disease Metabolic Diseases Acute Liver Failure Other Indications Contraindications to Liver Transplantation Evaluation of Potential LT Recipients Prioritization The Transplant Operation Allograft Procurement Donor Selection Whole-Liver Transplantation Reduced-Size Liver Transplantation Split-Liver Transplantation Living-Related Liver Transplantation Recipient Procedure Management During the Early Postoperative Period General Post-operative Management Respiratory Cardiovascular Gastrointestinal Renal Neurologic Specific Post-operative Considerations Surgical Considerations Primary Non-function and Sub-function of the Graft Vascular Complications Biliary Complications Medical Considerations Infections Acute Rejection Other Complications and Re-transplantation Immunosuppression Corticosteroids Calcineurin Inhibitors IL-2 Receptor Antibodies Other Immunosuppressive Drugs Results and Outcome Short-Term Results Outcome, Long-Term Complications and Quality of Life Conclusions and Future Directions References 30: Intestinal/Multivisceral Transplantation Introduction Indications for Transplant Pre-transplant Evaluation Surgical Approach Postsurgical Care and Surgical Complications Complications Related to Immunosuppression Immunosuppression Protocols Acute Cellular Rejection Antibody Mediated Rejection Graft-Versus-Host Disease Other Postoperative Complications Infectious Complications Respiratory Failure Sepsis and Septic Shock Acute Kidney Injury Chronic Kidney Disease Hematologic Complications Epstein-Barr Virus and Posttransplant Lymphoproliferative Disorders Neurological Complications Conclusion References 31: Kidney Transplantation Introduction Pre-operative Management Considerations Surgical Considerations Intra-operative Management Post-operative Management Considerations Surgical Complications Vascular Thrombosis Ureteral Obstruction and Urinary Leak Bleeding Acute Tubular Necrosis Immunosuppression Long-Term Complications Acute Rejection Chronic Rejection Hypertension Seizures Infections Polyomavirus (BK) Nephropathy Recurrence of Primary Disease Long-Term Outcome Conclusion References Index "The Editors and contributors of this book take seriously the statement that "For all of the science inherent in the specialty of pediatric critical care medicine, there is still art in providing comfort and solace to our patients and their families No technology will ever replace the compassion in the touch of a hand or the soothing words of a calm and gentle voice" The four volumes of Pediatric Critical Care Medicine: Basic Science and Clinical Evidence, 2nd Edition detail the continued growth and evolution of the pediatric critical care medicine speciality They reveal the technological innovations in monitoring and information management and gives witness to the rapid evolution and adoption of novel monitoring techniques, such as continuous venous oximetry and near-infrared spectroscopy They also cover advances in molecular biology that have led to the era of personalized medicine with the ability to individualize treatment to the unique and specific needs of a patient As such this volume and its three sister titles will be of immense value to all studying and practicing pediatric critical care medicine or those involved in the management of this group of patients - Font no determinada The second edition of Pediatric Critical Care Medicine spans three volumes, with major sections dedicated to specific organ systems. Each major section consists of separate chapters dedicated to reviewing the specific disease processes affecting each organ system. Each chapter concludes with a comprehensive list of references, with brief, concise remarks denoting references of ‘special interest'and ‘of interest'. Consequently, the books are unique in their comprehensive coverage of pediatric critical care and their ease of use and will be of value to those studying towards pediatric critical care examinations and those who are already qualified. This second edition spans four volumes, with major sections dedicated to specific organ systems. Each major section consists of separate chapters dedicated to reviewing the specific disease processes affecting each organ system. Each chapter concludes with a comprehensive list of references, with brief, concise remarks denoting references of ‘special interest'and ‘of interest'. Consequently, the books are unique in their comprehensive coverage of pediatric critical care and their ease of use and will be of value to those studying towards pediatric critical care examinations and those who are already qualified. V. 1. Care Of The Critically Ill Or Injured Child -- Volume 2. Respiratory, Cardiovascular And Central Nervous Systems -- Volume 3. Gastroenterological, Endocrine, Renal, Hematologic, Oncologic And Immune Systems -- Volume 4. Peri-operative Care Of The Critically Ill Or Injured Child. Derek S. Wheeler, Hector R. Wong, Thomas P. Shanley, Editors. Includes Bibliographical References And Index. Mode Of Access: World Wide Web.