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Recent Advances in Pediatric Anesthesia
Kirti N Saxena
CHAPTER 1:
Perioperative Fluid Therapy
INTRODUCTION
Renal System and Fluid Balance1
DETERMINING FLUID REQUIREMENTS2
Body Surface Area Method
Calorie Consumption and Body Weight
Insensible Water Loss
MAINTENANCE FLUID THERAPY
INTRAOPERATIVE FLUID THERAPY
NIL PER ORALLY(NPO) DEFICIT
Intraoperative Third Space Loss
WHAT FLUID IN PEDIATRIC SURGICAL PATIENT?
THE ARGUMENT FOR ISOTONIC MAINTENANCE FLUID
WHAT FLUID TO GIVE IN THE POSTOPERATIVE PERIOD?
CHAPTER 2:
Psychological Preparation and Premedication in Children
PSYCHOLOGICAL ASPECT OF HOSPITALIZATION
FACTORS GOVERNING THE PSYCHOLOGICAL RESPONSE
THE ROUTE OF ADMINISTRATION
Oral Route
Nasal Route
Rectal Route
Transdermal Route
Intravenous Route
Intramuscular Route
DRUGS USED FOR PREMEDICATION
Local Anesthetic Creams
Benzodiazepines
Opioids
KETAMINE
α2—ADRENORECEPTOR AGONIST
Chloral Hydrate
Phenothiazines
Nonopioid Analgesics
Anticholinergic Agents
Antiemetics
SUMMARY
CHAPTER 3:
Pediatric Airway Management
ANATOMY OF PEDIATRIC AIRWAY
Physiology of Pediatric Respiratory System
Routine Pediatric Airway Management
History and Physical Examination
Equipment and Devices
Face Mask
Oropharyngeal Airway
Nasopharyngeal Airway
Laryngoscopes Blades
Oxyscope
Endotracheal Tubes
Stylet
Laryngeal Mask Airway (LMA)
Procedures
Laryngoscopy and Intubation
Management of Difficult Airway
Anticipated Difficult Airway Management
Equipment for Anticipated difficult Airway Management
Intubation with Flexible Bronchoscopeand Laryngeal Mask Airway
Rigid Ventilating Bronchoscope
Endotracheal Tube Exchanger
Unanticipated difficult Airway Management
Emergency Access
Needle Cricothyrotomy (Jet Ventilation)
CHAPTER 4:
Overview of Pediatric and Neonatal Resuscitation
THE BLS SEQUENCE FOR INFANTS AND CHILDREN
BLS for Lay Rescuer
BLS for Health Care Provider
PEDIATRIC ADVANCED LIFE SUPPORT
Prevention of Cardiopulmonary Arrest
AIRWAY
Breathing: Oxygenation and Assisted Ventilation
Oxygen
Ventilation
Circulation
Emergency Fluids and Drugs
Defibrillation
Size of Paddles
Position of Paddles
Impedance
Energy Dose
AEDs
Management of Cardiopulmonary Arrest
Reversible causes of Cardiac Arrest (4 Hs and 4 Ts)
Asystole or Non-shockable Rhythm
Shockable Rhythms
Arrhythmias
Bradycardia
Tachycardia
Post-resuscitation Care
Respiratory System
Cardiovascular System
Drugs used to Maintain Cardiac Output
Neurologic System
Renal System
NEONATAL RESUSCITATION OR RESUSCITATION AT BIRTH
Initial Step
Initial Assessment
Airway
Breathing
Positive-Pressure Ventilation
Assisted Ventilation of Preterm Infants
Devices
Laryngeal Mask Airway
Endotracheal Intubation
Administration of Oxygen
Circulation
Drugs
Post Resuscitation Care
Glucose
Induced Hypothermia
ETHICS
Initiation of Resuscitation
Withholding Resuscitation
Discontinuing Resuscitative Efforts
HIGHLIGHTS OF 2005 AHA GUIDELINES
BLS Highlights
PALS Revisions
Neonatal Resuscitation Revisions
CHAPTER 5:
Pediatric Pain: Pathophysiology and Assessment
ABSTRACT
Defining Pain and Distress in Infants and Children
The Physiology of Pain in the Infant and Child, and its Consequences
Peripheral Transduction and Transmission
Central Mechanisms and Modulation
Neurodevelopment of Pain Perception
DIFFERENCE BETWEEN PEDIATRIC AND ADULT PAIN PATHWAYS AND THEIR CLINICAL IMPLICATIONS
Peripheral Mechanisms
Dorsal Horn Mechanisms
Inhibitory Nociceptive Mechanisms
Immediate Responses to Noxious Stimuli
CLINICAL ASSESSMENT OF PAIN
Visual Analogue Scales (VAS)
Category Rating Scales
Numerical Rating Scales
Non-verbal Measurement of Pain
Behavioral Measures of Pain
The Infant Pain Behavior Rating Scale
Procedural Behavioral Rating Scale and the Observational Scale of Behavioral Distress
Biological Measures
Composite Measures
CONCLUSION
CHAPTER 6:
Acute Pain Management: Neonates, Infants and Children
SOME ISSUES WITH USE OF OPIOIDS
Tolerance
Neonatal Consideration in the Administration of Opioids
Continuous Intravenous Opioids Infusion
PATIENT (PARENT AND NURSE) CONTROLLED ANALGESIA
SPINAL OPIOIDS
Novel Opioid Delivery Techniques15
Transmucosal
Transdermal
Tramadol
PEDIATRIC REGIONAL ANESTHESIA AS AN OPTION
Epidural/Caudal Blocks
Single-shot Caudal Analgesia
Caudal Versus Lumbar or Thoracic Catheter Insertion
Nerve Block as an Option
Complementary Therapies
CONCLUSION
CHAPTER 7:
Anesthesia for Pediatric Laparoscopic Surgery
INTRODUCTION
Advantages of Laparoscopic Surgery in the Pediatric Patient
ANESTHETIC HURDLES
Effects of Pneumoperitoneum
Pathophysiology of Pneumoperitoneum
Peritoneal Gas Insufflation
BLOOD GAS AND ACID BASE IMBALANCE
EFFECT ON RESPIRATORY MECHANICS
Clinical Significance
CARDIOVASCULAR EFFECTS
RENAL EFFECTS
CNS EFFECTS
ENDOCRINOLOGICAL EFFECTS
TEMPERATURE REGULATION
ANESTHETIC CONSIDERATIONS
PREMEDICATION
Anesthetic Technique
INDUCTION
Maintenance of Anesthesia
USE OF N2O
OPTIMUM IAP LEVELS
USE OF LMA
POSTOPERATIVE ANALGESIA
POSTOPERATIVE NAUSEA AND VOMITING
COMPLICATIONS OF PEDIATRIC LAPAROSCOPIC SURGERY
DISADVANTAGES WITH USE OF LAPAROSCOPY
CONCLUSION
CHAPTER 8:
Anesthesia for Premature Infants
APNEIC SPELLS
GENERAL ANESTHESIA
GENERAL ANESTHESIA OR REGIONAL ANESTHESIA?
SPINAL ANESTHESIA
CAUDAL ANESTHESIA
TOPICAL ANESTHESIA
ACUPUNCTURE IN EX PREMATURE INFANTS
POSTOPERATIVE ANALGESIA
INDEX
TOC
Index
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