{"title":"Anesthesia for the pediatric patient with a tracheostomy","authors":"Patrick Ross MD, FAAP","doi":"10.1053/j.sane.2007.06.009","DOIUrl":"10.1053/j.sane.2007.06.009","url":null,"abstract":"<div><p>Home ventilation programs support infants and children with chronic respiratory failure<span> either at home or in a long-term care facility. Commonly ventilatory support is via tracheostomy. Occasionally these patients will require anesthesia for emergency surgery. The goal of this article is to provide background on the patient population and techniques for managing the anesthetic. The pre-operative assessment as well as intra- and post-operative management will be addressed. There is specific focus on management of the airway to overcome potential leaks around the tracheostomy tube.</span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 3","pages":"Pages 153-157"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.06.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126619978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacqueline Drummond-Lewis MD, FAAP, William B. McIlvaine MD, CM, FRCPC, FAAP
{"title":"The experiences of epidural administration of clonidine in pediatric postoperative pain management","authors":"Jacqueline Drummond-Lewis MD, FAAP, William B. McIlvaine MD, CM, FRCPC, FAAP","doi":"10.1053/j.sane.2007.07.001","DOIUrl":"10.1053/j.sane.2007.07.001","url":null,"abstract":"<div><p><span><span>Regional anesthesia techniques have spread from the adult world to the </span>pediatric perioperative world over the past decades. Growth in the use of pediatric </span>epidural analgesia<span> in children has been accompanied by the necessary clinical studies on the safety and efficacy of these techniques. This paper addresses the scientific evidence in support of the use of clonidine<span> in the epidural space<span> of children for postoperative pain relief.</span></span></span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 3","pages":"Pages 149-152"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122438306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Routine pregnancy testing in adolescents: to test or not to test—what is the answer?","authors":"Randall C. Wetzel MB, BS, MRCP, LRCS, FAAP, FCCM","doi":"10.1053/j.sane.2007.06.005","DOIUrl":"10.1053/j.sane.2007.06.005","url":null,"abstract":"<div><p><span>Policies pertaining to routine pre-operative pregnancy testing in adolescent females continue to challenge pediatric<span> anesthesiologists. The expectation of safety for the mother regardless of pregnancy status, no risk of teratogenicity<span> of a single, general anesthetic, and a remaining suspicion that inhalation anesthetics are abortofacients guides this debate. Many medical, legal, ethical, moral, religious, economic justice, and practical issues are involved when considering routine pregnancy testing which must: 1) inform the parents of the test occurring and decide the consent procedures; 2) decide what to do with positive results; 3) decide who will receive the information of the positive test results; and 4) assure proper patient support and care from ancillary services, eg, counseling, child-life, social work, etc., in the event of a positive test. We should inform our patients of the controversy and make them aware of the potential, albeit slight, risk of </span></span></span>fetal loss or harm, while offering pregnancy testing for those concerned.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 3","pages":"Pages 120-125"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.06.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134177731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthesia for patients with cleft lip and palate","authors":"David J. Steward MB BS, FRCP","doi":"10.1053/j.sane.2007.06.004","DOIUrl":"10.1053/j.sane.2007.06.004","url":null,"abstract":"<div><p><span><span>Cleft lip and palate are common defects that may be a part of a syndrome or associated with other anomalies that are of real significance during anesthesia care. Accompanying facial or head and neck anatomical variations may result in difficulties with airway maintenance, </span>endotracheal intubation<span>, and postoperative ventilation, which can vary from mild to extreme. Concurrent congenital heart disease or other </span></span>systemic illness<span> may require special considerations during the perioperative period.</span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 3","pages":"Pages 126-132"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130781504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"MH-associated diseases: who really needs a non-triggering technique?","authors":"Ronald S. Litman DO, FAAP","doi":"10.1053/j.sane.2007.06.007","DOIUrl":"10.1053/j.sane.2007.06.007","url":null,"abstract":"<div><p><span>Malignant hyperthermia<span><span> (MH) is a pharmacogenetic clinical syndrome that occurs </span>in patients with preexisting abnormal </span></span>skeletal muscle<span><span>. It manifests clinically as a hypermetabolic crisis when a MH-susceptible individual is exposed to an inhalational anesthetic or a depolarizing </span>muscle relaxant (ie, succinylcholine).</span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 3","pages":"Pages 113-119"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.06.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125794114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Selected topics in perioperative multimodal pediatric pain management","authors":"Michael H. Joseph MD","doi":"10.1053/j.sane.2007.06.006","DOIUrl":"10.1053/j.sane.2007.06.006","url":null,"abstract":"<div><p>The term multimodal pain management often refers to the use of multiple pharmacological agents simultaneously in the postoperative period<span> in order to improve efficacy and minimize adverse effects. In this article, this therapeutic approach is discussed with a pediatric focus and expanded to include cognitive, behavioral, and complementary therapies. The overall goal being safe, effective management that can be easily delivered in any busy pediatric setting.</span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 3","pages":"Pages 141-148"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.06.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130567107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anterior mediastinal masses in children","authors":"Jerrold Lerman BASc, MD, FRCPC, FANZCA","doi":"10.1053/j.sane.2007.06.003","DOIUrl":"10.1053/j.sane.2007.06.003","url":null,"abstract":"<div><p><span>Anterior mediastinal masses<span><span><span><span><span><span> may present life-threatening challenges for the anesthesiologist, particularly in children. Children with symptoms referable to the respiratory involvement may present with dyspnea, orthopnea, or pleuritic </span>chest pain. Those with symptoms referable to cardiovascular involvement may present with syncope, shortness of breath with exertion and in certain positions, and swelling in the face. Chest x-rays, </span>CAT<span> scans, and echocardiography are commonly used to investigate these masses. The more common tumors in the anterior mediastinum are known by the four “T”s: </span></span>thymoma<span><span>, teratoma<span>, thyroid, and terrible lymphoma. T-cell lymphomas represent the most rapid growing tumors with a doubling time of 12 hours. These tumors may invaginate or compress adjacent structures, such as the trachea, causing </span></span>tracheomalacia<span><span> and tracheal narrowing and/or may compress the pulmonary artery and right atrium, infiltrate the </span>pericardium, and restrict the </span></span></span>superior vena cava<span>, thereby compromising cardiac output. The key strategy when planning these cases is to consider the type of anesthetic, spontaneous ventilation, and the position of the child. Local anesthesia<span>, sedation, or general anesthesia is suitable. Local anesthesia with sedation may be used in cooperative older children. General anesthesia should be accompanied by spontaneous ventilation. </span></span></span>Muscle relaxants<span><span><span> are proscribed. Children may not tolerate the supine position<span>, especially after induction of anesthesia<span>; turning the child to the left decubitus or </span></span></span>prone position<span> restores ventilation and cardiac output. The key strategy to restore cardiorespiratory </span></span>homeostasis when the anesthetized child with an anterior </span></span></span>mediastinal tumor begins to deteriorate is to turn them to the lateral decubitus or prone position.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 3","pages":"Pages 133-140"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.06.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114331953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John A. Williamson BSc, MBBS, DA(Melb.), FANZCA, DipDHM, FACTM, Peter Hibbert B App Sc (Physio), Grd Dip Comp, Cert Hlth Prog Ev, Klee Benveniste BA, Dip App Psych, PhD, MAPS, Bill Runciman MBBCh, FANZCA, FJFICM, FHKCA, FRCA, PhD
{"title":"The development of a crisis management manual for anesthetists and anesthesiologists","authors":"John A. Williamson BSc, MBBS, DA(Melb.), FANZCA, DipDHM, FACTM, Peter Hibbert B App Sc (Physio), Grd Dip Comp, Cert Hlth Prog Ev, Klee Benveniste BA, Dip App Psych, PhD, MAPS, Bill Runciman MBBCh, FANZCA, FJFICM, FHKCA, FRCA, PhD","doi":"10.1053/j.sane.2007.06.008","DOIUrl":"10.1053/j.sane.2007.06.008","url":null,"abstract":"<div><p>Crisis management is part and parcel of anesthesia practice. Cognitive science research and also common sense tell us that no one thinks clearly in a crisis. Taking example from other high-stress occupations, this paper describes the development of an anesthesia crisis management manual, based on data from 4000 anesthesia incidents reported anonymously by practicing anesthetists in Australia and New Zealand. Beginning with a “core algorithm” mnemonic, <strong>COVER ABCD A SWIFT CHECK</strong>, for routine monitoring and also for rendering any crisis situation “safe,” the anesthetist then chooses 1 of 24 specific, internally validated “sub-algorithms” to diagnose and correct the problem.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 3","pages":"Pages 173-177"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.06.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123891599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Volatile anesthetics and the hypoxic ventilatory response: effects, clinical implications, and future research","authors":"Jaideep J. Pandit MA, BM, DPhil, FRCA","doi":"10.1053/j.sane.2007.03.001","DOIUrl":"10.1053/j.sane.2007.03.001","url":null,"abstract":"<div><p><span><span>This review discusses the implications of some early findings concerning the effect of volatile anesthetic agents on the human </span>ventilatory response to hypoxia. The impact of different methods of study are discussed, as is the relevance and limitations of animal studies. The review speculates that a relatively simple observation from human study can lead to important questions, answerable using newer technologies such as functional magnetic resonance imaging, intracellular </span>calcium imaging and single-cell/single-channel voltage clamping.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 2","pages":"Pages 49-57"},"PeriodicalIF":0.0,"publicationDate":"2007-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124126149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Novel data on opioid effect on breathing and analgesia","authors":"Albert Dahan MD, PhD","doi":"10.1053/j.sane.2007.04.003","DOIUrl":"10.1053/j.sane.2007.04.003","url":null,"abstract":"<div><p><span>The most serious side effect of μ-opioid analgesics is the development of respiratory depression as this effect is potentially lethal. Recent genetic studies in mice revealed that opioid analgesia and respiratory depression are linked to one gene (</span><em>Oprm</em><span>) and consequently that the synthesis or discovery of a potent opioid analgesic without (respiratory) side effects is highly unlikely. Genetic studies in humans show that part of the variability in opioid analgesia and respiratory depression is related to one specific single nucleotide polymorphism (SNP): </span><em>OPRM1:c.118A</em>><em>G</em><span><span>. However, the effect of this SNP is different for analgesia and respiration. Whereas homozygous carriers of the mutated allele (about 4% of the Caucasian population) display reduced analgesia and respiratory depression, heterozygous carriers (29%) display a reduction in analgesia only. Evidently, these latter individuals carry an increased risk for opioid respiratory depression. Due to the </span>respiratory effects<span> of opioids, some physicians underdose or abstain from using potent opioids in the treatment of pain. Currently, the best approach to reduce the chance of opioid-induced respiratory depression and reduce the fear of clinicians is education and applying the knowledge that we have on the pharmacokinetics<span> and pharmacodynamics<span><span> (and their link) of opioids and their antagonists (naloxone). The latter is important in case a patient needs to be treated for opioid overdose. Furthermore, application of data on the genetics of opioid effect and variability will allow individualization of opioid therapy, aimed at optimal </span>analgesic efficacy and reduced toxicity. This will be possible in the near future.</span></span></span></span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"26 2","pages":"Pages 58-64"},"PeriodicalIF":0.0,"publicationDate":"2007-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2007.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123706059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}