Pub Date : 2018-10-01DOI: 10.1093/med/9780190685157.003.0057
H. Saadat, Z. Kain
Each year, about six million children undergo surgical procedures in the United States. More than 80% of all pediatric procedures in the United States are on an outpatient basis without hospital preoperative or postoperative admission. More than 60% of these children manifest emotional distress prior to the procedures and at the induction of anesthesia. The intense distress may lead to negative postoperative physiological and psychological outcomes in children and affect parental satisfaction. Preoperative stress can also exaggerate negative memories, which can exaggerate distress at subsequent procedures. Studies have looked into the incorporation of pharmacological agents as well as nonpharmacological strategies such as parental presence, and behavioral techniques such as imagery, relaxation, and hypnosis in the management of preoperative anxiety. The goal of this chapter is to examine the effects of preoperative anxiety and the effectiveness of these strategies in preventing preoperative psychological stress in children.
{"title":"Psychological Preparation of the Pediatric Patient for Surgery","authors":"H. Saadat, Z. Kain","doi":"10.1093/med/9780190685157.003.0057","DOIUrl":"https://doi.org/10.1093/med/9780190685157.003.0057","url":null,"abstract":"Each year, about six million children undergo surgical procedures in the United States. More than 80% of all pediatric procedures in the United States are on an outpatient basis without hospital preoperative or postoperative admission. More than 60% of these children manifest emotional distress prior to the procedures and at the induction of anesthesia. The intense distress may lead to negative postoperative physiological and psychological outcomes in children and affect parental satisfaction. Preoperative stress can also exaggerate negative memories, which can exaggerate distress at subsequent procedures. Studies have looked into the incorporation of pharmacological agents as well as nonpharmacological strategies such as parental presence, and behavioral techniques such as imagery, relaxation, and hypnosis in the management of preoperative anxiety. The goal of this chapter is to examine the effects of preoperative anxiety and the effectiveness of these strategies in preventing preoperative psychological stress in children.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85605285","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}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190678333.003.0057
E. Lin, J. Spaeth, Melanie Handley
The majority of children with Down syndrome are friendly and separate from parents easily. The presence of comorbidities should be the area of focus for the anesthesiologist. Cardiac anomalies are commonly present, and the most common of these is common atrioventricular canal. Not all patients present with cardiac disease though, and some may present with gastrointestinal anomalies. These children also exhibit sensitivity to inhalational anesthetics resulting in bradycardia during inhalation induction. They tend to have very narrow auditory canals, making myringotomy challenging and resulting in relatively longer anesthetics for ear tube placement. Careful attention should be paid to positioning of the neck during instrumentation of the airway as well due to possible instability of the cervical spine.
{"title":"Down Syndrome","authors":"E. Lin, J. Spaeth, Melanie Handley","doi":"10.1093/med/9780190678333.003.0057","DOIUrl":"https://doi.org/10.1093/med/9780190678333.003.0057","url":null,"abstract":"The majority of children with Down syndrome are friendly and separate from parents easily. The presence of comorbidities should be the area of focus for the anesthesiologist. Cardiac anomalies are commonly present, and the most common of these is common atrioventricular canal. Not all patients present with cardiac disease though, and some may present with gastrointestinal anomalies. These children also exhibit sensitivity to inhalational anesthetics resulting in bradycardia during inhalation induction. They tend to have very narrow auditory canals, making myringotomy challenging and resulting in relatively longer anesthetics for ear tube placement. Careful attention should be paid to positioning of the neck during instrumentation of the airway as well due to possible instability of the cervical spine.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85740318","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}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190696696.003.0011
K. Hovinga, Y. Esquenazi, P. Gutin
Meningiomas are the most common primary central nervous system tumors and account for about one third of all primary brain and spinal tumors. They are classified according to the World Health Organization into 3 groups (I–III). Treatment strategies range from observation, surgery, and/or a radiation therapy. Many meningiomas are slow growing and discovered incidentally. Symptoms can vary widely, depending on the location. Patient’s specific factors and the location of the meningioma in relation to critical brain structures are all important factors in determining the optimal treatment. This chapter presents common clinical scenarios of meningioma. Differential diagnosis, perioperative workup, surgical nuances, and postoperative complications are discussed.
{"title":"Meningiomas","authors":"K. Hovinga, Y. Esquenazi, P. Gutin","doi":"10.1093/med/9780190696696.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780190696696.003.0011","url":null,"abstract":"Meningiomas are the most common primary central nervous system tumors and account for about one third of all primary brain and spinal tumors. They are classified according to the World Health Organization into 3 groups (I–III). Treatment strategies range from observation, surgery, and/or a radiation therapy. Many meningiomas are slow growing and discovered incidentally. Symptoms can vary widely, depending on the location. Patient’s specific factors and the location of the meningioma in relation to critical brain structures are all important factors in determining the optimal treatment. This chapter presents common clinical scenarios of meningioma. Differential diagnosis, perioperative workup, surgical nuances, and postoperative complications are discussed.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80868354","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}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190678333.003.0069
M. Dalton
The Jehovah’s Witnesses are a unique group of patients that can pose a challenge to the anesthesiologist given their desire to avoid transfusion of blood products. This religious belief can include refusal of red cells, white cells, plasma, as well as platelets. The perioperative care of such patients can include the use of bloodless techniques in order to respect their beliefs. Given the desire to avoid blood products, it is imperative to utilize strategies that will prevent unnecessary transfusion. It is also important to understand the ethical and or legal ramifications of overriding parental/adolescent requests for no transfusion as well as acceptance of adolescent transfusion refusal.
{"title":"Managing Blood Loss in a Jehovah’s Witness Patient","authors":"M. Dalton","doi":"10.1093/med/9780190678333.003.0069","DOIUrl":"https://doi.org/10.1093/med/9780190678333.003.0069","url":null,"abstract":"The Jehovah’s Witnesses are a unique group of patients that can pose a challenge to the anesthesiologist given their desire to avoid transfusion of blood products. This religious belief can include refusal of red cells, white cells, plasma, as well as platelets. The perioperative care of such patients can include the use of bloodless techniques in order to respect their beliefs. Given the desire to avoid blood products, it is imperative to utilize strategies that will prevent unnecessary transfusion. It is also important to understand the ethical and or legal ramifications of overriding parental/adolescent requests for no transfusion as well as acceptance of adolescent transfusion refusal.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80868498","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}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190617127.003.0026
M. Socolovsky, R. Torino, L. Flores
This chapter focuses on the clinical and surgical management of facial nerve palsy that occurs as a consequence of injury during resection of a vestibular schwannoma. If the facial nerve is damaged during cerebellopontine angle (CPA) tumor resection, a first attempt to repair it at the skull base should be made. Because this is commonly infeasible, a nerve transfer—scheduled as an elective procedure after the patient has completely recovered from the resection procedure—is mandatory. Hemihypoglossal, masseter, and cross-facial nerve transfers are the techniques most widely used. The authors’ preferred technique is hemihypoglossal nerve transfer, and the surgical technique is described. By contrast, when the facial nerve is preserved during surgery, but complete facial palsy develops afterward, postoperative rehabilitation should be started and continued for up to 1 year. If, however, facial palsy persists beyond 1 year, then the patient should be offered the option of a nerve transfer.
{"title":"Facial Nerve Injury","authors":"M. Socolovsky, R. Torino, L. Flores","doi":"10.1093/med/9780190617127.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780190617127.003.0026","url":null,"abstract":"This chapter focuses on the clinical and surgical management of facial nerve palsy that occurs as a consequence of injury during resection of a vestibular schwannoma. If the facial nerve is damaged during cerebellopontine angle (CPA) tumor resection, a first attempt to repair it at the skull base should be made. Because this is commonly infeasible, a nerve transfer—scheduled as an elective procedure after the patient has completely recovered from the resection procedure—is mandatory. Hemihypoglossal, masseter, and cross-facial nerve transfers are the techniques most widely used. The authors’ preferred technique is hemihypoglossal nerve transfer, and the surgical technique is described. By contrast, when the facial nerve is preserved during surgery, but complete facial palsy develops afterward, postoperative rehabilitation should be started and continued for up to 1 year. If, however, facial palsy persists beyond 1 year, then the patient should be offered the option of a nerve transfer.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78330477","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}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190678333.003.0046
Karla E. K. Wyatt, O. Olutoye
Necrotizing enterocolitis (NEC) is a severe inflammatory bowel disease that commonly affects premature infants. The pathogenesis is multifactorial and poorly understood, although certain risk factors have been identified. This disease, more commonly detected in premature infants with accompanying cardiac and pulmonary comorbid conditions, is associated with increased morbidity and mortality. Multiorgan system homeostasis becomes critical for the pediatric anesthesiologist when approaching medical and surgical interventions for affected patients. This chapter focuses on the population at risk for developing necrotizing enterocolitis, medical and surgical management, providing anesthesia care in the neonatal intensive care unit, as well as perioperative considerations and complications.
{"title":"Exploratory Laparotomy for Necrotizing Enterocolitis","authors":"Karla E. K. Wyatt, O. Olutoye","doi":"10.1093/MED/9780190678333.003.0046","DOIUrl":"https://doi.org/10.1093/MED/9780190678333.003.0046","url":null,"abstract":"Necrotizing enterocolitis (NEC) is a severe inflammatory bowel disease that commonly affects premature infants. The pathogenesis is multifactorial and poorly understood, although certain risk factors have been identified. This disease, more commonly detected in premature infants with accompanying cardiac and pulmonary comorbid conditions, is associated with increased morbidity and mortality. Multiorgan system homeostasis becomes critical for the pediatric anesthesiologist when approaching medical and surgical interventions for affected patients. This chapter focuses on the population at risk for developing necrotizing enterocolitis, medical and surgical management, providing anesthesia care in the neonatal intensive care unit, as well as perioperative considerations and complications.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77449651","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}
Pub Date : 2018-10-01DOI: 10.1093/med/9780199362318.003.0005
Bryan T. Denny, K. Ochsner
This chapter takes a social cognitive affective neuroscience approach to describe the processes and systems to give rise to emotion and the volitional control of emotion. It provides a detailed description of the processes that underlie the regulation of emotion. It introduces and synthesizes the brain structures involved in emotion processing and regulation. There is a particular focus on the role of the ventrolateral, dorsolateral and dorsomedial prefrtonal cortex, amgydala, ventral striatum and insula, and on cognitive strategies such as reappraisal. It provides a critical framework for understanding the underlying behavioral and neural basis for the affect dysregulation observed across personality disorders, and summarizes future directions for this area of investigation.
{"title":"Minding the Emotional Thermostat","authors":"Bryan T. Denny, K. Ochsner","doi":"10.1093/med/9780199362318.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780199362318.003.0005","url":null,"abstract":"This chapter takes a social cognitive affective neuroscience approach to describe the processes and systems to give rise to emotion and the volitional control of emotion. It provides a detailed description of the processes that underlie the regulation of emotion. It introduces and synthesizes the brain structures involved in emotion processing and regulation. There is a particular focus on the role of the ventrolateral, dorsolateral and dorsomedial prefrtonal cortex, amgydala, ventral striatum and insula, and on cognitive strategies such as reappraisal. It provides a critical framework for understanding the underlying behavioral and neural basis for the affect dysregulation observed across personality disorders, and summarizes future directions for this area of investigation.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77827796","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}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190678333.003.0068
D. A. Young
Patients and families overwhelmingly want to be informed regarding matters related to poor outcomes and medical errors. After the occurrence of a medical error, most patients and families highly value an honest and transparent disclosure of the details as well as a sincere apology from the parties responsible regardless of the degree of apparent harm. When disclosing a medical error to a parent or patient, an organized approach using a truthful and compassionate discussion as the backbone is the most prudent strategy. Additionally, effective disclosure practices can decrease legal liability. This chapter discusses the differences between medical errors and poor clinical outcomes, the distinctions between near misses and sentinel events, the indications for disclosure of medical errors without apparent harm as well as the appropriate use of apology, and an approach for the effective disclosure of a pediatric medical error to a parent.
{"title":"Disclosure after Complication in the Operating Room","authors":"D. A. Young","doi":"10.1093/med/9780190678333.003.0068","DOIUrl":"https://doi.org/10.1093/med/9780190678333.003.0068","url":null,"abstract":"Patients and families overwhelmingly want to be informed regarding matters related to poor outcomes and medical errors. After the occurrence of a medical error, most patients and families highly value an honest and transparent disclosure of the details as well as a sincere apology from the parties responsible regardless of the degree of apparent harm. When disclosing a medical error to a parent or patient, an organized approach using a truthful and compassionate discussion as the backbone is the most prudent strategy. Additionally, effective disclosure practices can decrease legal liability. This chapter discusses the differences between medical errors and poor clinical outcomes, the distinctions between near misses and sentinel events, the indications for disclosure of medical errors without apparent harm as well as the appropriate use of apology, and an approach for the effective disclosure of a pediatric medical error to a parent.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73133990","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}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190850036.003.0016
Abigail E. Meigh, I. F. Antoine, Veronica Carullo
In children, the most common indication for spinal fusion is significant scoliotic curvature, either idiopathic or as a result of neuromuscular disease. Spinal fusion is high-risk surgery, which can be further complicated by comorbid disease. It carries substantial risk for significant fluid shifts, high intraoperative blood loss, physiologic strain secondary to duration and positioning, severe postoperative pain, and potential spinal cord injury. To mitigate risk and optimize outcomes, these patients should be carefully evaluated by the anesthetic team preoperatively and a comprehensive perioperative plan established. To protect the spinal cord and predict poor neurologic outcomes, the majority of these cases employ intraoperative neuromonitoring. The specific anesthetic agents to allow maximal neuromonitoring signals while ensuring adequate anesthetic depth and pain control should also be established collaboratively. These patients experience severe postoperative pain, and a multimodal approach to therapy should be employed to allow for expedited recovery and decreased length of stay.
{"title":"Pediatric Spine Surgery","authors":"Abigail E. Meigh, I. F. Antoine, Veronica Carullo","doi":"10.1093/MED/9780190850036.003.0016","DOIUrl":"https://doi.org/10.1093/MED/9780190850036.003.0016","url":null,"abstract":"In children, the most common indication for spinal fusion is significant scoliotic curvature, either idiopathic or as a result of neuromuscular disease. Spinal fusion is high-risk surgery, which can be further complicated by comorbid disease. It carries substantial risk for significant fluid shifts, high intraoperative blood loss, physiologic strain secondary to duration and positioning, severe postoperative pain, and potential spinal cord injury. To mitigate risk and optimize outcomes, these patients should be carefully evaluated by the anesthetic team preoperatively and a comprehensive perioperative plan established. To protect the spinal cord and predict poor neurologic outcomes, the majority of these cases employ intraoperative neuromonitoring. The specific anesthetic agents to allow maximal neuromonitoring signals while ensuring adequate anesthetic depth and pain control should also be established collaboratively. These patients experience severe postoperative pain, and a multimodal approach to therapy should be employed to allow for expedited recovery and decreased length of stay.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73172084","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}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190619268.003.0004
C. Rushton
An alternative path for addressing moral adversity and the resultant moral suffering engages the focal points in a cycle of imperiled integrity in response to moral harms, wrongs, failures, or other forms of moral adversity. Initially moral stress, a neutral state of readiness to respond that will eventually involve an appraisal as positive or negative, may be experienced. Depending on this appraisal and individual capabilities, moral stress may be rebalanced, released, or resolved, engaging our moral resilience to proactively or prospectively respond to moral adversity. Alternatively, when the moral stress of imperiled integrity exceeds our capacities and becomes unmanageable or overwhelming, it can instigate a pathway leading to moral suffering that includes moral distress, outrage, and injury. In some instances moral suffering leads to recalcitrant or persistent forms of moral decline. When moral resilience including a process of moral repair is leveraged, integrity can be restored.
{"title":"Mapping the Path of Moral Adversity","authors":"C. Rushton","doi":"10.1093/med/9780190619268.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780190619268.003.0004","url":null,"abstract":"An alternative path for addressing moral adversity and the resultant moral suffering engages the focal points in a cycle of imperiled integrity in response to moral harms, wrongs, failures, or other forms of moral adversity. Initially moral stress, a neutral state of readiness to respond that will eventually involve an appraisal as positive or negative, may be experienced. Depending on this appraisal and individual capabilities, moral stress may be rebalanced, released, or resolved, engaging our moral resilience to proactively or prospectively respond to moral adversity. Alternatively, when the moral stress of imperiled integrity exceeds our capacities and becomes unmanageable or overwhelming, it can instigate a pathway leading to moral suffering that includes moral distress, outrage, and injury. In some instances moral suffering leads to recalcitrant or persistent forms of moral decline. When moral resilience including a process of moral repair is leveraged, integrity can be restored.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73311354","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}
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