Pub Date : 2021-01-01DOI: 10.1093/med/9780190685188.003.0011
A. Lazar
During epidural anesthesia, local anesthetics and adjuvants are administered into the epidural space by a single-shot, intermittent, or continuous technique. Epidural analgesia is used for open thoracic surgery, major intra-abdominal surgery with extensive surgical dissection, major lower extremity surgery, and long-term pain management. Epidural anesthesia is contraindicated in pediatric patients with uncorrected coagulopathy, hemophilia, liver disease causing coagulopathy, skin infection at the insertion site, bacteremia/sepsis, or lack of parental consent. Anesthesiologists should be familiar with the current American Society of Regional Anesthesia and Pain Medicine guidelines regarding anticoagulation and bleeding disorders in the setting of neuraxial anesthesia before performing epidural anesthesia. In infants, the tip of the conus medullaris and dural sac are located lower in the spinal column than in adults. Additionally, because the epidural space contains less fat and fibrous tissue than in adults, in infants it is easier to insert an epidural catheter at a lower level and then to thread it up to a higher level. In infants younger than 6 months, the vertebral column remains cartilaginous, and epidural catheters can be visualized with ultrasonography. In infants, for the initial placement of the needle, there is a more subtle “give” as the ligamentum flavum is pierced than in adult patients. As a general rule, the depth of the epidural space is 1 mm/kg of body weight (e.g., the depth of the epidural space in a 10-kg child would be 10 mm). However, because wide variation exists in the depth of the epidural space, a test for loss of resistance is performed as soon as the epidural needle has entered the supraspinous ligament.
{"title":"Epidural Anesthesia","authors":"A. Lazar","doi":"10.1093/med/9780190685188.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780190685188.003.0011","url":null,"abstract":"During epidural anesthesia, local anesthetics and adjuvants are administered into the epidural space by a single-shot, intermittent, or continuous technique. Epidural analgesia is used for open thoracic surgery, major intra-abdominal surgery with extensive surgical dissection, major lower extremity surgery, and long-term pain management. Epidural anesthesia is contraindicated in pediatric patients with uncorrected coagulopathy, hemophilia, liver disease causing coagulopathy, skin infection at the insertion site, bacteremia/sepsis, or lack of parental consent. Anesthesiologists should be familiar with the current American Society of Regional Anesthesia and Pain Medicine guidelines regarding anticoagulation and bleeding disorders in the setting of neuraxial anesthesia before performing epidural anesthesia.\u0000In infants, the tip of the conus medullaris and dural sac are located lower in the spinal column than in adults. Additionally, because the epidural space contains less fat and fibrous tissue than in adults, in infants it is easier to insert an epidural catheter at a lower level and then to thread it up to a higher level. In infants younger than 6 months, the vertebral column remains cartilaginous, and epidural catheters can be visualized with ultrasonography. In infants, for the initial placement of the needle, there is a more subtle “give” as the ligamentum flavum is pierced than in adult patients. As a general rule, the depth of the epidural space is 1 mm/kg of body weight (e.g., the depth of the epidural space in a 10-kg child would be 10 mm). However, because wide variation exists in the depth of the epidural space, a test for loss of resistance is performed as soon as the epidural needle has entered the supraspinous ligament.","PeriodicalId":212759,"journal":{"name":"Pediatric Anesthesia Procedures","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127305467","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 : 2021-01-01DOI: 10.1093/med/9780190685188.003.0013
Sarah L. Nizamuddin
After birth, the neonate must be immediately examined to evaluate the need for further resuscitation. Presence of an adequate respiratory effort and heart rate is vital, in addition to adequate tone and temperature. Warm, dry, and closely monitor the infant immediately after birth. Give positive pressure ventilation if there are any signs of respiratory distress or bradycardia. Low heart rate in a neonate is almost always due to hypoxia, so establish adequate ventilation as soon as possible in these cases. In cases of continued bradycardia, chest compressions and medication (epinephrine) may be necessary. Following resuscitation, transfer the neonate to an appropriate unit for continued monitoring.
{"title":"Neonatal Resuscitation","authors":"Sarah L. Nizamuddin","doi":"10.1093/med/9780190685188.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780190685188.003.0013","url":null,"abstract":"After birth, the neonate must be immediately examined to evaluate the need for further resuscitation. Presence of an adequate respiratory effort and heart rate is vital, in addition to adequate tone and temperature. Warm, dry, and closely monitor the infant immediately after birth. Give positive pressure ventilation if there are any signs of respiratory distress or bradycardia. Low heart rate in a neonate is almost always due to hypoxia, so establish adequate ventilation as soon as possible in these cases. In cases of continued bradycardia, chest compressions and medication (epinephrine) may be necessary. Following resuscitation, transfer the neonate to an appropriate unit for continued monitoring.","PeriodicalId":212759,"journal":{"name":"Pediatric Anesthesia Procedures","volume":"26 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123609793","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 : 2021-01-01DOI: 10.1093/MED/9780190685188.003.0016
Ajay D’Mello, Vidya T. Raman
A tracheoesophageal fistula (TEF) is a communication that is congenital or acquired between the trachea and esophagus. The reported incidence of TEF or esophageal atresia (EA) is roughly one to two per 5,000 live births. The first successful surgery for TEF was in 1939. Presently, owing to progress in surgical techniques, neonatal intensive care, and neonatal anesthesia, the majority of neonates with a TEF/EA who do not have severe associated congenital anomalies are expected to have satisfactory outcomes. Coexisting congenital abnormalities occur in 30 to 50% of patients with TEF/EA. Congenital anomalies are more common in patients with isolated esophageal atresia (65%) compared with isolated tracheoesophageal fistula (10%).
{"title":"Anesthesia for Tracheoesophageal Fistula","authors":"Ajay D’Mello, Vidya T. Raman","doi":"10.1093/MED/9780190685188.003.0016","DOIUrl":"https://doi.org/10.1093/MED/9780190685188.003.0016","url":null,"abstract":"A tracheoesophageal fistula (TEF) is a communication that is congenital or acquired between the trachea and esophagus. The reported incidence of TEF or esophageal atresia (EA) is roughly one to two per 5,000 live births. The first successful surgery for TEF was in 1939. Presently, owing to progress in surgical techniques, neonatal intensive care, and neonatal anesthesia, the majority of neonates with a TEF/EA who do not have severe associated congenital anomalies are expected to have satisfactory outcomes. Coexisting congenital abnormalities occur in 30 to 50% of patients with TEF/EA. Congenital anomalies are more common in patients with isolated esophageal atresia (65%) compared with isolated tracheoesophageal fistula (10%).","PeriodicalId":212759,"journal":{"name":"Pediatric Anesthesia Procedures","volume":"9 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128751398","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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