Pediatric clinics of North America
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Pediatr. Clin. North Am. · Feb 1994
ReviewAnesthesia and apnea. Perioperative considerations in the former preterm infant.
Former preterm infants younger than 44 weeks postconceptual age are at increased risk for developing postoperative apnea and PB. When surgery cannot be deferred until the infant is developmentally more mature, several measures should be taken to minimize the risk of ventilatory dysfunction. First, outpatient surgery is not advisable for infants younger than 44 weeks postconceptual age. ⋯ Infants with anemia of prematurity, generally a benign condition, are at increased risk for postoperative apnea. It is therefore preferable to delay elective surgery and supplement the feeds with iron until the Hct is above 30%. When surgery cannot be deferred, anemic infants must be observed and monitored carefully in the postoperative period.
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This article addresses the preoperative fast in the context of its historic background, the physiology of gastric emptying, and recent clinical studies. A rationale is developed for minimizing the traditional preoperative fasting interval for elective surgery. The timing and the necessity for patients to resume ingesting clear liquids in the postoperative period is also explored.
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Pediatr. Clin. North Am. · Feb 1994
ReviewThe night after surgery. Postoperative management of the pediatric outpatient--surgical and anesthetic aspects.
Outpatient or "ambulatory" anesthesia and surgery has revolutionized the way surgery is practiced in the United States. Safe, reliable, inexpensive, and convenient outpatient surgery is an attractive option for parents, children, health care providers, and insurers.
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Pediatr. Clin. North Am. · Feb 1994
ReviewAnesthetic implications of an upper respiratory infection in children.
Pediatricians and pediatric anesthesiologists are frequently confronted with the dilemma of a child scheduled for elective surgery with or recently recovered from an upper respiratory tract infection. Modifications of routine anesthetic practice may decrease but not eliminate risks of associated complications. Guidelines for the evaluation and triage of these children are presented.
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Safe sedation of a pediatric patient requires a thorough knowledge of the pharmacokinetics and pharmacodynamics of the drugs used to sedate the patient and the skills necessary to deal effectively with potential adverse events as a result of the sedation. The Sedation Guidelines of the American Academy of Pediatrics are reviewed. Emphasis is placed on monitoring and appropriate selection of drugs.