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
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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There has been a tremendous amount of progress in the perioperative approach to the child since Levy wrote "Psychic trauma of operations in children and a note on combat neurosis" nearly 50 years ago. Recognition of prolonged behavioral derangements following the anesthetic-surgical-hospital experience and the prominent role that the parent and physician play in modifying these have dramatically changed the contemporary pediatric perioperative care. Of paramount importance is the psychological preparation of family and child. With increasing outpatient or same-day admission surgery and free-standing surgical centers, preoperative preparation will, of necessity, increasingly become the responsibility of the pediatrician.