Anesthesiology clinics
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The number of pediatric patients requiring sedation for procedures performed outside the operating room environment continues to grow yearly, as does the number of patients surviving to adulthood with the residua and sequelae of congenital heart disease. Ongoing efforts to develop guidelines to enhance the safety of these pediatric sedative encounters have resulted in great strides in the prevention of adverse events. ⋯ Care of the subset of patients with congenital heart disease or pulmonary hypertension remains especially demanding. The additional safety challenges posed by remote locations make the highest level of vigilance essential when planning and performing sedation for these children.
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Anesthesiology clinics · Jun 2009
Pediatric difficult airway management: current devices and techniques.
The anesthesiologist confronting the difficult pediatric airway is presented with a unique set of challenges. Adult difficult airway management techniques, such as awake or invasive approaches to airway management, often cannot be applied to children because of inadequate cooperation. ⋯ From a physiologic perspective, children have higher rates of oxygen consumption, significantly shortening the period of apnea that can be safely tolerated. Normal developmental anatomic differences of the pediatric airway and the presence of craniofacial dysmorphisms, presents additional challenges to tracheal intubation.
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Traditionally, sedation for gastrointestinal endoscopic procedures was provided by the gastroenterologist. Increasingly, however, complex procedures are being performed on seriously ill patients. As a result, anesthesiologists now are providing anesthesia and sedation in the gastrointestinal endoscopy suite for many of these patients. This article reviews the challenges encountered in this environment and anesthetic techniques that can be used successfully for these procedures.
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Anesthesiology clinics · Mar 2009
The role of the out-of-operating room anesthesiologist in the care of the cardiac patient.
Modern invasive cardiovascular procedures require patients to be both comfortable and cooperative. In addition, these procedures demand the complete attention of the attending cardiovascular specialist, and, to a large degree, the outcomes of these procedures depend on the amount of focus and concentration the cardiovascular specialist can give to performing the procedure itself. ⋯ This article clearly delineates the procedures cardiologists perform that might involve anesthesiologists. Mutual knowledge, understanding, and respect are fundamental requirements for integration of cardiology and anesthesia services to optimize patient outcomes.