Recent Advances in Pediatric Anesthesia
Recent Advances in Pediatric Anesthesia
Editor
Kirti N Saxena MBBS MD
Professor Department of Anesthesiology and Intensive Care Maulana Azad Medical College and Associated Lok Nayak Hospital New Delhi, India
Foreword
CK Dua
®
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[email protected] Central America Office Jaypee-Highlights Medical Publishers Inc., City of Knowledge, Bld. 237, Clayton, Panama City, Panama, Ph: (507)317-0160 Recent Advances in Pediatric Anesthesia © 2009, Jaypee Brothers Medical Publishers All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher. This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editor will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 2009 ISBN: 978-81-8448-680-3 Typeset at JPBMP typesetting unit Printed at Ajanta Press
To The memory of my late parents Shri Kameshwar Nath and Shrimati Priyamvada Who always encouraged me and taught me the value of knowledge and human values
Contributors Kirti N Saxena
MD
Professor Department of Anesthesiology and Intensive Care Maulana Azad Medical College and Lok Nayak Hospital New Delhi
Bharti Taneja
MD
Assistant Professor Department of Anesthesiology and Intensive Care Maulana Azad Medical College and Lok Nayak Hospital New Delhi
Gunjan Manchanda
DA DNB
Specialist Department of Anesthesiology and Intensive Care Maulana Azad Medical College and Lok Nayak Hospital New Delhi
Prachi Gaba
DA DNB
Specialist Department of Anesthesiology and Intensive Care Maulana Azad Medical College and Lok Nayak Hospital New Delhi
Amit Bhagwat
MD
Akhil Singhal
DA
Senior Resident Department of Anesthesiology and Intensive Care Maulana Azad Medical College and Lok Nayak Hospital New Delhi
Senior Resident Department of Anesthesiology and Intensive Care Maulana Azad Medical College and Lok Nayak Hospital New Delhi
Sandhya Od
MD
Senior Resident Department of Anesthesiology and Intensive Care Maulana Azad Medical College and Lok Nayak Hospital New Delhi
Foreword Pediatric anesthesia is one of the most challenging sub-specialties of anesthesiology. Pediatric patients, because of their unique anatomical, physiological and pharmacological characteristics, are not treated as miniature adults and hence, extrapolation of adult data is not feasible. It is axiomatic that advances in surgery cannot be achieved without concurrent developments in anesthesiology. Over the last two decades, there have been tremendous advances in pediatric surgical procedures and that has been possible only due to simultaneous development of appropriate management strategies and innovative technologies in pediatric anesthesia. Concurrent with these advances, there have been changes in airway management and cardio-pulmonary resuscitation of pediatric patients. This book entitled Recent Advances in Pediatric Anesthesia intends to provide comprehensive information in a legible and simplified manner. It covers most of the important aspects of pediatric anesthesia such as: psychological preparation and premedication, perioperative fluid management, pediatric airway management, pathophysiology assessment and management of acute pain, pediatric and neonatal resuscitation, anesthesia for premature infants and anesthetic management of pediatric laparoscopic surgical procedures. The topics are very well covered with special emphasis on the recent guidelines and protocols in a tabulated manner. The topics are also adequately referenced. It gives me immense pleasure to introduce the author of this book, Dr Kirti Nath Saxena, Professor Anesthesiology at MAMC. I have known her for more than 20 years, as a student, resident, and faculty. She is a highly dynamic and articulate author and has put in tremendous effort in compiling this book. The author has done a commendable job reviewing various aspects of pediatric anesthesia as well as introducing the reader to newer concepts that are and will become more important in the future. I recommend this book since it would prove useful not only for the students, but also for practitioners as well as teachers. Furthermore, it will serve as an excellent reference book for other providers including surgeons and anesthesiologists who care for pediatric patients. I am sure the readers of this book will benefit substantially from it. I wish this endeavor all success.
Dr CK Dua MBBS DA MD
Former Director-Professor and HOD Department of Anesthesiology Maulana Azad Medical College, New Delhi, India
Preface The field of anesthesiology is expanding so rapidly that it is difficult to keep pace with new developments every day. As an academician working and teaching in a premier medical college of India, I am priviledged to have access to the latest journals and books in my subject and have felt the need for the practitioners of my speciality to have the same. The aim of bringing out this publication is to bridge the gap between textbooks and journals. Though most of this information is available in journals, our endeavor is to present this knowledge in a concise and articulate manner in one place. It is aimed at the busy practitioners and postgraduate students specializing in this field. This book is the first in a series on recent advances in the field of anesthesiology. The focus of this issue is on pediatric anesthesia which has seen some major pathbreaking changes which are also related to rapid strides in the field of pediatric surgery.
Kirti N Saxena
Acknowledgements I am thankful to my husband, Dr Yogesh Krishna Saxena and both my sons, Prashant and Anshuman, who have always encouraged and supported me in all my endeavors. I am thankful to my head of department, Dr Raktima Anand for encouraging me to bring out this book. I am thankful to Dr Bharti Taneja, Dr Gunjan Manchanda, and Dr Prachi Gaba for showing faith in me and working tirelessly with me to bring out this publication. I also wish to thank Dr Amit Bhagwat, Dr Akhil Singhal, and Dr Sandhya Od, who were my students and have made me proud today by contributing to this book.
Kirti N Saxena
Contents 1. Perioperative Fluid Therapy ................................................................. 1 Kirti N Saxena, Akhil Singhal 2. Psychological Preparation and Premedication in Children ......... 12 Prachi Gaba 3. Pediatric Airway Management ........................................................... 34 Gunjan Manchanda, Sandhya Od 4. Overview of Pediatric and Neonatal Resuscitation ....................... 58 Prachi Gaba 5. Pediatric Pain: Pathophysiology and Assessment ........................ 113 Kirti N Saxena, Amit Bhagwat 6. Acute Pain Management: Neonates, Infants and Children ........ 129 Kirti N Saxena, Amit Bhagwat 7. Anesthesia for Pediatric Laparoscopic Surgery ............................ 145 Bharti Taneja 8. Anesthesia for Premature Infants .................................................... 162 Kirti N Saxena Index ....................................................................................................... 173
