Anesthetic Considerations In Pediatric Conditions PDF

Anesthetic Considerations in Specific Pediatric Conditions CONGENITAL DIAPHRAGMATIC HERNIA During fetal development, the gut can herniate into the thorax through one of three possible diaphragmatic defects. -Pulmonary hypertension is very common and may complicate management by impairing oxygenat...

Anesthetic Considerations in Specific Pediatric Conditions CONGENITAL DIAPHRAGMATIC HERNIA During fetal development, the gut can herniate into the thorax through one of three possible diaphragmatic defects. -Pulmonary hypertension is very common and may complicate management by impairing oxygenation and decreasing cardiac output. Anesthetic Considerations 1-Mask ventilation may cause visceral distention and worsen oxygenation. 2-Gastric distention must be minimized by placement of a nasogastric tube and avoidance of high levels of positive- pressure ventilation. 3-The patient is preoxygenated and intubated awake, or without the aid of muscle relaxants. 4-Hypoxia and expansion of air in the bowel contraindicate the use of nitrous oxide. 5-Most patients need to remain intubated in the postoperative period. **A sudden fall in lung compliance, blood pressure, or oxygenation may signal a contralateral (usually right-sided) pneumothorax and necessitate placement of a chest tube. 4-If possible, peak inspiratory airway pressures should be less than 30 cm H2 O. 5-Pulmonary hypoplasia is suspected.  TRACHEOESOPHAGEAL FISTULA Breathing results in gastric distention, whereas feeding leads to choking, coughing, and cyanosis (three Cs). Anesthetic Considerations 1-These neonates tend to have copious pharyngeal secretions that require frequent suctioning before and during surgery. 2-Positive-pressure ventilation is avoided prior to intubation, as the resulting gastric distention may interfere with lung expansion. 3-gastrostomy tube may permit positive-pressure ventilation without excessive gastric distention. 4-The patient in the left lateral position. 5-A precordial stethoscope ??. 6-These neonates are often dehydrated and malnourished due to poor oral intake. 7-A drop in oxygen saturation indicates that the retracted lung needs to be reexpanded. 8-Blood pressure should be continuously monitored with an arterial line. 9-Neck extension and instrumentation (eg ,Suctioning ) of the esophagus may disrupt the surgical repair and should be avoided. Postoperative complications 1-Gastroesophageal reflux 2-Aspiration pneumonia 3-Tracheal compression 4-Anastomotic leakage ------------------------------------------------------------------------------------------------------------------------------------------------ INTESTINAL MALROTATION & VOLVULUS Malrotation of the intestines is a developmental abnormality that permits spontaneous abnormal rotation of the midgut around the mesentery (superior mesenteric artery). Anaesthetic considerations in intestinal Malrotation &volvulus 1-High risk for pulmonary aspiration. 2-Techniques for intubation : TIVA.RSI (or awake intubation) should be employed. 3-Patients are usually hypovolemic, and may tolerate anesthesia poorly. 4-An opioid-based anesthetic can also be used as postoperative ventilation will often be necessary. 5-Fluid resuscitation, likely including blood products, and sodium bicarbonate therapy are usually necessary. How are patients with omphalocele or gastroschisis managed in the perioperative period? 1-It is important to prevent evaporative and heat loss from exposed viscera. 2-Respiratory distress is uncommon. 3-Ventilation is controlled with muscle relaxants to facilitate return of the bowel into the Abdomen. 4-After intubation, a nasogastric tube should be placed. 5-Patients need good IV access to replace third-space and evaporative losses. 6-The abdominal cavity may be too small for the viscera. Venous return from or blood flow to the lower extremity may be compromised. A pulse oximeter?? on the foot helps to detect such changes. Renal perfusion may decrease and manifest as oliguria 7-Patients usually remain intubated after surgery.