Local anesthetics are nondiscriminating compounds that have a low affinity for all seven isoforms of voltage-gated sodium channels in tissues (e.g., myocardium, skeletal muscle, brain, spinal cord, and nerves). There is minimal variation in local anesthetic affinity among these isoforms,…
Introduction History of inhaled anesthetics The discovery of inhalational agents played a critical role in anesthesia history. The search for the perfect agent capable of rapid induction of anesthesia, one with a high safety profile and minimal side effects, has…
Introduction Sedative hypnotic agents are an essential element in the care of pediatric patients. These drugs are used as premedicants, induction agents, and adjuvants for the maintenance of anesthesia or sedation. They are administered either as sole agents or in…
Introduction Developmental changes profoundly affect the clinical response to medicines. Dr. Abraham Jacobi, a founder of American pediatrics, recognized more than a century ago that children are not “miniature men and women, with reduced doses and the same class of…
Introduction Because of a sophisticated and efficient thermoregulatory system, humans are able to maintain their core body temperature constant within ±0.2°C of its normal value of 37.0°C despite changing ambient temperatures. This characteristic defines a homeothermic organism in contrast to…
Introduction Concentrations of minerals and electrolytes in extracellular fluid (ECF) are maintained nearly constant, despite large day-to-day variations in the dietary intake of salt and water. Such homeostasis is governed primarily by the kidneys through an array of intricate processes…
Introduction The cardiovascular system consists of a complex interaction between the heart and lungs, evolving along a continuum from fetal circulation to adolescence in order to meet the changing needs of an individual’s body as he or she grows and…
Developmental anatomy The upper airway Formation of the cranial vault and base The skull is a critical factor in the development of the face and upper airway. The skull develops from a membranous and cartilaginous neurocranium ( Fig. 4.1 ).…
Among many physiologic adaptations for the survival of humans at birth, cardiorespiratory adaptation is by far the most crucial. The respiratory and circulatory systems must be developed sufficiently in utero for the newborn infant to withstand drastic changes at birth—from…
Introduction Assessment of growth and development of infants and children typically falls under the domain of the pediatrician or pediatric subspecialist. Delays or deviations from normal often dictate the need to conduct extensive diagnostic evaluations and management strategies. Familiarity with…