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Abnormalities of cardiac conduction and cardiac rhythm

Introduction The development of the modern-day electrocardiogram (ECG) started with the recognition by scientists that the electric currents regulating the heart could be detected at the surface of the skin. In the late 1800s Willem Einthoven built a machine called a string galvanometer that recorded a tracing representing the direction of cell depolarization through the heart as a series of positive and negative deflections around an…

Congenital heart disease

Congenital heart disease (CHD) occurs in approximately 4 to 10 cases per 1000 live births. These numbers do not include bicuspid aortic valves, which would double or triple the incidence. Overall, CHD accounts for approximately a third of all congenital defects. Moreover, in developed countries, CHD has become the principal cause of heart failure in children, with 10% to 15% having other associated congenital anomalies of…

Valvular heart disease

Introduction The burden of valvular heart disease in developed countries is steadily increasing with current estimates of an overall prevalence of 2.5% in the United States who have moderate or severe valvular disease, increasing to 13% prevalence in those older than 75 years of age. Since the overall incidence of valvular heart disease increases with age, the need for cardiac surgery or percutaneous valvular interventions has…

Ischemic heart disease

The prevalence of ischemic heart disease and atherosclerotic vascular disease in the United States increases significantly with age ( Fig. 5.1 ). By some estimates, 30% of patients who undergo surgery annually in the United States have ischemic heart disease. Angina pectoris, acute myocardial infarction (AMI), and sudden death are often the first manifestations of ischemic heart disease, and cardiac dysrhythmias are probably the major cause…

Critical illness

Critical illness has been documented since the beginning of recorded history, an inherent component of the human experience. However, critical care is a recent development made possible by the technical and scientific advances of the 20th century. If the whole of critical illness could be reduced to a single common element, that element would be disordered perfusion. Simply stated, our effort to correct this imbalance is…

Restrictive respiratory diseases and lung transplantation

The perioperative management of patients with restrictive lung disease presents unique challenges to the anesthesiologist. Although these patients are at increased risk of perioperative respiratory complications with all surgeries, their incidence is higher in patients undergoing cardiac, thoracic, vascular, and trauma surgeries. Restrictive lung disease is associated with increased perioperative morbidity and mortality. Although several conditions can cause restrictive lung disease, all share some common characteristics,…

Anesthetic considerations for obstructive lung disease

Obstructive respiratory diseases are an important factor contributing to increased risk of perioperative pulmonary complications. There is increasing awareness of how these complications contribute to overall morbidity, mortality, and increased hospital length of stay. Perioperative pulmonary complications can also play an important role in determining long-term mortality after surgery. Modification of disease severity and patient optimization prior to surgery can significantly decrease the incidence of these…

Sleep-related breathing disorder

Sleep-related breathing disorder (SRBD) is the second most common category as classified by the International Classification of Sleep Disorders (ICSD-3), after insomnia, and the most common disorder encountered in sleep medicine labs. SRBD can refer to an exclusively sleep-related disorder or as sleep-induced exacerbation of a baseline persistent disorder. SRBDs are divided into four main categories: obstructive sleep apnea (OSA) disorders, central sleep apnea (CSA) syndromes,…

Multiple choice questions

Questions Chapter 2 : Behavioral development 1. Which neurodevelopmental outcomes have been used to assess children exposed to anesthesia? a. IQ testing b. Behavioral surveys c. Academic achievement d. All of the above 2. The age at which children are vulnerable to the neurotoxic effects of anesthesia is: a. In utero b. Under 1 month of age c. Under 3 years of age d. Unknown 3.…

Statistics

The increasing complexity of biomedical research highlights the need for greater focus in the teaching of statistics and probability to physicians. Pharmaceutical and medical device literature can contain complicated statistical testing, making critical appraisal challenging. Academic studies that present potentially beneficial therapeutic advances are difficult to incorporate into practice when the experimental designs are not well understood. Further, patients often come armed with studies and claims…

Education

This chapter will focus on the role of education and provide guidance to those who engage in teaching the specialty of pediatric anesthesiology as part of postgraduate training. It is organized into six sections. Sections 2 to 5 begin with a “mind map” (a graphic image of the key concepts) to provide a quick overview. The sections are (1) Historical Background; (2) Roles of the Clinical…

Medicolegal and ethical aspects of pediatric anesthesia

Introduction Physicians are confronted with a variety of unique legal issues on a daily basis. It would be nearly impossible to cover all of them—even in broad strokes—in a single chapter. Accordingly, this chapter focuses on two issues that may be of specific importance to pediatric physicians: informed consent and related medical malpractice actions. It is important to note at the outset that this chapter is…

History of pediatric anesthesia

Introduction The pediatric anesthesiologist does not generally diagnose or cure patients but rather guides and supports each young patient through a surgical or diagnostic procedure with the least possible mental and physical stress. The history of pediatric anesthesia is best told by tracing the steps others have taken, steps toward increased precision in regulation and control of neurologic, respiratory, cardiovascular, and other body systems to serve…

Safety and outcome in pediatric anesthesia

Introduction Patients engage the healthcare system seeking help—help managing pain, help regaining function, and help restoring some level of homeostasis in their lives. Unfortunately, for many patients, the system designed to help instead introduces new risks, new ailments, and new disabilities. The ability of the healthcare system to both heal and harm is one of the central conflicts for providers, patients, and policy makers alike. Patients…

Cardiac critical care medicine

Background and historical context Pediatric critical care began with the pediatric intensive care unit (PICU) created by Dr. Jack Downes in 1967 at Children’s Hospital of Philadelphia, many years after the initial attempts to palliate or repair congenital cardiac anomalies ( ; ). The development of the dedicated PICU offered hope to critically ill children suffering from respiratory failure, sepsis, and trauma. For many years, there…