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Solid organ transplantation

Organ donor management Pediatric brain death International guidelines have been developed that define death as “the permanent loss of capacity for consciousness and all brainstem functions, as a consequence of permanent cessation of circulation or catastrophic brain injury,” with permanent meant to represent a loss of function that will not return spontaneously and/or with intervention ( ). Brain death is a clinical diagnosis that is based…

Anesthesia for ophthalmic surgery

Introduction Uncorrected ophthalmic problems can impair child development, interfere with learning, and even lead to permanent vision loss, so early detection and treatment are critical ( ). An examination under anesthesia (EUA) is often necessary for diagnosis, especially in infants or uncooperative children. Anesthesia for ophthalmologic procedures in infants and children is essential for optimal diagnosis and intervention. Because ophthalmologic procedures range in complexity from exams…

Anesthesia for orthopedic surgery

Introduction Anesthesia for pediatric orthopedic surgery encompasses the entire age and medical spectrum of pediatrics—the newborn through adolescent, the otherwise normal, the critically ill, the chronically ill, the child with multiple complex congenital anomalies, the traumatically injured, and the “frequent flyer” patient. Pediatric orthopedic surgeons operate on virtually every area of the body, from the cervical spine to the pelvis to the toes. In many instances,…

Anesthesia for plastic surgery

Introduction Plastic and reconstructive surgery for the pediatric patient can involve any part of the body and includes children with a variety of pathologies related to coexisting diseases and syndromes. This may require surgery on the face, skull, thorax, and extremities. These procedures also may involve other surgical specialties such as pediatric neurosurgery and otolaryngology. This chapter will focus on reconstruction as it relates to the…

Anesthesia for otorhinolaryngologic surgery

Introduction Anesthesia for procedures of the head and neck, while not always complicated surgeries, may be challenging because of the underlying pathology and the shared airway. Airway protection is paramount, and otolaryngology head and neck surgeons understand this better than most other surgeons. Nevertheless, close communication with the surgeons about airway management must occur throughout the preoperative, intraoperative, and postoperative phases. Joint planning for patient management…

Anesthesia for general abdominal, urologic surgery

Introduction A thorough preoperative assessment of the patient’s physical examination and history, along with appropriate laboratory evaluation as indicated, is essential. Many of these patients will present for emergency surgery and present a potential risk for aspiration of gastric contents. As in adults, the anesthesiologist may elect to perform a rapid-sequence induction or, much less commonly in children, an awake intubation. Regional anesthesia techniques are increasingly…

Anesthesia for thoracic surgery

Introduction Thoracic surgery in children is performed for a wide variety of congenital, neoplastic, infectious, and traumatic lesions ( Box 32.1 ). The patient may be a few hours old with a congenital cystic adenomatoid malformation (CCAM, also commonly referred to as congenital pulmonary airway malformation, or CPAM) and life-threatening respiratory distress or an adolescent with an asymptomatic mediastinal tumor. Regardless of age or disease, four…

Anesthesia for neurosurgery

Introduction This chapter aims to highlight the unique perioperative challenges faced by anesthesiologists in caring for pediatric neurosurgical patients. While many fundamental truths of neuroanesthesia remain consistent for both pediatric and adult patients, young children often present with pathology rarely seen in adults. Providing optimal operating conditions and managing challenging and often changing perioperative conditions requires a keen understanding of pediatric neuroanatomy and physiology, which this…

Anesthesia for congenital heart disease

Introduction Congenital heart disease (CHD) is the most common congenital defect, affecting approximately 1% of live births ( Video 30.1A – B , Video 30.2 ) ( ; ). The population of children and adults with repaired, palliated, or unrepaired CHD continues to increase. With declining mortality from CHD, survival to adulthood (≥18 years) in well-developed medical systems is approximately 98%, 90%, and 56% for children…

Anesthesia for fetal surgery

Introduction Fetal interventions are procedures that are performed on a fetus either during gestation or immediately prior to delivery. They are intended to correct a pathologic condition that would otherwise be associated with fetal or neonatal demise or significant postnatal morbidity. Although fetal procedures are performed for the benefit of the fetus, they come with significant risks to both the fetus and mother. Therefore strict selection…

Anesthesia for general surgery in neonates

Introduction The field of pediatric anesthesia has mirrored that of pediatric surgery—developing as a result of the need for specialized treatment of uncommon and complex congenital anomalies and childhood surgical diseases ( ; ). Despite the complexity, general surgery of the neonate is becoming increasingly common and safe. Twenty-five percent of the most common pediatric general surgery operations occur in neonates ( ). Improved safety within…

Neonatology for anesthesiologists

Brief history of modern neonatology With origins in the 1960s to 1970s, neonatology remains a relatively young specialty. Fifty years ago, premature birth earlier than 3 to 4 weeks before term implied high risk for mortality, primarily from pulmonary insufficiency associated with immature lungs—the neonatal respiratory distress syndrome (RDS) ( ; ). Although in the 1960s premature infants had been ventilated with cumbersome devices that were…

Pediatric palliative care and hospice

Introduction In the last decade, anesthesiologists have assumed the mantle of perioperative physicians, assuming a larger role in the care of patients both before and after surgery. This role is a natural extension of our long history of caring for patients in intensive care units (ICUs). As pediatric anesthesiologists, we are caring for increasingly ill children presenting for surgical and interventional procedures, both curative and palliative;…

Chronic pain management

Introduction Recurrent or persistent chronic pain is common among children and adolescents. Chronic pain can be the result of an underlying medical condition such as cancer or cystic fibrosis, or pain can be a primary disorder such as complex regional pain syndrome (CRPS) or functional abdominal pain. Regardless of underlying causes, chronic pain can result in severe suffering, significant impairments in physical and emotional functioning, and…

Regional anesthesia

Introduction Proper pain management is an important aspect of perioperative pediatric anesthesia care and is also a significant contributor to patient/parent satisfaction ( ; ; ; ; Walkeret al. 2015). Commonly used regional anesthetic techniques are an essential component in pediatric pain management. These regional anesthesia techniques, which include spinal, neuraxial, and ultrasound-guided paravertebral and peripheral nerve blocks, not only provide patient analgesia but also increase…

Acute pain management

“We must all die. But that I can save (a person) from days of torture, that is what I feel as my great and ever new privilege. Pain is a more terrible lord of mankind than even death itself.” Albert Schweitzer Introduction The treatment and alleviation of pain is a basic human right that exists regardless of age. The old “wisdom” that young children neither respond…

Transfusion medicine

The year 1492 is often recalled as the year in which “Columbus sailed the ocean blue.” In that same year the first recorded attempt at therapeutic transfusion occurred in Rome. After having an apoplectic stroke, Pope Innocent VIII lapsed into a coma. His physician ordered that the blood of three of the pope’s young sons be transfused in an attempt to revive him. Unsurprisingly, the attempt…

Induction, maintenance, and recovery

Introduction Anesthetic induction, maintenance, and recovery in infants and children requires a unique approach and special considerations not often necessary in the adult population. It is the anesthesiologist’s responsibility to develop a comprehensive plan that accounts for all aspects of the patient’s perioperative care, including their baseline health status, preoperative concerns, intraoperative requirements, and postoperative recovery. The anesthetic plan should be designed as a continuous process…

Point-of-care ultrasonography

Introduction Point-of-care ultrasound is being used for an increasing number of diagnostic and procedural applications. This chapter will focus on the clinical use of point-of-care ultrasound as it applies to pediatric anesthesia, including basic principles of ultrasound physics and the literature and technique for common applications. Ultrasound fundamentals Sound wave physics Sound is vibration that travels as a wave of alternating compression and rarefaction through a…

Normal and difficult airway management

Introduction Airway management is a fundamental aspect of anesthesia. In pediatrics, airway anatomy and physiology change as patients develop. These changes can be further altered by the patient’s disease and/or underlying genetic syndrome. Thus children are at risk for presenting with airways that may result in the inability to ventilate and oxygenate the patient (i.e., difficult airways). These difficult airways can be challenging to manage and…