History Malignant hyperthermia (MH) is a serious and possibly fatal syndrome of skeletal muscle hypermetabolism and calcium dysregulation that occurs when genetically susceptible individuals are exposed to certain anesthetic “triggering” agents, specifically the potent halogenated inhaled volatile anesthetics and the…
Acknowledgement The authors are grateful to Henry Rosenberg, MD, who authored the previous edition of this chapter. It has served as a framework for this updated edition. Risk Incidence of MH impossible to know because of lack of reporting mechanisms;…
Risk Incidence estimated at 1:40,000 live births (but milder cases go unrecognized). Slight female predilection (63%). Perioperative Risks Cervical spine instability and cardiopulmonary complications. Often occurs in association with other clinical syndromes (e.g., fetal alcohol, Goldenhar). Worry About Exacerbation of…
Case Synopsis A healthy 12-year-old boy is undergoing a tympanomastoidectomy under general anesthesia with sevoflurane in oxygen and air, and supplemented with fentanyl. He has also received dexamethasone, ondansetron, and cefazolin. Approximately 2 hours into the case, he is noted…
History Malignant hyperthermia (MH) is a serious and possibly fatal syndrome of skeletal muscle hypermetabolism and calcium dysregulation that occurs when genetically susceptible individuals are exposed to certain anesthetic “triggering” agents, specifically the potent halogenated inhaled volatile anesthetics and the…
The Differences Between The pediatric and adult airways are important determinants of the anesthetic technique. Knowledge of normal developmental anatomy and physiologic function is required to understand and manage both the normal and the pathologic airways of infants and children…
The pediatric postanesthesia care unit (PACU) is a noisy and chaotic environment. Nurses are attempting to calm crying toddlers, parents are being educated, physicians are being summoned for discharge orders, and the phones ring continuously with reports of available inpatient…
More and more pediatric anesthesia cases are scheduled in non operating room (OR) locations. These locations are often far from the main surgical area, and some anesthesiologists feel out of place in these environments because they may not have easy…
Most urologic procedures are simple surgical repairs in healthy children and are performed on an outpatient basis. Some children require complex repairs, and it helps to understand the repair to tailor the anesthetic technique. Circumcision Children beyond the newborn period…
In this chapter we review plastic surgery procedures that pose a wide range of perioperative challenges for the anesthesiologist, including difficult airway management, significant intraoperative blood loss, and comorbidities secondary to an underlying genetic syndrome. We also review considerations for…