Ebook Handbook of pediatric anesthesia: Part 2
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Ebook Handbook of pediatric anesthesia: Part 2
PART 7GASTROINTESTINAL DISEASESc o ES0PHAG0GASTR0-o DUODENOSCOPYPhilipp J. Houck, MDYOUR PATIENTAn 8-year-old presents for esophagogastroduodenoscopy Ebook Handbook of pediatric anesthesia: Part 2 (EGD) for gastroesophageal reflux disease (GERD).PREOPERATIVE CONSIDERATIONSGastroesophageal reflux disease is one of the most common comorbidities in our field. It is more prevalent in patients with neurologic impairment, obesity, repaired esophageal atresia or other congenital esophageal diseases Ebook Handbook of pediatric anesthesia: Part 2, and cystic fibrosis. GER is a normal physiologic process that occurs several times per day in healthy infants, children, and adults. GERD is presentEbook Handbook of pediatric anesthesia: Part 2
when the reflux of gastric contents causes troublesome symptoms and/or complications. Patients may present with asthma, bronchopulmonary dysplasia, oPART 7GASTROINTESTINAL DISEASESc o ES0PHAG0GASTR0-o DUODENOSCOPYPhilipp J. Houck, MDYOUR PATIENTAn 8-year-old presents for esophagogastroduodenoscopy Ebook Handbook of pediatric anesthesia: Part 2 in pediatric anesthesia, may be necessary.•If pulmonary aspiration is not a leading concern (ie, symptoms are not severe and are mostly postprandial) and the patient is school-aged, tracheal intubation can be avoided and a total intravenous anesthesia technique can be used, with supplemental oxygen Ebook Handbook of pediatric anesthesia: Part 2 being supplied through a nasal cannula.•In smaller children, a mask induction and endotracheal intubation is the most practical choice. Tills allowsEbook Handbook of pediatric anesthesia: Part 2
insertion and manipulation of the endoscope without impeding the patency of the airway.184PART 7Gastrointestinal DiseasesPOSTOPERATIVE CONSIDERATIONSIPART 7GASTROINTESTINAL DISEASESc o ES0PHAG0GASTR0-o DUODENOSCOPYPhilipp J. Houck, MDYOUR PATIENTAn 8-year-old presents for esophagogastroduodenoscopy Ebook Handbook of pediatric anesthesia: Part 2erforation can present with a similar picture.DOsandDON'Ts/ Do flex the head during the insertion of the scope./ Do choose a rapid-sequence induction in patients with severe GERD, particularly when the patient regurgitates food even after adequate fasting.0 Do not use high insufflation pressures in Ebook Handbook of pediatric anesthesia: Part 2infants./ Do intubate young children.CONTROVERSIESTopicalization ofthe larynx may decrease the incidence of laryngospasm during insertion of the endosEbook Handbook of pediatric anesthesia: Part 2
cope, but it results in an unprotected airway during and after emergence from anesthesia.SURGICAL CONCERNSThe incidence of intestinal perforation is lPART 7GASTROINTESTINAL DISEASESc o ES0PHAG0GASTR0-o DUODENOSCOPYPhilipp J. Houck, MDYOUR PATIENTAn 8-year-old presents for esophagogastroduodenoscopy Ebook Handbook of pediatric anesthesia: Part 2GD in a stable patient without peritonitis can be managed conservatively; colonic perforation during a sigmoidoscopy requires immediate surgical repair.FACTOIDMore than 25% of adults in the United States use antisecretory medications at least 3 times per month.c /I C0NTR0L0F UPPER■ GASTROINTESTINAL Ebook Handbook of pediatric anesthesia: Part 2BLEEDINGManon Haché, MDYOUR PATIENTA 10-year-old presented to the emergency room after having emesis of bright red blood 3 times. Hematocrit on admissEbook Handbook of pediatric anesthesia: Part 2
ion was 15. Ihe patient received 20 mL/kg of packed red blood cells and was booked for an emergency diagnostic esophagogastroduodenoscopy with bandingPART 7GASTROINTESTINAL DISEASESc o ES0PHAG0GASTR0-o DUODENOSCOPYPhilipp J. Houck, MDYOUR PATIENTAn 8-year-old presents for esophagogastroduodenoscopy Ebook Handbook of pediatric anesthesia: Part 2varices 3 times in the past. He also has chronic lung disease requiring chest physical therapy (PT), a cough assist vest, inhaled tobramycin, and DNase, fluticasone, and albuterol inhalers. He just finished a course of IV antibiotics last week for increased pulmonary secretions and presumed pneumoni Ebook Handbook of pediatric anesthesia: Part 2a.PREOPERATIVE CONSIDERATIONSPART 7GASTROINTESTINAL DISEASESc o ES0PHAG0GASTR0-o DUODENOSCOPYPhilipp J. Houck, MDYOUR PATIENTAn 8-year-old presents for esophagogastroduodenoscopy PART 7GASTROINTESTINAL DISEASESc o ES0PHAG0GASTR0-o DUODENOSCOPYPhilipp J. Houck, MDYOUR PATIENTAn 8-year-old presents for esophagogastroduodenoscopyGọi ngay
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