Ebook Principles and practice of pediatric anesthesia: Part 2
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Ebook Principles and practice of pediatric anesthesia: Part 2
17ChapterAnesthesia for Plastic and Reconstructive SurgeryNeerja BhardwajINTRODUCTIONThe commonly performed plastic surgical procedures In children In Ebook Principles and practice of pediatric anesthesia: Part 2nclude repair for cleft lip and palate and reconstruction procedures for craniofacial anomalies, temporomandibular joint ankylosis, anomalies of the foot and hands and burns (see Chapter 20). Anesthesia considerations for these procedures require a thorough assessment of the existing anomaly and pre Ebook Principles and practice of pediatric anesthesia: Part 2vention and management of airway difficulties, blood loss, aspiration of blood and secretions, adverse respiratory events like bronchospasm, laryngospEbook Principles and practice of pediatric anesthesia: Part 2
asm and respiratory obstruction. In addition, these children may have associated congenital anomalies and medical illnesses which have an adverse impa17ChapterAnesthesia for Plastic and Reconstructive SurgeryNeerja BhardwajINTRODUCTIONThe commonly performed plastic surgical procedures In children In Ebook Principles and practice of pediatric anesthesia: Part 2outcome.CLEFT LIP AND PALATEThe condition is present since birth with difficulty in feeding and swallowing, nasal regurgitation, history of (H/O) repeated upper respiratory infection (UR1), pulmonary aspiration, chest infection and hearing problems, delayed dentition or maloccluded teeth and nasal s Ebook Principles and practice of pediatric anesthesia: Part 2peech.1 A child with a cleft lip is unable to suck as negative pressure cannot be established; he is unable to make consonants like B, D, K, p, and TEbook Principles and practice of pediatric anesthesia: Part 2
and has typical cleft palate voice and audloinetrlcally detected hearing loss of 10 decibels Is present due to Inflammation of the orifice of Eustachi17ChapterAnesthesia for Plastic and Reconstructive SurgeryNeerja BhardwajINTRODUCTIONThe commonly performed plastic surgical procedures In children In Ebook Principles and practice of pediatric anesthesia: Part 2f drugs like cortisone, diazepam and phenytoin, vitamin deficiency and viral infection like rubella In 1st trimester. In these children, milestones are delayed and In 10% of cases associated congenital anomalies are present (Table 1).Preoperative AssessmentThe child should be assessed for:•Presence Ebook Principles and practice of pediatric anesthesia: Part 2of other congenital anomalies•Eustachian tube dysfunction and chronic serous otitis with clear rhinorrhea•Anemia•UR1 may be difficult to control in prEbook Principles and practice of pediatric anesthesia: Part 2
eoperative period in children with cleft palate. In these children, an effective dose of antibiotics can be given before surgery•Undernourishment and 17ChapterAnesthesia for Plastic and Reconstructive SurgeryNeerja BhardwajINTRODUCTIONThe commonly performed plastic surgical procedures In children In Ebook Principles and practice of pediatric anesthesia: Part 2 and foot anomaliesHydrocephalusCongenital blindnessMental deficiencyVander Woude syndromeDown syndromePierre - Robin syndromeKJippet Fell syndromeTreacher Collins syndromeChapter 17: Anesthesia for Plastic and Reconstructive SurgeryInvestigations•Routine—complete blood count and urine examination•C Ebook Principles and practice of pediatric anesthesia: Part 2hest X-ray if there is fever, running nose, purulent secretions and noisy chest•Investigations dictated by associated congenital anomalies.ANESTHESIAEbook Principles and practice of pediatric anesthesia: Part 2
MANAGEMENTAll children should be fasted according to ASA guidelines.2 Oral midazolam 0.5 mg/kg, 20-30 min before Induction can be used for parental se17ChapterAnesthesia for Plastic and Reconstructive SurgeryNeerja BhardwajINTRODUCTIONThe commonly performed plastic surgical procedures In children In Ebook Principles and practice of pediatric anesthesia: Part 2etry, end-tidal co, and end-tidal anesthetic agents, noninvasive blood pressure (N1BP), temperature and fluid balance and blood loss.Children may be anesthetized with inhalational or intravenous routes utilizing oxygen, sevoflurane or halothane followed by securing of IV access or with thiopentone o Ebook Principles and practice of pediatric anesthesia: Part 2r propofol if IV access is available.’3 Before administering a muscle relaxant, confirm effective mask ventilation and use a tooth guard/rolled gauzeEbook Principles and practice of pediatric anesthesia: Part 2
piece over the defect while performing laryngoscopy and intubation to avoid trauma to the lips and gums. It also prevents the laryngoscope blade from 17ChapterAnesthesia for Plastic and Reconstructive SurgeryNeerja BhardwajINTRODUCTIONThe commonly performed plastic surgical procedures In children In Ebook Principles and practice of pediatric anesthesia: Part 2Intubation may be difficult In presence of syndromes and bilateral cleft where succinylcholine(1-1.5 mg,’kg) may be administered. After Intubation with an appropriate RAE endotracheal tube, check bilateral air entry. Introduce pack and protect eyes. Hie surgeon Introduces a mouth gag before performi Ebook Principles and practice of pediatric anesthesia: Part 2ng cleft palate surgery and care should be taken to see that the endotracheal tube Is not compressed when It is opened. We use hypodermic needle coverEbook Principles and practice of pediatric anesthesia: Part 2
to prevent tube compression (Fig. 2). One should auscultate for the breath sounds and chest compliance during placement and manipulation of the mouth17ChapterAnesthesia for Plastic and Reconstructive SurgeryNeerja BhardwajINTRODUCTIONThe commonly performed plastic surgical procedures In children In Ebook Principles and practice of pediatric anesthesia: Part 2eased bag compliance if manually ventilating.17ChapterAnesthesia for Plastic and Reconstructive SurgeryNeerja BhardwajINTRODUCTIONThe commonly performed plastic surgical procedures In children InGọi ngay
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