Anesthesia for Infants and Children

The Pediatric Patient

Gibson and Palmer have written a brief overview of Paediatric Anaesthesia, which may be useful to the practicing anesthesiologist. The Department of Anasthesia at Basel have compiled some Normal Values, which may save some efforts. Important differences between adult and fetal hemoglobin are outlined by Dr. Voth of the University of Wisconsin. See Fetal vs Adult Hemoglobin. Some information relevant to determination of body surface area is available on the Internet Journal of Anesthesiology, authored by the chapter organizer. Viginia Apgar’s original paper on the Apgar score is also available.

Airway Management

Bergsbaken of the University of Wisconsin has very briefly outlined the anatomy of the infant airway in his Notes on the Infant Airway. A more extensive discussion of pediatric airway management may be found at the Vanderbilt University site, written by Dr. Deshpande: Management of the Pediatric Airway. A site with excellent graphic images of obstructing lesions is produced by Dr. Rothschild, the Pediatric Airway Obstruction page. Relevant tips on the use of anesthesia ventilation bags may be found at ENW:  Using Anesthesia Bags by Tom Trimble.

Santer and D’Allesandro have an interesting presentation on Upper Airway Problems in Children, including Pediatric Airway Case Studies. The topics of Acute Epiglottitis andSupraglottitis are discussed and Inspiratory Stridor is reviewed at these sites. Dr. Pachigolla of the University of Texas Medical Branch discusses Stridor in Neonates, Infants and Children, with some slides for presentation. An annotated bibliography from the University of Wisconsin on Pediatric Tracheostomy may be found.

Fluid and Electrolytes

Some information relevant to water balance and the composition of body fluids may be found in Water Metabolism, Fluids and Electrolytes. A somewhat more detailed discussion ofPerioperative Management of Fluids, by Iris Kuhn is worth reviewing. An abstract supporting the need for intraoperative glucose administration is titled: Glucose Versus Lactated Ringer’s Solution During Pediatric Cardiac Surgery.

Anesthetic Techniques

Dr. Goody of the Walter Reed Army Medical Center has published a powerpoint presentation: LMA, Adult and Pediatric. Dr. O’Neill at the same institution has also offered a powerpoint presentation on Pediatric Regional. Lunaas of the University of Wisconsin has outlined the factors influencing the Inhalation Induction in Infants. George S. Bause, M.D., of the Wood Library-Museum of Anesthesiology has published a very interesting pictorial on Historical Anesthesia Related Equipment. A comprehensive summary of the Management of the Latex Allergy Patient is provided by the Cleveland Clinic Foundation.

Medications and Dosage

A rather extensive list of anesthesia related medications and dosages has been compiled by Air Force Major Thomas Evans, entitled Anesthesia Medication Guide. The University of Basel presents some guidelines for Digoxin Dosages. Diprivan References are offered by Zeneca Pharmaceuticals. A package insert forDesflurane, including some pediatric information is available. Armstrong discusses the use of cisatracurium and rocuronium in children. While Prosniewski does the same for vecuronium.

Pain Management

The Pediatric Pain Sourcebook offers a resource to inform medical professionals as well as other concerned parents or patients about pain management methods. Patient Controlled Analgesia is one method to improve patient pain relief and give the patients more control over their analgesia. Cottage Health Systems have made available a monograph entitledChildren’s Pain, consisting of excerpts from Clinical Practice Guidelines for Acute Pain Management.


Specific Procedures

Information on specific procedures relevant to Pediatric Anesthesia are offered on the following topics:

Tracheoesophageal Fistula
Diaphragmatic Hernia
Congenital Diaphragmatic Hernia, a powerpoint presentation.
Abdominal Wall Defects, a powerpoint presentation.
Sedation and Anesthesia for Pediatric Dental Treatment
LMA in Pediatric Opthalmic Surgery
Cervical Lymphadenopathy
Thyroglossal Duct Cyst
Branchial Cleft Fistula
Cystic Hygroma
Intestinal Atresia
Meconium Ileus
Hirschsprung’s Disease
Total Colonic Aganglionosis
Chronic Intestinal Pseudo-Obstruction
Neuronal Intestinal Dysplasia
Biliary Atresia
Choledochal Cyst
Idiopathic Bile Duct Perforation
Burkitt’s Lymphoma
Labial Adhesions
Ovarian Cysts
Intestinal Obstruction
Pediatric Laparoscopy


Pediatric Critical Care and Resuscitation

An attempt at a comprehensive on-line resource for pediatric critical care is made at: picuBOOK on line resource for pediatric critical care, which includes several useful medical calculators. Dr. Flick at the Mayo Clinic discusses Mechanical Ventilation in ARDS, with a list of references. Another attempt at a practical resource for Pediatric Critical Care is thePediatric Critical Care Medicine Website. The goal of the Pediatric Cardiac Arrest Registry is to “collect a large set of cases of cardiac arrests and deaths of pediatric patients during the administration of or recovery from anesthesia in order to investigate the possible relationship of anesthesia to these incidents. ” Reanimation, a very brief summary of PALS is offered by the University of Basel. Dr. Dave Sainsbury offers us an Acid-Base Program, usable in determination of base excess. Drs. Diaz and Joffe discuss early extubation after cardiac surgery in pediatric patient in: Selective Early Extubation in Infants and Neonates. The Merck manual has a chapter on Basic and Advanced Life Support.


General Pediatrics and Subspecialties

Pediatric Cardiology Almanac reviews topics on congenital heart disease. Pediatric Database offers links for description of pediatric cardiac anomalies. Pediatric ECG Interpretationgives examples of abnormal tracings. Neonatology on the web offers links to topics of interest in neonatology. Pediatric Points of Interest at the Johns Hopkins University offers a searchable site of pediatric topics. Online Mendelian Inheritance at the National Center for Biotechnology Information offers links to genetics related materials. Emory University Pediatric Links also offers links on general pediatric topics. PEDINFO, index of the pediatric internet is a searchable index of a number of pediatric topics including several subspecialties. The American Academy of Pediatrics has a very professional site which not only has links but they are reviewed for quality. The On-Line Pediatric Surgery Handbook has rather extensive written reviews of pediatric surgical topics.


Information for Parents and Patients

The American Society of Anesthesiologists has some written information for parents concerning When Your Child Needs Anesthesia. They also have a newsletter article on the history of pediatric anesthesia: Some History of Pediatric Anesthesia


Professional Societies

The following professional societies may be of interest to some:
Society for Pediatric Anesthesia, website
American Academy of Pediatrics. website
American Society of Anesthesiologists, professional resources
Society of Pediatric Urology
The Anesthesia Patient Safety Foundation
The Society of Cardiovasular Anesthesiologists


Professional Journals

The premier on line professional anesthesiology journal: The Internet Journal of Anesthesiology
Paediatric Anaesthesia
Pediatric Surgery International
Pediatric Research
Pediatric Surgery Update, electronic newsletter
Abstracts of the International Anesthesia Research Society related to Pediatric Anesthesia may be found at: Abstracts on the Web


Published Guidelines

The American Academy of Pediatrics has published guidelines relevant to the practicing anesthesiologist. These include:
American Academy of Pediatrics (AAP) Guidelines for the Pediatric Perioperative Anesthesia Enviornment
AAP Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures
AAP Guidelines for Evaluation and Preparation of Pediatric Patients Undergoing Anesthesia

The American Heart Association has also published guidelines which may be of interest, to include:
Guidelines for Evaluation and Management of Common Congenital Cardiac Problems in Infants, Children, and Adolescents
Recommendations for Prevention of Bacterial Endocarditis

PALS, Australian Resuscitation Council Guidelines summarize medications and measures used in pediatric resuscitation.

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