Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_3
© Springer International Publishing Switzerland 2014
Pediatric Anesthesiology
(1)
Department of Anesthesiology, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 20-25, Danville, PA 17822, USA
Abstract
There are special anesthetic implications for the newborn and pediatric patient.
There are special anesthetic implications for the newborn and pediatric patient.
1.
Anatomy, physiology and pharmacology: “Children are not small adults!” Children’s anatomy and physiology evolve with changing age, in terms of organ size and maturity, structure, performance, and proportion of different parts of the body.
(a)
Cardio-pulmonary:
(i)
Intra- to extra-uterine cardiopulmonary transition.
(ii)
Parallel-to-series circuit change in neonates, the three shunts – placenta, ductus arteriosus, and foramen ovale.
(iii)
Transition of the pulmonary system.
(iv)
Changes in pulmonary compliance.
(v)
Airway anatomic differences: Head size and shape, mouth, tongue, epiglottis, location of the larynx, glottis is the narrowest portion of the vairway.
(vi)
Differences in the thoracic cage structure: Mostly cartilaginous at birth but most bones will ossify by middle age.
(vii)
The role of the intercostal and accessory muscles during respiration increases with age.
(viii)
Pulmonary measurements (volumes and capacities change with age).
(ix)
Maturation of components of the cardiovascular system – myocardial compliance improves (constant stroke volume for the first few years of life) and heart rate decreases with age, Components of the blood pressure- constant stroke volume, systemic vascular resistance dependence on autonomic nervous system is less compared to adults.
(b)
CNS:
(i)
Brain continues to develop for years after birth, cortical hyperplasia into toddler years.
(ii)
Brain tissue’s sensitivity to anesthetic drugs, alcohol beverages, etc.
(iii)
Effect of anesthesia on the developing brain: A source of controversy due to recent research demonstrating an effect on the brain by multiple anesthetic episodes.
(iv)
Fragile intracranial vessels.
(c)
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Renal system, fluids and electrolytes:
(i)
Transition and maturation of the renal system: ability to filter, reabsorb, concentrate urine, and excrete waste changes with growth.
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