Basics: Anesthesia Intensive Care and Pain in Neonates and Children (Anaesthesia, Intensive Care and Pain in Neonates and Children)

256 Pages·2008·1.79 MB·English

by  Marinella Astuto

Anesthesia, Intensive Care and Pain in Neonates and Children
Series Editors:A. Gullo, Catania University Hospital, Catania, Italy
M. Astuto, Catania University Hospital, Catania, Italy
I. Salvo, “V. Buzzi” Hospital, Milan, Italy
Marinella Astuto
Editor
Basics
In cooperation with
Luigi Marchiori
Silvia Pachera
Luca Bortolasi
Riccardo Manfredi
Paola Capelli
1 3
Marinella Astuto,MD
Department of Anesthesia and Intensive Care
Pediatric Anesthesia and Intensive Care Section
Catania University Hospital
Catania,Italy
Library of Congress Control Number:2008936497
ISBN 978-88-470-0654-6 Springer Milan Berlin Heidelberg New York
e-ISBN 978-88-470-0655-3
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To my father, who would have been the first
and most interested reader of this book,
and to Maria, my teacher, both of anesthesia and of life
Foreword
In March 2006 I took up my new position as Chairman of the Department of Anes-
thesia and Intensive Care and Director of the School at the University of Catania,a
position that represents an ideal continuity with 30 years of professional teaching at
the bed-side involving several hundred students and anesthesiologists in training at
Trieste Medical School.
In Catania the excellent working group of anesthesiologists established a coop-
erative program with the prestigious Children’s Hospital of McGill University in Mon-
treal,Canada.
Giuliana Rizzo,MD,during 2 years of fellowship in Montreal was interested in
taking part actively in a dynamic process of development in clinical anesthesia,in-
tensive care and pain management in neonates and children. The excellent background
of Giuliana Rizzo gained at the University of Catania in this field favored her appoint-
ment to the staff of the Children’s Hospital with autonomy and decision making abil-
ity in routine procedures and also in the management of difficult and life-threaten-
ing critical care conditions.
In September 2007 a special task force coordinated by Marinella Astuto,MD,as
clinical leader of the Catania team in pediatric anesthesia,in collaboration with the
Montreal group directed by Prof. Ronald Gottsman,organized a 3-day masterclass
in pediatric anesthesia,intensive care and pain in which 45 experts from several re-
gions of Italy participated.
During 2008 the two groups worked actively to finalize the 19 chapters which are
collected in the present volume. My hope is that residents and practicing anesthesi-
ologists find the contents of this book a useful guide to good clinical practice.
Catania,27 September 2008 Prof. Antonino Gullo
Director,Department and School of Anesthesia
and Intensive Care,Catania School of Medicine,Catania,Italy
Council World Federation Societies of Intensive
and Critical Care Medicine (WFSICCM)
Preface
The success of the fellowship program developed by the School of Medicine of
Catania in collaboration with McGill University of Montreal led to the organization
of the first masterclass in anesthesia,intensive care and pain in neonates and chil-
dren,held in September 2007 in Catania with a selected group of participants.
An additional remarkable outcome of this cooperation is the present book pub-
lished by Springer-Verlag Italia and based on the content of the masterclass includ-
ing formal lectures,interactive sessions,case presentation,and problem solving.
It is my opinion that anyone who anesthetizes infants and children, who takes
care of children in the ICU or who manages pain in children must understand the
differences in physiology and clinical pharmacology that exist between children
and adults. For many years it has been considered that infants and children are
small adults, but in the majority of situations this is no true. The anesthesiologist
who fails to understand these differences will have a hard time when facing unex-
pected events,and the result could be dangerous for the patient.
My goal was to produce a book that provides a basic approach to anesthesia,
perioperative medicine, intensive care and pain management in pediatric patients
(from the neonate to the child). To reach this goal,I convinced a group of pediatri-
cians,experts on infectious diseases,and anesthesiologists to contribute with their
talent to pass on their expertise to all allied professionals interested in the field.
I thank Prof. Gullo for his enthusiasm and strong support for an exciting and
successful initiative. Finally,I am grateful to the residents; I have learned as much
from them as they have heard from me. Their curiosity and their interest in improv-
ing their knowledge and professional skill shows to all that the mission to achieve
excellence may be possible.
Catania,27 September 2008 Marinella Astuto,MD
Table of Contents
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XIII
List of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XVII
Part I: Highlights
1 Anatomy and Physiology in Neonates and Children . . . . . . . . . . . . . . . . 3
M. Astuto,A.L. Paratore,A. Gullo
2 Strategy to Manage Pediatric Patients:the Family and the Child . . . . 11
G. Rosano,M. Antoci,M. Astuto
3 Off-Label Drugs in Pediatric Perioperative Medicine . . . . . . . . . . . . . . . 19
M. Astuto,M. Antoci,A. Gullo
Part II: Guidelines and Standardization of Procedures
4 The Pediatric Difficult Airway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
T. Valois
5 Central Venous Cannulation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
N. Disma,M. Astuto
6 Prevention of Bloodstream Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
H.K.F. van Saene,K. Thorburn,A.J. Petros
Part III: Perioperative Medicine, Intensive Care, Pain
7 Preoperative Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
I. Salvo,A. Camporesi
XII Table of Contents
8 Anesthesia Induction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
M. Astuto,D. Lauretta
9 Monitoring the Level of Anesthesia and Sedation in Children:
An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
N. Disma,A.J. Davidson,M. Astuto
10 Locoregional Anesthesia in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
M. Astuto
11 Perioperative Fluid Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
D.E. Withington
12 Adrenal Insufficiency in Pediatric Critical Illness . . . . . . . . . . . . . . . . . . .151
G. Rizzo,K. Menon
13 Perioperative Care in Pediatric Cardiac Surgery . . . . . . . . . . . . . . . . . . .161
J. Lavoie
14 Acute Pain Service:Clinical Assessment and Standard of Care . . . . . .173
J. Desparmet
15 Anesthesia Outside the Operating Room . . . . . . . . . . . . . . . . . . . . . . . . . . .185
T. Valois
16 Tracheotomy in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
G. Rizzo,P. Murabito,F. Rubulotta,C. Cutuli,M. Sorbello,M. Astuto
17 Infection Control in Neonates and Children . . . . . . . . . . . . . . . . . . . . . . . .215
R.E. Sarginson,H.K.F. van Saene,A. Gullo
18 Pediatric Palliative Care in the Intensive Care Unit . . . . . . . . . . . . . . . . .231
S. Liben
19 Chronic Pain Management:Organization,
Techniques and Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241
J. Desparmet
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
List of Contributors
Manuela Antoci
Department of Anesthesia and Intensive Care,Postgraduate School of Anesthesia
and Intensive Care,Catania University Hospital,Catania,Italy
Marinella Astuto
Department of Anesthesia and Intensive Care,Pediatric Anesthesia and Intensive
Care Section,Catania University Hospital,Catania,Italy
Anna Camporesi
Department of Pediatric Anesthesia and Intensive Care,“V. Buzzi”Hospital,
Milan,Italy
Carmela Cutuli
Department of Anesthesia and Intensive Care,Postgraduate School of Anesthesia
and Intensive Care,Catania University Hospital,Catania,Italy
Andrew J. Davidson
Department of Anesthesia and Pain Management,Royal Children’s Hospital,
Melburne,Australia
Joëlle Desparmet
Acute and Chronic Pain Service (Pediatric),Montreal Children’s Hospital,
Montreal,Canada
Nicola Disma
Department of Anesthesia,Pediatric and Neonatal Intensive Care,“G. Gaslini”
Children’s Hospital,Genoa,Italy
Antonino Gullo
Department of Anesthesia and Intensive Care,Postgraduate School of Anesthesia
and Intensive Care,Catania University Hospital,Catania,Italy