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Gregory’s Pediatric Anesthesia EDITED BY George A. Gregory MD Professor Emeritus Department of Anesthesia and Perioperative Care and Department of Pediatrics University of California San Francisco (UCSF) San Francisco, CA, USA Dean B. Andropoulos MD, MHCM Chief of Anesthesiology Texas Children’s Hospital Professor, Anesthesiology and Pediatrics Baylor College of Medicine Houston, TX, USA FIFTH EDITION A John Wiley & Sons, Ltd., Publication This edition fi rst published 2012, © 2012 by Blackwell Publishing Ltd Previous editions: 2002, 1994, 1989, 1983 by Churchill Livingstone Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientifi c, Technical and Medical business to form Wiley-Blackwell. Registered offi ce: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offi ces: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offi ces, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identifi ed as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. 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The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifi cally disclaim all warranties, including without limitation any implied warranties of fi tness for a particular purpose. In view of ongoing research, equipment modifi cations, changes in governmental regulations, and the constant fl ow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. 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Library of Congress Cataloging-in-Publication Data Gregory’s pediatric anesthesia / edited by George A. Gregory, Dean B. Andropoulos. – 5th ed. p. ; cm. Pediatric anesthesia Rev. ed. of: Pediatric anesthesia / [edited by] George A. Gregory. 4th ed. c2002. Includes bibliographical references and index. ISBN-13: 978-1-4443-3346-6 (hard cover : alk. paper) ISBN-10: 1-4443-3346-1 (hard cover : alk. paper) ISBN-13: 978-1-4443-4515-5 (ePDF) ISBN-13: 978-1-4443-4518-6 (Wiley Online Library) [etc.] 1. Pediatric anesthesia. I. Gregory, George A., 1934- II. Andropoulos, Dean B. III. Pediatric anesthesia. IV. Title: Pediatric anesthesia. [DNLM: 1. Anesthesia. 2. Child. 3. Infant. WO 440] RD139.P4 2012 617.9'6083–dc23 2011027299 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Set in 9.5/12pt Palatino by Toppan Best-set Premedia Limited, Hong Kong 1 2012 v Contents List of Contributors, vii 10 Fluids, Electrolytes, and Nutrition, 205 Claire Brett & Danton Charr Preface, xii 11 Coagulation, Bleeding, and Blood Transfusion, 224 List of Abbreviations, xiii Bruce E. Miller & Jeanne E. Hendrickson 12 Cardiopulmonary Resuscitation, 255 Part 1 Principles of Pediatric Anesthesia Todd J. Kilbaugh, Alexis A. Topjian, Robert M. Sutton, Vinay M. Nadkarni & Robert A. Berg 1 Ethical Considerations, 1 David B. Waisel 2 History of Pediatric Anesthesia, 15 Part 2 Pediatric Anesthesia Management Burdett S. Dunbar & Dean B. Andropoulos 13 Preoperative Evaluation and Preparation, Anxiety, 3 Educating Pediatric Anesthesiologists: What’s Best Awareness, and Behavior Change, 273 for the Kids?, 27 Andrew Davidson, Kelly Howard, William Browne, Alan Jay Schwartz Walid Habre & Ursula Lopez 4 An Introduction to the Ethical Design, Conduct, and 14 Pediatric Airway Management, 300 Analysis of Pediatric Clinical Trials, 40 John E. Fiadjoe, Paul A. Stricker & Myron Yaster, Jeffrey Galinkin & Mark S. Schreiner Ronald S. Litman 5 Developmental Physiology of the Cardiovascular 15 Induction, Maintenance, and Emergence from System, 60 Anesthesia, 330 Wanda C. Miller-Hance, Ivan Wilmot & Dean B. Jerrold Lerman, Venkata Sampathi & Stacey Watt Andropoulos 16 Postanesthesia Care Unit Management, 361 6 Developmental Physiology of the Respiratory Warwick Ames & Allison Kinder Ross System, 95 Susan H. Guttentag, Maria Victoria Fraga & 17 Monitoring and Vascular Access, 381 Dean B. Andropoulos Dean B. Andropoulos 7 Developmental Physiology of the Central Nervous 18 Pediatric Regional Anesthesia, 419 System, 117 Claude Ecoffey Ken M. Brady, R. Blaine Easley & Bruno Bissonnette 8 Developmental Physiology of the Liver, Gastrointestinal Tract, and Renal System, 139 Part 3 Practice of Pediatric Anesthesia Peter N. Bromley, Ellen Rawlinson & James Bennett 9 Pharmacology, 168 19 Anesthesia for Fetal Intervention and Surgery, 444 Jean X. Mazoit Mark D. Rollins & Mark A. Rosen vi Contents 20 Anesthesia for Premature Infants, 475 35 Anesthesia for Burns and Trauma, 896 George A. Gregory Patrick J. Guffey & Dean B. Andropoulos 21 Anesthesia for the Full-Term and Ex-Premature 36 Anesthesia and Sedation Outside the Operating Infant, 497 Room, 919 Neil S. Morton, Ross Fairgrieve, Anthony Moores & Robert S. Holzman & Keira P. Mason Ewan Wallace 37 Pediatric Intensive Care, 946 22 Anesthesia for the Adolescent and Young Adult Patrick A. Ross, Robert Bart III & Patient, 520 Randall C. Wetzel Loren A. Bauman, Joseph R. Tobin & Dean B. Andropoulos 38 Anesthesia for the Patient with a Genetic Syndrome, 993 23 Anesthesia for Neurosurgical Procedures, 540 David Mann, Priscilla J. Garcia & Bruno Bissonnette, Ken M. Brady & R. Blaine Easley Dean B. Andropoulos 24 Anesthesia for Thoracic Surgery, 569 39 Pediatric Anesthesia in Developing Countries, 1140 Grant McFadyen, Stefan Budac, Michael Richards & Adrian T. Bosenberg Lynn D. Martin 25 Anesthesia for Congenital Heart Disease, 588 Part 4 Quality, Outcomes, and Complications in Kirsten C. Odegard, James A. DiNardo & Peter C. Pediatric Anesthesia Laussen 26 Anesthesia for Spinal Surgery in Children, 654 40 Clinical Complications in Pediatric Anesthesia, 1152 Joseph D. Tobias Randall Flick 27 Anesthesia for Transplantation, 678 41 Impact of Pediatric Surgery and Anesthesia on Brain Stephen A. Stayer, Glynn Williams & Dean B. Development, 1183 Andropoulos Andreas W. Loepke & Sulpicio G. Soriano 28 Anesthesia for Abdominal Surgery, 720 42 Patient Simulation and Its Use in Pediatric Lena S. Sun, Neeta R. Saraiya & Anesthesia, 1219 Philipp J. Houck Anita Honkanen & Michael Chen 29 Anesthesia for Pediatric Urological Procedures, 740 43 Databases and Outcome Research in Pediatric Ira S. Landsman, Laura N. Zeigler & Anesthesia, 1239 Jayant K. Deshpande Donald C. Tyler, Laura Schleelein & Harshad Gurnaney 30 Anesthesia for Orthopedic Surgery, 757 44 Electronic Anesthesia and Medical Records, 1257 Cathy Lammers & Cecile Wyckaert James Edward Caldwell & David Robinowitz 31 Eyes, Ears, Nose, and Throat Surgery, 777 45 Operating Room Safety, Communication, and Olutoyin A. Olutoye & Mehernoor F. Watcha Teamwork, 1279 Thomas L. Shaw & Stephen A. Stayer 32 Anesthesia for Plastic and Craniofacial Surgery, 810 Ehrenfried Schindler, Markus Martini & Martina Appendix A: Pediatric Anesthesia Drugs and Other Messing-Jünger Treatments in the Perioperative Period, 1293 Dean B. Andropoulos 33 Pain Management in Children, 845 Charles Berde & Christine Greco Appendix B: Pediatric Normal Laboratory Values, 1300 34 Outpatient Anesthesia, 875 Dean B. Andropoulos Joseph A. Scattoloni, Olubukola O. Nafi u & Shobha Malviya Index, 1315 vii List of Contributors Warwick Ames Robert A. Berg Peter N. Bromley MBBS, FRCA MD MBBS, FRCA Assistant Professor of Anesthesiology and Professor of Anesthesiology and Critical Care Consultant Anaesthetist Pediatrics Medicine Birmingham Children ’ s Hospital; Duke University Medical Center The University of Pennsylvania School of Honorary Consultant Anaesthetist Durham, NC, USA Medicine; Liver Unit Russell Raphaely Endowed Chair Queen Elizabeth Hospital; Robert Bart III Division Chief, Critical Care Medicine Honorary Senior Lecturer in Clinical The Children ’ s Hospital of Philadelphia Medicine MD Philadelphia, PA, USA University of Birmingham Assistant Professor Birmingham, UK Department of Anesthesiology Critical Care Bruno Bissonnette Medicine William Browne Children ’ s Hospital Los Angeles MD University of Southern California Professor of Anesthesia MBBS, FANZCA Keck School of Medicine Department of Anesthesia Department of Aneasthesia and Pain Los Angeles, CA, USA University of Toronto; Management President and Founder Royal Children ’ s Hospital Loren A. Bauman Children of the World Anesthesia Parkville, Australia Foundation MD Toronto, Ontario, Canada Stefan Budac Associate Professor Department of Anesthesiology MD Adrian T. Bosenberg Wake Forest University School of Medicine; Acting Assistant Professor Pediatric Anesthesiologist MB,ChB, FFA(SA) Department of Anesthesiology and Pain Wake Forest University Baptist Medical Director of Anesthesia Medicine Center Seattle Children ’ s Hospital; University of Washington School of Winston - Salem, NC, USA Professor, Department of Anesthesiology and Medicine; Pain Management Attending Anesthesiologist James Bennett University of Washington Seattle Children ’ s Hospital Seattle, WA, USA Seattle, WA, USA MBBS, FRCA Consultant Anaesthetist Ken M. Brady James Edward Caldwell Birmingham Children ’ s Hospital and Honorary Consultant Anaesthetist MD MB ChB Liver Unit Associate Professor Professor and Vice Chair Queen Elizabeth Hospital Department of Anesthesiology and Pediatric Department of Anesthesia and Perioperative Birmingham, UK Baylor College of Medicine; Care Texas Children ’ s Hospital University of California San Francisco Charles Berde Houston, TX, USA San Francisco, CA, USA MD, PhD Claire Brett Danton Charr Sara Page Mayo Chair in Pediatric Pain Medicine MD MD Chief, Division of Pain Medicine Professor of Anesthesia and Perioperative Instructor of Anesthesiology Department of Anesthesiology, Perioperative Care Department of Anesthesia and Pain Medicine Department of Anesthesia and Perioperative Stanford Hospital and Clinics Children ’ s Hospital Boston; Care Stanford University Professor of Anaesthesia (Pediatrics) University of California San Francisco Stanford, CA, USA Harvard Medical School San Francisco, CA, USA Boston, MA, USA viii List of Contributors Michael Chen Ross Fairgrieve Patrick J. Guffey MD MBChB, FRCA MD Department of Anesthesia Consultant in Paediatric Anaesthesia and Department of Anesthesiology Stanford Hospital and Clinics; Pain Management University of Colorado School of Medicine; Assistant Professor of Anesthesia Royal Hospital for Sick Children Children’s Hospital Colorado Stanford University Glasgow, Scotland, UK Aurora, CO, USA Stanford, CA, USA John E. Fiadjoe Harshad Gurnaney Andrew Davidson MD MBBS MD, MBBS, FANZCA Assistant Professor of Anesthesiology Assistant Professor of Anesthesiology and Associate Professor University of Pennsylvania School of Critical Care Department of Anaesthesia and Pain Medicine; The University of Pennsylvania School of Management Attending Anesthesiologist Medicine; Royal Children ’ s Hospital The Children ’ s Hospital of Philadelphia Anesthesiologist Parkville, Australia Philadelphia, PA, USA The Children ’ s Hospital of Philadelphia Philadelphia, PA, USA Jayant K. Deshpande Randall Flick Susan H. Guttentag MD, MPH MD Professor of Pediatrics and Anesthesiology Consultant, Department of Anesthesiology MD University of Arkansas for Medical Sciences Mayo Clinic; Department of Anesthesiology and Critical Arkansas Children ’ s Hospital Assistant Professor of Anesthesiology Care Medicine Little Rock, AR, USA College of Medicine The University of Pennsylvania School of Rochester, MN, USA Medicine; James A. DiNardo Associate Professor of Pediatrics Maria Victoria Fraga The Children ’ s Hospital of Philadelphia MD Philadelphia, PA, USA Senior Associate in Anesthesia MD Cardiac Anesthesia Service Department of Anesthesiology and Critical Walid Habre Children ’ s Hospital Boston; Care Medicine Associate Professor in Anaesthesia The University of Pennsylvania School of MD, PhD Harvard Medical School Medicine; Associate Professor Boston, MA, USA Neonatology Fellow Department of Anaesthesiology, The Children ’ s Hospital of Philadelphia Pharmacology and Intensive Care Burdett S. Dunbar Philadelphia, PA, USA University Hospitals Geneva, Switzerland MD Jeffrey Galinkin Professor, Anesthesiology and Pediatrics Jeanne E. Hendrickson Baylor College of Medicine; MD, FAAP Former Chief, Pediatric Anesthesiology Department of Anesthesiology and Pediatrics MD Texas Children ’ s Hospital The Children ’ s Hospital; Afl ac Cancer Center and Blood Disorders Houston, TX, USA Associate Professor, Anesthesiology and Service Pediatrics Associate Medical Director R. Blaine Easley University of Colorado at Denver Blood and Tissue Services Aurora, CO, USA Children ’ s Healthcare of Atlanta; MD Assistant Professor of Pediatrics and Associate Professor Priscilla J. Garcia Pathology Department of Anesthesiology and Pediatrics Emory University School of Medicine Baylor College of Medicine; MD Atlanta, GA, USA Texas Children ’ s Hospital Assistant Professor Houston, TX, USA Anesthesiology and Pediatrics Robert S. Holzman Baylor College of Medicine; Claude Ecoffey Staff Pediatric and Obstetric Anesthesiologist MD, FAAP Texas Children ’ s Hospital Senior Associate in Anesthesia MD Houston, TX, USA Department of Anesthesiology, Perioperative Chairman and Pain Medicine Service d ’ Anesth é sie - R é animation Christine Greco Children ’ s Hospital Boston; Chirurgicale Associate Professor of Anaesthesia H ô pital Pontchaillou MD Harvard Medical School University of Rennes Director, Acute Pain Services Boston, MA, USA Rennes, France Department of Anesthesiology, Perioperative and Pain Medicine Children ’ s Hospital Boston; Assistant Professor (Anesthesia) Harvard Medical School Boston, MA, USA List of Contributors ix Anita Honkanen Jerrold Lerman Markus Martini MD MD, FRCPC, FANZCA Dr. med, Dr. med. dent Service Chief, Anesthesia Clinical Professor of Anesthesiology Department of Maxillo - Facial Surgery Clinical Professor of Anesthesia Women and Children ’ s Hospital of Buffalo Bonn University Hospital Department of Anesthesia State University at Buffalo Bonn, Germany Stanford Hospital and Clinics; Buffalo and Strong Memorial Hospital Associate Professor of Anesthesia University of Rochester Keira P. Mason Stanford University, Stanford, CA, USA Rochester, NY, USA MD Senior Associate in Anesthesia Philipp J. Houck Ronald S. Litman Department of Anesthesiology, Perioperative MD DO and Pain Medicine Assistant Professor of Anesthesiology Professor of Anesthesiology and Pediatrics Children ’ s Hospital Boston; Columbia University College of Physicians University of Pennsylvania School of Associate Professor of Anaesthesia and Surgeons Medicine; (Radiology) New York, NY, USA Attending Anesthesiologist Harvard Medical School The Children ’ s Hospital of Philadelphia Boston, MA, USA Kelly Howard Philadelphia, PA, USA Jean X. Mazoit BSc(Hons), MPsych (Clinical Child), PhD Andreas W. Loepke Department of Anaesthesia and Pain MD, PhD Management MD, PhD Paediatric Anaesthetist Royal Children ’ s Hospital Departments of Anesthesia and Pediatrics Universit é Paris - Sud Parkville, Australia Cincinnati Children ’ s Hospital Medical Paris, France Center; Todd J. Kilbaugh Associate Professor of Clinical Anesthesia & Grant McFadyen Pediatrics MD MBChB, DA(SA), FRCA University of Cincinnati College of Medicine Assistant Professor of Anesthesiology and Acting Assistant Professor Cincinnati, OH, USA Critical Care Medicine Department of Anesthesiology and Pain The University of Pennsylvania School of Medicine Ursula Lopez Medicine; University of Washington School of The Children ’ s Hospital of Philadelphia DIPPsych Medicine; Philadelphia, PA, USA Psychologist Attending Anesthesiologist Department of Anaesthesiology Seattle Children ’ s Hospital Cathy Lammers Pharmacology and Intensive Care Seattle, WA, USA University Hospitals MD Geneva, Switzerland Martina Messing- Jünger Director, Pediatric Anesthesiology UC Davis Children ’ s Hospital; MD, PhD Shobha Malviya University of California Department of Pediatric Neurosurgery Davis, CA, USA MD Asklepios Klinik Sankt Augustin Professor of Anesthesiology and Pediatrics Sankt Augustin, Germany Ira S. Landsman Division of Pediatric Anesthesiology University of Michigan Health System Bruce E. Miller MD Ann Arbor, MI, USA Monroe Carell Jr Children ’ s Hospital at MD Vanderbilt Director, Pediatric Cardiac Anesthesiology David Mann Department of Anesthesiology Children ’ s Healthcare of Atlanta; Vanderbilt University Medical Center MD Associate Professor of Anesthesiology Nashville, TN, USA Assistant Professor Emory University School of Medicine Anesthesiology and Pediatrics Atlanta, GA, USA Peter C. Laussen Baylor College of Medicine; Staff Pediatric and Obstetric Anesthesiologist Wanda C. Miller -Hance MBBS Texas Children ’ s Hospital Senior Associate in Anesthesia MD Houston, TX, USA Children ’ s Hospital Boston; Professor of Pediatrics and Anesthesiology Professor of Anaesthesia Baylor College of Medicine; Lynn D. Martin Harvard Medical School Associate Director for Pediatric Boston, MA, USA MD, FAAP, FCCM Cardiovascular Anesthesia Director Director of Intraoperative Echocardiography Department of Anesthesiology & Pain Texas Children ’ s Hospital Medicine Houston, TX, USA Medical Director Bellevue Clinics and Surgery Center Seattle Children ’ s Hospital; University of Washington School of Medicine Seattle, WA, USA x List of Contributors Anthony Moores Michael Richards Neeta R. Saraiya MBChB, FRCA BM, MRCP, FRCA MD Consultant in Paediatric Anaesthesia Assistant Professor Assistant Professor of Anesthesiology Royal Hospital for Sick Children Department of Anesthesiology and Pain Columbia University College of Physicians Glasgow, Scotland, UK Medicine and Surgeons University of Washington School of New York, NY, USA Neil S. Morton Medicine; Attending Anesthesiologist Joseph A. Scattoloni MD, FRCA, FRCPCH, FFPMRCA Seattle Children ’ s Hospital Reader in Paediatric Anaesthesia & Pain Clinical Lecturer Seattle, WA, USA Management Division of Pediatric Anesthesiology Royal Hospital for Sick Children University of Michigan Health System David Robinowitz Glasgow, Scotland, UK Ann Arbor, MI, USA MD Vinay M. Nadkarni Assistant Professor Ehrenfried Schindler Department of Anesthesia and Perioperative MD, MS Dr. med Care Associate Professor of Anesthesiology and Professor and Head University of California San Francisco Critical Care Medicine Department of Pediatric Anesthesiology San Francisco, CA, USA The University of Pennsylvania School of Asklepios Klinik Sankt Augustin Medicine; Sankt Augustin, Germany Mark D. Rollins Endowed Chair, Pediatric Critical Care Medicine MD, PhD Laura Schleelein The Children ’ s Hospital of Philadelphia Assistant Professor of Anesthesia and MD Philadelphia, PA, USA Perioperative Care Assistant Professor of Clinical University of California San Francisco Anesthesiology and Critical Care Olubukola O. Nafi u San Francisco, CA, USA The University of Pennsylvania School of MD Medicine; Mark A. Rosen Division of Pediatric Anesthesiology Anesthesiologist University of Michigan Health System MD The Children ’ s Hospital of Philadelphia Ann Arbor, MI, USA Professor of Anesthesia and Perioperative Philadelphia, PA, USA Care Kirsten C. Odegard Professor of Obstetrics, Gynecology and Mark S. Schreiner Reproductive Sciences MD MD Director of Obstetric Anesthesia Senior Associate in Anesthesia Associate Professor University of California San Francisco Cardiac Anesthesia Service, Children ’ s Department of Anesthesiology and Critical San Francisco, CA, USA Hospital Boston; Care Medicine Associate Professor in Anaesthesia The University of Pennsylvania School of Allison Kinder Ross Harvard Medical School Medicine; Boston, MA, USA MD The Children ’ s Hospital of Philadelphia Associate Professor of Anesthesiology and Philadelphia, PA, USA Olutoyin A. Olutoye Pediatrics Duke University Medical Center Alan Jay Schwartz MD Durham, NC, USA Associate Professor MD, MSEd Anesthesiology and Pediatrics Professor of Clinical Anesthesiology Patrick A. Ross Baylor College of Medicine; and Critical Care Staff Anesthesiologist MD Perelman School of Medicine Texas Children ’ s Hospital Assistant Professor of Clinical University of Pennsylvania; Houston, TX, USA Anesthesiology and Pediatrics Senior Attending Anesthesiologist Department of Anesthesiology Critical Care The Children ’ s Hospital of Philadelphia Ellen Rawlinson Medicine Philadelphia, PA, USA Children ’ s Hospital Los Angeles FRCA University of Southern California Thomas L. Shaw Clinical Fellow in Paediatric Anaesthesia Keck School of Medicine Birmingham Children ’ s Hospital, MD Los Angeles, CA, USA Liver Unit Assistant Professor Queen Elizabeth Hospital Anesthesiology and Pediatrics Venkata Sampathi Birmingham, UK Baylor College of Medicine; MD Staff Anesthesiologist Clinical Instructor Texas Children ’ s Hospital Associate Program Director for Residency Houston, TX, USA Department of Anesthesiology SUNY Upstate University Hospital Syracuse, NY, USA List of Contributors xi Sulpicio G. Soriano Alexis A. Topjian Randall C. Wetzel MD MD MB, MBA Department of Anesthesiology, Perioperative Assistant Professor of Anesthesiology and Chairman Department of Anesthesiology and Pain Medicine Critical Care Medicine and Critical Care Medicine Children ’ s Hospital Boston; The University of Pennsylvania School of Director of the Lorna P and Leland K. Associate Professor of Anaesthesia Medicine; Whittier Virtual PICU Harvard Medical School The Children ’ s Hospital of Philadelphia Professor of Pediatrics, Anesthesiology and Boston, MA, USA Philadelphia, PA, USA Critical Care Medicine Department of Anesthesiology Critical Care Stephen A. Stayer Donald C. Tyler Medicine Children ’ s Hospital Los Angeles MD MD, MBA University of Southern California Professor, Anesthesiology and Pediatrics Associate Professor of Anesthesiology and Keck School of Medicine Baylor College of Medicine; Critical Care Medicine Los Angeles, CA, USA Associate Chief of Anesthesiology The University of Pennsylvania School of Medical Director of Perioperative Services Medicine; Glynn Williams Texas Children ’ s Hospital Anesthesiologist Houston, TX, USA The Children ’ s Hospital of Philadelphia MD Philadelphia, PA, USA Pediatric Cardiovascular Anesthesiology Paul A. Stricker Lucille Packard Children ’ s Hospital at David B. Waisel Stanford; MD Associate Professor of Anesthesia Assistant Professor of Anesthesiology MD Stanford University School of Medicine University of Pennsylvania School of Senior Associate in Anaesthesia Palo Alto, CA, USA Medicine; Department of Anesthesiology, Perioperative Attending Anesthesiologist and Pain Medicine Ivan Wilmot The Children ’ s Hospital of Philadelphia Children ’ s Hospital Boston; Philadelphia, PA, USA Associate Professor of Anaesthesia MD Harvard Medical School Attending Pediatric Cardiologist Lena S. Sun Boston, MA, USA All Children ’ s Hospital Heart Institute St Petersburg, FL, USA MD Ewan Wallace Professor of Anesthesiology and Pediatrics Cecile Wyckaert Columbia University College of Physicians MBChB, FRCA and Surgeons Locum Consultant in Paediatric Anaesthesia MD New York, NY, USA Royal Hospital for Sick Children Pediatric Anesthesiology Glasgow, Scotland, UK UC Davis Children ’ s Hospital; Robert M. Sutton University of California Mehernoor F. Watcha Davis, CA, USA MD, MSCE Assistant Professor of Anesthesiology and MD Myron Yaster Critical Care Medicine Associate Professor The University of Pennsylvania School of Anesthesiology and Pediatrics MD Medicine; Baylor College of Medicine; Richard J Traystman Professor The Children ’ s Hospital of Philadelphia Staff Anesthesiologist Departments of Anesthesiology, Critical Care Philadelphia, PA, USA Texas Children ’ s Hospital Medicine and Pediatrics Houston, TX, USA The Johns Hopkins University Joseph D. Tobias Baltimore, MD, USA Stacey Watt MD Laura N. Zeigler Chairman MD Department of Anesthesiology and Pain Associate Professor of Anesthesiology MD Medicine Program Director Pediatric Anesthesiology Assistant Professor of Clinical Nationwide Children ’ s Hospital; Fellowship Anesthesiology Professor of Anesthesiology and Pediatrics Department of Anesthesia Monroe Carell Jr Children ’ s Hospital at The Ohio State University Women and Children ’ s Hospital of Buffalo Vanderbilt and Department of Columbus, OH, USA State University at Buffalo Anesthesiology Buffalo and Strong Memorial Hospital Vanderbilt University Medical Center Joseph R. Tobin University of Rochester Nashville, TN, USA Rochester, NY, USA MD Professor and Chairman Department of Anesthesiology Wake Forest University School of Medicine; Pediatric Anesthesiologist Wake Forest University Baptist Medical Center Winston - Salem, NC, USA xii Preface Many changes have occurred in the practice in pediatric cal data pertinent to each chapter. Without this informa- anesthesia during the past few years. This, the fi fth edition tion, the clinician often must provide care by rote. Many ofPediatric Anesthesia , refl ects these changes. The book is children do not respond well to rote! If the clinician now the work of multiple new authors from several con- understands the pharmacology and physiology of the tinents and many countries, which gives all of us the situation, he/she can effectively respond to problems. opportunity to broaden our view of pediatric anesthesia. Knowledge of physiology and pharmacology also allow It is also the work of Dean Andropoulos who is now the better planning for anesthesia and surgery. co - editor of this book. Both the authors and Dean have We thank Rob Blundell and Helen Harvey of Wiley - helped move the book to a new and higher level. Blackwell for their constant support and help in the pro- The book is divided into several parts that include: duction of this book. Their clear understanding of our Principles of Pediatric Anesthesia; Pediatric Anesthesia vision has provided the guidance necessary to produce Management; Practice of Pediatric Anesthesia; and the book in the way we envisioned. Quality, Outcomes, and Complications in Pediatric And last but not least, we thank the residents and Anesthesia. The latter part includes new chapters address- fellows for teaching us as much, or more, than we taught ing important contemporary issues, including anesthetic them. Their insightful questions, thoughts, and prodding neurotoxicity; simulation; databases and outcomes is what academic medicine is about. This probing forces research; electronic anesthesia and medical records; and everyone to get out of her/his comfort zone and think operating room safety, communication, and teamwork. differently. We also thank the surgeons and nurses for Also included are appendices on drug dosing and normal their support. Most of all, we thank the patients for giving laboratory values. This edition is published in full color, us the privilege of caring for them and for their continu- to better present the myriad images that illustrate the ing to teach us every single day. They are the best unique features of pediatric anesthesia. New with this teachers! edition are online videos of common anesthesia procedures that concisely and effectively show how to do the George A. Gregory procedures. There are also cases presented at the end of Dean B. Andropoulos each clinical chapter that highlight the main concepts presented in that chapter. One goal of the book has not changed, i.e., to provide pharmacological and physiologi-

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Millions of pediatric patients receive anesthetics every year, but it has been established that those under 12 months of age have a higher risk of poor outcomes. Well established at the forefront of the field, and founded and edited by one of its modern pioneers, Pediatric Anesthesia is renowned for

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