Perioperative Medicine in Pediatric Anesthesia PDF
Preview Perioperative Medicine in Pediatric Anesthesia
Anesthesia, Intensive Care and Pain in Neonates and Children Marinella Astuto Pablo M. Ingelmo Editors Perioperative Medicine in Pediatric Anesthesia Anesthesia, Intensive Care and Pain in Neonates and Children Series editor: Antonino Gullo Marinella Astuto Ida Salvo Marinella A stuto (cid:129) P ablo M . Ingelmo Editors Perioperative Medicine in Pediatric Anesthesia Editors Marinella Astuto Pablo M . Ingelmo UCO di Anestesia e Rianimazione Department of Anesthesia AO-U Policlinico di Catania MUHC Montreal Children’s Hospital Catania McGill University Italy Montreal, QC Canada ISSN 2281-1788 ISSN 2281-1796 (electronic) Anesthesia, Intensive Care and Pain in Neonates and Children ISBN 978-3-319-21959-2 ISBN 978-3-319-21960-8 (eBook) DOI 10.1007/978-3-319-21960-8 Library of Congress Control Number: 2015955168 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper S pringer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Foreword For some readers, the title of this book might raise a main question: why a book on perioperative medicine in pediatric anesthesia. The reply is in the understand- ing that the anesthesia practice has evolved from a limited environment such as the operating room to the whole perisurgical care, starting from the time a patient is referred by the surgical treating team till the time the infant-child has recov- ered and is back with his own family and community. Therefore, it would make sense that pediatric anesthesiologists apply this concept to their own milieu. The introduction of sophisticated technology in endoscopic surgery and the better understanding of the pathophysiology of neonatal surgical stress emphasize the role of the anesthesiologist as a perioperative physician. For example, there has been an expansion of regional anesthesia applied to pediatric surgery as a result of improved and more reliable imaging techniques together with better training. This has allowed a better quality of analgesia and accelerated recovery. Other examples are the interactions of pediatric anesthesiologists with respiratory physiologists and neuroscientists to better understand the control of breathing and neurobehavioral development, thanks to major development in modern molecular biology and physiology. Also, better monitoring has allowed complex surgeries to be performed on an outpatient basis, and over the years a greater proportion of surgical operations are safely performed on an outpatient basis. Each chapter stresses the scientifi c principles necessary to understand and man- age various situations encountered in pediatric anesthesia from a multidisci- plinary point of view. I commend Drs. Astuto and Ingelmo, both pediatric anesthesiologists in two large pediatric institutions in Italy and Canada, respectively, who have assembled an international group of illustrious experts to dissect the topic of perioperative pediat- ric medicine and to present the various aspects of pediatric anesthesia care, from preoperative preparation of the child, education of the family and optimization of medical, physical, nutritional and psychological functions, to perioperative man- agement of specifi c conditions. The last four chapters are dedicated to acute and chronic pain and to the impact of anesthesia and surgery on the infant brain. Overall, v vi Foreword these chapters will guide not only the trainee, but also the experienced and seasoned clinicians who are interested in expanding their knowledge on topics of relevant importance. Francesco Carli , MD, MPhil Department of Anesthesia MUHC, Montreal General Hospital, McGill University , Montreal , QC , Canada Pref ace P erioperative clinical outcomes in procedures involving infants and children have dramatically improved in recent years. Various factors may be responsible for those benefi ts such as emerging of new technologies, standardized anesthesia protocols, minimally invasive surgeries, improvements in acute postoperative care, and wide- spread use of perioperative safety standards, to mention just a few. T raditionally, surgeons coordinate perioperative care of patients undergoing sur- gery. In some European countries, most of the perioperative care relies on anesthe- siologists and pediatricians. Perioperative medicine becomes a multidisciplinary speciality aiming to provide continuum of care with coordinated interventions in the preoperative, intraoperative, and postoperative periods. The collaboration among a variety of doctors and nurses with specifi c pediatric training in pediatric environ- ments allows the development of multidisciplinary clinical care pathways incorpo- rating multiple evidence-based interventions. With this book, we aim to provide a comprehensive overview of current practices in pediatric perioperative care. In all sections, from the preoperative care to the consequences of anesthesia and surgery through the perioperative care during sur- gery and in special clinical conditions, we look for practical answers to the most common questions of pediatric perioperative care. This book was possible due to the efforts of an exquisite list of anesthesiologists, pediatricians, and surgeons from Europe and North America. This international team of contributors ranges from worldwide experts who had changed the way we care for our patients to young specialists who will lead the future of perioperative medicine. We are truly and deeply grateful for their collaboration and friendship. There has been a progressive accumulation of good evidence related to periop- erative care in the last decade. A long series of well-designed studies now permit an evidence-based approach to pediatric perioperative care. However, translation of research fi ndings and guidelines into clinical practice remains a signifi cant barrier affecting real clinical scenarios. Differences in type of surgeries, ages, interven- tions, clinical settings, and their interaction justify the need of establishing proce- dure-specifi c perioperative programs. Perioperative care is a multidimensional phenomenon, requiring multimodal management plan and strategies. It is evident that not a single specialist is able to provide solutions in all circumstances. Perioperative medicine gives us a unique opportunity to re-imagine the vii viii Preface anesthetic-surgical-pediatrician relationship. This partnership should not continue to be experienced as independent entities divided by the operating theater “blood- brain barrier,” but as a united team working towards the shared goal of optimal patient trajectory throughout the perioperative process to normality. Catania, Italy Marinella Astuto, MD Montreal, QC, Canada Pablo Mauricio Ingelmo, MD Acknowledgments I would like to express my deep gratitude to Professor Gullo for his patient guidance and enthusiastic encouragement of my work. I would also like to thank my dear friend Dr. Pablo Ingelmo for his invaluable support throughout the planning and development phases of this book. Finally, I thank all the authors who honored me with their contributions. Prof. Marinella Astuto M.D. I wish to thank my wife, Francesca, and my sons, Matteo and Marco, for their patient support. I also wish to thank Prof. Miguel Angel Paladino and Prof. Roberto Fumagalli for their mentorship in shaping my clinical and academic career, and to the KISS group to make it valuable. Finally, this would not be possible without my friends: Walter, Marinella, and Pierre. Pablo M. Ingelmo M.D. ix
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