By George Whitfield Holcomb III, MD, MBA, J. Patrick Murphy, MD, Associate Editor and Daniel J. Ostlie, MD (Eds.)
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Additional info for Ashcraft's Pediatric Surgery
Other side effects that vary from drug to drug and patient to patient are somnolence, nausea and vomiting, pruritus, constipation, and urinary retention. Given time, patients develop tolerance to most, if not all, of these side effects while they continue to experience their analgesic properties. The side effects may be treated symptomatically while tolerance is developing, thereby making the patient much more comfortable and manageable. Changing the narcotics will often reduce or eliminate the side effects.
Performing a median sternotomy and placing the child on cardiopulmonary bypass has been reported as an emergency measure but does not seem to be a practical alternative considering the time constraints of performing this procedure in the face of extreme hypoxia and hypotension. It is extremely important that the anesthesia, surgery, and the nursing teams be prepared with contingency plans to intervene emergently with alternative positioning and airway interventions. chapter 3 n ANESTHETIC CONSIDERATIONS 37 Table 3-2 Physiologic Effects of Creation of a Pneumoperitoneum ↑ Systemic vascular resistance ↑ Pulmonary vascular resistance ↓ Stroke volume ↓ Cardiac index ↑ Pco2 ↓ Functional residual capacity ↓ pH ↓ Po2 ↓ Venous return (head up) Figure 3-2.
An optimal anesthetic plan m considers respiratory derangements due to positioning, lung exclusion, CO2 insufflation into the pleural cavity, and methods of airway management for each age group in the pediatric population. Anesthesiologists must take into consideration the ventilation-perfusion mismatch that is induced by the lateral decubitus position in the anesthetized patient, single-lung ventilation, and CO2 insufflation. 46 In a recently published study of 50 pediatric patients undergoing thoracoscopy for a variety of surgical procedures, systolic and diastolic blood pressure was significantly lower and ETco2 was significantly higher during thoracoscopy.