Pediatric Anesthesia and Postoperative Analgesia

Feldman, Doron; Reich, Neal T.; Foster, James M.

doi:10.1016/s0031-3955(05)70102-4

Cited by 15 publications

(4 citation statements)

References 14 publications

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“…Infants, children, and adolescents pose unique considerations as surgical patients, ranging from positive factors such as reduced medical comorbidities and rapid wound healing, to challenges because of growth considerations and immature organ systems. 21,23 Although significant focus has been placed on optimizing perioperative care and developing enhanced recovery after surgery protocols for adult patients undergoing microvascular reconstruction, little has been done to standardize the perioperative care of pediatric patients. Despite technical challenges, free tissue transfer in pediatric patients has successfully been performed for over 40 years and in infants as young as 4 months.…”

Section: Discussionmentioning

confidence: 99%

“…5,[17][18][19][20] The saying that "children are not small adults" is often used to emphasize the anatomical, physiologic, and pharmacologic features that are distinctive to children. [21][22][23] For instance, cerebral immaturity and plasticity result in unique pain responses and medication sensitivity in children, and increased potential for harmful effects of anesthesia on neurodevelopment and behavior. 24,25 Normal physiologic parameters such as breathing rate undergo dramatic changes from infancy to childhood.…”

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confidence: 99%

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Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer

Mountziaris

Rudolph

Fournier

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer and to use it to develop evidence-based care guidelines. Methods: A systematic review was conducted in the PubMed, Embase, Scopus, and Cochrane Library databases. Because a preliminary search of the pediatric microsurgical literature yielded scant data with a low level of evidence, pediatric anesthesia guidelines for healthy children undergoing major operations were also included. Exclusion criteria included vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children. Results: Two hundred four articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High-quality data were found for anesthesia, analgesia, fluid administration/blood transfusion, and anticoagulation (Level I Evidence). Lower quality evidence was identified for patient temperature (Level III Evidence) and vasodilator use (Level IV Evidence). Key recommendations include administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin level is less than 7 g/dl unless the patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high-risk patients. Conclusions: Pediatric-specific guidelines are important, as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer

Mountziaris

Rudolph

Fournier

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Most paediatric anaesthetists currently use Berry's formula for paediatric patients who are fasted for more than 6–8 h before surgery (e.g. 3–6).…”

Section: Calculation Of the Volume To Be Infusedmentioning

confidence: 99%

“…According to Berry (2), three types of fluids are needed: transcellular fluid such as fluid from the gastrointestinal tract, interstitial fluid and blood. Replacement fluid volumes depend on the type of surgical trauma and vary between 2 and 6 mL/kg/h (5, 6). Specific replacement of blood losses, which are generally weak in routine surgery, will not be discussed in this paper.…”

Section: Calculation Of the Volume To Be Infusedmentioning

confidence: 99%

Perioperative infusions in paediatric patients: rationale for using Ringer-lactate solution with low dextrose concentration

Berleur

Dahan

Murat

et al. 2003

Journal of Clinical Pharmacy and Therapeutics

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To assess the usefulness of Ringer-lactate solution with 0.9% dextrose, fluid therapy during surgery in paediatric patients was reviewed. From the literature, the need for intravenous (i.v.) infusion and water could be established. The need for sodium was also evident and use of normonatraemic i.v. solutions should be recommended to avoid hyponatraemia. Little data were found about the value of the other electrolytes. Dextrose requirements have been the subject of debate for the last two decades. The choice of dextrose concentration is a compromise between avoiding hypoglycaemia and hyperglycaemia. Four clinical trials assessing the use of Ringer-lactate solution with 0.9 or 1% dextrose in paediatric patients suggest that it is appropriate for routine infusion in paediatric patients during the perioperative period. However, fluid therapy during surgery has rarely been studied, probably because it is inexpensive, rarely leads to problems and is used in very different clinical settings. Development of consensus clinical guidelines on the use of electrolyte infusions in paediatric surgery would be helpful.

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