Download Ashcraft's Pediatric Surgery by George Whitfield Holcomb III, MD, MBA, J. Patrick Murphy, PDF

By George Whitfield Holcomb III, MD, MBA, J. Patrick Murphy, MD, Associate Editor and Daniel J. Ostlie, MD (Eds.)

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Multiple methods for single-lung ventilation have been described for infants and children. The most common and easiest method is to use a conventional single-lumen endotracheal tube (ETT) to intubate a main-stem bronchus (Fig. 3-3A). Fiberoptic bronchoscopy, in addition to clinical examination, is utilized to confirm proper placement. It is important to avoid obstruction of the right upper lobe bronchus or protrusion into the trachea from overinflation of the cuff 39 Figure 3-3. There are several methods available for single-lung ventilation in infants and children.

Morphine remains the standard by which most pain therapy is measured. Some pharmacologic differences between morphine and other analgesics must be appreciated to use this narcotic well. Although morphine has roughly the same plasma elimination halflife as other narcotics, its effect and duration of action may have considerable variability because of the drug’s low lipid solubility. Because a poor correlation exists between the plasma concentration of morphine and its desired analgesic effect—a fourfold variation has been measured in the plasma concentration of morphine at which patients medicate themselves for pain—many clinicians believe that morphine is best administered in a patient-controlled device (patient-controlled analgesia [PCA]).

POSTANESTHESIA CARE Pain Management The incidence of postoperative pain in the pediatric population, although difficult to evaluate objectively, is probably similar to that in the adult population. chapter 3 n ANESTHETIC CONSIDERATIONS 43 Table 3-3 Recommendations for the Anesthetic Management of Patients with Congenital Heart Disease 1. P  reoperative medication with an anxiolytic, such as oral midazolam, should be considered to prevent agitation and increased oxygen consumption. 2. P  reoperative intravenous fluids should be considered in patients at risk for hyperviscosity.

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