scholarly journals Anatomy for Anaesthesia in Paediatric Patients

2019 ◽  
Vol 9 (9) ◽  
pp. 599-605
Author(s):  
Dr Sandeep Arora*,Dr Biren Suri,Dr Simmi Khatri
Keyword(s):  
Body Composition ◽  
Cardiac Output ◽  
Drug Sensitivity ◽  
Tracheobronchial Tree ◽  
Congenital Defects ◽  
Physiological Variables ◽  
Organ Systems ◽  
Potential Damage ◽  
Oxygen Requirements ◽  
And Behavior

Anesthesia for children is attenuated by the changes that occur during growth anddevelopment. The dose of the drug is affected by the size and maturation processesof purification, as well as by the changing body composition that occurs with age.All organ systems undergo these maturation changes and most are completed in thefirst years of life. Normal physiological variables in childhood and childhood are quitedifferent from those of adults. The central nervous, cardiovascular and respiratorysystems are particularly important. Brain immaturity and plasticity impact drug sensitivity,pain responses and behavior and increase the potential damage of apoptosiswith anesthesia. The heart experiences a transition from fetal to adult circulationduring the first weeks of life. Congenital defects not diagnosed are not uncommon.The newborn is very susceptible to conditions that trigger an increase in pulmonaryvascular resistance, with reversion to fetal circulatory patterns. The anatomy and respiratorymechanics affect the apnea propensity, the maintenance of the airways, theartificial ventilation modalities, the absorption of inhalant agents and the size of thetracheal tubes. The metabolic rate and oxygen requirements increase with age. Thisphysiology influences various aspects that include the desaturation rate during apnea,hypoglycemia during hunger, cardiac output, drug metabolism, fluid requirements andheat production or loss.Key words: Physiology–respiratory system–Anatomy–bronchomotor tone–functionalresidual capacity–tracheobronchial tree–ventilationperfusion

Anatomy, physiology, and pharmacology in paediatric anaesthesia

2017 ◽  
Author(s):  
Niall Wilton ◽  
Brian J. Anderson ◽  
Bruno Marciniak
Keyword(s):  
Cardiac Output ◽  
Growth And Development ◽  
Artificial Ventilation ◽  
Drug Dose ◽  
Congenital Defects ◽  
Potential Harm ◽  
Physiological Variables ◽  
Organ Systems ◽  
Infancy And Childhood ◽  
Oxygen Requirements

Anaesthesia for children is tempered by changes that occur during both growth and development. Drug dose is affected by size and clearance maturation processes as well as the changing body composition that occurs with age. All organ systems undergo these maturation changes and most are complete within the first few years of life. Normal physiological variables in infancy and childhood are quite different from adults. The central nervous, cardiovascular, and respiratory systems are particularly important. Cerebral immaturity and plasticity impacts sensitivity to drugs, pain responses, and behaviour and increases potential harm from apoptosis with anaesthesia. The heart undergoes a transition from fetal to adult circulation during the first few weeks of life. Undiagnosed congenital defects are not uncommon. The neonate is very susceptible to conditions that trigger an increase in pulmonary vascular resistance, with reversion to fetal circulatory patterns. Respiratory anatomy and mechanics affect the propensity to apnoea, airway maintenance, artificial ventilation modalities, uptake of inhalational agents, and tracheal tube sizes. Metabolic rate and oxygen requirements increase with decreasing age. This physiology influences diverse aspects that include the rate of desaturation during apnoea, hypoglycaemia during starvation, cardiac output, drug metabolism, fluid requirements, and heat production or loss.

scholarly journals Cardiopulmonary performance in allogeneic hematopoietic cell transplantation recipients—evaluation of pre-transplant risk assessments

2021 ◽  
Author(s):  
Antonia Pahl ◽  
Sarah Waibel ◽  
Anja Wehrle ◽  
Gabriele Ihorst ◽  
Albert Gollhofer ◽  
...  
Keyword(s):  
Body Composition ◽  
Cell Transplantation ◽  
Predictive Power ◽  
Hematopoietic Cell Transplantation ◽  
Risk Index ◽  
Hematopoietic Cell ◽  
Risk Assessments ◽  
Risk Scores ◽  
Organ Systems ◽  
Cardiopulmonary Performance

AbstractCardiopulmonary performance reflects how well different organ systems interact. It is inter alia influenced by body composition, determines patients’ quality of life and can also predict mortality. However, it is not yet used for risk prediction prior to allogeneic hematopoietic cell transplantations (alloHCT). Thus, we aimed to examine the predictive power of peak oxygen consumption (VO2peak) as a representative of cardiopulmonary performance and that of body composition before alloHCT to determine overall survival (OS) and non-relapse mortality (NRM) 2 years after transplantation. We also compared it with the predictive power of four commonly-used risk scores: revised Pretransplant Assessment of Mortality (rPAM), Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI), revised Disease Risk Index (rDRI), European Society for Blood and Marrow Transplantation (EBMT). Fifty-nine patients performed a cardiopulmonary exercise test and body composition assessments before alloHCT and were observed for 2 years. Sixteen patients died. VO2peak and most risk scores assessed pre-transplant revealed no association with OS or NRM. Body composition parameters only within univariable analyses. But higher rDRI and the male sex, were associated with shorter OS and higher NRM. We thus propose that the current risk assessments be reconsidered. The predictive value of VO2peak and body composition need further clarification, however.

Asymmetric Crying Facies: Which Is the `Right-Wrong' Side?

PEDIATRICS ◽  
1983 ◽  
Vol 71 (1) ◽  
pp. 144-145
Author(s):  
KARL-GEORG EVERS ◽  
PETER GRONECK
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Soft Palate ◽  
Congenital Heart ◽  
Cleft Lip ◽  
Congenital Defects ◽  
Wrong Side ◽  
Organ Systems ◽  
Depressor Muscle ◽  
The Right

To the Editor.— Congenital asymmetric crying facies is generally considered to be due to unilateral agenesis or hypoplasia of the anguli oris depressor muscle (HAODM). Electromyographic (EMG) examinations of the affected sides have revealed absent spontaneous activity or diminished motor unit activity.1-3 Association of HAODM syndrome with congenital heart disease, the "cardiofacial syndrome," has been described.4 Major defects of other organ systems and minor congenital defects may be associated with asymmetric crying facies as well.5 Monreal6 reported five patients with asymmetric congenital crying facies syndroms who besides this anomaly displayed juxtaoral defects, egm atresia of one side of the jaw and soft palate, cleft lip, hypoplasis of mandible and ear.

scholarly journals Cardiac responses to hypoxia and reoxygenation in Drosophila

2015 ◽  
Vol 309 (11) ◽  
pp. R1347-R1357 ◽  
Author(s):  
Rachel Zarndt ◽  
Sarah Piloto ◽  
Frank L. Powell ◽  
Gabriel G. Haddad ◽  
Rolf Bodmer ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Genetic Model ◽  
Heart Function ◽  
Acute Hypoxia ◽  
Hypoxia Inducible Factor ◽  
High Energy ◽  
Hypoxic Exposure ◽  
Low Oxygen ◽  
Cardiac Responses ◽  
Organ Systems

An adequate supply of oxygen is important for the survival of all tissues, but it is especially critical for tissues with high-energy demands, such as the heart. Insufficient tissue oxygenation occurs under a variety of conditions, including high altitude, embryonic and fetal development, inflammation, and thrombotic diseases, often affecting multiple organ systems. Responses and adaptations of the heart to hypoxia are of particular relevance in human cardiovascular and pulmonary diseases, in which the effects of hypoxic exposure can range in severity from transient to long-lasting. This study uses the genetic model system Drosophila to investigate cardiac responses to acute (30 min), sustained (18 h), and chronic (3 wk) hypoxia with reoxygenation. Whereas hearts from wild-type flies recovered quickly after acute hypoxia, exposure to sustained or chronic hypoxia significantly compromised heart function upon reoxygenation. Hearts from flies with mutations in sima, the Drosophila homolog of the hypoxia-inducible factor alpha subunit (HIF-α), exhibited exaggerated reductions in cardiac output in response to hypoxia. Heart function in hypoxia-selected flies, selected over many generations for survival in a low-oxygen environment, revealed reduced cardiac output in terms of decreased heart rate and fractional shortening compared with their normoxia controls. Hypoxia-selected flies also had smaller hearts, myofibrillar disorganization, and increased extracellular collagen deposition, consistent with the observed reductions in contractility. This study indicates that longer-duration hypoxic insults exert deleterious effects on heart function that are mediated, in part, by sima and advances Drosophila models for the genetic analysis of cardiac-specific responses to hypoxia and reoxygenation.

The Effects of Body composition (Percent Fat) On Acclimatization to Heat

1981 ◽  
Vol 25 (1) ◽  
pp. 774-778
Author(s):  
Alex Loewenthal ◽  
David J. Cochran ◽  
Michael W. Riley
Keyword(s):  
Heart Rate ◽  
Weight Loss ◽  
Body Composition ◽  
Skin Temperature ◽  
Heat Exposure ◽  
Temperature Differential ◽  
Mean Skin Temperature ◽  
Physiological Variables ◽  
The Core ◽  
Rate Of Decay

Nine fully acclimatized men falling in the lean, medium and obese categories of body composition were observed during heat exposure periods for four days following acclimatization decay periods of various lengths in order to determine the effects of body composition on the decay and reinduction of acclimatization. The physiological variables taken into consideration were core temperature, “DuBois” mean skin temperature, heart rate, weight loss due to perspiration and the temperature differential between the core and surface. All of the men were subjected to an acclimatization schedule of twelve daily sessions in order to insure that they were all fully acclimatized. Three decay, or non-exposure, periods of four, eight and twelve days were each followed by four days of reinduction. It was determined that body composition does not affect the rate of decay or reinduction of acclimatization, although this parameter as well as the extent of decay and the duration of the reinduction period does affect the physiological variables monitored in this study.

scholarly journals Practice Variation in Spontaneous Breathing Trial Performance and Reporting

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Stephanie Godard ◽  
Christophe Herry ◽  
Paul Westergaard ◽  
Nathan Scales ◽  
Samuel M. Brown ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Ventilatory Support ◽  
Standard Of Care ◽  
Practice Variation ◽  
Ventilator Support ◽  
Physiological Variables ◽  
Physiologic Parameters ◽  
Spontaneous Breathing Trials ◽  
Oxygen Requirements

Background. Spontaneous breathing trials (SBTs) are standard of care in assessing extubation readiness; however, there are no universally accepted guidelines regarding their precise performance and reporting.Objective. To investigate variability in SBT practice across centres.Methods. Data from 680 patients undergoing 931 SBTs from eight North American centres from the Weaning and Variability Evaluation (WAVE) observational study were examined. SBT performance was analyzed with respect to ventilatory support, oxygen requirements, and sedation level using the Richmond Agitation Scale Score (RASS). The incidence of use of clinical extubation criteria and changes in physiologic parameters during an SBT were assessed.Results. The majority (80% and 78%) of SBTs used 5 cmH2O of ventilator support, although there was variability. A significant range in oxygenation was observed. RASS scores were variable, with RASS 0 ranging from 29% to 86% and 22% of SBTs performed in sedated patients (RASS < −2). Clinical extubation criteria were heterogeneous among centres. On average, there was no change in physiological variables during SBTs.Conclusion. The present study highlights variation in SBT performance and documentation across and within sites. With their impact on the accuracy of outcome prediction, these results support efforts to further clarify and standardize optimal SBT technique.

scholarly journals Chronic Variable Stress Induces Sex-Specific Alterations in Social Behavior and Neuropeptide Expression in the Mouse

Endocrinology ◽  
2018 ◽  
Vol 159 (7) ◽  
pp. 2803-2814 ◽  
Author(s):  
Amanda P Borrow ◽  
Natalie J Bales ◽  
Sally A Stover ◽  
Robert J Handa
Keyword(s):  
Social Behavior ◽  
Disease Risk ◽  
Multiple Organ ◽  
Preclinical Research ◽  
Coping Responses ◽  
Specific Effects ◽  
Organ Systems ◽  
Chronic Stressor ◽  
Chronic Variable Stress ◽  
And Behavior

Abstract Chronic exposure to stressors impairs the function of multiple organ systems and has been implicated in increased disease risk. In the rodent, the chronic variable stress (CVS) paradigm has successfully modeled several stress-related illnesses. Despite striking disparities between men and women in the prevalence and etiology of disorders associated with chronic stress, most preclinical research examining chronic stressor exposure has focused on male subjects. One potential mediator of the consequences of CVS is oxytocin (OT), a known regulator of stress neurocircuitry and behavior. To ascertain the sex-specific effects of CVS in the C57BL/6 mouse on OT and the structurally similar neuropeptide arginine vasopressin (AVP), the numbers of immunoreactive and mRNA-containing neurons in the paraventricular nucleus (PVN) and supraoptic nucleus (SON) were determined using immunohistochemistry and in situ hybridization, respectively. In addition, the mice underwent a battery of behavioral tests to determine whether CVS affects social behaviors known to be regulated by OT and AVP. Six weeks of CVS increased sociability in the female mouse and decreased PVN OT immunoreactivity (ir) and AVP mRNA. In the male mice, CVS decreased PVN OT mRNA but had no effect on social behavior, AVP, or OT-ir. CVS also increased the soma volume for PVN OT neurons. In contrast, OT and AVP neurons in the SON were unaffected by CVS treatment. These findings demonstrate clear sex differences in the effects of CVS on neuropeptides in the mouse, suggest a pathway through which CVS alters sociability and stress-coping responses in females and reveals a vulnerability to CVS in the C57BL/6 mouse strain.

scholarly journals EFFECT OF GRADED CONDITIONING ON SELECTED PHYSIOLOGICAL VARIABLES AND BODY COMPOSITION OF CHILDREN WITH CEREBRAL PALSY

2020 ◽  
Vol 13(62) (2) ◽  
pp. 219-226
Author(s):  
C.K. PASWAN
Keyword(s):  
Body Composition ◽  
Cerebral Palsy ◽  
Neurological Impairment ◽  
The Other ◽  
Breath Holding ◽  
Control Group ◽  
Resting Heart Rate ◽  
Physiological Variables ◽  
Children With Cerebral Palsy ◽  
Experimental Group

Cerebral palsy is one of the known and famous types of neurological impairment among children across the globe. The study aimed to see the effect of graded conditioning and exercises over some of the physiological variables of children with cerebral palsy. For the purpose of the study 20 children with cerebral palsy were selected and were divided into two groups of ten each the experimental group were given the treatment and the other was the kept as control group for twelve weeks. To obtain the results the analysis of co-variance was applied and it was seen that resting heart rate (.006), triceps girth (.002), suprailliac girth (.002), abdominal umbilicus (.001), sub-scapular girth (.009), positive breath holding capacity (.007) and cardio-respiratory endurance (.001) showed positive significance at .005 level. As after twelve weeks of graded conditioning it can be seen that most of the physiological variables and variables of body composition showed great signs of improvement and showed positive significance, so it can be concluded that with good graded training (according to their need and capability) the positive physiological improvement can be made among children with cerebral palsy.

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