Neonatal Physiology

2018 ◽  
Author(s):  
Brian Frugoni ◽  
Laura Downey
Keyword(s):  
Anesthetic Management ◽  
Ductus Arteriosus ◽  
Respiratory Physiology ◽  
Lung Mechanics ◽  
Older Children ◽  
Anesthetic Care ◽  
Disease States ◽  
Organ Systems ◽  
Neonatal Physiology ◽  
Apnea Of Prematurity

The neonate has many unique physiologic characteristics that set it apart from older children and adults. Many of these differences arise from the requirements for fetal growth and development and the abrupt transition from fetal to extrauterine life. All organ systems are impacted, with critical implications for medical management. Understanding the unique features of the neonate is essential for the safe anesthetic care of these patients. This chapter reviews fetal development of the different organ systems, along with their function during the neonatal period. Placental physiology as it pertains to anesthetic management will be reviewed. Special attention will be paid to transitional cardiac and respiratory physiology as well as neonatal respiratory mechanics. Renal acid–base maintenance, fluid and electrolyte management, hematologic and neurologic systems will be discussed. Emphasis is on the term neonate, although preterm neonatal physiology is also briefly reviewed. Common neonatal disease states are also covered. The goal is for the anesthesia practitioner to gain a greater understanding of the unique aspects of the neonate so that they may better care for this vulnerable subset of patients. This review contains 8 figures, 13 tables, and 52 references. Key Words: apnea of prematurity, chronic lung disease, infant lung mechanics, intraventricular hemorrhage, neonate, patent ductus arteriosus, patent foramen ovale, persistent fetal circulation, transitional circulation, retinopathy of prematurity

scholarly journals Patients With Type 2 Diabetes: Anesthetic Management in the Ambulatory Setting. Part 1: Pathophysiology and Associated Disease States

2016 ◽  
Vol 63 (4) ◽  
pp. 208-215 ◽  
Author(s):  
Bryant W. Cornelius
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Anesthetic Management ◽  
Multiple Organ ◽  
Ambulatory Setting ◽  
Diabetic Patients ◽  
Ambulatory Anesthesia ◽  
Disease States ◽  
Organ Systems ◽  
Patients With Diabetes

The increasing prevalence of diabetes mellitus in the general population has many implications for the ambulatory anesthesia provider. Complications, particularly associated with poor glycemic control, can affect multiple organ systems and jeopardize the safety of any planned anesthetic. It is essential that anesthesiologists and sedation providers have in-depth knowledge of the pathophysiology of diabetes mellitus and the comorbid conditions that commonly accompany it. Anesthesiologists and sedation providers must also understand certain surgical and anesthetic considerations when planning an effective and safe anesthetic for diabetic patients. This is a 2-part series concerning perioperative glycemic control for patients with diabetes mellitus. Part 1 will focus on the physiology of diabetes and its associated disease states. Part 2 will address the pharmacology associated with the wide variety of medications used to treat the disorder and the most recent guidelines for blood glucose management in ambulatory surgical patients.

Anesthetic management for the correction of a patent ductus arteriosus by means of either surgical ligation or transarterial occlusion in dogs Anesthesie voor de correctie van een persisterende ductus arteriosus via chirurgie of transarteriële occlusie bi

2012 ◽  
Vol 81 (1) ◽  
pp. 17-23
Author(s):  
M. Gozalo-Marcilla ◽  
C. J. Seymour ◽  
S. Schauvliege ◽  
T. Bosmans ◽  
F. Gasthuys
Keyword(s):  
Veterinary Medicine ◽  
Case Report ◽  
Patent Ductus Arteriosus ◽  
Anesthetic Management ◽  
Ductus Arteriosus ◽  
The Other ◽  
Corrective Surgery ◽  
Vascular Abnormalities ◽  
Surgical Ligation ◽  
Patent Ductus

Patent ductus arteriosus (PDA) is one of the most common congenital vascular abnormalities in the dog. In veterinary medicine, surgical ligation (SL) and transarterial occlusion (TO) are two possible treatments that require general anesthesia. Two 4-month-old dogs were anesthetized for the correction of PDA, one by SL and the other by TO. Two different anesthetic and analgesic protocols were used, and were chosen to avoid potential complications. This case report describes two possible anesthetic approaches for PDA corrective surgery (SL and TO).

Paediatric and neonatal anaesthesia

2021 ◽  
pp. 899-966
Author(s):  
Simon Berg ◽  
Stewart Campbell
Keyword(s):  
Cleft Lip ◽  
Life Support ◽  
Cleft Lip And Palate ◽  
Ductus Arteriosus ◽  
Fluid Management ◽  
Anaesthetic Techniques ◽  
Medical Problems ◽  
Nerve Blocks ◽  
Congenital Talipes Equinovarus ◽  
Neonatal Physiology

This chapter discusses the anaesthetic management of the neonate, infant and child. It begins with a description of neonatal physiology, then discusses fluid management, anaesthetic equipment and the conduct of anaesthesia in children, including postoperative analgesia. Regional anaesthetic techniques in children are discussed, including caudal, epidural, spinal and regional nerve blocks. Surgical procedures covered include repair of diaphragmatic hernia; gastroschisis/exomphalos; tracheo-oesophageal fistula (TOF); patent ductus arteriosus (PDA); pyloric stenosis; intussusception; herniotomy; circumcision; hypospadias repair; orchidopexy; cleft lip and palate; congenital talipes equinovarus (CTEV); femoral osteotomy, and inhaled foreign body. It includes a discussion of paediatric sedation, paediatric medical problems, paediatric advanced life support, resuscitation of the neonate, the collapsed septic child, stabilisation of the critically ill child, and paediatric drug doses and equipment.

Anesthesia

2019 ◽  
pp. 175-187
Author(s):  
Christopher J. Plambeck ◽  
Michael K. Loushin ◽  
Michael F. Sweeney
Keyword(s):  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Management Plan ◽  
Left Ventricular ◽  
Care Providers ◽  
Anesthetic Care ◽  
Ventricular Assist ◽  
Hemodynamic Deterioration ◽  
Left Ventricular Assist ◽  
Post Cardiopulmonary Bypass

The anesthetic care of the left ventricular assist device (LVAD) recipient presents to the anesthesiologist a unique set of challenges which must be skillfully managed for the successful completion of this complex surgical procedure. The anesthesiologist must perform a thorough preoperative evaluation and carefully assess the patient’s cardiovascular, pulmonary, renal, and hepatic systems. Special consideration to the risk of post-implantation right ventricular (RV) dysfunction is critical. In patients with advanced heart failure, a well-formulated anesthetic management plan must be developed to provide adequate anesthesia while at the same time preventing hemodynamic deterioration. The performance of a comprehensive transesophageal echocardiogram study is essential for identifying potential issues that may need to be addressed during the surgery. The post-cardiopulmonary bypass period is fraught with several challenges which the anesthesiologist must address, such as RV dysfunction or failure, vasoplegia, and coagulopathy. The transition of care to the ICU is facilitated by the application of a standardized checklist to ensure that all critical information is conveyed to the critical care providers. The anesthesiologist also frequently provides care for the LVAD patient undergoing a non-cardiac surgery or procedure. A careful preoperative evaluation and a thorough understanding of the technology and physiology of the LVAD patient is essential to the development of a safe and sensible anesthetic management plan.

Transsphenoidal/Pituitary Surgery

2018 ◽  
Author(s):  
Vaia T. Abatzis ◽  
Edward C. Nemergut
Keyword(s):  
Pituitary Gland ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Pituitary Surgery ◽  
Anesthetic Care ◽  
Anesthetic Agents ◽  
Intraoperative Management ◽  
Transsphenoidal Pituitary Surgery ◽  
Early Diagnosis Of Diabetes

Patients with tumors of the pituitary gland represent a heterogeneous yet commonly encountered neurosurgical population. Optimal anesthetic care requires an understanding of the complex pathophysiology secondary to each patient’s endocrine disease. Although patients presenting with Cushing’s disease and acromegaly have unique manifestations of endocrine dysfunction, all patients with tumors of the pituitary gland require meticulous preoperative evaluation and screening. There are many acceptable strategies for optimal intraoperative anesthetic management; however, the selection of anesthetic agents should be tailored to facilitate surgical exposure, preserve cerebral perfusion and oxygenation, and provide for rapid emergence and neurological assessment. Postoperatively, careful monitoring of fluid balance and serum sodium is essential to the early diagnosis of diabetes insipidus (DI). DI is most often transient but can require medical therapy. A thorough understanding of the preoperative assessment, intraoperative management, and potential complications are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.

scholarly journals Heart rate variability: Measurement and emerging use in critical care medicine

2019 ◽  
Vol 21 (2) ◽  
pp. 148-157 ◽  
Author(s):  
Brian W Johnston ◽  
Richard Barrett-Jolley ◽  
Anton Krige ◽  
Ingeborg D Welters
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Intensive Care ◽  
Sinus Node ◽  
Heart Rate Variability Analysis ◽  
Time Interval ◽  
Physiological Basis ◽  
Disease States ◽  
Organ Systems ◽  
Heart Rate Variability Measurement

Variation in the time interval between consecutive R wave peaks of the QRS complex has long been recognised. Measurement of this RR interval is used to derive heart rate variability. Heart rate variability is thought to reflect modulation of automaticity of the sinus node by the sympathetic and parasympathetic components of the autonomic nervous system. The clinical application of heart rate variability in determining prognosis post myocardial infarction and the risk of sudden cardiac death is well recognised. More recently, analysis of heart rate variability has found utility in predicting foetal deterioration, deterioration due to sepsis and impending multiorgan dysfunction syndrome in critically unwell adults. Moreover, reductions in heart rate variability have been associated with increased mortality in patients admitted to the intensive care unit. It is hypothesised that heart rate variability reflects and quantifies the neural regulation of organ systems such as the cardiovascular and respiratory systems. In disease states, it is thought that there is an ‘uncoupling’ of organ systems, leading to alterations in ‘inter-organ communication’ and a clinically detectable reduction in heart rate variability. Despite the increasing evidence of the utility of measuring heart rate variability, there remains debate as to the methodology that best represents clinically relevant outcomes. With continuing advances in technology, our understanding of the physiology responsible for heart rate variability evolves. In this article, we review the current understanding of the physiological basis of heart rate variability and the methods available for its measurement. Finally, we review the emerging use of heart rate variability analysis in intensive care medicine and conditions in which heart rate variability has shown promise as a potential physiomarker of disease.

scholarly journals Anesthetic Management of a Patient with Sustained Severe Metabolic Alkalosis and Electrolyte Abnormalities Caused by Ingestion of Baking Soda

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Jose Soliz ◽  
Jeffrey Lim ◽  
Gang Zheng
Keyword(s):  
Head And Neck Cancer ◽  
Alternative Medicine ◽  
Head And Neck ◽  
Neck Cancer ◽  
Metabolic Alkalosis ◽  
Anesthetic Management ◽  
Herbal Remedies ◽  
Anesthetic Care ◽  
Electrolyte Abnormalities

The use of alternative medicine is prevalent worldwide. However, its effect on intraoperative anesthetic care is underreported. We report the anesthetic management of a patient who underwent an extensive head and neck cancer surgery and presented with a severe intraoperative metabolic alkalosis from the long term ingestion of baking soda and other herbal remedies.

Sign in / Sign up

Export Citation Format

Share Document