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(BQ) Part 1 book “Principles and practice of pediatric anesthesia” has contents: Anatomy, growth and development, physiological characteristics and anesthetic implications, essentials of pharmacology in neonates, infants and children, understanding the pediatric chest radiograph,… and other contents.
Principles and Practice of Pediatric Anesthesia Principles and Practice of Pediatric Anesthesia Editors Snehalata H Dhayagude MBBS DA FRCA (UK) Consultant Pediatric Anesthesiologist Bombay Hospital and Research Centre Formerly, Head of Department BJ Wadia Hospital for Children Mumbai, Maharashtra, India Nandini M Dave MD DNB MNAMS PGDHHM PGDMLS Additional Professor Department of Anesthesiology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Foreword VM Divekar The Health Sciences Publisher New Delhi | London | Philadelphia | Panama Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83 Victoria Street, London SW1H 0HW (UK) Phone: +44 20 3170 8910 Fax: +44 (0)20 3008 6180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 235, 2nd Floor, Clayton Panama City, Panama Phone: +1 507-301-0496 Fax: +1 507-301-0499 Email: cservice@jphmedical.com Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B, Shaymali Mohammadpur, Dhaka-1207 Bangladesh Mobile: +08801912003485 Email: jaypeedhaka@gmail.com Jaypee Medical Inc 325 Chestnut Street Suite 412, Philadelphia, PA 19106, USA Phone: +1 267-519-9789 Email: support@jpmedus.com Jaypee Brothers Medical Publishers (P) Ltd Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 Email: kathmandu@jaypeebrothers.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © Digital Version 2017, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and not necessarily represent those of editor(s) of the book All rights reserved No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book Medical knowledge and practice change constantly This book is designed to provide accurate, authoritative information about the subject matter in question However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications It is the responsibility of the practitioner to take all appropriate safety precautions Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book This book is sold on the understanding that the publisher is not engaged in providing professional medical services If such advice or services are required, the services of a competent medical professional should be sought Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com Principles and Practice of Pediatric Anesthesia First Edition: Digital Version 2017 ISBN: 978-93-85891-70-0 To our families For their support and patience & To all our little patients who inspire us to better Contributors Amit Nagpal MD Assistant Professor Department of Anesthesiology Program Coordinator Medical Simulation Laboratory DY Patil University Mumbai, Maharashtra, India Amrita Narang MBBS Postgraduate Student Department of Radiology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Anila Malde MD DA Professor Department of Anesthesiology Lokmanya Tilak Municipal Medical College and General Hospital Mumbai, Maharashtra, India Anuradha G MD PDF (Pediatric Anesthesia) Bharati Awalegaonkar Kulkarni MD Consultant Pediatric Anesthesiologist Saifee Hospital Mumbai, Maharashtra, India Bhoomika Thakore DNB Consultant Anesthesiologist PD Hinduja Hospital Mumbai, Maharashtra, India Bikash Ranjan Ray MD Assistant Professor Department of Anesthesiology Pain Medicine and Critical Care AIIMS, New Delhi, India Chandrashekara CR MD Assistant Professor Department of Pediatric Anesthesiology Indira Gandhi Institute of Child Health Bengaluru, Karnataka, India Specialist Pediatric Anesthetist and Head Department of Anesthesiology and Pain Management Sagar Hospitals Bengaluru, Karnataka, India Aparna A Nerurkar MD DNB Chandrika Bhat MD Additional Professor Department of Anesthesiology Lokmanya Tilak Municipal Medical College and General Hospital Mumbai, Maharashtra, India Speciality Medical Officer Department of Pediatrics Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Basanth Rayani DA DNB Chandrika YR Consultant Anesthesiologist Indo-American Cancer Hospital Hyderabad, Telangana, India Professor and Head Department of Pediatric Anesthesia Indira Gandhi Institute of Child Health Bengaluru, Karnataka, India MD Principles and Practice of Pediatric Anesthesia Charusmita Modi MD PhD Hemangi S Karnik MD Additional Professor Department of Transfusion Medicine Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Professor Department of Anesthesiology Lokmanya Tilak Municipal Medical College and General Hospital Mumbai, Maharashtra, India Chhaya A Divecha MD Hemant Deshmukh MD DNB Assistant Professor Department of Pediatrics Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Professor and Head Department of Radiology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Deepa Suvarna DA DNB Indrani Hemantkumar Chincholi MD Assistant Professor Department of Anesthesiology Topiwala National Medical College and BYL Nair Charitable Hospital Mumbai, Maharashtra, India Devangi Parikh MD DNB Jayanthi Sripathi DA DNB Associate Professor Department of Anesthesiology Lokmanya Tilak Municipal Medical College and General Hospital Mumbai, Maharashtra, India Senior Consultant Anesthesiologist Kanchi Kamakoti CHILDS Trust Hospital Chennai, Tamil Nadu, India Diganta Saikia MD Lakshmi Kumar MD, Fellowship in Assistant Professor Department of Anesthesiology and Critical Care Medicine Assam Medical College and Hospital Dibrugarh, Assam, India Elsa Varghese DA MD Fellowship in Pediatric Anesthesiology(USA) Formerly, Professor and Head Department of Anesthesiology Kasturba Medical College Manipal, Karnataka, India Hemalata R Iyer DA MD Formerly, Professor and Head Department of Anesthesiology Topiwala National Medical College and BYL Nair Hospital Mumbai, Maharashtra, India viii Professor and Head Department of Anesthesiology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Pediatric Anesthesia (MGH) Fellowship in Critical Care (CCEF) Professor and Head Department of Anesthesia and Critical care Amrita Institute of Medical Sciences Kochi, Kerala, India Milind S Tullu MD Additional Professor Department of Pediatrics Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India MSRC Murthy DA DNB Professor Department of Anesthesia Osmania Medical College Hyderabad, Telangana, India Contributors Naina P Dalvi MD DNB FCPA Rachana D Chhabria MD Fellowship in Additional Professor Department of Anesthesiology HBT Medical College and Dr RN Cooper Municipal General Hospital Mumbai, Maharashtra, India Assistant Professor Department of Anesthesiology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Nandini M Dave MD DNB MNAMS Rajen Daftary MD DA PGDHHM PGDMLS Additional Professor Department of Anesthesiology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Neerja Bhardwaj MD Department of Anesthesia and Intensive Care Postgraduate Institute of Medical Education and Research Chandigarh, India Neha Hasija MD DNB Fellowship in Obstetric and Pediatric Anesthesia Senior Resident Department of Anesthesiology Maulana Azad Medical College New Delhi, India Pradnya Sawant MD DA Pediatric Anesthesia Consultant Anesthesiologist Global Hospital Mumbai, Maharashtra, India Rakesh Garg MD DNB MNAMS PGCCHM Assistant Professor Department of Anesthesiology Intensive Care, Pain and Palliative Care BRAIRCH, AIIMS, New Delhi, India Renu Sinha MD Additional Professor Department of Anesthesiology Rajendra Prasad Institute for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Rochana G Bakhshi DNB DA MNAMS Head, Department of Anesthesiology BJ Wadia Hospital for Children and Research Centre Mumbai, Maharashtra, India PGDHHM PGDMLS Pramila Kurkal MD DA Roopali Telang Senior Consultant PD Hinduja Hospital Mumbai, Maharashtra, India Professor DY Patil Medical College Department of Anesthesiology Mumbai, Maharashtra, India (Pediatric Anesthesia) MD PDCC Consultant Anesthesiologist PD Hinduja Hospital Mumbai, Maharashtra, India Sachin Patil MD FNB (Cardiac Anesthesia) Priti Devalkar MD MHA Assistant Professor Department of Anesthesiology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Consultant Department of Pediatric Cardiac Anesthesia and Intensive Care Fortis Hospital Mumbai, Maharashtra, India ix 16 Chapter Anesthesia for Ear, Nose and Throat Procedures in Children Hemalata R Iyer, Snehlata Tavri INTRODUCTION Ear, nose and throat surgeries are some of the most commonly performed procedures in infants and children They may be diagnostic or therapeutic in nature Understanding the concepts and learning to administer safe anesthesia for these surgeries form an important part of post-graduate training in anesthesiology In this chapter we have attempted to present the anesthesia considerations for frequently performed procedures like adenotonsillectomy, grommet insertion, etc and also for complex surgeries like laryngotracheal surgeries performed in tertiary care centers ANESTHESIA FOR EAR SURGERY Ear surgeries are commonly performed under operating microscope and include the following: Myringotomy Myringotomy with tympanostomy tube placement is a surgical procedure performed for fluid drainage from middle ear following persistent middle ear effusions due to acute or chronic otitis media, eustachian tube dysfunction and/or chronic upper respiratory tract infection (URTI) A small incision is made in the tympanic membrane, usually in both ears Ear tubes (grommet) or tympanostomy tubes are small tubes open at both ends that are inserted into Chap-16.indd 225 the incisions in the eardrums during myringotomy to allow ventilation of the middle ear Anesthesia Concerns The child undergoing this procedure is usually a healthy child, but may have associated respiratory tract infection, craniofacial anomalies, and/or obstructive airway problems requiring special care.1 Generally, it is a short general anesthesia (GA) procedure in expert hands, done on an outpatient basis, under face mask or laryngeal mask airway (LMA) The patency of the airway is to be ensured with the head turned to either side Endotracheal tube (ETT) may be required in some cases Standard monitoring and postoperative care is necessary Pain can be treated with paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) Above procedure is at times performed along with adenoidectomy and/or tonsillectomy Myringoplasty, Tympanoplasty and Mastoidectomy Myringoplasty involves repair of a tympanic membrane perforation in a dry ear Tympanoplasty is performed when there is extensive middle-ear damage and involves reconstruction of the tympanic membrane and the ossicular chain The approach to the ear can be permeatal or post-aural Mastoidectomy is performed to 4/13/2016 2:11:32 PM Principles and Practice of Pediatric Anesthesia eradicate chronic suppurative middle-ear disease Above procedures require GA with controlled ventilation Anesthesia Considerations • • • • • • • Careful rotation of the head and neck while positioning the patient under GA to avoid the risk of atlanto-axial rotational subluxation.2 The patient’s arm is tucked adjacent to their body with adequate padding to protect ulnar nerve and to facilitate the surgeon’s work An extension tubing for intravenous line is helpful Muscle relaxants are to be avoided in patients requiring facial nerve monitoring Deep levels of anaesthesia will be required to achieve intermittent positive pressure ventilation (IPPV) without relaxants A head-up tilt of 10°–15°, epinephrine infiltration, avoidance of tachycardia, relative hypotension [mean arterial pressure (MAP) 10–20% 10s and an apnea/ hypopnea index (AHI, i.e total number of obstructive episodes per hour of sleep) >5.23 Air flow cessation is confirmed by auscultation or oxygen desaturation