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 a Lange medical book

HANDBOOK
of PEDIATRIC
ANESTHESIA
Editors
Philipp J. Houck, MD
Assistant Professor of Anesthesiology
Division of Pediatric Anesthesia
Department of Anesthesiology
Director of Pediatric Liver Transplant Anesthesia
New York Presbyterian-Morgan Stanley Children's Hospital
Columbia University Medical Center
New York. New York
Manon Hache, MD
Assistant Professor of Anesthesiology
Division of Pediatric Anesthesia
Department of Anesthesiology
Director of Pediatric Trauma Anesthesia
New York Presbyterian-Morgan Stan ley Children's Hospital
Columbia University Medical Center
New York. New York
Lena S. Sun, MD
Emanuel M. Papper Professor of Pediatric Anesthesiology
Chief, Division of Pediatric Anesthesia
Vice Chair, Department of Anesthesiology
New York Presbyterian-Morgan Stan ley Children's Hospital
Columbia University Medical Center
New York, New York

II
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 CONTENTS

Contributors ......................................................... xi
Preface ............................................................. xiii

1 Introduction (Robert Kazim) ........ .. ... . ... . ... . ... .. .. .. ..... 1

Part 1: Airway
Z Tonsillectomy and Adenoidectomy in a Patient With
Obstructive Sleep Apnea (Gracie M. Almeida-Chen) .. . ... . ..... 17
3 Posttonsillectomy Bleeding (Neeta R. Saraiya) . ... . ... . ... . ..... 23
4 Bilateral Myringotomy and Tubes in a Patient With an Upper
Respiratory Tract Infection (Neeta R. Saraiya) . . ... . ... . ......... 25
5 Cleft Lip and Palate Repair (Gracie M.Aimeida-Chen) . . ......... 27
6 Epiglottitis (Gracie M. Almeida-Chen) .......................... 31
7 Postoperative Stridor (Gracie M. Almeida-Chen) ................ 34
8 Subglottic Stenosis (Gracie M. Almeida-Chen) .................. 37
9 Cystic Hygroma {Susan Y. LeO •••••••••••••••••••••••••••••••••• 41
10 Aspirated Foreign Body (Neeta R. Saraiya) •••••••••••••••••••••• 44
11 Laryngeal Papillomatosis {Neeta R. Saraiya) •••••••••••••••••••• 46
1Z Difficult Airway Management (Philipp J. Houck) ................ 48

Part 2: Cardiovascular
13 cardiopulmonary Bypass (Riva R. Ko) .......................... 55
14 Ventricular Septum Defect Repair (PhilippJ. Houck) ............ 59
15 Tetralogy ofFallot (Anthony J. Clapcich) ....................... 61
16 Single Ventricle Physiology(Riva R. Ko) ........................ 65
17 Pulmonary Hypertension (Arthur J. Smerling) .................. 70
18 cardiac catheterization After Heart
Transplantation (Philipp J. Houck) ............................. 73

Part 3: Respiratory
19 Asthma (Gracie M. Almeida-Chen) .. .. .. .. ... .. . .. .. ... .. .. .. .. 77
20 Bronchopulmonary Dysplasia (Gracie M. Almeida-Chen) • •• •• •• 80
21 Croup (Gracie M. Almeida-Chen) ••• •• ••• •• •• •• •• •• •• •• •• •• •• •• 84
22 Aspiration Pneumonia {Manon Hache) ........................ 87
23 Pulmonary Sequestration (Leila M. Pang, Manon Hache)........ 90

Part 4: Neonates
24 Necrotizing Enterocolitis (Neeta R. Saraiya) .................... 95
25 Pyloric Stenosis (Philipp J. Houck) ............................. 97
26 Congenital Diaphragmatic Hernia (Neeta R. Saraiya)............ 99
27 Tracheoesophageal Fistula (Neeta R. Saraiya) ................. 101
28 Gastroschisis and Omphalocele (Neeta R. Saraiya) ............. 103

vii
viii Contents

29 Duodenal Atresia (Neeta R. Saraiya) ........................... 105

30 Malrotation (Neeta R. Saraiya) ................................ 107
31 Meconium Ileus (Leila M. Pang) ............................... 109
32 Imperforate Anus (Leila M. Pang) ............................. 111
33 Myelomeningocele (Leila M. Pang) ........................... 114
34 Sacrococcygeal Tumor (Leila M. Pang) ........................ 116

Part 5: Neuro
35 Hydrocephalus (Leila M. Pang) ••• •••• •••• •••• •• •• •• ••• •••• ••• 121
36 Status Epilepticus (William S. Schechter) •• •••• •• •• •• ••• •••• ••• 124
37 Chiari Malformation (Riva R. Ko) , ••••• •••• •• • , •• • , ••• , ••••• ••• 128
38 Muscular Dystrophy (Riva R. Ko) .. . .. .. ... . ... . ... . ... .. .. .. .. 132
39 Myotonic Dystrophy (Riva R. Ko) .. . ... . ... . ... . ........ . ... . .. 136
40 Spinal Muscular Atrophy (WilliamS. Schechter) .... . ... . ... . .. 140
41 Selective Dorsal Rhizotomy (Riva R. Ko) ....................... 143
42 Myasthenia Gravis (Riva R. Ko) ................................ 146
43 Moyamoya Disease (Riva R. Ko) ............................... 150
44 Tethered Spinal Cord (E. Heidi Jerome) ........................ 153

Part 6: Hematology/Oncology
45 Wilms'Tumor (Teeda Pinyavat) ••••••••••••••••••••••••••••••• 157
46 Anterior Mediastinal Mass (Teeda Pinyavat) ••••••••••••••••••• 160
47 Osteosarcoma (Teeda Pinyavat) •••••••••••••••••••••••••••••• 163
48 Posttransplant Lymphoproliferative
Disorder (Teeda Pinyavat) •••••••••••••••••••••••••••••••••••• 166
49 Sickle Cell Disease (Caleb lng) ................................ 169
50 Massive Transfusion (Manon Hache) .......................... 172
51 Methemoglobinemia (Teeda Pinyavat) ....................... 174
52 Heparin-Induced Thrombocytopenia (Caleb lng) .............. 177

Part 7: Gastrointestinal Diseases

53 Esophagogastroduodenoscopy (Philipp J. Houck)............. 183
54 Control of Upper Gastrointestinal
Bleeding (Manon Hache) ..................................... 185
55 Liver Biopsy (Manon Hache) .................................. 188
56 Liver Transplantation (PhilippJ. Houck) ....................... 190
57 Crohn's Disease (PhilippJ. Houck) ............................ 193

Part 8: Metabolic Diseases

58 Egg and Soy Allergy (Manon Hache) •• •••• •••• •• •• •• ••• •••• ••• 197
59 Hyperkalemia (Radhika Dinavahi) ... .. .. .. ... .. .. .. .. .. .. .. .. 199
 Contents ix

60 Morbid Obesity (Tatiana Kubacki) ............................ 201

61 Mitochondrial Diseases (Teed a Pinyavat) ..................... 204
62 Diabetes Mellitus (Manon Hach~) ............................ 207

Part 9: Musculoskeletal
63 Hip Osteotomy (Susumu Ohkawa) ............................ 213
64 Shoulder Arthroscopy (Susumu Ohkawa) ..................... 215
65 Clubfoot (Susumu Ohkawa) .................................. 218
66 Osteogenesis lmperfecta (Philipp J. Houck) •• ••• •• ••• ••• •• •• •• 222
67 Arthrogryposis (Susumu Ohkawa) ••• •• ••• •• •• •• •• ••• ••• •• •• •• 224

Part 1 0: Syndromes
68 Down Syndrome (Tatiana Kubacki, Manon HaeM) ... . ... . .... 229
69 DiGeorge Syndrome (Manon Hach~) . ... . ... . ... . ... . ........ 232
70 Pierre Robin Sequence (Gracie M. Almeida-Chen) . ... . ........ 234
71 Treacher Collins Syndrome (Gracie M. Almeida-Chen) ......... 237
72 Klippei-Feil Syndrome (Gracie M. AI meida-Chen) .............. 240
73 CHARGE Syndrome (PhilippJ. Houck) ......................... 243
74 Cornelia de Lange Syndrome (Radhika Dinavahi) •••••••••••••• 245
75 Epidermolysis Bullosa (Philipp J. Houck) •••••••••••••••••••••• 247
76 Kearns-Sayre Syndrome (Radhika Dinavahi) ••••••••••••••••••• 249
77 PHACE Syndrome (Teeda Pinyavat) ........................... 251

Part 11: Off-Site Anesthesia

78 MRI for Brain Tumor (Riva R. Ko) ............................... 257
79 CT Scan for Craniosynostosis (William S. Schechter) ........... 260
80 SPECT Scan (William S. Schechter) ........................... 263
81 Gamma Knife Radiosurgery (WilliamS. Schechter) ............ 267

Part 12: Adults With Congenital Diseases

82 Adult With Down Syndrome (Susan Y. Lei) •• •• •• •• •• •• •• •• •• •• •273
83 Cystic Fibrosis (Susan Y. Lei) ..... .. . .. .. .. .. ...... ... .. .. .. .. . 277
84 Fontan Physiology (Susan Y. Lei) •••• •• •• ••• •• •• •• •• •• •• •• •• • , •281
85 Eisenmenger Syndrome (Susan Y. Lei) ......................... 284
86 Juvenile Idiopathic Arthritis (Susan Y. Lei) ..................... 287

Part 13: Pain

87 Pain Management After Scoliosis Repair (John M. Saroyan) .... 293
88 Postoperative Pain Management in Sickle Cell Disease for
Laparoscopic Cholecystectomy (Mary E. Tresgallo) ••• •• •• •• •• •295
89 Intravenous Patient-Controlled
Analgesia (Mary E. Tresgallo) ••••••• •• •• •• ••• •••• •••• •• •• •• •• •298
x Contents

Appendix
1 Pediatric Anesthesiology Suggested Drug Dosages
(Philipp J. Houck) ............................................ 303
2 Pediatric Sizing Chart (PhilippJ. Houck) ....................... 310
3 Pediatric Critical Events Checklists ............................ 31 3
Index ............................................................. 339
 CONTRIBUTORS

Ciracie M. Almeida-Olen. MD. MPH E. Heidi Jerome. MD

Assistant Professor of Anesthesiology Associate Professor of Anesthesiology
Division of Pediatric Anesthesia and Pediatrics
Department of Anesthesiology Division of Pediatric Anesthesia
New York Presbyterian-Morgan Stanley Department of Anesthesiology
Children's Hospital Medical Director of Therapeutic and
Columbia University Medical Center Interventional Imaging Unit
New York, New York New York Presbyterian-Morgan Stanley
Children's Hospital
Anthony J. Capclch. MD Columbia University Medical Center
Associate Professor of Anesthesiology New York, New York
Division of Pediatric Anesthesia
Department of Anesthesiology Robert Kazim. MD
Director of Difficult Airway Simulation Professor of Anesthesiology
Program Division of Pediatric Anesthesia
Director of Pediatric Cardiothoradc Clinical Director, Division of Pediatric
Anesthesia Anesthesia
New York Presbyterian-Morgan Stanley Vice Chair for Pediatric Clinical Affairs
Children's Hospital Department of Anesthesiology
Columbia University Medical Center New York Presbyterian-Morgan Stanley
New York, New York Children's Hospital
Columbia University Medical Center
Radhika Dinavabi, MD New York, New York
Anesthesiologist
Miller Children's Hospital/Long Beach Riva R. Ko, MD
Memorial Hospital Assistant Professor of Anesthesiology
Long Beach, California Division of Pediatric Anesthesia
Department of Anesthesiology
Manon Hadl6. MD Co-Director of Pediatric Orthopedic
Assistant Professor of Anesthesiology Anesthesia
Division of Pediatric Anesthesia New York Presbyterian-Morgan Stanley
Department of Anesthesiology Children's Hospital
Director of Pediatric Trauma Anesthesia Columbia University Medical Center
New York Presbyterian-Morgan Stanley New York, New York
Children's Hospital
Columbia University Medical Center Tatiana Kubacki. MD
New York, New York Assistant Professor of Anesthesiology
Division of Pediatric Anesthesia
Philipp J. Houck. MD Department of Anesthesiology
Assistant Professor of Anesthesiology New York Presbyterian-Morgan Stanley
Division of Pediatric Anesthesia Children's Hospital
Department of Anesthesiology Columbia University Medical Center
Director of Pediatric Liver Transplant New York, New York
Anesthesia
New York Presbyterian-Morgan Stanley Susan Y. LeL MD
Children's Hospital Assistant Professor of Anesthesiology
Columbia University Medical Center Division of Pediatric Anesthesia
New York, New York Department of Anesthesiology
New York Presbyterian-Morgan Stanley
caleb lng. MD. MS Children's Hospital
Assistant Professor of Anesthesiology Columbia University Medical Center
Division of Pediatric Anesthesia New York, New York
Department of Anesthesiology
New York Presbyterian-Morgan Stanley Susumu Ohkawa. MD
Children's Hospital Staff Anesthesiologist
Columbia University Medical Center Lenox Hill Hospital
New York, New York New York, New York

xi
xll Contributors

Leila M. Pang, MD William 5. Schemt., MD

Ngai-Jubilee Professor of Professor of Anesthesiology and
Anesthesiology Pediatrics
Vice Chair for Resident Education Division of Pediatric Anesthesia
Department of Anesthesiology Department of Anesthesiology
New York Presbyterian-Morgan Stanley Director of Pediatric Pain Medicine and
Children's Hospital Advanced Care Medicine
Columbia Univenity Medical Center New York Presbyterian-Morgan Stanley
New York, New York Children's Hospital
Columbia University Medical Center
Teeda Pinyavat. MD New York, New York
Assistant Professor of Anesthesiology
Division of Pediatric Anesthesia Arthur J. Smerling, MD
Department of Anesthesiology Associate Professor of Pediatrics and
Co-Director of Pediatric Orthopedic Anesthesiology
Anesthesia Medical Director of Pediatric Cardiac
New York Presbyterian-Morgan Stanley Critical Care Unit
Children's Hospital New York Presbyterian-Morgan Stanley
Columbia University Medical Center Children's Hospital
New York, New York Columbia University Medical Center
New York, New York
Neeta R. Saraiya. MD
Assistant Professor of Anesthesiology Lena 5. Sun. MD
Division of Pediatric Anesthesia Emanuel M. Papper Professor of
Department of Anesthesiology Pediatric Anesthesiology
Director of Student Anesthesia Chief; Division of Pediatric Anesthesia
Internship Program Vtce Chair, Department of
New York Presbyterian-Morgan Stanley Anesthesiology
Children's Hospital New York Presbyterian-Morgan Stanley
Columbia University Medical Center Children's Hospital
New York, New York Columbia University Medical Center
New York, New York
John M. Saroyan. MD
Medical Director Mary E. Trespllo, DNP, MPH,
BAYADA Hospice FNP-BC
Norwich, Vennont Assistant Professor of Nursing
School of Nursing
Columbia University Medical Center
New York, New York
 PREFACE

The pediatric anesthesiology faculty at Columbia University Medical

Center has put together this book as a guide to the practice of clinical
anesthesia in neonates, infants, children, and adolescents. The authors
are clinicians with considerable experience in the practice of pediatric
anesthesiology. They are also teachers of pediatric anesthesiology. Their
daily work includes the education and training ofresidents and fellows in
pediatric anesthesiology in a major academic teaching hospital. This
book is not "Pediatric Anesthesia for Dummies." Rather, the authors
have organized it as a collection of common and important conditions in
children. For each condition, the authors outline the pathophysiology,
key perioperative considerations, and important management issues. We
hope that residents and practicing physicians will find the book useful as
they plan to provide anesthesia care for children.

xiii
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