TAILIEUCHUNG - PEDIATRIC ANESTHESIA & PAIN MANAGEMENT

That the influence of environmental pollution on children should be more seriously considered was clearly acknowledged internationally for the first time in the 1997 Declaration of the Environment Leaders of the Eight on Children's Environmental Health. The declaration gave the protection of children's environmental health the highest priority among environmental issues, and it was agreed that, within the jurisdiction of each minister, research on the relationship between child health and the environment should be promoted and that the findings should be reflected in risk assessments and standard-setting. In the United States, the National. | Lucile Packard Children s Hospital Jr Stanford University Medic ai Center Department of Anesthesia Ầ Pain Management pediatric Anesthesia Pain Management 650 723 57 2B Anesthesia in Children with Congenital Heart Disease Elliot Krane . Anesthesia In Children With Congenital Heart Disease Introduction The evolution of medicine to managed care and contracted medical services has often had the effect of shifting a sicker and more complicated population of patients from specialized urban medical centers and children s hospitals to regional and community medical centers. The general practice anesthesiologist therefore may find him herself in a position to care for children who would primarily have been operated upon in tertiary medical centers in years gone past. More commonly you may be examining a previously well child for surgery and be the first to hear a heart murmur. The rapid definition of a murmur as innocent or functional or indicative of congenital heart disease will reduce the need to postpone surgery and order expensive diagnostic evaluations. In this lecture one of the more common complex pediatric disease states will be reviewed congenital heart diseases. We will discuss the evaluation of the heart how to listen to and classify heart murmurs and the anesthetic implications of congenital heart disease. The Newborn Heart A special case While the normal newborn s heart cannot be said to be an example of congenital heart disease its physiology is quite distinct from that of the older child or adult therefore it is worthwhile reviewing some of the salient differences that have importance to an anesthesiologist. The newborn s heart has ventricular tissue that contains fewer myocytes and a greater proportion of connective tissue and the right ventricle is relatively hypertrophied. The heart s compliance is therefore diminished and the heart is more sensitive to preload. Furthermore the newborn functions very much at the peak of its Starling curve meaning that

• Sức khỏe trẻ em
• Compromised Fetus
• Recent Insights
• Insulin Like Growth
• Factor Axis
• Preeclampsia
• Blood Parameters
• Evasion Strategies
• Neisseria gonorrhoeae
• Syphilis
• Integration of HPV