This document discusses the anesthetic management of several pediatric surgical conditions:
1. Pyloric stenosis - presents with projectile vomiting. Preparation focuses on correcting dehydration and electrolyte abnormalities. Induction is done with pentathol and suxamethonium followed by caudal epidural for pain relief.
2. Tracheoesophageal fistula - presents with excessive salivation and cyanotic spells. Pre-op management aims to avoid feeding and suction secretions. Induction risks entering the fistula; careful intubation and ventilation are needed.
3. Congenital diaphragmatic hernia - presents with cyanosis, dyspnea and apparent dextrocardia
Physiotherapy in surgery in abdominal and thoracic surgeryDrKhushbooBhattPT
Rehabilitation is one of the important aspect in pre and post surgery care.
This presentation is mainly focusing on the "thoracic and abdominal rehabilitation" and also gives details about assessment and management of "intercostal drains".
Physiotherapy in surgery in abdominal and thoracic surgeryDrKhushbooBhattPT
Rehabilitation is one of the important aspect in pre and post surgery care.
This presentation is mainly focusing on the "thoracic and abdominal rehabilitation" and also gives details about assessment and management of "intercostal drains".
Anesthesia consideration in intestinal obstruction is gastric aspiration, rapid sequence induction, electrolyte and acid base disorder, hydration, AKI and hemodynamic status.
Anaesthesia challenges in neonatal emergencies-1.pptxsouravdash24
Neonatal emergencies present unique challenges in anesthesia, requiring specialized knowledge and skills to ensure safe and effective care for these vulnerable patients. This presentation delves into the intricacies of providing anesthesia to neonates in emergency situations, discussing physiological differences, equipment considerations, medication dosages, and monitoring techniques tailored to this population. Explore essential strategies and best practices for managing airway, ventilation, and hemodynamic stability in neonatal emergencies, aiming to optimize outcomes and mitigate risks. Whether you're a seasoned anesthesiologist or a healthcare professional seeking insight into neonatal anesthesia, this presentation offers valuable insights into navigating the complexities of neonatal emergencies with confidence and expertise.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
3. PYLORIC STENOSIS
• Incidence:1 in 2000
• Male > female (first male child)
• Preterm = full term
• Etiology:Autonomic N system imbalance
& humeral disorder(?)
• Pathology : gross thickening of circular
smooth muscle of pylorus---gradual
obstruction of gastric outlet.
4. PYLORIC STENOSIS
• Diagnosis:
clinical: projectile vomits, mass in upper abd.
(‘olive in abdomen’)
upper G.I.series with barium
Ultrasound
• Anaesthetic concerns: - dehydration
- acid-base
abnormalities
-risk of aspiration
5. PYLORIC STENOSIS
• Pathophysiology:
Hypochloremia, hypokalemia, hyponatremia
& metabolic alkalosis.
• Preparation:
Medical emergency- parameters for surgery:
normal skin turgor,
Na>130mg/l
k at least 3meq/l,
Cl <85 meq/l
urine output 1-2ml/kg/hr
Resucitation c balanced salt soln, pot chlor after
urination.
6. PYLORIC STENOSIS
• Induction of Anesthesia:
-preoxygenation with 100% O2
- Ryles tube asspiraton
-Pentathol – 5 mg/kg.
-Suxa2mg/kg…intubation
-surgeon needs relaxation twice
a) at the time of delivery of pylorus
b)at the time of putting pylorus into abdomen
7. – Atracurium 0.5 mg/kg-best nondepolarizing
relaxant after induction followed by caudal
epidural 1.25ml/kg bupivacaine 0.25% with
1:200000 adrenaline.
– Reversal as usual
• Post-op care:respiratory depression is
common.
8. Tracheo - Esophageal Fistula,
with/without Esophageal Atresia
1. Incidence-1:3-4.5000 births
20-25% assoc. with
VSD,ASD,TOF,Coarctation of aorta.
another 20-25% with TEF are premature
wt<2kg
9. Tracheo Esophageal Fistula,
• Anatomy/Classification:
– Mostly TEF &EA occur together
– 90% lesions are type’C’ – i.e. fistula between
trachea & lower esophagus above carina.upper
esophagus ends blindly.
10. Tracheo Esophageal Fistula,
• Associated anomalies:
– TEF with other anomalies in 30-50% pts.
– VATER association – 1973 by Quan & Smith
• V- vertebral defect / VSD
• A- anal defect
• T-TEF
• E- atresia
• R- radial dysplasia / renal dysplasia
11. Tracheo Esophageal Fistula
• Diagnosis:
– Early diagnosis is imp.to prevent pulmonary
complications- which determines prognosis.
– In utero-polyhydramnios-
– At delivery-pt.has excessive salivation,drooling,
cyanotic spells, cough-relieved by suction.
– Resp.depression
– Inability to pass a catheter(feeding tube#8)
– X-ray-radioopaque cath ending in proximal esophagus-
simple & diagnostic
12. Tracheo Esophageal Fistula,
• Pre-op management:
– ‘has the baby suffered any pulmonary insult’?
Aspiration pneumonia-more morbidity-delay the
procedure; stomach decompression by gastrostomy
– Avoid feeding
– Nurse in propped up position
– Intermittent suction
– Antibiotic therapy & physiotherapy
– Hydration
13. Tracheo Esophageal Fistula,
• Surgical management:
– Primary repair in 24-48 hrs.
– Gastrostomy under LA, delay thoracotomy for 48-72
hrs.,which allows proper hydration & assessment of
resp. & CVS.
• Anesthetic considerations:
– Pre-medication:inj.atropine IM.
– OT- AC off, warmers kept ready,(heat loss is more in
thoracotomy).
– Monitors:ECG,BP,FIO2,pulse oximetry,rectal
temp,arterial line,foley cath,precardial steth.
14. Tracheo Esophageal Fistula
– Induction /intubation.
• Decompression of stomach (gastrostomy tube allowed to vent,
& kept at head end of patient),
• Pre-oxygenation
• Awake/anesthetic intubation
• Correct position of ETT
• Induction with N2O+O2+ halothane
• IPPV cautiously attempted before NMJ blocker.
– ETT might enter fistula during intubation,or during
surgery difficulty in ventilation saturation and
ETCO2
15. Tracheo Esophageal Fistula,
• Maintenance:
– Continue inhalational agents.discontinue N2O if gastric
dilatation occurs
– Non depolarising muscle relaxant , conc of halothane
–less CVS depression
– O2 conc by ABG sampling. High FiO2 if pulmonary
pathology is present.
– Manual ventilation best- changes can be detected
easily. Airway obstruction can occur during surgery &
due to accumulation of blood & secretions in tube.
– Blood loss 20-30%. If Hct <30,and EBL >10-15%,vol.
replacement with blood.
– IV fluids for maintenance
17. CONGENITAL
DIAPHRAGMATIC HERNIA
• Incidence:
1:4000 live births
mortality with heroic post-op measures-30%
(earlier 40-50%)
• Def: herniation of abdominal contents into chest
through a defect in the diaphragm.
– Types: Lt.posterolateral defect in foramen of
Bochdalek(75-85%) - commonest
– anterior opening (foramen of Morgagni) -rarely
18. CONGENITAL DIAPHRAGMATIC HERNIA…
• Associated anomalies:
still borns c CDH – 95% of other anomalies
live borns –20% CVS (esp. PDA) defects
• Clinical presentation:
variable
– Early hernia,pressure on lung bud small lung
– Hernia in late fetal life normal lung,but compressed
infants c severe hypoplasia symptoms in 1st hour
less severe forms symptoms in 24 hrs.
20. CONGENITAL DIAPHRAGMATIC HERNIA…
• Diagnosis:
antenatal:1) 30% c polyhydramnios
2) ultrasound
after delivery: x-ray chest
• Anesthetic considerations:
delay surgery till infant stabilises
(24-48hrs.to 1week)…levin 1987
21. 1. Pre-op care:
– Decompress c nasogastric tube
– Don’t ventilate c mask
– Awake intubation paralyse, sedate, ventilate
c 100% O2
– Lowest possible inflation pressure (30cmH2O)
used (vs.-in pneumothorax)
– Tr.of acidosis-ventilation,soda bicarb,improve
circulation by fluids& inotropes
22. CONGENITAL DIAPHRAGMATIC HERNIA…
2.anesthetic management:
– Intubation & paralyses before arrival to OT,or
preoxygenation-rapid sequence awake intubation-low
airway pressure & high resp.rate
– Frequent blood gas estimations,ET CO2 & pulse
oximetry-maintain effective ventilation
– Prevent hypothermia
– Low conc.of inhalational agent c high inspired O2 or
high doses of narcotics (fentanyl). Avoid N2O
– Primary closure of abdomen,or chimney prosthesis,or
silastic pouch
– Continue paralysis & controlled ventilation post-op,
except in infants c small defects & good gas exchange .
23. CONGENITAL DIAPHRAMATIC HERNIA…
Options:
– in infants c severe lung dysplasia,tr. c ECMO
preop, wean then schedule for surgery
– Repair defect when on ECMO & maintain
ECMO post-op for 30 days
– Neonates c CDH have surfactant deficiency,
using ECMO will improve surfactant
24. CONGENITAL DIAPHRAGMATIC HERNIA…
– Pts. given ECMO with NO before & after ECMO &
after surgery. NO was ineffective pre-ECMO. NO after
ECMO followed by surgery was able to increase
oxygenation. (Karamanaoukian et al.)
– UK study- pts. c CDH not treated c ECMO but c preop
stabilisation & supportive care had same results as c
ECMO therapy.
– ‘what is the best time to operate?
operation should be postponed till PVR is decreased as
revealed by Doppler EchoCardiography.
25. CONGENITAL DIAPHRAMATIC HERNIA…
• Post-Op problems:
– Determination of outcome
• a) extent of Pulmonary Hypoplasia
• b) degree of pulmonary hypertension
Infants with post-op PaCo2 < 40mm.Hg. who could be
hyperventilated c airway pressure < 20 cm. H2O , & who had
a resp.rate < 60 /mt. survived well.(Bohn.,J.Paediatrics,1984)
Reducing PVR & prevention of Rt.to Lt. Shunt is accomplished
by ----- hyperventilation, ligation of PDA & drugs include
tolazoline, PGE1, & ECMO.
27. INTESTINAL OBSTRUCTION
• Upper GI obstruction:
– Persistent bilious or non-bilious vomiting
deficit of fluids & electrolytes.(Stomach contains
100-130 meq/l/Na.,& 5-10 meq/l of K.
– To prevent aspiration, awake / RSI.
• Anesthetic considerations:
– Pre-op preparation-
• Correction of dehydration
• Correction of electrolytes
• Ryles tube decompression
28. INTESTINAL OBSTRUCTION
• Anesthesia:
– Awake, rapid sequence intubation
– Repair of congenital defect & closure of abdominal
defect.
– N2O can be used.
• Extubation
– Possible only with good g.c.
– Patient debilitated,extensive surgery,big incision,
– Post-op ventilation c PEEP.
29. INTESTINAL OBSTRUCTION
• Lower GI obstruction:
– Problem develops between 2-7 days
– Incomplete anus can be evident after birth
– Vomiting secondary to obstruction
electrolyte or fluid disturbances.Large fluid
sequestration within GI tract, (ECF c high Na+
content)
– Na must be >130meq/l , & urine volume of
1.2ml/kg/hr.
30. INTESTINAL OBSTRUCTION
• Anesthetic considerations:
– Decompression of stomach
– Electrolyte & fluid management
– Awake, rapid sequence intubation
– N2O should not be used.
– Adequate relaxation
– If patients g.c. is good,reverse & extubated with post-
op O2 supplementation
– If patients g.c. is not good, post-op ventilation is
continued c PEEP.
31. OMPHALOCELE &
GASTROSCHISIS
Omphalocele:
• herniation of intestine into base of umbilical
cord.
Gastroschisis:
• defect of abdominal wall lateral to base of
umbilicus
• Incidence: omphalocele-1:10000 births
gastroschisis – 1: 30000 births
boys : girls 1:1
25-30% are premature or LBW
32. OMPHALOCELE & GASTROSCHISIS
Omphalocele:
• membrane covering peritoneum inside,
amniotic membrane outside.
• Sac may be small or large containing
liver,spleen etc.
• Prematurity 25-30%
• Associated anomalies:77%
33. OMPHALOCELE & GASTROSCHISIS
Gastroschisis:
• Eviscerated abdominal contents,involves small or
large lntestines
• Umbilical cord is to left of defect
• Prematurity is 58%
Anesthetic considerations:
• Pre-op management:
– Search for associated anomalies,
– Ruptured omphalocele is a surgical emergency.
34. • Fluid resuscitation:
– Fluid loss is high,
– 3rd space loss,protein loss, increased fluid
requirements
– 150-300 ml / kg / day RL or 5% Albumin is
used.
– Correct acid – base status
– Insensible loss – wrapping the child in
polythene bag filled c warm saline.
35. OMPHALOCELE & GASTROSCHISIS
• Atropine
• Temperature regulation
• Hypoglycemia & hyperglycemia are
avoided.
• Nasogastric tube for decompression of
stomach.
36. OMPHALOCELE & GASTROSCHISIS
• Peri-operative management:
– Monitoring
– Induction c I.V. inhalation
– Awake intubation
• Maintenance:
– FiO2 to maintain saturation of 95-97%
– N2O should be avoided,
– Maintenance by balanced anesthesia,
– Airway pressure to be monitored
– Post-op ventilation for 24-48 hrs.
– Excellent skeletal muscle relaxation
– Repair is staged if primary closure is not possible
37. OMPHALOCELE & GASTROSCHISIS
• Post-op complications:
– Respiratory insufficiency
– Ileus,
– Venacaval compression due to tight closure.
– Sepsis is major cause of mortality & morbidity
– Temperature regulation
39. NECROTISING ENTEROCOLITIS
• Clinical Signs:
– Retained gastric secretions,
– Vomiting , bloody , mucoid diarrhea,
– Thermal instability,
– Abdominal distension c bloody, sticky stools
– Signs appear in first few days of life/2or 3 days after
feeding
– Lethargy & apnea, metabolic acidosis, jaundice,
– DIC c prolonged PT & APTT.
– X-ray abdomen: early – distended gas filled loops,
– Late gas in the bowel., (pneumatosis intestinalis ).
40. NECROTISING ENTEROCOLITIS…
• Non – surgical management:
– Decompression of stomach,
– Cessation of feeding, broad spectrum antibiotics,
– Fluid & electrolyte therapy
– Ionotropic agents, steroids in septic shock
• Indications for surgery:
– Peritonitis, air in portal system, ascitis,progressive
deteriotion.
46. CONGENITAL LOBAR EMPHYSEMA…..
• Anesthesia:
– Crying, struggling amount of trapped air
– IPPV emphysema
– Halothane + O2 c mask , intubation c or c out
relaxation.
– IPPV postponed until thorax is opened.( cote,1978)
– Extubated at the end of lobectomy.
– Humidity, coughing mininises atelectasis in post-op
period,
– Results are good.
47. REFERENCES
• 1. Wylie & Churchill Davidsons :
– ‘A practice of anesthesia’ ; 6th Ed.,Chapter 30th
by James.M.Steven & John Downes.
• 2. Physiology of the neonate of importance to
anesthesiologists , by Frederic.A.Berry, M.D., 42nd
anesthesiology review course lectures.
• 3. Emergency neonatal surgery , by
Frederic.A.Berry, M.D., 42nd anesthesiology review
course lectures.
• 4. Anesthetic management of neonatal
emergencies, by Anna Lucia Pappas, M.D.,
asst.prof. Loyola University Medical Centre.