Cardiovascular Physiology: A Primer
KEY POINTS 1. The heart has a fibrous skeleton that provides an insertion site at each valvular ring. This fibrous structure also connects cardiac myocytes so that “stretch” or preload…
ANESTHESIA
Pain Management for Cardiothoracic Procedures
KEY POINTS 1. Chronic pain due to intercostal nerve injury develops in approximately 50% of postthoracotomy patients, and in 5% this pain becomes severe and disabling. 2. Thoracic epidural analgesia…
The Postcardiopulmonary Bypass Period: Weaning to ICU Transport
KEY POINTS 1. Core temperature (nasopharyngeal or tympanic membrane) should be greater than 36°C before terminating cardiopulmonary bypass (CPB). However, the nasopharyngeal temperature should not exceed 37°C, as this will…
Induction of Anesthesia
KEY POINTS 1. On the day of surgery, most cardiovascular medications should be administered orally, with the exceptions of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and (selectively) diuretic agents….
Regional Anesthesia
1. Large prospective studies indicate that regional anesthetics have a high degree of safety and efficacy in pediatric patients, and can be used for intraoperative anesthesia, postoperative analgesia, and for a…
The Head and Neck: Specialty and Multidisciplinary Surgery
1. The shaping of the skull base and contiguous structures is a dynamic process involving reciprocal influences between the cranial base, the pharynx, the face, and primary and secondary palates. 2. Multiple…
The Cardiovascular System
1. Much of our understanding of cardiac development is derived from research in nonhuman species with the expectation that the same processes occur in humans. 2. The etiology of congenital heart disease…
Developmental Pharmacology
1. Pediatric responses to drugs are determined by a large number of factors that change independently of one another during growth and development. 2. Children aged less that 12 months may have…
Fundamental Differences between Children and Adults
1. Pediatric anesthesiologists have long recognized that pharmacologic and physiologic calculations are larger on a “per kg” basis for infants and children than for adults. 2. Using the kg3/4 calculation, metabolic oxygen…
The Musculoskeletal System and Orthopedic Surgery
1. The musculoskeletal system is derived from the paraxial mesoderm which begins to differentiate into somites during the 4th week of development. 2. Many common pediatric syndromes and associations such as VACTERL…
