tailieunhanh - Ebook Handbook of pediatric anesthesia: Part 2

(BQ) Part 2 book has contents: Gastrointestinal diseases, metabolic diseases, musculoskeletal, syndromes, off-site anesthesia, adults with congenital diseases, pain, fontan physiology, eisenmenger syndrome, juvenile idiopathic arthritis, pain management after scoliosis repair, and other contents. | PART7 GASTROINTESTINAL DISEASES This page intentionally left blank 53 ESOPHAGOGASTRODUODENOSCOPY PhilippJ. Houck, MD YOUR PATIENT An 8-year-old presents for esophagogastroduodenoscopy (EGD) for gastroesophageal reflux disease (GERD). PREOPERATIVE CONSIDERATIONS Gastroesophageal reflux disease is one of the most common comorbidities in our field It is more prevalent in patients with neurologic impairment, obesity, repaired esophageal atresia or other congenital esophageal diseases, and cystic fibrosis. GER is a normal physiologic process that occurs several times per day in healthy infants, children, and adults. GERD is present when the reflux of gastric contents causes troublesome symptoms and/or complications. Patients may present with asthma. bronchopulmonary dysplasia, or apparent life-threatening events that may be related to pulmonary aspiration. ANESTHETIC MANAGEMENT • Rapid-sequence induction, which has its own risks in pediatric anesthesia, may be necessary. • If pulmonary aspiration is not a leading concern (ie, symptoms are not severe and are mostly postprandial) and the patient is schoolaged, tracheal intubation can be avoided and a total intravenous anesthesia technique can be used, with supplemental oxygen being supplied through a nasal cannula. • In smaller children, a mask induction and endotracheal intubation is the most practical choice. This allows insertion and manipulation of the endoscope without impeding the patency of the airway. • The most stimulating part of this procedure is the insertion of the endoscope. To facilitate the insertion of the endoscope in the esophagus, the head can be flexed while the patient is in left lateral position. 183 184 PART7 Gastrointestinal Diseases POSTOPERATIVE CONSIDERATIONS In infants, prolonged insufflation and the use of high insufflation pressures can lead to a distended abdomen that may impede ventilation. Intestinal perforation can present with a similar picture. DOs and .