1 Pediatric Anesthesia Dr. K. Rupp Dr. J. Holzki Dr. T. Fischer Dr. C. Keller Because you care 2 Author: Dr. Katrin Rupp Dräger Medizintechnik GmbH Moislinger Allee 53-55 D-23542 Lübeck With special thanks to the following people for their kind assistance: Dr. J. Holzki Kinderklinik Köln (Children’s Hospital, Cologne) Amsterdamstraße 59 D-50735 Köln Dr. T. Fischer Deutsches Herzzentrum Berlin (German Center for Cardiology, Berlin) Augustenbürgerplatz 1 D-13353 Berlin Dr. C. Keller Klinik für Anästhesie und Allgemeine Intensivmedizin (Clinic for Anesthesiology and General Intensive Care Medicine) Leopold-Franzens-Universität Innsbruck Anichstraße 35 A-6020 Innsbruck Dräger Medizintechnik GmbH reserves all rights to this publication, especially as pertaining to its duplication and distribution. No part of this publication may be reprinted or saved through any means, mechanical, electrical/electronic or photographic, without the expressed written consent of the Dräger Medizintechnik GmbH. E-Mail:
[email protected] ISBN 3-926762-48-9 translated by: L.A. Weaver 3 Pediatric Anesthesia 4 Important Information: Medical knowledge is constantly changing as a result of research and clinical testing. The editors and authors of this primer have taken great care to ensure that the information and therapeutic details contained herein correspond to the most up-to-date research results (especially as pertains to indications, dosages and undesirable side effects), they cannot, however, guarantee this. Those persons using this book as a reference are advised to carefully peruse all instructions included with medications used and to make all decisions pertaining to dosage or application at their own discretion. The Editors October, 1999 5 Table of Contents 1. Introduction 8 2. Special Anatomical and Physiological Features 2.1 Breathing 2.1.1 Anatomical Fundamentals of the Respiratory Tract 2.1.2 Controlling the Respiratory Process 2.1.3 Respiratory Mechanics 2.1.4 Pulmonary Volumes 2.1.5 Surfactant 2.1.6 Oxygen Requirements 2.1.7 Extrapulmonary Oxygen Toxicity 2.2 The Heart and Circulatory System 2.2.1 The Fetal Circulatory System 2.2.2 The Heart 2.2.3 Blood Volume and Blood Pressure 2.2.4 Hemoglobin Contents 2.3 Temperature Regulation 2.4 The Balance between Water and Electrolytes 15 17 19 23 24 26 27 27 29 30 31 32 35 3. Anesthetic Agents 3.1 Inhalation Anesthesia 3.2 Interactions with Soda Lime 3.3 Intravenous Anesthesia 3.4 Muscle Relaxants 37 38 45 49 51 4. Anesthesia Accessories 4.1 Masks 4.2 Tubes 4.3 Laryngeal Masks 53 54 55 58 12 13 13 6 5. Ventilation in Pediatric Anesthesia 5.1 Mechanical Modes of Ventilation 5.1.1 The Ventilation Mode IPPV 5.1.2 The Ventilation Mode SIMV 5.1.3 The Ventilation Mode PCV 5.2 Ventilation Parameters 5.3 Breathing Systems 5.3.1 Flow-controlled Non-rebreathing Systems 5.3.2 Valve-controlled Non-rebreathing Systems 5.3.3 Partial Rebreathing Systems (Semi-closed Breathing Systems) 5.3.4 Complete Rebreathing Systems (Closed Systems) 5.4 Characteristics of Ventilation for Pediatric Anesthesia 5.4.1 Manual and Mechanical Ventilation for Neonates and Infants 5.4.2 Respirator Requirements for Children 5.4.3 The Fresh-gas Decoupler 5.4.4 Compliance Compensation 5.4.5 Dead Space Volume 5.5 Anesthetic Machines 5.5.1 Cato/Cicero EM 5.5.2 Julian 5.5.3 PhysioFlex 5.6 Monitoring 5.6.1 The Stethoscope 5.6.2 Pulse Oximetry 5.6.3 Measuring Body Temperature 5.6.4 Measuring Blood Pressure(NiBP/iBP) 5.6.5 The ECG 60 61 61 63 64 73 78 79 86 87 89 90 90 92 94 96 98 99 99 101 102 108 109 110 113 115