Abstract
Pediatric anesthesia and intensive care management has improved dramatically over the past two decades. Improved understanding of the pathophysiology underlying newborn surgical emergencies, new medications and new modes of ventilatory support have all contributed to better patient outcome. The authors have reviewed the anatomy and physiology of the infant airway, indications for and principles of endotracheal intubation, the management of newborn surgical emergencies, indications for post-operative ventilatory support, different modes of mechanical ventilation available, complications of mechanical ventilation with weaning parameters and extubation criteria. The introduction of nitric oxide and the implications of extracorpreal membrane oxygenation in the management of newborn emergency refractory to conventional ventilation are discussed.
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Cote CJ, Todres ID. The Pediatric Airway. In: Cote CJ, Ryan J, Todres ID, Goudsouzian NG ed.A Practice of Anesthesia for Infants and Children, 2nd ed. Philadelphia: W.B. Saunders Company, 1993; 55–83.
Goudsouzian NG. Anatomy and Physiology in Relation to Pediatric Anesthesia. In Katz J, Steward DJ. eds.Anesthesia and Uncommon Pediatric Diseases, 2nd ed. Philadelphia, W.B. Saunders Company, 1993; 1–18.
Keens TG, Bryan AC, Levison H, et al: Developmental pattern of muscle fibers in human ventilatory muscles.J Appl Physiol 1978; 44: 909–913.
Shapiro BA, Harrison RA, Trout CA.Clinical Application of Respiratory Care. Chicago: Year Book Publishers, 1979; 239.
Gold MI, Duarte I, Muravchick S. Arterial oxygenation in conscious patients after five minutes and 30 seconds of oxygen breathing.Anes Anal 1981; 60: 313–315.
Dorsch JA, Dorsch SE:Understanding Anesthesia Equipment. Baltimore: Williams & Wilkins, 1984: 4–5.
Motoyama EK, Davis PJ, ed. Smith’sAnesthesia for Infants and Children, 5th Edition, St Louis: C.V. Mosby Company, 1990; 269–290.
Cote’ CJ, Goldstein EA, Cote MA, Hoaglin DC, Ryan J. A single-blind study of pulse oximetry in children.Anesthesiology 1988; 68: 184–188.
Hazinski MF, Chameides L, eds.Textbook of Advanced life Support. American Heart Association, 1994; Chapter 4.
Seelick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anesthesia.Lancet. 1961; 2: 404–406.
Koka BV, Jeon IS, Andre JM: Post intubation croup in children.Anesth Anal 1977; 56: 501–505.
Birmingham PK, Cheney FW, Ward RJ. Esophageal intubation: a review of detection techniques.Anesth Anal 1986; 65: 886–891.
Batra AK, Cohn MA. Uneventful prolonged misdiagnosis of esophageal intubation.Crit Care Med 1983; 11: 763–764.
Foregin B, Whale J. Tracheal dimensions in the living infant.Ann Tool Rhinol Laryngol, 1967; 76: 964–974.
Todres ID, deBros F, Kramer SS. Endotracheal dispiacement in the newborn infant.J Pediatr 1976; 89: 126–127.
Tochen ML. Orotracheal intubation in the newborn infant; a method for determining the depth of tube insertion.J Pediatr 1979; 95: 1050–1051.
Perkin RM, Anas NG. Pulmonary hypertension in the pediatric patient.J Pediatr 1984; 105: 511–522.
Drummond WH, Gregory GA, Heman MA. The independent effects of hperventilation, tolazoline and dopamine on infants with persistent pulmonary nary hypertension.J Pediatr 1981; 98: 603–611.
Greenwood, RD Rosenthal A. Cardiovascular malformations associated with tracheo-esophageal fistula and esophageal atresia.Pediatrics 1976; 57: 87–91.
Ngyuen L, Guttman FM. The mortality of congenital diaphragmatic hernia: Is total pulmonary mass inadequate, no matter what?Ann Sur 1983: 198: 766–770.
Charlton AJ, Bruce J, Davenport M. Timming of surgery in congenital diaphragmatic hermia. Low mortality after pre-operative stabilization.Anesthesia 1991; 46: 820–823.
Frostell CG, Lonnqvist PA, Sonesson SE et al. Near fatal pulmonary hypertension after surgical repair of congenital diphragmatic hernia: Successful use of inhaled nitric oxide.Anesthesia 1993; 48: 679–683.
Breux CW, Rouse TM, Cain WS. Congenital diaphragmatic hernia in an era of delayed repair after medical/or extracorporeal membrane oxygen stabilization: A prognostic and management classification.J Ped Surg 1992; 27: 1192–1196.
DeVries PA. Pathogenesis of gastroschisis and omphalocele.J Ped Surg 1980; 15: 553–557.
King DR, Sarvin R, Boles T Jr. Gastroschisis Update.J Ped Srug 1980; 15: 553–557.
Yaster M, Buck JR, Dudgeon DL, et al. Hemodynamic effects of primary closure of omphalocele/gastroschisis in human newborns.Anesthesiology 1989; 69:84–88.
Schwartz MZ, Tyson KRT, Milliorn K et al. Staged reduction using a silastic sac is the treatment of choice for large congenital abdominal wall defects.J Ped Surg 1983; 18: 713–719.
Pontoppidan H. Mechanical adi to lung expansion in non-intubated surgical patients.Am Rev Resp Dis 1980; 122: 109–112.
Hotchkiss RS, Wilson RS. Mechanical ventilatory support.Surg Clin North Amer 1983; 63: 417–438.
Kirby RR, Smith RA, Desautels DA.Mechanical Ventilation. Churchill Livingstone. New York, 1985.
Gioia FR, Stephenson RL, Alterwitz SA. Principles of respiratory support and mechanical ventilation. In: Rogers M (Ed.)Text book of Pediatric Intensive Care. Baltimore. William and Wilkins, 1987; 113–169.
Kirby L, Robinson E, Schulz J et al. Continuous flow ventilators as an alternative to assist control ventilation in infants.Anesth Analg 1972; 51: 871.
Tyler DC. Positive end expiratory pressure: A review.Crit Care Med 1983; 11: 300–308.
Marini JJ. Caps JS, Culver BH. The inspiratory work of breathing during assisted mechanical ventilation.Chest 1985; 87: 612.
Downs JB, Prekin HM, Modell JH. Intermittent mandatory ventilation.Arch Surg 1974; 109: 519–525.
Froese AB, Bryan AC. Effects of anesthesia and paralysis on diaphragmatic mechanics in man.Anesthesiology, 1974; 41: 242–55.
MacIntryre NR. Respiratory function during pressure support ventilation.Chest 1986; 89: 677–683.
Hewlett AM, Plott AS, Terry VG. Mandatory minute volume, a new concept in weaning from mechanical ventilation.Anesthesia 1977; 32: 163–169.
Stock MC, Downs JB, Frolicher DA. Airway pressure release ventilation.Crit Care Med 1982; 15: 462–46?
Klain M, Smith RB. High frequency percutaneous transtracheal jet ventilation.Crit Care Med 1977; 5: 280–287.
Slutsky AS, Drazzen AM, Ingram RH et al. Effective pulmonary ventilation with small volume oscillations at high frequency.Science 1980; 209: 609–617.
Amold JH, Hanson JH, Toro-Figuero L et al. Prospective, randomized comparison of high frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure.Crit Care Med Oct 1994; 22: 1530–1539.
Chang HK: Mechanism of gas transport during ventilation by high frequency oscillation.J Appl Physiol 1984; 56: 553–563.
Kinsella JP, Abman SH: Clinical responses to prolonged treatment of persistent pulmonary hypertension of the newborn with low dose inhaled nitric oxide.Ped Res 1993; 33: 210A.
Bartlett RH, Roloff DW, Cornell RG et al. Extracorporeal circulation in neonatal respiratory failure. A prospective randomized study.Pediatrics 1985; 76: 479–487.
Lain DC, DiBenedetto R, Morris SL et al. Pressure control inverse ratio ventilation as a method to reduce peak inspiratory pressure and provide adequate ventilation and oxygenation.Chest 1989; 95: 1081–1085.
Shimada Y, Yoshya I, Tanaka K et al. Crying vital capacity and maximal inspiratory pressure as clinical indicators of readiness for weaning of infants less than year of age.Anethesiology 1979; 51: 456–459.
Perkin RM, Levin DL. Adverse effects of positive pressure ventilation in children. In: Gregory GA, editor.Respiratory Failure in the Child. New York: Churchill Livingstone. 1981; 163.
Hickling KG, Walsh J, Henderson S et al. Low mortality rate in adult respiratory distress syndrome using low volume, pressure limited ventilation with permissive hypercapnea: A prospective study.Crit Care Med 1994; 22: 1568–1578.
Kumar A, Falke KJ, Geffine B et al. Continuous positive pressure ventilation in acute respiratory failure. Effect on hemodynamics and lung function.N Eng J Med 1970; 283: 1430–1436.
Suzuki M and Sasaki CT: Laryngeal Spasm: A neurophysiological redefinition.Ann Otol Rhinol Laryngol 1977; 86: 150–157.
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Suresh, S., Birmingham, P.K. & Ravindranath, T.M. Ventilatory support for infants in emergency and in the intensive care unit. Indian J Pediatr 62, 395–419 (1995). https://doi.org/10.1007/BF02755059
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DOI: https://doi.org/10.1007/BF02755059