Skip to main content
SpringerLink
Log in

Anesthesia Concerns in Congenital Anomalies of the Upper Extremity

  • Chapter
  • First Online:
Congenital Anomalies of the Upper Extremity

  • 491 Accesses

Abstract

The pediatric anesthesiology team may act as a facilitator during the perioperative period by helping organize the child and family preoperatively, managing the physiology of the child intraoperatively, and providing guidance with management of postoperative pain. Upon completion of reading the upcoming chapter, readers should be able to:

  • Predict which children may require additional preoperative workup and organize their preoperative care.

  • Express the unknown risk of neurotoxicity from general anesthesia.

  • Defend the presence of a board-certified pediatric anesthesiologist for all pediatric patients aged 2 years or younger.

  • Recognize children who are at risk for cancellation due to illness or violation of preoperative fasting guidelines.

  • Identify risk factors and propose management options for preoperative anxiety in children and their family.

  • Identify the importance of thermoregulation, glucose management, and fluid management in regard to the length of a surgical procedure.

  • Discuss the risks and benefits of single-shot and catheter regional anesthesia.

  • Recognize the risks associated with using codeine or tramadol in the perioperative period.

  • Utilize multimodal analgesia throughout the perioperative period.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Food and Drug Administration. FDA drug safety communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women. 2016 Dec. fda.gov/media/101937/download.

  2. SmartTots. Consensus statement on the use of anesthetic and sedative drugs in infants and toddlers. 2015 Oct. pedsanesthesia.org/wp-content/uploads/2017/11/ConsensusStatement.pdf.

  3. Olney JW, Wozniak DF, Jevtovic-Todorovic V, Ikonomidou C. Glutamate signaling and the fetal alcohol syndrome. Ment Retard Dev Disabil Res Rev. 2001;7(4):267–75.

    Article  CAS  PubMed  Google Scholar 

  4. Brambrink AM, Evers AS, Avidan MS, Farber NB, Smith DJ, Zhang X, et al. Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain. Anesthesiology. 2010;112(4):834–41.

    Article  CAS  PubMed  Google Scholar 

  5. Zou X, Patterson TA, Divine RL, Sadovova N, Zhang X, Hanig JP, et al. Prolonged exposure to ketamine increases neurodegeneration in the developing monkey brain. Int J Dev Neurosci. 2009;27(7):727–31.

    Article  CAS  PubMed  Google Scholar 

  6. Slikker W Jr, Zou X, Hotchkiss CE, Divine RL, Sadovova N, Twaddle NC, et al. Ketamine-induced neuronal cell death in the perinatal rhesus monkey. Toxicol Sci. 2007;98(1):145–58.

    Article  CAS  PubMed  Google Scholar 

  7. Ikonomidou C, Bosch F, Miksa M, Bittigau P, Vöckler J, Dikranian K, et al. Blockade of NMDA receptors and apoptotic neurodegeneration in the developing brain. Science. 1999;283(5398):70–4.

    Article  CAS  PubMed  Google Scholar 

  8. Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Wilder RT, Flick RP, Sprung J, Katusic SK, Barbaresi WJ, Mickelson C, et al. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;110(4):796–804.

    Article  PubMed  Google Scholar 

  10. Flick RP, Katusic SK, Colligan RC, Wilder RT, Voigt RG, Olson MD, et al. Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics. 2011. peds-2011.

    Google Scholar 

  11. Ing C, DiMaggio C, Whitehouse A, Hegarty MK, Brady J, von Ungern-Sternberg BS, et al. Long-term differences in language and cognitive function after childhood exposure to anesthesia. Pediatrics. 2012. peds-2011.

    Google Scholar 

  12. Bartels M, Althoff RR, Boomsma DI. Anesthesia and cognitive performance in children: no evidence for a causal relationship. Twin Res Hum Genet. 2009;12(3):246–53.

    Article  PubMed  Google Scholar 

  13. Davidson AJ, Disma N, de Graaff JC, Withington DE, Dorris L, Bell G, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet. 2016;387(10015):239–50.

    Article  PubMed  Google Scholar 

  14. McCann ME, de Graaff JC, Dorris L, Disma N, Withington D, Bell G, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised controlled equivalence trial. Lancet. 2019;393(10172):664–77.

    Article  PubMed  PubMed Central  Google Scholar 

  15. American College of Surgeons. Optimal resources for children’s surgical care v.1. 2015. facs.org/-/media/files/quality-programs/csv/acs-cav_standartdmanual.ashx.

  16. Auroy Y, Ecoffey C, Messiah A, Rouvier B. Relationship between complications of pediatric anesthesia and volume of pediatric anesthetics [letter]. Anesth Analg. 1997;84:234–5.

    Article  CAS  PubMed  Google Scholar 

  17. Campling EA, Devlin HB, Lunn JN. The report of the national confidential enquiry into perioperative deaths. London: NCEPOD; 1989.

    Google Scholar 

  18. Keenan RL, Shapiro JH, Dawson K. Frequency of anesthetic cardiac arrest in infants: effect of pediatric anesthesiologists. J Clin Anesth. 1991;3:433–6.

    Article  CAS  PubMed  Google Scholar 

  19. Crone RK. Frequency of anesthetic cardiac arrest in infants: effect of pediatric anesthesiologists [editorial]. J Clin Anesth. 1991;3:431–2.

    Article  CAS  PubMed  Google Scholar 

  20. American Society of Anesthesiologists Practice Parameter. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application of healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacological agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126(3):376–93.

    Article  Google Scholar 

  21. Dennhardt N, Beck C, Huber D, Sander B, Boehne M, Boethig D, et al. Optimized preoperative fasting times decrease ketone body concentration and stabilize mean arterial blood pressure during induction of anesthesia in children younger than 36 months: a prospective observational cohort study. Paediatr Anaesth. 2016;26(8):838–43.

    Article  PubMed  Google Scholar 

  22. Tait AR, Malviya S. Anesthesia for the child with an upper respiratory tract infection: still a dilemma? Anesth Analg. 2005;100(1):59–65.

    Article  PubMed  Google Scholar 

  23. Watson S. The principles of management of congenital anomalies of the upper limb. Arch Dis Child. 2000;83(1):10–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Banchs R, Lerman J. Preoperative anxiety management, emergence delirium, and postoperative behavior. Anesthesiol Clin. 2014;32(1):1–23.

    Article  PubMed  Google Scholar 

  25. Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118(2):651–8.

    Article  PubMed  Google Scholar 

  26. Kain ZN, Mayes LC, O’Connor TZ, Cicchetti DV. Preoperative anxiety in children: predictors and outcomes. Arch Pediatr Adolesc Med. 1996;150(12):1238–45.

    Article  CAS  PubMed  Google Scholar 

  27. O’Byrne K, Peterson L, Saldana L. Survey of pediatric hospitals’ preparation programs: evidence of the impact of health psychology research. Health Psychol. 1997;16:147–54.

    Article  PubMed  Google Scholar 

  28. Saile H, Burgmeier R, Schmidt LR. A meta-analysis of studies on psychological preparation of children facing medical procedures. Psychol Health. 1988;2:107–32.

    Article  Google Scholar 

  29. American Academy of Pediatrics. Child life services. Pediatrics. 2014;133(5):e1471–8.

    Article  Google Scholar 

  30. Eijlers R, Utens EMWJ, Staals LM, de Nijs PFA, Berhmans JM, Wijnen RMH, et al. Systematic review and meta-analysis of virtual reality in pediatrics: effects on pain and anxiety. Anesth Analg. 2019;129(5):1344–53.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Martin SR, MacLaren Chorney J, Tan ET, Fortier MA, Blount RL, Wald SH, et al. Changing healthcare providers’ behavior during pediatric inductions with an empirically-based intervention. Anesthesiology. 2011;115(1):18–27.

    Article  PubMed  Google Scholar 

  32. Kain Z, Mayes L, Wang S, Caramico LA, Hofstadter MB. Parental presence during induction of anesthesia vs. sedative premedication: which intervention is more effective? Anesthesiology. 1998;89(5):1147–56.

    Article  CAS  PubMed  Google Scholar 

  33. Gauderer MW, Lorig JL, Eastwood DW. Is there a place for parents in the operating room? J Pediatr Surg. 1989;24(7):705–6.

    Article  CAS  PubMed  Google Scholar 

  34. Messeri A, Caprilli S, Busoni P. Anaesthesia induction in children: a psychological evaluation of the efficiency of parents’ presence. Paediatr Anaesth. 2004;14(7):551–6.

    Article  PubMed  Google Scholar 

  35. Kain ZN, Mayes LC, Bell C, Weisman S, Hofstadter MB, Rimar S. Premedication in the United States: a status report. Anesth Anal. 1997;84:427–32.

    Article  CAS  Google Scholar 

  36. Feld LH, Champeau MW, van Steennis CA, Scott JC. Preanesthetic medication in children: a comparison of oral transmucosal fentanyl citrate versus placebo. Anesthesiology. 1989;71(3):374–7.

    Article  CAS  PubMed  Google Scholar 

  37. Fuks AB, Kaufman E, Ram D, Hovav S, Shapira J. Assessment of two doses of intranasal midazolam for sedation of young pediatric dental patients. Pediatr Dent. 1994;16(4):301–5.

    CAS  PubMed  Google Scholar 

  38. Behrle N, Birisci E, Dalabih A. Intranasal dexmedetomidine as a sedative for pediatric procedural sedation. J Pediatric Pharmacol Ther. 2017;22(1):4–8.

    Google Scholar 

  39. Chatrath V, Kumar R, Thakur M. Intranasal fentanyl, midazolam, and dexmedetomidine as premedication in pediatric patients. Anesth Essays Res. 2018;12(3):748–53.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Graudins A, Meek R, Egerton-Warburton D, Oakley E, Seith R. The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: a randomized controlled trial comparing intranasal ketamine and fentanyl for relief of moderate to severe pain in children with limb injuries. Ann Emerg Med. 2015;65(3):248–54.

    Article  PubMed  Google Scholar 

  41. Hodge D, Fleisher G. Pediatric catheter flow rates. Am J Emerg Med. 1985;3(5):403.

    Article  PubMed  Google Scholar 

  42. Maxwell LG, Yaster M. Perioperative management issues in pediatric patients. Anaesthesiol Clin North Am. 2000;18:601–32.

    Article  CAS  Google Scholar 

  43. Deshpande S, Platt MW. The investigation and management of neonatal hypoglycemia. Semin Fetal Neonatal Med. 2005;10(4):351–61.

    Article  PubMed  Google Scholar 

  44. Feld LG, Neuspiel DR, Foster BA, Leu MG, Garber MD, Austin K, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142(6):e20183083.

    Article  PubMed  Google Scholar 

  45. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823–32.

    Article  CAS  PubMed  Google Scholar 

  46. Rizoli S. PlasmaLyte. J Trauma. 2011;70(5 Suppl):S17–8.

    CAS  PubMed  Google Scholar 

  47. Meyers RS. Pediatric fluid and electrolyte therapy. J Pediatric Pharmacol Ther. 2009;14(4):204–11.

    Google Scholar 

  48. Gregory GA, Brett C. Neonatology for anesthesiologists. In: Davis PJ, Cladis FP, Motoyama EK, editors. Smith’s anesthesia for infants and children. Philadelphia: Elsevier; 2011. p. 512–53.

    Chapter  Google Scholar 

  49. Diaz M, Becker D. Thermoregulation: physiological and clinical consideration during sedation and general anesthesia. Anesth Prog. 2010;51(1):25–33.

    Article  Google Scholar 

  50. Polerman KH. Hypothermia and coagulation. Crit Care. 2012;16(Suppl 2):A20.

    Article  Google Scholar 

  51. Bull A, Wilson J, Worth LJ, Stuart RL, Gillespie E, Waxman B, et al. A bundle of care to reduce colorectal surgical infections: an Australian experience. J Hosp Infect. 2011;78(4):297–301.

    Article  CAS  PubMed  Google Scholar 

  52. Tredwell SJ, Wilmink M, Inkpen K, McEwen JA. Pediatric tourniquets: analysis of cuff and limb interface, current practice, and guidelines for use. J Pediatr Orthop. 2001;21:671–6.

    Article  CAS  PubMed  Google Scholar 

  53. Kutty S, McElwain JP. Padding under tourniquets in tourniquet controlled surgery: Bruner’s ten rules revisited. Injury. 2002;33:75.

    Article  PubMed  Google Scholar 

  54. Sharma JP, Salhorta R. Tourniquets in orthopedic surgery. Indian J Orthop. 2012;46(4):377–83.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Amiri HR, Espandar R. Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series. J Child Orthop. 2010;4:315–9.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Shah RD, Suresh S. Applications of regional anaesthesia in paediatrics. Br J Anaesth. 2013;111(51):i114–24.

    Article  PubMed  Google Scholar 

  57. Bosenberg A. Upper and lower limb blocks in children. Updates Anaesth. 2015;30(1):99–111.

    Google Scholar 

  58. Polaner DM, Taenzer AH, Walker BJ, Bosenberg A, Krane EJ, Suresh S, et al. Pediatric regional anesthesia network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 2012;115(6):1353–64.

    Article  CAS  PubMed  Google Scholar 

  59. Ecoffey C. Safety in pediatric regional anesthesia. Pediatr Anesth. 2012;22:25–30.

    Article  Google Scholar 

  60. Taenzer A, Walker BJ, Bosenberg AT, Krane EJ, Martin LD, Polaner DM, et al. Interscalene brachial plexus blocks under general anesthesia in children: is this safe practice? Reg Anesth Pain Med. 2014;39(6):502–5.

    Article  CAS  PubMed  Google Scholar 

  61. Fisher WJ, Bingham RM, Hall R. Axillary brachial plexus block for perioperative analgesia in 250 children. Pediatr Anesth. 1999;9(5):435–8.

    Article  CAS  Google Scholar 

  62. Van Geffen JG, Tielens L, Gielen M. Ultrasound-guided interscalene brachial plexus block in a child with femur fibula ulna syndrome. Pediatr Anesth. 2006;16(3):330–2.

    Article  Google Scholar 

  63. Pande R, Pande M, Bhadani U, Pandey CK, Bhattacharya A. Supraclavicular brachial plexus block as a sole anaesthetic technique in children: an analysis of 200 cases. Anaesthesia. 2000;55(8):798–802.

    Article  CAS  PubMed  Google Scholar 

  64. De Jose MB, Banus E, Egea MN, Serrano S, Perello M, Mabrok M. Ultrasound-guided supraclavicular versus infraclavicular brachial plexus blocks in children. Pediatr Anesth. 2008;18(9):838–44.

    Article  Google Scholar 

  65. Dadure C, Raux O, Troncin R, Rochette A, Capdevia X. Continuous infraclavicular brachial plexus block for acute pain management in children. Anesth Analg. 2003;97(3):691–3.

    Article  PubMed  Google Scholar 

  66. Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 2004;59(7):642–6.

    Article  CAS  PubMed  Google Scholar 

  67. Walker BJ, Long JB, De Oliveira GS, Szmuk P, Setiawan C, Polaner DM, Suresh S. Peripheral nerve catheters in children: an analysis of safety and practice patterns from the pediatric regional anesthesia network (PRAN). Br J Anaesth. 2015;115(3):457–62.

    Article  CAS  PubMed  Google Scholar 

  68. Gurnaney H, Kraemer FW, Maxwell L, Muhly WT, Schleelein L, Ganesh A. Ambulatory continuous peripheral nerve blocks in children and adolescents: a longitudinal 8-year single center study. Anesth Analg. 2014;118(3):621–7.

    Article  PubMed  Google Scholar 

  69. Graf BM, Abraham I, Eberbach N, Kunst G, Stowe DF, et al. Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physiochemical and stereoselective properties. Anesthesiology. 2002;96(6):1427–34.

    Article  CAS  PubMed  Google Scholar 

  70. El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. 2018;11:35–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Society of Pediatric Anesthesia. Pedi crisis critical events checklist. Revision 2020 Jan. http://www.pedsanesthesia.org/wpcontent/uploads/2018/03/SPACriticalEventsChecklists.pdf.

  72. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;2(6):59–66.

    Google Scholar 

  73. Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Pediatr Anesth. 2006;16(3):258–65.

    Article  Google Scholar 

  74. Wong C, Lau E, Campbell F. Pain management in children: part 1 – assessment tools and a brief review of nonpharmacological and pharmacological options. Can Pharm J (Ott). 2012;145(5):222–5.

    Article  Google Scholar 

  75. Tobias JD, Green TP, Cote CJ. Codeine: time to say “no”. Pediatrics. 2016;138(4):e20162396.

    Article  PubMed  Google Scholar 

  76. Yaster M. Multimodal analgesia in children. Eur J Anaesthesiol. 2010;27(10):851–7.

    Article  CAS  PubMed  Google Scholar 

  77. Suresh S, Birmingham PK, Kozlowski RJ. Pediatric pain management. Anesthesiol Clin. 2012;30(1):101–17.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Anesthesiology and Pediatrics, University of Vermont Medical Center, Larner College of Medicine, Burlington, VT, USA

    Rebecca Evans

  2. University of Vermont Medical Center, University of Vermont Larner College of Medicine, Burlington, VT, USA

    Ann F. T. Lawrence

  3. Department of Anesthesiology, The University of Vermont Medical Center, Burlington, VT, USA

    Emily L. Stebbins

Authors
  1. Rebecca Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ann F. T. Lawrence
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily L. Stebbins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rebecca Evans .

Editor information

Editors and Affiliations

  1. Colchester, VT, USA

    Donald R. Laub Jr.

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Evans, R., Lawrence, A.F.T., Stebbins, E.L. (2021). Anesthesia Concerns in Congenital Anomalies of the Upper Extremity. In: Laub Jr., D.R. (eds) Congenital Anomalies of the Upper Extremity. Springer, Cham. https://doi.org/10.1007/978-3-030-64159-7_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-64159-7_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-64158-0

  • Online ISBN: 978-3-030-64159-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation