Pediatric Anesthesia 1999 Pediatric Anesthesia 1999
Draeger Medical Draeger Medical
K. Rupp, J. Holzki, T. Fischer, C. Keller K. Rupp, J. Holzki, T. Fischer, C. Keller
ISBN 3-926762-48-9 ISBN 3-926762-48-9
PDF 200 Pages PDF 200 Pages
Important Information: Important Information:
Medical knowledge is constantly changing as a result of Medical knowledge is constantly changing as a result of
research and clinical testing. The editors and authors of research and clinical testing. The editors and authors of
this primer have taken great care to ensure that the this primer have taken great care to ensure that the
information and therapeutic details contained herein information and therapeutic details contained herein
correspond to the most up-to-date research results correspond to the most up-to-date research results
(especially as pertains to indications, dosages and (especially as pertains to indications, dosages and
undesirable side effects), they cannot, however, guarantee undesirable side effects), they cannot, however, guarantee
this. Those persons using this book as a reference are this. Those persons using this book as a reference are
advised to carefully peruse all instructions included with advised to carefully peruse all instructions included with
medications used and to make all decisions pertaining to medications used and to make all decisions pertaining to
dosage or application at their own discretion. dosage or application at their own discretion.
The Editors October, 1999 The Editors October, 1999
Table of Contents Table of Contents
1. Introduction 8 1. Introduction 8
2. Special Anatomical and Physiological Features 12 2. Special Anatomical and Physiological Features 12
2.1 Breathing 13 2.1 Breathing 13
2.1.1 Anatomical Fundamentals 13 2.1.1 Anatomical Fundamentals 13
of the Respiratory Tract of the Respiratory Tract
2.1.2 Controlling the Respiratory Process 15 2.1.2 Controlling the Respiratory Process 15
2.1.3 Respiratory Mechanics 17 2.1.3 Respiratory Mechanics 17
2.1.4 Pulmonary Volumes 19 2.1.4 Pulmonary Volumes 19
2.1.5 Surfactant 23 2.1.5 Surfactant 23
2.1.6 Oxygen Requirements 24 2.1.6 Oxygen Requirements 24
2.1.7 Extrapulmonary Oxygen Toxicity 26 2.1.7 Extrapulmonary Oxygen Toxicity 26
2.2 The Heart and Circulatory System 27 2.2 The Heart and Circulatory System 27
2.2.1 The Fetal Circulatory System 27 2.2.1 The Fetal Circulatory System 27
2.2.2 The Heart 29 2.2.2 The Heart 29
2.2.3 Blood Volume and Blood Pressure 30 2.2.3 Blood Volume and Blood Pressure 30
2.2.4 Hemoglobin Contents 31 2.2.4 Hemoglobin Contents 31
2.3 Temperature Regulation 32 2.3 Temperature Regulation 32
2.4 The Balance between Water and Electrolytes 35 2.4 The Balance between Water and Electrolytes 35
3. Anesthetic Agents 37 3. Anesthetic Agents 37
3.1 Inhalation Anesthesia 38 3.1 Inhalation Anesthesia 38
3.2 Interactions with Soda Lime 45 3.2 Interactions with Soda Lime 45
3.3 Intravenous Anesthesia 49 3.3 Intravenous Anesthesia 49
3.4 Muscle Relaxants 51 3.4 Muscle Relaxants 51
4. Anesthesia Accessories 53 4. Anesthesia Accessories 53
4.1 Masks 54 4.1 Masks 54
4.2 Tubes 55 4.2 Tubes 55
4.3 Laryngeal Masks 58 4.3 Laryngeal Masks 58
5. Ventilation in Pediatric Anesthesia 60 5. Ventilation in Pediatric Anesthesia 60
5.1 Mechanical Modes of Ventilation 61 5.1 Mechanical Modes of Ventilation 61
5.1.1 The Ventilation Mode IPPV 61 5.1.1 The Ventilation Mode IPPV 61
5.1.2 The Ventilation Mode SIMV 63 5.1.2 The Ventilation Mode SIMV 63
5.1.3 The Ventilation Mode PCV 64 5.1.3 The Ventilation Mode PCV 64
5.2 Ventilation Parameters 73 5.2 Ventilation Parameters 73
5.3 Breathing Systems 78 5.3 Breathing Systems 78
5.3.1 Flow-controlled 79 5.3.1 Flow-controlled 79
Non-rebreathing Systems Non-rebreathing Systems
5.3.2 Valve-controlled 86 5.3.2 Valve-controlled 86
Non-rebreathing Systems Non-rebreathing Systems
5.3.3 Partial Rebreathing Systems 5.3.3 Partial Rebreathing Systems
(Semi-closed Breathing Systems) 87 (Semi-closed Breathing Systems) 87
5.3.4 Complete Rebreathing Systems 5.3.4 Complete Rebreathing Systems
(Closed Systems) 89 (Closed Systems) 89
5.4 Characteristics of Ventilation for 5.4 Characteristics of Ventilation for
Pediatric Anesthesia 90 Pediatric Anesthesia 90
5.4.1 Manual and Mechanical Ventilation for 90 5.4.1 Manual and Mechanical Ventilation for 90
Neonates and Infants Neonates and Infants
5.4.2 Respirator Requirements for Children 92 5.4.2 Respirator Requirements for Children 92
5.4.3 The Fresh-gas Decoupler 94 5.4.3 The Fresh-gas Decoupler 94
5.4.4 Compliance Compensation 96 5.4.4 Compliance Compensation 96
5.4.5 Dead Space Volume 98 5.4.5 Dead Space Volume 98
5.5 Anesthetic Machines 99 5.5 Anesthetic Machines 99
5.5.1 Cato/Cicero EM 99 5.5.1 Cato / Cicero EM 99
5.5.2 Julian 101 5.5.2 Julian 101
5.5.3 PhysioFlex 102 5.5.3 PhysioFlex 102
5.6 Monitoring 108 5.6 Monitoring 108
5.6.1 The Stethoscope 109 5.6.1 The Stethoscope 109
5.6.2 Pulse Oximetry 110 5.6.2 Pulse Oximetry 110
5.6.3 Measuring Body Temperature 113 5.6.3 Measuring Body Temperature 113
5.6.4 Measuring Blood Pressure(NiBP/iBP) 115 5.6.4 Measuring Blood Pressure (NiBP / iBP) 115
5.6.5 The ECG 118 5.6.5 The ECG 118
5.6.6 Capnography 120 5.6.6 Capnography 120
5.6.7 Measuring Respiratory Pressure 125 5.6.7 Measuring Respiratory Pressure 125
5.6.8 Volumetry 126 5.6.8 Volumetry 126
5.6.9 Measuring the Concentration 127 5.6.9 Measuring the Concentration 127
of Anesthetic Agent of Anesthetic Agent
5.6.10 Measuring the Inspiratory 128 5.6.10 Measuring the Inspiratory 128
Oxygen Concentration Oxygen Concentration
5.6.11 Oxygen Uptake 129 5.6.11 Oxygen Uptake 129
5.6.12 Anesthetic Agent Uptake 130 5.6.12 Anesthetic Agent Uptake 130
5.7 Low-flow Anesthesia 132 5.7 Low-flow Anesthesia 132
5.7.1 The Wash-in/Wash-out Rate 137 5.7.1 The Wash-in/Wash-out Rate 137
of Anesthetic Agent of Anesthetic Agent
5.8 Breathing Gas Conditioning 5.8 Breathing Gas Conditioning
for Anesthetic Ventilation Systems 142 for Anesthetic Ventilation Systems 142
6. Bibliography 151 6. Bibliography 151
7. Practical Application 161 7. Practical Application 161
7.1 Anesthetic Ventilation for Infants 161 7.1 Anesthetic Ventilation for Infants 161
and Small Children and Small Children
Dr. J. Holzki Dr. J. Holzki
Children's Clinic, Cologne, Germany Children's Clinic, Cologne, Germany
7.2 PCV during Pediatric Cardio-anesthesia 176 7.2 PCV during Pediatric Cardio-anesthesia 176
Dr. T. Fischer Dr. T. Fischer
German Heart Center, Berlin German Heart Center, Berlin
7.3 Using a Laryngeal Mask for Pediatric Anesthesia 185 7.3 Using a Laryngeal Mask for Pediatric Anesthesia 185
Dr. C. Keller Dr. C. Keller
Leopold-Franzens University, Innsbruck Leopold-Franzens University, Innsbruck
8. Abbreviations 193 8. Abbreviations 193
http://ifile.it/y0do86u
Draeger Medical Draeger Medical
K. Rupp, J. Holzki, T. Fischer, C. Keller K. Rupp, J. Holzki, T. Fischer, C. Keller
ISBN 3-926762-48-9 ISBN 3-926762-48-9
PDF 200 Pages PDF 200 Pages
Important Information: Important Information:
Medical knowledge is constantly changing as a result of Medical knowledge is constantly changing as a result of
research and clinical testing. The editors and authors of research and clinical testing. The editors and authors of
this primer have taken great care to ensure that the this primer have taken great care to ensure that the
information and therapeutic details contained herein information and therapeutic details contained herein
correspond to the most up-to-date research results correspond to the most up-to-date research results
(especially as pertains to indications, dosages and (especially as pertains to indications, dosages and
undesirable side effects), they cannot, however, guarantee undesirable side effects), they cannot, however, guarantee
this. Those persons using this book as a reference are this. Those persons using this book as a reference are
advised to carefully peruse all instructions included with advised to carefully peruse all instructions included with
medications used and to make all decisions pertaining to medications used and to make all decisions pertaining to
dosage or application at their own discretion. dosage or application at their own discretion.
The Editors October, 1999 The Editors October, 1999
Table of Contents Table of Contents
1. Introduction 8 1. Introduction 8
2. Special Anatomical and Physiological Features 12 2. Special Anatomical and Physiological Features 12
2.1 Breathing 13 2.1 Breathing 13
2.1.1 Anatomical Fundamentals 13 2.1.1 Anatomical Fundamentals 13
of the Respiratory Tract of the Respiratory Tract
2.1.2 Controlling the Respiratory Process 15 2.1.2 Controlling the Respiratory Process 15
2.1.3 Respiratory Mechanics 17 2.1.3 Respiratory Mechanics 17
2.1.4 Pulmonary Volumes 19 2.1.4 Pulmonary Volumes 19
2.1.5 Surfactant 23 2.1.5 Surfactant 23
2.1.6 Oxygen Requirements 24 2.1.6 Oxygen Requirements 24
2.1.7 Extrapulmonary Oxygen Toxicity 26 2.1.7 Extrapulmonary Oxygen Toxicity 26
2.2 The Heart and Circulatory System 27 2.2 The Heart and Circulatory System 27
2.2.1 The Fetal Circulatory System 27 2.2.1 The Fetal Circulatory System 27
2.2.2 The Heart 29 2.2.2 The Heart 29
2.2.3 Blood Volume and Blood Pressure 30 2.2.3 Blood Volume and Blood Pressure 30
2.2.4 Hemoglobin Contents 31 2.2.4 Hemoglobin Contents 31
2.3 Temperature Regulation 32 2.3 Temperature Regulation 32
2.4 The Balance between Water and Electrolytes 35 2.4 The Balance between Water and Electrolytes 35
3. Anesthetic Agents 37 3. Anesthetic Agents 37
3.1 Inhalation Anesthesia 38 3.1 Inhalation Anesthesia 38
3.2 Interactions with Soda Lime 45 3.2 Interactions with Soda Lime 45
3.3 Intravenous Anesthesia 49 3.3 Intravenous Anesthesia 49
3.4 Muscle Relaxants 51 3.4 Muscle Relaxants 51
4. Anesthesia Accessories 53 4. Anesthesia Accessories 53
4.1 Masks 54 4.1 Masks 54
4.2 Tubes 55 4.2 Tubes 55
4.3 Laryngeal Masks 58 4.3 Laryngeal Masks 58
5. Ventilation in Pediatric Anesthesia 60 5. Ventilation in Pediatric Anesthesia 60
5.1 Mechanical Modes of Ventilation 61 5.1 Mechanical Modes of Ventilation 61
5.1.1 The Ventilation Mode IPPV 61 5.1.1 The Ventilation Mode IPPV 61
5.1.2 The Ventilation Mode SIMV 63 5.1.2 The Ventilation Mode SIMV 63
5.1.3 The Ventilation Mode PCV 64 5.1.3 The Ventilation Mode PCV 64
5.2 Ventilation Parameters 73 5.2 Ventilation Parameters 73
5.3 Breathing Systems 78 5.3 Breathing Systems 78
5.3.1 Flow-controlled 79 5.3.1 Flow-controlled 79
Non-rebreathing Systems Non-rebreathing Systems
5.3.2 Valve-controlled 86 5.3.2 Valve-controlled 86
Non-rebreathing Systems Non-rebreathing Systems
5.3.3 Partial Rebreathing Systems 5.3.3 Partial Rebreathing Systems
(Semi-closed Breathing Systems) 87 (Semi-closed Breathing Systems) 87
5.3.4 Complete Rebreathing Systems 5.3.4 Complete Rebreathing Systems
(Closed Systems) 89 (Closed Systems) 89
5.4 Characteristics of Ventilation for 5.4 Characteristics of Ventilation for
Pediatric Anesthesia 90 Pediatric Anesthesia 90
5.4.1 Manual and Mechanical Ventilation for 90 5.4.1 Manual and Mechanical Ventilation for 90
Neonates and Infants Neonates and Infants
5.4.2 Respirator Requirements for Children 92 5.4.2 Respirator Requirements for Children 92
5.4.3 The Fresh-gas Decoupler 94 5.4.3 The Fresh-gas Decoupler 94
5.4.4 Compliance Compensation 96 5.4.4 Compliance Compensation 96
5.4.5 Dead Space Volume 98 5.4.5 Dead Space Volume 98
5.5 Anesthetic Machines 99 5.5 Anesthetic Machines 99
5.5.1 Cato/Cicero EM 99 5.5.1 Cato / Cicero EM 99
5.5.2 Julian 101 5.5.2 Julian 101
5.5.3 PhysioFlex 102 5.5.3 PhysioFlex 102
5.6 Monitoring 108 5.6 Monitoring 108
5.6.1 The Stethoscope 109 5.6.1 The Stethoscope 109
5.6.2 Pulse Oximetry 110 5.6.2 Pulse Oximetry 110
5.6.3 Measuring Body Temperature 113 5.6.3 Measuring Body Temperature 113
5.6.4 Measuring Blood Pressure(NiBP/iBP) 115 5.6.4 Measuring Blood Pressure (NiBP / iBP) 115
5.6.5 The ECG 118 5.6.5 The ECG 118
5.6.6 Capnography 120 5.6.6 Capnography 120
5.6.7 Measuring Respiratory Pressure 125 5.6.7 Measuring Respiratory Pressure 125
5.6.8 Volumetry 126 5.6.8 Volumetry 126
5.6.9 Measuring the Concentration 127 5.6.9 Measuring the Concentration 127
of Anesthetic Agent of Anesthetic Agent
5.6.10 Measuring the Inspiratory 128 5.6.10 Measuring the Inspiratory 128
Oxygen Concentration Oxygen Concentration
5.6.11 Oxygen Uptake 129 5.6.11 Oxygen Uptake 129
5.6.12 Anesthetic Agent Uptake 130 5.6.12 Anesthetic Agent Uptake 130
5.7 Low-flow Anesthesia 132 5.7 Low-flow Anesthesia 132
5.7.1 The Wash-in/Wash-out Rate 137 5.7.1 The Wash-in/Wash-out Rate 137
of Anesthetic Agent of Anesthetic Agent
5.8 Breathing Gas Conditioning 5.8 Breathing Gas Conditioning
for Anesthetic Ventilation Systems 142 for Anesthetic Ventilation Systems 142
6. Bibliography 151 6. Bibliography 151
7. Practical Application 161 7. Practical Application 161
7.1 Anesthetic Ventilation for Infants 161 7.1 Anesthetic Ventilation for Infants 161
and Small Children and Small Children
Dr. J. Holzki Dr. J. Holzki
Children's Clinic, Cologne, Germany Children's Clinic, Cologne, Germany
7.2 PCV during Pediatric Cardio-anesthesia 176 7.2 PCV during Pediatric Cardio-anesthesia 176
Dr. T. Fischer Dr. T. Fischer
German Heart Center, Berlin German Heart Center, Berlin
7.3 Using a Laryngeal Mask for Pediatric Anesthesia 185 7.3 Using a Laryngeal Mask for Pediatric Anesthesia 185
Dr. C. Keller Dr. C. Keller
Leopold-Franzens University, Innsbruck Leopold-Franzens University, Innsbruck
8. Abbreviations 193 8. Abbreviations 193
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