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Published on: May 26, 2023
Pediatric perioperative life support
Donald H Shaffner1, Eugenie S Heitmiller, Jayant K Deshpande
1From the Departments of Anesthesiology and Critical Care Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Departments of Anesthesiology and Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
Insights
This review provides anesthesiologists with pediatric advanced life support guidelines tailored for the perioperative setting. It covers preparation, resuscitation techniques, and post-resuscitation care for pediatric patients undergoing surgery.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Emergency Medicine
Background:
- Pediatric advanced life support (PALS) guidelines are primarily for out-of-hospital use.
- Anesthesiologists require PALS guidance specific to the perioperative environment.
Purpose of the Study:
- To review pediatric resuscitation in the perioperative period.
- To provide anesthesiologists with tailored PALS information.
Main Methods:
- Focused review of preresuscitation preparation, resuscitation techniques, and postresuscitation management.
- Inclusion of common pediatric perioperative arrest scenarios and their management.
- Review of hemodynamic and metabolic stability maintenance post-resuscitation.
Main Results:
- Detailed management strategies for pediatric perioperative arrest scenarios.
- Guidance on maintaining hemodynamic and metabolic stability.
- Appendices include an intraoperative arrest record, key medications, and defibrillation techniques.
Conclusions:
- Perioperative-specific PALS guidelines are essential for anesthesiologists.
- This review offers practical information for managing pediatric resuscitation during surgery.
- The resource aims to improve outcomes for critically ill pediatric surgical patients.
Abstract:
Pediatric advanced life support training and guidelines are typically designed for first-responders and out-of-hospital resuscitation. Guidelines and scenarios that are more applicable to the perioperative environment would be beneficial for anesthesiologists. The goal of this article is to review resuscitation of pediatric patients during the perioperative period. We use a format that focuses on preresuscitation preparation, resuscitation techniques, and postresuscitation management in the perioperative period. In an effort to provide information of maximum benefit to anesthesiologists, we include common pediatric perioperative arrest scenarios with detailed description of their management. We also provide a section on postresuscitation management and review the techniques for maintaining the child's hemodynamic and metabolic stability. Finally, 3 appendices are included: an example of an intraoperative arrest record that provides feedback for interventions; a table of key medications for pediatric perioperative resuscitation; and a review of defibrillator use and simulation exercises to promote effective defibrillation.
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