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Ebook Principles and practice of pediatric anesthesia: Part 2

(BQ) Part 2 book “Principles and practice of pediatric anesthesia” has contents: Anesthesia for plastic and reconstructive surgery, anesthesia for pediatric dentistry, anesthesia for ophthalmic procedures, anesthesia for pediatric neurosurgical procedures, anesthesia and pediatric liver diseases, and other contents. | 17 Chapter Anesthesia for Plastic and Reconstructive Surgery Neerja Bhardwaj INTRODUCTION The commonly performed plastic surgical procedures in children include repair for cleft lip and palate and reconstruction procedures for craniofacial anomalies, temporomandibular joint ankylosis, anomalies of the foot and hands and burns (see Chapter 20). Anesthesia considerations for these procedures require a thorough assessment of the existing anomaly and prevention and management of airway difficulties, blood loss, aspiration of blood and secretions, adverse respiratory events like bronchospasm, laryngospasm and respiratory obstruction. In addition, these children may have associated congenital anomalies and medical illnesses which have an adverse impact on anesthesia management. It therefore becomes very important that these children are thoroughly evaluated and optimized before surgery for a good outcome. CLEFT LIP AND PALATE The condition is present since birth with difficulty in feeding and swallowing, nasal regurgitation, history of (H/O) repeated upper respiratory infection (URI), pulmonary aspiration, chest infection and hearing problems, delayed dentition or maloccluded teeth and nasal speech.1 A child with a cleft lip is unable to suck as negative pressure cannot be established; he is unable to make consonants like B, D, K, P, and T and has typical cleft palate voice and audiometrically detected hearing loss of 10 decibels is present due to inflammation of the orifice of Eustachian tubes consequent on pharyngeal Chap-17.indd 240 inflammation from regurgitated food. During the antenatal period, mother may have history exposure to X-ray, intake of drugs like cortisone, diazepam and phenytoin, vitamin deficiency and viral infection like rubella in 1st trimester. In these children, milestones are delayed and in 10% of cases associated congenital anomalies are present (Table 1). Preoperative Assessment The child should be assessed for: • Presence of other .