Chapter 186 - Special techniques in pediatric vascular surgery Flashcards
First description of aortic coarctation
1760 Giovanni Morgagni
First successful pediatric liver transplant
1967 Thomas Starzl
19 month old
Timing of surgery for renovascular and thoracic aortic coarctation
Renovascular - delay if possible until 3 years - better result once vessel > 2mm
coarctation - operate early low risk of reintervention
Heparin use in children special consideration
1) neonate need more than children
2) protamine not always needed in neonate
3) aPTT values are calculated using adult plasma and therefore can be inaccurate
Reyes syndrome
swelling of liver and brain
caused by viral infection of ASA (90% kids)
ASA dose to cause Reye
> 40 mg/kg
Safe dose of ASA in children perioperatively
1-5 mg/kg
Plavix dose in children
0.2mg/kg
Pediatric anesthetic concerns key points
1) ambient room temperature 23-25 C
2) approprimately sized anes equipments
3) Inhallation induction (NO and sevoflurane
5) lateral decubitus when emerging from anesthesia
6) antiemetic and dexamethasone (minimize tracheal edema)
Abdominal retraction in pediatric population
Thompson pediatric abdominal system
Benefit of transverse incision in children
1) better exposure due to barrel shape
2) less chance of fascial dehiscence in children < 1 year
Aortic graft sizes based on age
Young children 8-12 mm
Early adolescent 12-16 mm
Late adolescent 14-20 mm
Tissue expansion for mid aortic syndrome
Periodically inflating tissue expander in normal distal aorta
The elongated aorta can then be used to primarily disconnect the stenotic mid aorta
Maximum contrast dose in neonate and children
4-5ml/kg nenonate
6-8 ml/kg infant
Power injector safely be used when children weight this much
15 kg
