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PEDI AT R IC A NESTHESIOLOGY
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PEDIATR IC
A NESTHESIOLOGY:
A COMPR EHENSIV E
BOAR D R EVIEW
EDITED BY
Kai Matthes, MD, PhD Ellen Wang, MD
ASSOCIATE PROFESSOR OF ANAESTHESIA, ASSISTANT PROFESSOR OF ANESTHESIOLOGY,
HARVARD MEDICAL SCHOOL PERIOPERATIVE AND PAIN MEDICINE
ASSOCIATE IN PERIOPERATIVE ANESTHESIA, STANFORD UNIVERSITY SCHOOL OF
DEPARTMENT OF ANESTHESIOLOGY, MEDICINE
PERIOPERATIVE AND PAIN MEDICINE STANFORD, CALIFORNIA
BOSTON CHILDREN’S HOSPITAL
BOSTON, MASSACHUSETTS
T. Anthony Anderson PhD, MD
Anjolie E. Laubach, MD ASSISTANT PROFESSOR OF ANAESTHESIA
HARVARD MEDICAL SCHOOL
INSTRUCTOR IN ANAESTHESIA DEPARTMENT OF ANESTHESIA, CRITICAL
HARVARD MEDICAL SCHOOL CARE AND PAIN MEDICINE
ASSISTANT IN PERIOPERATIVE ANESTHESIA MASSACHUSETTS GENERAL HOSPITAL
DEPARTMENT OF ANESTHESIOLOGY, BOSTON, MASSACHUSETTS
PERIOPERATIVE AND PAIN MEDICINE
BOSTON CHILDREN’S HOSPITAL
BOSTON, MASSACHUSETTS
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1
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Library of Congress Cataloging-in-Publication Data
Pediatric anesthesiology : a comprehensive board review / edited by Kai Matthes, Anjolie E. Laubach, Ellen Wang, T. Anthony Anderson.
p. ; cm.
Includes bibliographical references and index.
ISBN 978–0–19–939834–8 (alk. paper)
I. Matthes, Kai, editor. II. Laubach, Anjolie E., editor. III. Wang, Ellen, editor. IV. Anderson, T. Anthony, editor.
[DNLM: 1. Anesthesia—Examination Questions. 2. Anesthetics—administration & dosage—Examination
Questions. 3. Child. 4. Infant. WO 218.2]
RD139
617.9′6083—dc23
2014018476
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PREFACE
Board certification in Pediatric Anesthesiology was estab- With more than 600 questions formatted according to
lished in 2013 and provides this dynamic subspecialty with the new American Board of Anesthesiology standards,
a mechanism to formally recognize expertise in periop- this text includes a comprehensive review of each subtopic
erative care for pediatric patients undergoing surgical and in the content outline. Each answer discussion provides a
diagnostic procedures. The field of Pediatric Anesthesiology thorough overview of the subject and includes key points
continues to expand and now includes the subspecialties of after each question, which allows for efficient review of the
chronic pain management and ultrasound-guided regional subject matter for rapid recall. Numerous figures and tables
anesthesia. Individuals who practice this discipline must allow for efficient consolidation of key facts during review.
complete a 4-year Anesthesiology residency followed by a 1- Furthermore, references after each answer discussion pro-
to 2-year Pediatric Anesthesiology fellowship. Additional vide readers with resources to major texts and seminal
training in pediatric cardiac anesthesia, intensive care, papers on each subject matter.
pain management, and regional anesthesia can be pursued We are grateful to our contributing authors for sharing
as well. their expertise through the question-and-answer format
This textbook was compiled as a high-yield study employed in this textbook. Their efforts have made this
aid that will assist Anesthesiology residents, Pediatric project successful. We are also grateful for the support of
Anesthesiology attending physicians, and certified regis- Drs. Paul Hickey and Mark Rockoff of Boston Children’s
tered nurse anesthetists (CRNAs) to rapidly consolidate Hospital, whose support and encouragement made this
knowledge in the fundamentals of this specialty while pre- endeavor possible. We are also indebted to the staff at
paring for written certification in anesthesiology, pediatric Oxford University Press, particularly Andrea Seils and
subspecialty certification, and in the routine care of their Rebecca Suzan.
patients. We hope that you find Pediatric Anesthesiology:
The textbook follows the published American Board of A Comprehensive Board Review a valuable addition to the
Anesthesiology Pediatric Anesthesiology certification con- materials used in preparation for the written certification
tent outline. Major topics include basic sciences, organ-based examination as well as in the daily care of your patients.
clinical sciences, subspecialties, and special techniques.
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CONTENTS
Contributors ix 11. Genetics 289
Monica A. Hoagland
SECTION I
BASIC SCIENCE SECTION III
CLINICAL SUBSPECIALTIES
1. Anatomy 3
Amber N. Borucki and Herodotos Ellinas 12. Fetal 325
2. Physics and Anesthesia Equipment 21 Matthew C. Wang
James Peyton, Matthew C. Gummerson, 13. Neonatal 351
Radhamangalam J. Ramamurthi, Albert Yeung,
Matthew C. Gummerson, Maria Irwin, Laura
and Robert M. Brustowicz
Leduc, and Jennifer Dearden
3. Pharmacology 42
14. Painful Disease States 401
Lauren R. Kelly Ugarte, Daniel Agne, and
Aykut Bilge, Jason S. Lee, and Pascal Scemama
Chul-Kyun Park
de Gialluly
15. Otolaryngology 420
Daniel K. Broderick and Pacifico Tuason
SECTION II
16. Plastic and Oral-Maxillary Facial Surgery 445
ORGAN-BASED BASIC AND CLINICAL
Dusica Bajic
SCIENCES
17. Ophthalmology 462
Aman Kalra, Tasneem T. Dohadwala, and
4. Respiratory System 79
Najma Mehter
Anjali Koka, Elizabeth C. Eastburn, and
18. Orthopedic Surgery 475
Raymond Park
Solmaz P. Manuel, Christine L. Mai, and Robert
5. Cardiovascular System 99
Brustowicz
Audrius Zibaitis, Tomas Walsh, David A. August,
19. Trauma and Burns 489
Jamie Rubin, Vincent Collard, Hayden Nguyen,
Scott Pritzlaff, and Annette Schure Cathie Jones
6. Central Nervous System 176
Ryan Palacio, Megan Clinton, Albert Yeung,
SECTION IV
Meredith Brooks, and Herodotos Ellinas
7. Gastrointestinal System 211 CLINICAL SCIENCE OF ANESTHESIA
Luke S. Janik, Somaletha T. Bhattacharya, and
Laura A. Downey 20. Evaluation of Coexisting Disease 509
8. Renal and Urinary System 237 Jacob T. Arnett and Chien-Hsiang Chow
Amy E. Vinson 21. Fluid, Electrolyte, and Temperature Management 543
9. Endocrine/Metabolic System 249 Cornelius Sullivan and Robert M. Brustowicz
Birgit Maass 22. Regional Anesthesia 553
10. Hematology/Oncology 266 Michael R. King, Nisha Kandiah,
Patcharee Sriswasdi Karen Boretsky, and T. Anthony Anderson
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23. General Anesthesia 584 SECTION V
Bryan M. Sabbe SPECIAL PROBLEMS OR ISSUES
24. Complications of Anesthesia 609
Andrew Infosino and Marla Ferschl 27. Professional Issues 655
25. Special Techniques and Situations 629 Solmaz P. Manuel and Christine L. Mai
Raymond Park and Elizabeth C. Eastburn 28. Principles of Biostatistics and Study Design 664
26. Postoperative Period 639 Herodotos Ellinas and D. John Doyle
Laura A. Downey, Herodotos Ellinas, and
Aykut Bilge
Index 681
viii • Contents
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CONTRIBUTORS
Daniel Agne, DO Aykut Bilge, MD, PhD
Department Anesthesiology, Perioperative and Instructor in Anaesthesia
Pain Medicine Harvard Medical School
Stanford University School of Medicine Associate in Perioperative Anesthesia and Assistant
Stanford, California in Pain Medicine
Department of Anesthesiology, Perioperative and Pain Medicine
Richard Anderson, MD Boston Children’s Hospital
Department of Anesthesia, Critical Care and Boston, Massachusetts
Pain Medicine
Harvard Medical School Karen Boretsky, MD
Massachusetts General Hospital Instructor in Anesthesia
Boston, Massachusetts Harvard Medical School
Department of Anesthesia, Perioperative and Pain Medicine
Jacob T. Arnett, MD Boston Children’s Hospital
Department of Anesthesiology Boston, Massachusetts
University of Kansas School of Medicine
Wichita, Kansas Amber N. Borucki, MD
Harvard Medical School
David A. August, MD, PhD
Department of Anesthesiology, Perioperative and Pain
Lecturer on Anesthesia
Medicine
Department of Anesthesia, Critical Care and
Boston Children’s Hospital
Pain Medicine
Boston, Massachusetts
Harvard Medical School
Massachusetts General Hospital
Daniel K. Broderick, MD
Boston, Massachusetts
Department of Anesthesia, Critical Care and Pain Medicine
Dusica Bajic, MD, PhD Harvard Medical School
Massachusetts General Hospital
Assistant Professor of Anaesthesia
Boston, Massachusetts
Harvard Medical School
Assistant in Perioperative Anesthesia
Department of Anesthesiology, Perioperative and Pain Medicine Meredith Brooks, MD, MPH
Boston Children’s Hospital Clinical Assistant Professor of Pediatric Anesthesia and Pain
Boston, Massachusetts Management
Stanford University Schools of Medicine
Somaletha T. Bhattacharya, MD, FFARCSI Lucile Packard Children’s Hospital
Instructor in Anesthesia Stanford, California
Department of Anesthesia, Critical Care and Pain Medicine
Harvard Medical School Robert M. Brustowicz, MD
Massachusetts General Hospital Assistant Professor of Anaesthesia
Boston, Massachusetts Harvard Medical School
Senior Associate in Perioperative Anesthesia
Vipul Bhimani, MD Department of Anesthesiology, Perioperative and Pain
Department of Anesthesiology Medicine
University of Kansas School of Medicine Boston Children’s Hospital
Wichita, Kansas Boston, Massachusetts
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