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Anesthesia in Pediatric Urology

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Abstract

Anesthesia in pediatric urology presents some aspects typical to this surgery.

Urological pathologies are many and include a wide variety of treatments for brief and simple surgery in day surgery but also for difficult pathologies and in severe clinical conditions.

Preoperative evaluation allows the benefit/risk to be considered for each procedure and guides the choice of anesthesiological planning.

Specific aspects such as latex allergy, coexisting pathology, renal failure, and fluid-electrolyte balance must be considered with particular attention.

Anesthesiological management, today, foresees combined general-regional anesthesia to provide safe and effective pain relief during and after surgery. Standard intraoperative monitoring is applied in accordance with the indications of the safety guidelines.

Renal transplantation is considered apart because the appropriate choice of anesthesia for these patients requires minimal toxicity and accurate monitoring for patients at high risk for metabolic, cardiovascular, and respiratory perioperative complications.

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References

  1. Kalkman CJ, Peelen L, Moons KG, Veenhuizen M, Bruens M, Sinnema G, de Jong TP (2009) Behavior and development in children and age at the time of first anesthetic exposure. Anesthesiology 110(4):805–812

    Article  PubMed  Google Scholar 

  2. Wilder RT, Flick RP, Sprung J et al (2009) Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology 110:796–804

    Article  PubMed Central  PubMed  Google Scholar 

  3. Serafini G, Ingelmo PM, Astuto M, Baroncini S, Borrometi F, Bortone L, Ceschin C, Gentili A, Lampugnani E et al (2014) Preoperative evaluation in infants and children: recommendations of the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI). Minerva Anestesiol 80(4):461–469

    CAS  PubMed  Google Scholar 

  4. Gandhi M, Vashisht R (2010) Anaesthesia for paediatric urology. Contin Educ Anaesth Crit Care Pain 10(5):152–157

    Article  Google Scholar 

  5. Han KR, Kim HL, Pantuck AJ (2004) Use of ASA classification to assess perioperative risk in patients undergoing radical nephrectomy for renal cell carcinoma. Urology 63:841–846

    Article  PubMed  Google Scholar 

  6. Freilich DA, Cilento BG Jr, Graham D, Zhou J, Retik AB, Nguyen HT (2010) Perioperative risk factors for surgical complications in pediatric urology: a pilot study in preoperative risk assessment in children. Urology 76(1):3–8

    Article  PubMed  Google Scholar 

  7. Committee ASA on Standards and Practice Parameters (2011) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by ASA Committee on Standards and Practice Parameters. Anesthesiology 114:495–511

    Article  Google Scholar 

  8. Murat I (2000) Latex allergy: were are we? Paediatr Anaesth 10:577–579

    Article  CAS  PubMed  Google Scholar 

  9. Bernardini R, Novembre E, Lombardi E et al (1999) Risk factors for latex allergy in patients with spina bifida and latex sensitization. Clin Exp Allergy 29:681–686

    Article  CAS  PubMed  Google Scholar 

  10. Ricci G, Gentili A, Di Lorenzo F et al (1999) Latex allergy in subjects who had undergone multiple surgical procedures for bladder exstrophy: relationship with clinical intervention and atopic diseases. BJU Int 83:1058–1062

    Google Scholar 

  11. Gentili A, Ricci G, Di Lorenzo FP, Pigna A, Masi M, Baroncini S (2003) Latex allergy in children with oesophageal atresia. Paediatr Anaesth 13:668–675

    Article  CAS  PubMed  Google Scholar 

  12. Holzman RS (1997) Clinical management of latex-allergic children. Anesth Analg 85:529–533

    CAS  PubMed  Google Scholar 

  13. Gentili A, Lima M, Ricci GP, Pigna A, Fae M, Masi M, Baroncini S (2007) Perioperative treatment of latex-allergic children. J Patient Saf 3(3):166–172

    Google Scholar 

  14. Gentili A, Ricci GP, Di Lorenzo F, Pigna A, Tonini C, Baroncini S (2001) Latex allergy in pediatric age: an interdisciplinary perioperative management and case reports. Minerva Anestesiol 67(1–2):29–40

    CAS  PubMed  Google Scholar 

  15. Lindahal SG (1988) Energy expenditure and fluid and electrolyte requirements in anesthetized infants and children. Anesthesiology 69(3):377–382

    Article  Google Scholar 

  16. Holliday M, Segar W (1957) The maintenance need for water in parenteral fluid therapy. Pediatrics 19:823–832

    CAS  PubMed  Google Scholar 

  17. Lönnqvist PA (2007) Inappropriate perioperative fluid management in children: time of solution. Paediatr Anaesth 17:203–205

    Article  PubMed  Google Scholar 

  18. Murat I, Dubois MC (2008) Perioperative fluid therapy in pediatrics. Paediatr Anaesth 18(5):363–370

    Article  PubMed  Google Scholar 

  19. Gregory GA (2012) Gregory’s pediatric anesthesia. Wiley-Blackwell, Chichester

    Book  Google Scholar 

  20. Hayes-Jordan A, Green H, Ludwig J, Anderson P (2012) Toxicity of hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric patients with sarcomatosis/carcinomatosis: early experience and phase 1 results. Pediatr Blood Cancer 59(2):395–397

    Article  CAS  PubMed  Google Scholar 

  21. Owesu-Aagymang P, Arunkumar R, Green H, Hurstd D, Landoski K, Hayes-Jordan A (2012) Anesthetic management and renal functional in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin. Ann Surg Oncol 19(8):2652–2656

    Article  Google Scholar 

  22. Gruppo di Studio SIAARTI “Vie Aeree Difficili”, Frova G et al (2006) Recommendations for airway control and difficult airway management in paediatric patients. Minerva Anestesiol 72(9):723–748

    CAS  PubMed  Google Scholar 

  23. Bresil P, Nielsson MS, Malver LP, Kraemer K, Schjørring O, Dethlefsen C, Lambert PH (2013) Impact of bispectral index for monitoring propofol remifentanil anaesthesia. A randomised clinical trial. Acta Anaesthesiol Scand 57(8):978–987

    Article  CAS  PubMed  Google Scholar 

  24. www.drugs.com/pro/sevoflurane.html

  25. Ghanta S, Abdel-Latif ME, Lui K, Ravindranathan H, Awad J, Oei J (2007) Propofol compared with the morphine, atropine, and suxamethonium regimen as induction agents for neonatal endotracheal intubation: a randomized, controlled trial. Pediatrics 119(6):1248–1255

    Article  Google Scholar 

  26. Papoff P, Mancuso M, Caresta E, Moretti C (2008) Effectiveness and safety of propofol in newborn infants. Pediatrics 121(2):448–449

    Article  PubMed  Google Scholar 

  27. Shah PS, Shah VS (2011) Propofol for procedural sedation/anaesthesia in neonates. Cochrane Database Syst Rev (3):CD007248

    Google Scholar 

  28. Allegaert K, de Hoon J, Verbesselt R, Naulaers G, Murat I (2007) Maturational pharmacokinetics of single intravenous bolus of propofol. Paediatr Anaesth 17(11):1028–1034

    Article  PubMed  Google Scholar 

  29. Allegaert K, Peeters MY, Verbesselt R et al (2007) Inter-individual variability in propofol pharmacokinetics in preterm and term neonates. Br J Anaesth 99(6):864–870

    Article  CAS  PubMed  Google Scholar 

  30. Allegaert K, De Hoon J, Naulaers G, Van De Velde M (2008) Neonatal clinical pharmacology: recent observations of relevance for anaesthesiologists. Acta Anaesthesiol Belg 59:283–288

    CAS  PubMed  Google Scholar 

  31. Skinner AV (2010) Neonatal pharmacology. Anaesth Intensive Care 12(3):79–84

    Article  Google Scholar 

  32. Tobias JD, Flannagan J, Brock J, Brin E (1993) Neonatal regional anesthesia: alternative to general anesthesia for urologic surgery. Urology 41(4):362–365

    Article  CAS  PubMed  Google Scholar 

  33. Bernstein S (1993) Regional anesthesia for urological surgery. Int Anesthesiol Clin 31(1):57–66

    Article  CAS  PubMed  Google Scholar 

  34. Dalens B (2006) Some current controversies in paediatric regional anaesthesia. Curr Opin Anaesthesiol 19(3):301–308

    Article  PubMed  Google Scholar 

  35. Ecoffey C, Locroix F, Giaufre E (2010) Epidemiology and morbidity of regional anesthesia in children: a follow up one-year survey prospective of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Pediatr Anaesth 20:1061–1069

    Article  Google Scholar 

  36. Bordet AEF, Duflo F, Lanais S, Combet S, Taylor P, Pouyau A, Paturel B, James R, Allaouchiche B, Chassard D (2003) Patient-controlled epidural analgesia versus continuous epidural infusion with ropivacaine for postoperative analgesia in children. Anesth Analg 97:1608–1611

    Article  PubMed  Google Scholar 

  37. Pavar D (2004) Regional anaesthesia in pediatric patients. Indian J Anaesth 48(5):394–399

    Google Scholar 

  38. Denny NM, Harrop-Griffiths W (2005) Location, location, location! Ultrasound imaging in regional anaesthesia. Br J Anaesth 94(1):1–3

    Article  CAS  PubMed  Google Scholar 

  39. Schug SA, Saunders D, Kurowski I, Paech MJ (2006) Neuraxial drug administration: a review of treatment options for anaesthesia and analgesia. CNS Drugs 20(11):917–933

    Article  CAS  PubMed  Google Scholar 

  40. Samol NB, Furstein JS, Moore DL (2012) Regional anesthesia and pain management for the pediatric patient. Int Anesthesiol Clin 50(4):83–95

    Article  PubMed  Google Scholar 

  41. Murrell D, Gibson PR, Cohen RC (1993) Continuous epidural analgesia in newborn infants undergoing major surgery. J Pediatr Surg 28:548–553

    Article  CAS  PubMed  Google Scholar 

  42. Ruston FG (1961) Epidural anaesthesia in paediatric surgery. Present status in the Hamilton General Hospital. Can Anaesth Soc J 11:12–34

    Article  Google Scholar 

  43. Spiegel P (1962) Caudal anesthesia in paediatric surgery: a preliminary report. Anesth Analg 41:219–221

    Article  Google Scholar 

  44. Fortuna A (1967) Caudal analgesia: a simple and safe technique in paediatric surgery. Br J Anaesth 39:165–170

    Article  CAS  PubMed  Google Scholar 

  45. Anand KJ, Sippell WG, Aynsley-Green A (1987) Randomized trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. Lancet 1:62–66

    Article  CAS  PubMed  Google Scholar 

  46. Sara CA, Lowrt CJ (1984) A complication of circumcision and dorsal nerve block of the penis. Anesth Intensive Care 13:79–85

    Google Scholar 

  47. Dalens B, Vanneuville G, Dechellotte P (1989) Penile block via subpubic space in 100 children. Anesth Analg 69:41–45

    CAS  PubMed  Google Scholar 

  48. Cyna AM, Middleton P (2008) Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys. Cochrane Database Syst Rev 8(4):CD003005

    Google Scholar 

  49. Kundra P, Yuvaraj K, Agrawal K, Krishnappa S, Kumar LT (2012) Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block. Paediatr Anaesth 22(7):707–712

    Article  PubMed  Google Scholar 

  50. Willschke H, Bösenberg A, Marhofer P, Johnston S, Kettner S, Eichenberger U et al (2006) Ultrasonographic-guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: what is the optimal volume? Anesth Analg 102(6):1680–1684

    Article  CAS  PubMed  Google Scholar 

  51. Willschke H, Bösenberg A, Marhofer P, Johnston S, Kettner SC, Wanzel O, Kapral S (2006) Ultrasonography-guided rectus sheath block in paediatric anaesthesia-a new approach to an old technique. Br J Anaesth 97(2):244–249

    Article  CAS  PubMed  Google Scholar 

  52. Mai CL, Young MJ, Quraishi SA (2012) Clinical implications of the transversus abdominis plane block in pediatric anesthesia. Paediatr Anaesth 22(9):831–840

    Article  PubMed  Google Scholar 

  53. Marks JL, Ata B, Tulandi T (2012) Systematic review and metaanalysis of intraperitoneal instillation of local anesthetics for reduction of pain after gynecologic laparoscopy. J Minim Invasive Gynecol 19(5):545–553

    Article  PubMed  Google Scholar 

  54. Chalkiadis G (2003) The rise and fall of continuous epidural infusions in children. Paediatr Anaesth 13:91–93

    Article  PubMed  Google Scholar 

  55. Williams M, Milner QK (2003) Postoperative analgesia following renal transplantation – current practice in the UK. Anaesthesia 58:712–713

    Article  CAS  PubMed  Google Scholar 

  56. Dawidson I, Berglin E, Brynger H et al (1987) Intravascular volumes and colloid dynamics in relation to fluid management in living related kidney donors and recipients. Crit Care Med 15:631–636

    Article  CAS  PubMed  Google Scholar 

  57. Giessing M, Muller D, Winkelmann B, Roigas J, Loening SA (2007) Kidney transplantation in children and adolescents. Transplant Proc 39(7):2197–2201

    Article  CAS  PubMed  Google Scholar 

  58. Coupe N, O’Brien M, Gibson P, de Lima J (2005) Anesthesia for pediatric renal transplantation with and without epidural analgesia-a review of 7 years experience. Paediatr Anaesth 15(3):220–228

    Article  PubMed  Google Scholar 

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Correspondence to Simonetta Baroncini .

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Baroncini, S., Fae, M., Gentili, A., Mondardini, C. (2015). Anesthesia in Pediatric Urology. In: Lima, M., Manzoni, G. (eds) Pediatric Urology. Springer, Milano. https://doi.org/10.1007/978-88-470-5693-0_4

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  • DOI: https://doi.org/10.1007/978-88-470-5693-0_4

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