| Popis: |
Summary Anaesthesia for paediatric neurosurgery requires an intimate knowledge of the pathophysiology and control of raised ICP, and also of the physiology of small children. The main differences in practice between an adult and paediatric population are related to the higher metabolic rate of the child with greater oxygen demands and increased speed of development of hypoxia. The relatively large head results in much greater blood losses and the difficulties in accurate assessment of these losses common to all neurosurgery. Patients with small blood volumes may frequently require exchange transfusions and are therefore liable to the complication of massive transfusion, though in general children cope extremely well with large transfusions provided they do not become hypovolaemic, acidotic or hypoxic. Temperature control is another major factor in neurosurgery in small children because of the large surface area exposed during prolonged surgery, or even short procedures in those with poor central control. These potentially complex operations require close cooperation between the surgeon and anaesthetist, and also an anaesthetist who is confident in dealing with all aspects of anaesthesia in children, constantly alert to the mishaps which can so readily develop. |
