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All patients presenting for surgical procedures under anesthesia benefit greatly from a thorough preanesthetic/preoperative assessment and targeted preparation, which serve to optimize any coexisting medical conditions and minimize the potential for complications. An increasing number of procedures are being performed on an outpatient basis, and the preoperative assessment and preparation often occurs...
Birth defects are increasingly being identified prenatally, allowing the pediatric surgeon to become involved before presentation in the neonatal intensive care unit. Congenital malformations are the most frequent cause of mortality during the first year of life, accounting for approximately 20% of all infant deaths in the United States. The overall risk of birth defects for any couple undertaking...
Children undergoing surgical procedures benefit from many improvements in pain management that have occurred over the past few decades. These enhancements are the result of changes in the attitudes of physicians, nurses, hospital administrators, and patients and their families, coupled with increased pressure from external regulatory agencies mandating the adequate assessment and effective treatment...
Providing adequate nutrition is necessary for infants and children to grow and develop properly, especially following major surgery or trauma when catabolic demands are greater than normal. However, the need to provide additional nutritional support is sometimes overlooked as we focus on treating the primary disease and managing complications in the perioperative period.
Parenteral nutrition has advanced significantly since it was first developed by Shohl and colleagues in 1939. Numerous early problems included allergic reactions to heterogeneous protein hydrosylates, side effects from intravenous fat preparations, and sclerosing of peripheral veins due to hyperosmolar infusions. Over time, protein hydrosylates were replaced by amino acid preparations, the development...
It is increasingly clear that the application of systematic and evidence-based perioperative protocols can help make patients more comfortable and hasten their recovery. Many also believe that patient care should be straightforward and that patients should not be subjected to the discomfort and indignity of unnecessary procedures, worthless rituals, and therapies that are not supported by scientific...
Historically, there has been a great disparity in the advancement of pediatric clinical services and the development of pediatric quality and safety indicators. The development and expansion of pediatric care in the United States began with the opening of the Children’s Hospital of Philadelphia in 1855. Despite this major advancement in the organization and administration of medical care for the pediatric...
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