When your child needs medical treatment, you want him or her to have the very best care available. Therefore, it stands to reason that if your child needs an operation, you will want to consult with a surgeon who is qualified and experienced in operating on children. Surgeons who specialize in general surgery often provide surgical care for children, and they are fully qualified to perform many operations on children. In more urbanized areas of the country, another kind of surgeon - the pediatric surgeon - is also available to provide comprehensive surgical care for children. Pediatric surgeons operate on children whose development ranges from the newborn stage through the teenage years.
In addition to completing training and achieving board certification, pediatric surgeons complete two additional years of training exclusively in children's surgery. They then receive special certification in the subspecialty of pediatric surgery. What is the pediatric surgeon's role in treating the child? Pediatric surgeons are primarily concerned with the diagnosis, preoperative, operative, and postoperative management of surgical problems in children. Some medical conditions in newborns are not compatible with a good quality of life unless these problems are corrected surgically. These conditions must be recognized immediately by neonatologists, pediatricians, and family physicians. Pediatric surgeons cooperate with all of the specialists involved in a child's medical care to determine whether surgery is the best option for the child. What is the focus of pediatric surgery? Pediatric surgeons utilize their expertise in providing surgical care for all problems or conditions affecting children that require surgical intervention. They also have particular expertise in the following areas of responsibility:
Neonatal - * Pediatric surgeons have specialized knowledge in the surgical repair of birth defects, some of which may be life threatening to premature and full-term infants.
Prenatal - * Pediatric surgeons, in cooperation with radiologists, use ultrasound and other technologies during the fetal stage of a child's development to detect any abnormalities. They can then plan corrective surgery and educate and get to know parents before their baby is born. Prenatal diagnosis may lead to fetal surgery, which is a new forefront in the subspecialty of pediatric surgery. Application of most fetal surgical techniques is still in the experimental stage.
Trauma - * Because trauma is the number one killer of children in the United States, pediatric surgeons are routinely faced with critical care situations involving traumatic injuries sustained by children that may or may not require surgical intervention. Many pediatric surgeons are involved in accident prevention programs in their communities that are aimed at curbing traumatic injuries in children.
Pediatric Oncology - * Pediatric surgeons are involved in the diagnosis and surgical care of children with malignant tumors as well as those with benign growths.
Pediatric surgeons specialize in the surgical care of
children. They are surgeons who, by training, are oriented toward working with
children and understanding their special needs.Pediatric surgeons are able to save whole lifetimes, and have the
opportunity to follow their patients through a productive young life into
adulthood. We have two general pediatric surgeons, three orthopedic pediatric
surgeons, and one pediatric urological surgeon in Wichita.
The pediatric patient requires special attention and care in the PACU (Post Anesthesia Care Unit). The nurse must be ever vigilant for potential complications that can occur in the pediatric population. There are major differences between pediatric postoperative patients and adult postoperative patients. We will deal with some of these differences in the text that follows. Children and infants have more airway difficulties including obstruction, stridor, laryngospasm, and hypoventilation.
As with all post anesthesia patients careful monitoring of p02, blood pressure, EKG and pulse, respirations, and temperature is especially crucial in the pediatric patient. Immediate interventions must be instituted with our pediatric patients.
Common problems in the pediatric patients include airway obstruction, croup, and aspiration. An airway of children under the age of five differs dramatically from the adult airway. Infants and neonates have proportionately large heads, short necks, and large tongues that can easily exacerbate airway obstruction. Laryngeal spasm in the newborn, and infant is especially frightening to new nurses in the PACU. Treated promptly and effectively however, laryngospasm does not have to be life ending.
Intubation prior to the institution of general anesthesia is more difficult for anesthesia personnel to perform than in the adult. The larynx is more cephalad in the infant and the shape and angle of the epiglottis is different as well. Since children have large heads and short necks, hyperextension of the neck can by itself cause airway obstruction. Adults respond to hypoxia and hypercarbnia with stimulation of the respiratory drive whereas neonates respond with respiration depression. Infants respond with an increased respiratory effort depleting glycogen stores when hypoxic.
Since the infant's airway is so small and has more areolar tissue around the glottis, 1mm increase in edema can reduce the airway lumen by 75% producing life-threatening airway obstruction. Symptoms of increasing laryngeal edema will include:
Other physiological differences in the pediatric patient vs. adult patient should be noted as well. The thoracic cage of the infant is small, with the ribs positioned at a more horizontal slant than the downward slope of the adult. The adult uses a "bucket handle" type of respiratory motion to expand the chest cavity, while the infant relies on diaphragmatic-abdominal breathing. There is a significant difference between the respiratory rates of the adult and those of the infant and child. The respiratory rate is higher for the infant and child due to greater oxygen demand and increased metabolic rate. The average respiratory rate for the infant is 40 breaths per minute.
The preschooler averages 30 breaths per minute, while the school-aged child averages 20 breaths per minute. Since the infant has a metabolic rate twice as high as the adult, his or her ventilatory requirement per unit lung volume is greatly increased. The infant also has less reserve in lung surface area; the small airways are the primary cause of airway resistance in the pediatric patient under 5 whereas, in the adult, the larger airways are the more significant factory in airway obstruction. Lung compliance is higher in infants and children than adults, tending to cause premature closure of small airways.
Any questions or suggestions: e-mail author.
© Copyright April 2000 by Ken Jones.
