By Jacob C. Langer, Craig T. Albanese
This authoritative advisor stories the evoloving evidence-based literature for a wide selection of approaches and methods in pediatric minimum entry surgical procedure (MAS)-providing expertly-written chapters that hide the options particular to a vast variety of ailments, in addition to present advances in urology, neurosurgery, and spinal and cardiac surgical procedure.
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Extra info for Pediatric Minimal Access Surgery (No Series)
In adults, transient cellular and humoral immunosuppression after a different degree of operative stress has been well documented (8,9). Such immunological studies in the neonate are largely absent. In 1-week-old rats, however, immunosuppression up to 7 days depending on the degree of invasiveness of the procedure was demonstrated (10). Incisions and the subsequent scars are permanent and do grow proportionally with the child. Moreover, as the newborn and especially the premature newborn lacks subcutaneous fat, the skin scar may become adherent to the fascia giving a poor cosmetic result.
Balloon Occlusion Bronchial Blockers. , Redding, PA), and the Arndt Endobronchial Blocker (Cook Critical Care, Bloomington, IN) may be used to seal the bronchus on the operative side. The catheter may be placed into the trachea under direct vision with laryngoscopy. Following this the trachea is intubated with an appropriate sized ET. Using a FOB via a swivel adapter in the ET, the catheter is manipulated into the operative mainstem bronchus. Care is taken to assure that the ET remains above the carina.
When it becomes severe in the neck, subcutaneous emphysema may impede respiration. It may be necessary to leave patients intubated to maintain airway patency until some of the emphysema resolves. Patients who require postoperative positive-pressure ventilation should have chest tubes left in place following thoracoscopy to avoid a pneumothorax. Though the conversion rate to open surgery is declining over time, the complexity of cases dictates that occasionally hemorrhage or technical difficulties will arise.