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Anesthesia, Intensive Care and Pain in Neonates
and Children

Marinella Astuto
Pablo M. Ingelmo Editors

Perioperative
Medicine
in Pediatric
Anesthesia
Anesthesia, Intensive Care and Pain
in Neonates and Children

Series editor:
Antonino Gullo
Marinella Astuto
Ida Salvo
Marinella Astuto • Pablo M. Ingelmo
Editors

Perioperative Medicine
in Pediatric Anesthesia
Editors
Marinella Astuto Pablo M. Ingelmo
UCO di Anestesia e Rianimazione Department of Anesthesia
AO-U Policlinico di Catania MUHC Montreal Children’s Hospital
Catania McGill University
Italy Montreal, QC
Canada

ISSN 2281-1788 ISSN 2281-1796 (electronic)

Anesthesia, Intensive Care and Pain in Neonates and Children
ISBN 978-3-319-21959-2 ISBN 978-3-319-21960-8 (eBook)
DOI 10.1007/978-3-319-21960-8

Library of Congress Control Number: 2015955168

Springer Cham Heidelberg New York Dordrecht London

© Springer International Publishing Switzerland 2016
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.

Printed on acid-free paper

Springer International Publishing AG Switzerland is part of Springer Science+Business Media

(www.springer.com)
Foreword

For some readers, the title of this book might raise a main question: why a book
on perioperative medicine in pediatric anesthesia. The reply is in the understand-
ing that the anesthesia practice has evolved from a limited environment such as
the operating room to the whole perisurgical care, starting from the time a patient
is referred by the surgical treating team till the time the infant-child has recov-
ered and is back with his own family and community. Therefore, it would make
sense that pediatric anesthesiologists apply this concept to their own milieu. The
introduction of sophisticated technology in endoscopic surgery and the better
understanding of the pathophysiology of neonatal surgical stress emphasize the
role of the anesthesiologist as a perioperative physician. For example, there has
been an expansion of regional anesthesia applied to pediatric surgery as a result
of improved and more reliable imaging techniques together with better training.
This has allowed a better quality of analgesia and accelerated recovery. Other
examples are the interactions of pediatric anesthesiologists with respiratory
physiologists and neuroscientists to better understand the control of breathing
and neurobehavioral development, thanks to major development in modern
molecular biology and physiology. Also, better monitoring has allowed complex
surgeries to be performed on an outpatient basis, and over the years a greater
proportion of surgical operations are safely performed on an outpatient basis.
Each chapter stresses the scientific principles necessary to understand and man-
age various situations encountered in pediatric anesthesia from a multidisci-
plinary point of view.
I commend Drs. Astuto and Ingelmo, both pediatric anesthesiologists in two
large pediatric institutions in Italy and Canada, respectively, who have assembled an
international group of illustrious experts to dissect the topic of perioperative pediat-
ric medicine and to present the various aspects of pediatric anesthesia care, from
preoperative preparation of the child, education of the family and optimization of
medical, physical, nutritional and psychological functions, to perioperative man-
agement of specific conditions. The last four chapters are dedicated to acute and
chronic pain and to the impact of anesthesia and surgery on the infant brain. Overall,

v
vi Foreword

these chapters will guide not only the trainee, but also the experienced and seasoned
clinicians who are interested in expanding their knowledge on topics of relevant
importance.

Francesco Carli, MD, MPhil

Department of Anesthesia
MUHC, Montreal General Hospital, McGill University,
Montreal, QC, Canada
Preface

Perioperative clinical outcomes in procedures involving infants and children have

dramatically improved in recent years. Various factors may be responsible for those
benefits such as emerging of new technologies, standardized anesthesia protocols,
minimally invasive surgeries, improvements in acute postoperative care, and wide-
spread use of perioperative safety standards, to mention just a few.
Traditionally, surgeons coordinate perioperative care of patients undergoing sur-
gery. In some European countries, most of the perioperative care relies on anesthe-
siologists and pediatricians. Perioperative medicine becomes a multidisciplinary
speciality aiming to provide continuum of care with coordinated interventions in the
preoperative, intraoperative, and postoperative periods. The collaboration among a
variety of doctors and nurses with specific pediatric training in pediatric environ-
ments allows the development of multidisciplinary clinical care pathways incorpo-
rating multiple evidence-based interventions.
With this book, we aim to provide a comprehensive overview of current practices
in pediatric perioperative care. In all sections, from the preoperative care to the
consequences of anesthesia and surgery through the perioperative care during sur-
gery and in special clinical conditions, we look for practical answers to the most
common questions of pediatric perioperative care.
This book was possible due to the efforts of an exquisite list of anesthesiologists,
pediatricians, and surgeons from Europe and North America. This international
team of contributors ranges from worldwide experts who had changed the way we
care for our patients to young specialists who will lead the future of perioperative
medicine. We are truly and deeply grateful for their collaboration and friendship.
There has been a progressive accumulation of good evidence related to periop-
erative care in the last decade. A long series of well-designed studies now permit an
evidence-based approach to pediatric perioperative care. However, translation of
research findings and guidelines into clinical practice remains a significant barrier
affecting real clinical scenarios. Differences in type of surgeries, ages, interven-
tions, clinical settings, and their interaction justify the need of establishing proce-
dure-specific perioperative programs. Perioperative care is a multidimensional
phenomenon, requiring multimodal management plan and strategies. It is evident
that not a single specialist is able to provide solutions in all circumstances.
Perioperative medicine gives us a unique opportunity to re-imagine the

vii
viii Preface

anesthetic-surgical-pediatrician relationship. This partnership should not continue

to be experienced as independent entities divided by the operating theater “blood-
brain barrier,” but as a united team working towards the shared goal of optimal
patient trajectory throughout the perioperative process to normality.

Catania, Italy Marinella Astuto, MD

Montreal, QC, Canada Pablo Mauricio Ingelmo, MD
Acknowledgments

I would like to express my deep gratitude to Professor Gullo for his patient guidance
and enthusiastic encouragement of my work.
I would also like to thank my dear friend Dr. Pablo Ingelmo for his invaluable
support throughout the planning and development phases of this book. Finally, I
thank all the authors who honored me with their contributions.
Prof. Marinella Astuto M.D.

I wish to thank my wife, Francesca, and my sons, Matteo and Marco, for their
patient support. I also wish to thank Prof. Miguel Angel Paladino and Prof. Roberto
Fumagalli for their mentorship in shaping my clinical and academic career, and to
the KISS group to make it valuable. Finally, this would not be possible without my
friends: Walter, Marinella, and Pierre.
Pablo M. Ingelmo M.D.

ix
Contents

1 Perioperative Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Gabriele Baldini

Part I Perioperative Care Before Surgery

2 Preoperative Evaluation in Pediatric Anesthesia . . . . . . . . . . . . . . . . 11

Giovanni Mangia, Caterina Patti, and Paola Presutti
3 Preoperative Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Luciano Bortone, Luca La Colla, and Marinella Astuto
4 Preoperative Consideration in Common Pathological
and Nonpathological Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Marinella Astuto, Gianpaolo Serafini, Simonetta Baroncini,
Fabio Borrometi, Luciano Bortone, Cristina Ceschin,
Andrea Gentili, Elisabetta Lampugnani, Giovanni Mangia,
Luisa Meneghini, C. Minardi, Giovanni Montobbio,
Francesca Pinzoni, Barbara Rosina, Carlotta Rossi,
Marina Sammartino, Emre Sahillioğlu, Rita Sonzogni,
Valter Sonzogni, Simonetta Tesoro, Costanza Tognon,
Tiziana Tondinelli, Nicola Zadra, and Pablo M. Ingelmo

Part II Perioperative Care During Surgery

5 Perioperative Care in Day Hospital Surgery. . . . . . . . . . . . . . . . . . . . 55

Simonetta Tesoro and Laura Marchesini
6 Perioperative Care in Remote Locations . . . . . . . . . . . . . . . . . . . . . . . 75
Maria Sammartino, Fabio Sbaraglia,
and Francesco Antonio Idone
7 Perioperative Care in Paediatric Orthopaedic Surgery . . . . . . . . . . . 87
A.U. Behr
8 Perioperative Care of the Pediatric Neurosurgical Patient . . . . . . . . 115
Massimo Lamperti

xi
xii Contents

9 Pain After Surgical Correction of Congenital Chest

Wall Deformities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Robert Baird and Pablo M. Ingelmo
10 General Approach to Abdominal and Pelvic Procedures. . . . . . . . . . 137
Jean-Francois Courval

Part III Perioperative Care in Special Situations and Conditions

11 Perioperative Care of Children with a Difficult Airway . . . . . . . . . . 147

Alan Barnett and Thomas Engelhardt
12 Perioperative Care of Children with Neuromuscular Disease. . . . . . 159
Fabrizio Racca and Chiara Robba
13 Perioperative Care of Children with a Metabolic Disease . . . . . . . . . 175
Veyckemans Francis and Scholtes Jean-Louis
14 Perioperative Care of Children with OSA. . . . . . . . . . . . . . . . . . . . . . 187
Gianluca Bertolizio and Karen Brown
15 Perioperative Care of Children with Trauma . . . . . . . . . . . . . . . . . . . 213
Leonardo Bussolin
16 Perioperative Care of Children with Cancer. . . . . . . . . . . . . . . . . . . . 229
Navi Virk, B. Senbruna, and Jerrold Lerman
17 Perioperative Care of Children with Cerebral Palsy
and Behavioral Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Martin Jöhr and Thomas M. Berger
18 Perioperative Care of Neonates with Airway Obstruction . . . . . . . . 273
Pierre Fiset and Sam J. Daniel

Part IV Important Techniques for Perioperative Care

19 Vascular Access in the Perioperative Period . . . . . . . . . . . . . . . . . . . . 285

Thierry Pirotte
20 US-Guided Nerve Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Giorgio Ivani and Valeria Mossetti
21 Noninvasive Hemodynamic and Respiratory Monitoring
During the Perioperative Period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Brian Schloss and Joseph D. Tobias

Part V Early and Long Term Consequences of Anesthesia

and Surgery

22 Negative Behaviour After Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

Marta Somaini and Pablo M. Ingelmo
Contents xiii

23 Acute Pain Management and Prevention . . . . . . . . . . . . . . . . . . . . . . 417

Sylvain Tosetti
24 Long-Term Consequences of Anesthesia (and Surgery)
on the Infant Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
Tom Giedsing Hansen
25 Prevention of Chronic Postsurgical Pain . . . . . . . . . . . . . . . . . . . . . . . 447
Gonzalo Rivera
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
Contributors

Marinella Astuto Anesthesia, Intensive Care, University of Catania, Policlinico

Hospital, Catania, Italy
Dipartimento di Anestesia e Rianimazione, Ospedale Universitario Policlinico,
Catania, Italy
Robert Baird, MDCM, MSc, FRCSC, FACS Department of Pediatric Surgery,
MUHC, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
Gabriele Baldini, MD, MSc Department of Anesthesia, Montreal General
Hospital, McGill University Health Center, Montreal, QC, Canada
Alan Barnett Department of Surgery, Radiology, Anaesthesia and Intensive Care,
The University of the West Indies, Mona, Jamaica, West Indies
Simonetta Baroncini Dipartimento di Anestesia e Rianimazione Pediatrica,
Ospedale S. Orsola-Malpighi, Università di Bologna, Bologna, Italy
A. U. Behr Istituto di Anestesia e Rianimazione, Azienda Ospedaliera Università,
Padova, Italy
Thomas M. Berger Neonatal and Pediatric Intensive Care Unit,
Children’s Hospital, Luzern, Switzerland
Gianluca Bertolizio Department of Anesthesia, Montreal Children’s Hospital,
McGill University, Montreal, QC, Canada
Fabio Borrometi Servizio di Cure Palliative e Terapia del Dolore,
Ospedale Santobono Pausilipon, Napoli, Italy
Luciano Bortone First Service of Anesthesia and Intensive Care, Parma Hospital,
Parma, Italy,
Dipartimento di Anestesia e Rianimazione, Azienda Ospedaliera di Parma,
Parma, Italy
Karen Brown Department of Anesthesia, Montreal Children’s Hospital,
McGill University, Montreal, QC, Canada

xv
xvi Contributors

Leonardo Bussolin Department of Neuroanesthesia and Neurointensive Care,

Pediatric Trauma Center, Pediatric Hospital Meyer, Florence, Italy
Cristina Ceschin Servizio di Anestesia e Rianimazione, Dolo Hospital,
Mirano, Italy
Jean-Francois Courval Anesthesia Department, Montreal Children’s Hospital,
Montreal, QC, Canada
Sam J. Daniel, MD, FRCPC Department of Pediatric Surgery and
Otolaryngology, Montreal Children’s Hospital, MUHC, McGill University,
Montreal, QC, Canada
Thomas Engelhardt Department of Anaesthesiology, Royal Aberdeen
Children’s Hospital, Aberdeen, UK
Pierre Fiset, MD, FRCPC Department of Anesthesia, Montreal Children’s
Hospital, MUHC, McGill University, Montreal, QC, Canada
Veyckemans Francis, MD Anesthesiology, Cliniques universitaires St Luc,
Université Catholique de Louvain, Bruxelles, Belgium
Andrea Gentili Dipartimento di Anestesia e Rianimazione Pediatrica,
Ospedale S. Orsola-Malpighi, Università di Bologna, Bologna, Italy
Tom Giedsing Hansen, MD, PhD Department of Anesthesiology and Intensive
Care – Pediatric Section, Odense University Hospital, Odense, Denmark
Institute of Clinical Research – Anesthesiology, University of Southern Denmark,
Odense, Denmark
Francesco Antonio Idone Department of Anesthesia and Intensive Care,
Catholic University of Sacred Heart, Training Hospital “A. Gemelli”, Rome, Italy
Pablo M. Ingelmo, MD Department of Anesthesia, Montreal Children’s
Hospital, MUHC, McGill University, Montreal, QC, Canada
Giorgio Ivani Anesthesiology and Intensive Care, Regina Margherita
Children Hospital, Turin, Italy
Scholtes Jean-Louis, MD Anesthesiology, Cliniques universitaires St Luc,
Université Catholique de Louvain, Bruxelles, Belgium
Martin Jöhr Pediatric Anesthesia, Department of Anesthesia, Luzerner
Kantonsspital, Luzern, Switzerland
Luca La Colla First Service of Anesthesia and Intensive Care, Parma Hospital,
Parma, Italy
Massimo Lamperti, MD Anesthesiology Institute, Cleveland Clinic Abu Dhabi
(CCAD), Abu Dhabi, United Arab Emirates (UAE)
Elisabetta Lampugnani Dipartimento di Anestesia e Rianimazione,
IRCCS Ospedale dei Bambini G. Gaslini, Genova, Italy
Contributors xvii

Jerrold Lerman, MD, FRCPC, FANZCA University of Rochester, Rochester,

NY, USA
Giovanni Mangia Department of Anesthesia, San Camillo Hospital, Rome, Italy
Laura Marchesini, MD Department of Anesthesia, Analgesia and Intensive
Care, University of Perugia, Perugia, Italy
Luisa Meneghini Dipartimento di Anestesia e Rianimazione, Università di
Padova, Padova, Italy
C. Minardi Dipartimento di Anestesia e Rianimazione, Università di Padova,
Padova, Italy
Giovanni Montobbio Dipartimento di Anestesia e Rianimazione, IRCCS
Ospedale dei Bambini G. Gaslini, Genova, Italy
Valeria Mossetti Anesthesiology and Intensive Care, Regina Margherita Children
Hospital, Turin, Italy
Caterina Patti Surgeon Freelancer, Rome, Italy
Francesca Pinzoni Dipartimento di Anestesia Pediatrica, Ospedali Civili,
Brescia, Italy
Thierry Pirotte Department of Anesthesia, Cliniques universitaires Saint-Luc,
Université catholique de Louvain – UCL, Brussels, Belgium
Paola Presutti Department of Anesthesia, San Camillo Hospital, Rome, Italy
Fabrizio Racca, MD Anesthesiology and Intensive Care Unit, S.C. Anestesia e
Rianimazione Pediatrica Azienda Ospedaliera SS Antonio Biagio e Cesare Arrigo
Hospital, Alessandria, Italy
Gonzalo Rivera, MD Department of Anesthesia, Clinica Las Condes, Santiago,
Chile
Chronic Pain Service, Department of Anesthesia, The Montreal Children’s
Hospital, McGill University, Montreal, QC, Canada
Chiara Robba Anesthesiology and Intensive Care Unit, SS Antonio Biagio e
Cesare Arrigo Hospital, Alessandria, Italy
Barbara Rosina Dipartimento di Anestesia Pediatrica, Ospedali Civili,
Brescia, Italy
Carlotta Rossi Servizio di Anestesia e Rianimazione, Dolo Hospital,
Mirano, Italy
Emre Sahillioğlu Department of Anesthesiology and Reanimation,
Acibadem University, Istanbul, Turkey
Maria Sammartino Dipartimento di Anestesia e Rianimazione, Ospedale
Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
xviii Contributors

Department of Anesthesia and Intensive Care, Catholic University of Sacred Heart,

Training Hospital “A. Gemelli”, Rome, Italy
Fabio Sbaraglia Department of Anesthesia and Intensive Care, Catholic
University of Sacred Heart, Training Hospital “A. Gemelli”, Rome, Italy
Brian Schloss, MD Department of Anesthesiology and Pain Medicine,
Nationwide Children’s Hospital, Columbus, OH, USA
Department of Anesthesiology and Pain Medicine, The Ohio State University,
Columbus, OH, USA
B. Senbruna, MD University of Rochester, Rochester, NY, USA
Gianpaolo Serafini Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico
S. Matteo, Università di Pavia, Pavia, Italy
Marta Somaini, MD Department of Anaesthesia and Intensive Care, Niguarda
Ca’ Granda Hospital, Milan-Bicocca University, Milan, Italy
Valter Sonzogni Primo Servizio di Anestesia e Rianimazione, Ospedali Riuniti di
Bergamo, Bergamo, Italy
Rita Sonzogni Primo Servizio di Anestesia e Rianimazione, Ospedali Riuniti di
Bergamo, Bergamo, Italy
Simonetta Tesoro, MD Sezione di Anestesia, Analgesia e Rianimazione,
Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Perugia,
Italy
Department of Anesthesia, Analgesia and Intensive Care, University of Perugia,
Perugia, Italy
Joseph D. Tobias, MD Department of Anesthesiology and Pain Medicine,
Nationwide Children’s Hospital, Columbus, OH, USA
Department of Anesthesiology and Pain Medicine, The Ohio State University,
Columbus, OH, USA,
Department of Pediatrics, The Ohio State University, Columbus, OH, USA
Costanza Tognon Dipartimento di Anestesia e Rianimazione, Università di
Padova, Padova, Italy
Tiziana Tondinelli Dipartimento di Anestesia, Ospedale S. Camillo, Rome, Italy
Sylvain Tosetti, MD Anaesthesia Department, The Montreal Children’s Hospital,
Montreal, QC, Canada
Navi Virk, MD University of Rochester, Rochester, NY, USA
Nicola Zadra Dipartimento di Anestesia e Rianimazione, Università di Padova,
Padova, Italy
Perioperative Medicine
1
Gabriele Baldini

1.1 What Is Perioperative Medicine?

Perioperative medicine is the practice of medicine that relates to and encompasses

all aspects of care provided to patients from the moment surgery is considered the
primary treatment to when patients are discharged from the hospital after the opera-
tion [1, 2]. It is considered a multidisciplinary speciality that aims to provide con-
tinuum of care with coordinated and evidence-based interventions in the preoperative,
intraoperative, and postoperative period with the ultimate goals to prevent the
occurrence of adverse outcomes, timely diagnose and treat perioperative complica-
tions (timely rescue) [3], and optimize surgical recovery.

1.2 Patients, Surgery, and Complications

Complications not only delay surgical recovery and increase healthcare costs but
can also determine patients’ survival [4, 5]. In the last years, significant advance-
ments in surgical care have been achieved. Despite advancements in anesthesia and
surgical care have significantly attenuated the stress response associated with sur-
gery, complications still occur in a significant proportion of patients. This demon-
strates that the development of postoperative complications mainly depends on the
interaction between patient’s physiologic reserve and the metabolic and inflamma-
tory response induced by surgery [6]. Consequently, improvement of perioperative
care by optimizing patients’ physiologic reserve and medical needs, and

G. Baldini, MD, MSc

Department of Anesthesia, Montreal General Hospital,
McGill University Health Center, Montreal, QC, Canada
e-mail: gabriele.baldini@mcgill.ca

© Springer International Publishing Switzerland 2016 1

M. Astuto, P.M. Ingelmo (eds.), Perioperative Medicine in Pediatric Anesthesia,
Anesthesia, Intensive Care and Pain in Neonates and Children,
DOI 10.1007/978-3-319-21960-8_1
2 G. Baldini

minimizing organ dysfunction caused by surgery, might significantly reduce adverse

outcomes and further accelerate surgical recovery.

1.3 A Model of Perioperative Medicine: Learning

from Enhanced Recovery After Surgery (ERAS)
Programs

Traditionally, surgeons coordinate perioperative care of patients undergoing sur-

gery. Enhanced recovery after surgery (ERAS) programs are multidisciplinary clini-
cal care pathways incorporating multiple evidence-based preoperative,
intraoperative, and postoperative interventions designed to decrease the surgical
stress response, enhance recovery, and improve outcomes (Fig. 1.1). They have
been successfully adopted by a variety of surgical specialities, and they have shown
to decrease hospital stay and reduce postoperative complications without increasing
readmission rates [7]. As consequence, variability in perioperative clinical practice
has been reduced, and collaboration among a variety of medical specialities, such as
anesthesiologists, surgeons, internists, physiotherapists, and dieticians, increased.
For these reasons, ERAS programs can be considered a well-proven clinical model
of perioperative care that encompasses many of the perioperative care principles.

Mid-thoracic epidural anesthesia/analgesia Preadmission counseling

No nasogastic tubes Fluid and carbohydrate loading

Prevention of nausea and vomiting No prolonged fasting

Avoidance of salt and water overload No/selective bowel preparation

Early removal of catheter Antibiotic prophylaxis

Thromboprophylaxis
Early oral nutrition Postoperative Preoperative
No premedication
Non-opioid oral
analgesia/NSAIDs ERAS
Short-acting anesthetic
Early mobilization Intraoperative agents
Stimulation of gut motility
Mid-thoracic epidural anesthesia/analgesia
Audit of compliance
and outcomes No drains

Avoidance of salt and water overload

Maintenance of normothermia (body warmer/warm intravenous fluids)

Fig. 1.1 Enhanced recovery after surgery (ERAS) for abdominal surgery: perioperative elements.
Published by Varadhan KK et al Crit Care Clin 2010;26:527–47– Fig. 3. Components of
ERAS. – Elsevier Inc
1 Perioperative Medicine 3

ERAS programs have been effectively developed also for pediatric patients [8–12],
but further studies are warranted to establish their safety in this population.

1.4 Areas of Perioperative Medicine

1.4.1 Preoperative Phase

1.4.1.1 Preoperative Risk Assessment and Optimization

Patients’ comorbidities are one of the main determinants of postoperative complica-
tions. In the preoperative period, the aim of perioperative medicine is to assess pre-
operative risk and optimize functional reserve and preoperative conditions that
delay surgical recovery and increase the risk of morbidity and mortality. Ideally,
once high-risk patients have been identified, multidisciplinary meeting should dis-
cuss the efficacy of alternative treatments to surgery to avoid the occurrence of
surgical adverse events without affecting patients’ care [13]. If surgery remains the
best treatment, preoperative strategies to optimize patients’ comorbidities should be
adopted to minimize adverse outcomes [13].

1.4.1.2 Pre-habilitation
In the preoperative phase physicians should also take the opportunity to com-
mence lifestyle changes by supporting adolescent or adult patients with smoking
and alcohol cessation programs, improve nutritional status and functional capacity.
Recovering from surgery takes longer than expected. Even in absence of surgical
complications, physiological and functional capacities are reduced by 20–40 %
after surgery and take time to return to baseline values. Surprisingly, even following
a relatively invasive surgical procedure such as ambulatory laparoscopic cholecys-
tectomy, more than 50 % of patients do not recover to baseline activity levels 1
month after surgery [14]. Pre-habilitation programs aim at improving functional
capacity and physiologic reserve before surgery and are becoming popular and
effective preoperative strategies to help adult patients recover faster from surgery
[15–17]. They include preoperative multimodal interventions such exercise train-
ing, nutrition supplement, and relaxation techniques for a period of 3–4 weeks, and
they have demonstrated to be more effective than rehabilitation programs interven-
ing only in the postoperative phase [18]. Although pre-habilitation programs
enhance functional exercise capacity and reduce hospital stay, it remains unclear if
they positively affect clinical outcomes [17].

1.4.2 Intraoperative Phase

Anesthesia care plays a pivotal role to attenuate surgical stress and minimize organ
dysfunction associated with surgery. Several intraoperative interventions directly
controlled by anesthesiologists [19], such as avoidance of hypothermia and deep
anesthesia, glycemic control, optimal fluid management, adequate hemodynamic
4 G. Baldini

monitoring, and appropriate analgesia, have shown to improve clinical outcomes

and accelerate the early and intermediate phase of surgical recovery [20].

1.4.3 Postoperative Phase

1.4.3.1 Intensity of Postoperative Care

Postoperative care of surgical patients is essential to ensure adequate surgical recov-
ery. Determining the intensity of postoperative care is pivotal as early recognition
and treatment of postoperative complications has been shown to significantly reduce
surgical mortality [5]. The intensity of postoperative care should be determined
considering patient’s preoperative risk and the invasiveness of the surgery.
Admission to intensive care units or high dependency units should be reserved for
high-risk patients or for complicated surgeries.

1.4.3.2 Postoperative Pain Management

Postoperative acute pain management must ensure optimal analgesia, minimizing
opioid side effects and facilitating early mobilization. The introduction of acute
pain services has facilitated the management of surgical patients with inadequate
pain control or with adverse events related to common analgesia techniques. It has
also improved patients’ satisfaction and accelerated hospital discharge. The use of
ultrasound-guided regional analgesia techniques for inpatients and outpatients has
increased and successfully improved postoperative pain control. Indeed, also ambu-
latory patients can be comfortably and safely discharged home with continuous
peripheral nerve blocks.

1.4.3.3 Hemodynamic Management and Echocardiography

Perioperative hemodynamic management is essential to guarantee optimal organ
perfusion and oxygen delivery. The use of cardiac output monitoring was typically
limited in cardiac patients during the intraoperative and postoperative period or for
critically ill patients admitted to intensive care units. Recently, the widespread use
of perioperative echocardiography and noninvasive cardiac output monitors outside
the operating room has gained popularity even in patients undergoing noncardiac
surgery. Thanks to these devices physicians can now administer intravenous fluids
based on more objective and accurate measures of hypovolemia, facilitating the
hemodynamic management of high-risk surgical patients [21] and hemodynami-
cally unstable patients [3]. In the perioperative period, echocardiography can also
be utilized as diagnostic tool, for example, to identify preoperative cardiopulmonary
conditions that can influence the management of surgical patients.

1.4.3.4 Noncardiac Ultrasound

The use of ultrasound in the perioperative period is gaining popularity also to mange
patients without cardiac conditions. For example, ultrasound-guided peripheral
nerve blocks are considered standard of care in many institutions; bedsides, ultra-
sound of the lungs guides physicians to promptly diagnose and treat postoperative
1 Perioperative Medicine 5

Preoperative Intraoperative Postoperative

Preoperative risk assesment Temperature control Intensity of postoperative care

Cardiovascular Depth of Anesthesia Analgesia
Respiratory Glycemic control Hemodynamic monitoring
Renal Fluid management Noncardiac ultrasound
OSA Hemodynamic monitoring Chronic pain
Metabolic Analgesia
Nutritional

Optimization
Anemia
OSA
Diabetes Mellitus
Functional status (pre-habilitation)
Nutritional
Mental
Pharmacological
Smoking and alcohol cessation

Fig. 1.2 Areas of perioperative medicine

respiratory complications such as pulmonary edema, lung consolidation, pleural

effusion, and pneumothorax [22]; ultrasound assessment of the gastric content pro-
vides important information about the individual risk of aspiration before the induc-
tion of anesthesia [23–26].

1.4.3.5 Chronic Postsurgical Pain

Chronic postsurgical pain (CPSP) can affect a significant proportion of surgical
patients even following minor surgical procedures. Although the incidence of CPSP
is higher after certain surgeries than others, uncontrolled severe acute surgical pain
represents one of the main risk factors associated with the development of CPSP
[27]. Identification of patients at higher risk of CPSP, nerve-sparing surgical tech-
niques, and prevention and treatment of acute postoperative pain represent periop-
erative interventions that must be considered in every surgical patient to decrease
the occurrence of this physically, mentally, and socially disabling condition [28].
Figure 1.2 summarized the most important areas of perioperative medicine dis-
cussed in this section.

1.5 Perioperative Medicine: A Natural Extension

of Anesthesiology?

Anesthesiologists possess extensive perioperative knowledge and skills to be con-

sidered the ideal perioperative physician [6]. While many anesthesiologists have
already identified themselves as perioperative physicians (some anesthesiology
6 G. Baldini

departments have already entitled their departments “Department of Anesthesia and

Perioperative Medicine”), others still consider their practice limited to the operating
room. This mixed vision can be attributed to several reasons, such as workforce and
economic issues, absence of a cohesive and consensus-based perioperative medi-
cine curricula, and lack of a formal and recognized training [1, 2, 29].
Despite these considerations, it is unquestionable that anesthesiologists should
start looking beyond the intraoperative period, as they have done in critical care and
pain management [6]. Improvements of anesthetic knowledge and advancements in
anesthesia care have made the delivery of anesthesia a safer practice. Consequently
the need of anesthesiologists in every operating room has started to be considered
not essential, and many institutions, especially in the North America, have already
tried to replace anesthesiologists with physicians’ assistants, certified nurse anes-
thetists, and other nonphysician figures. If anesthesiologists continue to exclusively
practice in the operating room, the speciality of anesthesiology will be at risk
of being undervalued, the role of the anesthesiologists underestimated, and periop-
erative medicine might be practiced by other specialities (e.g., internal medicine,
surgery).
However, before being considered a true perioperative speciality, anesthesiology
must face important challenges. The residency program should be redesigned by
implementing a robust perioperative curriculum that considers the continuum of
care and clearly defines the required, basic, intermediate, and advanced competen-
cies that a perioperative physician must have. For this purpose, collaboration with
other specialities such as internal medicine, cardiology, and respirology is essential,
and it must be intensified during the residency training to improve anesthesiolo-
gists’ perioperative knowledge. Alternatively, a perioperative fellowship program
could be offered to those anesthesiologists who specifically want to support patient’s
care throughout the entire perioperative period and obtain advance perioperative
knowledge and skills [29]. Finally, expanding the horizons of anesthesia beyond the
operating theatre will provide strong basic science and clinical knowledge to
improve perioperative care.
In conclusion, perioperative medicine aims to provide continuum of care with
coordinated and evidence-based interventions in the preoperative, intraoperative,
and postoperative period with the ultimate goals to reduce morbidity and mortality
and accelerate surgical recovery.

References
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adverse effect of postoperative complications. Ann Surg 242(3):326–341; discussion

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 Part I
Perioperative Care Before Surgery
Preoperative Evaluation in Pediatric
Anesthesia 2
Giovanni Mangia, Caterina Patti, and Paola Presutti

2.1 Introduction

The preoperative assessment is the process of evaluating the patient’s clinical condi-
tion, aimed to define the risks and eligibility for anesthesia and surgery. The infor-
mation needed to make decisions comes from the anamnesis, the physical exam,
and the complementary test collected by a multidisciplinary team including sur-
geons, nurses, pediatricians, and anesthetists.
The preoperative evaluation defines the physical status of the child, foresees the
surgical and anesthetic risks, prescribes preoperative tests and therapies or special
preparation, and provides information regarding the perioperative care. It also helps
to make appropriate use of hospital resources and programs the surgical activities
based on the clinical characteristic and the risk of the patients.
Although other medical specialists may provide additional information in decid-
ing the eligibility of a patient for anesthesia, the preoperative evaluation is an anes-
thesiologist’s responsibility. Only an anesthesiologist can define the eligibility for
anesthesia.

2.2 Operating Risk Stratification

The clinical risk is the probability of a patient presenting “damage or inconvenience

caused, even if unintentionally, by the medical care given during the hospitalization
period, that causes a prolongation of hospitalization, a health status deterioration or

G. Mangia (*) • P. Presutti

Department of Anesthesia, San Camillo Hospital, Rome, Italy
e-mail: mangia.giovanni@fastwebnet.it
C. Patti
Surgeon Freelancer, Rome, Italy

© Springer International Publishing Switzerland 2016 11

M. Astuto, P.M. Ingelmo (eds.), Perioperative Medicine in Pediatric Anesthesia,
Anesthesia, Intensive Care and Pain in Neonates and Children,
DOI 10.1007/978-3-319-21960-8_2
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and at a mile’s distance. The weavers allege, in excuse of their retreat, that the
butcher squadron had been ordered up to assist the tailors, and that they did not
incline to engage with these men of blood.’—C. M.
A circumstance somewhat like the Tain 1733. Oct. 30.
entertainment, in honour of Governor Macrae, took
place in Edinburgh, on this king’s birthday, which was observed with unusual
rejoicings, on account of the recent stimulus to loyalty from the marriage of the
Princess Royal to the Prince of Orange. ‘David Campbell, his Majesty’s Tailor for
Scotland, came to this kingdom from Jamaica, purely on design to solemnise the
day. He accordingly entertained at his lodgings in the Abbey his Majesty’s Blue
Gowns [a set of licensed beggars, corresponding in number to the king’s years,
which were now fifty], and at night he kept open table, where several gentlemen
were entertained, all the royal healths were drunk, and those of every remarkable
person of the illustrious name of Campbell, with the sound of trumpet and other
music.’—C. M.
The Caledonian Mercury gives a droll, chirping Oct.
account of an association which, it is easy to see, had
in view the prevention of an over-severe excise system for Scotland. Yesternight,
says the paragraph, ‘there came on, at the Parrot’s Nest in this city, the annual
election of office-bearers in the ancient and venerable Assembly of Birds; when the
Game-cock was elected preses; the Blackbird, treasurer; the Gled, principal clerk;
the Crow, his depute; and the Duck, officer; all birds duly qualified to our happy
establishment, and no less enemies to the excise scheme. After which an elegant
entertainment was served up; all the royal and loyal healths were plentifully drunk
in the richest wines; the glorious 205; all the bonny birds, &c. On this joyful
occasion nothing was heard but harmonious music, each bird striving to excel in
chanting and warbling their respective melodious notes.’ The glorious 205, it may
be remarked, were those members of the House of Commons who had recently
thrown out a bill for increasing the tax on tobacco.
‘John Park, some time dempster to the Court of 1734. Mar. 6.
Justiciary, and who lately stood a trial there for
horse-stealing, was whipped through the city, pursuant to his sentence; by which
also he stands condemned to transport himself, 1734.
never again to return to Scotland, on pain of being
whipped quarterly till he is again transported. He is a very old man, with a
graceless gray head, gray beard, and but one hand, having left the other in some
scrape.’—C. M.
‘When Mr Adam Fergusson, minister of Killin, Apr. 19.
came to Perth to intimate the sentence of the
commission (which looses Mr William Wilson’s pastoral relation in that burgh),
Mr Fergusson was met in the suburbs by several of the inhabitants, who fell upon
the gentleman, though vested with supreme authority, and attended by several
armed men; yet they were all severely cudgelled, and obliged to retire, re infectâ.’—
C. M.
 ‘Died here, the Rev. Mr John Maclaren, one of the July 12.
ministers of the city; esteemed a well-meaning man,
and void of hypocrisy.’—C. M.
‘On Saturday was se’nnight [Dec. 28, 1734], died at 1735. Jan. 9.
Balquhidder, in Perthshire, the famous Highland
partisan, Rob Roy.’—C. M.
‘Died, in the 12th year of her age, the Lady Jane Jan. 24.
Campbell, fourth daughter to his Grace the Duke of
Argyle.... His Grace has no male issue, but several daughters living, and it is the
peculiar right of this family, that when they marry any daughters, their vassals are
obliged to pay their portions, and are taxed in order to it, according to the number
of their cattle.’—C. M.
We find at this time a beginning to that system of Aug. 18.
emigration to America by which the Highlands were
so much depopulated during the eighteenth century. ‘The trustees for the colony of
Georgia have projected a settlement of Highlanders from this country, and have
actually sent round for Inverness and Cromarty a ship commanded by Captain
Dunbar, to take in 160 men, women, and children, who are to be settled on the far
boundary of the river Alatamaha, who will be a gallant barrier in case of a war with
France and Spain. And Mr Oglethorpe, with the other trustees, are applying to the
society in Scotland for Propagating Christian Knowledge to send a minister along
with them who speaks Irish, with proper encouragement; and we are assured the
society are so well satisfied with the project, that they have amply instructed their
committee of directors to close in with it.’—C. M.
‘The annual friendly meeting of the gentlemen of 1736. Jan. 19.
the name of Wilson, was held at the house of Jean
Wilson, spouse to Arthur Cumming, periwig-maker, opposite to the City Guard;
the Right Hon. Alexander Wilson, Lord Provost of the city, preses. There were
present about forty gentlemen and others of that clan, who were served at supper
by persons of the name. The entertainment was sumptuous, and choice wines went
merrily round.’—C. M.
‘A very uncommon chain of events happened here Jan. 21.
[Lanark] t’other week. Elizabeth Fairy was
proclaimed in order to marriage on Sunday, was accordingly married on Monday,
bore a child on Tuesday; her husband went and stole a horse on Wednesday, for
which he was banished on Thursday; the heir of this marriage died on Friday, and
was decently interred on Saturday; all in one week.’—C. M.
‘The 4th inst., several young gentlemen of this Feb. 9.
place [Montrose] acted Mr Allan Ramsay’s
celebrated Pastoral Comedy, for the diversion of the gentlemen and ladies of and
about this town, with all the dresses suitable, and performed it with so much spirit
and humour, as agreeably surprised the whole audience; to oblige whom they re-
enacted it and the farce of the Mock Doctor two succeeding nights. The money
taken, after deducting the necessary charges, being very considerable, was
distributed among the poor.’—C. M.
‘This week, several gentlemen laid a wager that a Mar. 13.
horse, twenty-six years old, belonging to Mr. Pillans,
brewer, should not draw 101 stone-weight up the West Bow to the Weigh-house;
and yesterday it was surprisingly performed, one of the wagerers riding on the top
of all.’—C. M.
Nine unfortunate young women—‘very naked and July 9.
meagre beings’—‘made an amende honorable
through the several streets of the city [of Edinburgh], 1736.
the hangman attending them, and drums beating to
the tune of Cuckolds-come-dig.’—C. M.
While Allan Ramsay was preparing his playhouse, an Italian female rope-dancer,
named Signora Violante, performed in Edinburgh and some other Scottish towns.
It was announced that she danced a minuet on the rope, as well as it could be done
on the floor—danced on a board placed loosely on the rope—danced on the rope
with two boys fastened to her feet—danced with two swords at her feet—the rope
being no thicker than penny whip-cord. In Edinburgh, the scene of her
performances was the ‘Old Assembly Hall.’—C. M.
‘A grand convention was held of the adherents to 1738. Mar. 22.
the seceding ministers of the Church of Scotland, in
a square plain on Braid Hills, two miles south of this city. About 10 before noon,
Mr Thomas Mair, minister of Orwel, in Kinross-shire, opened the service of the day
(standing in a pulpit reared up within a tent), with a sermon from Jeremiah i. 5. At
noon, Mr William Wilson, one of the ministers of Perth, preached from Ezekiel
xxii. 24, and afterwards baptized ten children, brought thither some 20, some 30
miles off. At four afternoon, Mr Ralph Erskine, one of the ministers of
Dunfermline, preached from Hosea xxiii. 9, &c. The apparent tendency of these
sermons was to excite devotion and fervour, a renewal of solemn engagements, to
deprecate sin in general, and those of this corrupt age in particular: and it was
observed that it was no proper expedient either to wash away sin, or indemnify the
sinner, to purchase indulgences at the hand of the kirk-treasurer, and some other
tenets that savoured of a popish tincture were soundly lashed. There were about
5000 hearers at each sermon (I mean of the household of faith), some of whom
from South Britain and Ireland, besides the ungodly audience, consisting of many
thousands, some of whom set fire to furze; others hunted the hare around ’em to
create disturbance, a certain huntsman having laid a plot to carry off the collection.
The convention dispersed at 7 at night.’—C. M.
In consequence of a butcher’s dog going mad, and Apr. 7.
biting some others of her species, the magistrates of
Edinburgh ordered the slaughter of all the butchers’ dogs in the city, and,
commanding the seclusion of all other dogs whatsoever, put a shilling on the head
of every one which should be found abroad. There then took place a crusade
against the canine species, which seems to have been nearly the sole Scottish
incident reported in London for the year. ‘The street cadies went very early into
obedience to this edict; for the drum had scarce gone round to intimate the same,
when they fell a-knocking on the head all suspicious or ill-affected curs, some of
which they hanged on sign-posts, &c.; and with difficulty could they be restrained
from killing the dogs that lead the blind about the streets, or attacking the ladies
with their lap-dogs. A detachment of the City Guard was ordered down to the
butcher-market, when they made very clean havoc of all the dogs there. Saturday,
at noon, the town-officers being provided with large oaken clubs, went a dog-
hunting, and killed every cur they could see or hear of; so that nothing was to be
seen but chasing, hacking, and slashing, or heard other than the lamentation of
butchers’ wives, &c., for the loss of Credit, Honesty, Turk, Twopenny, Cæsar, &c.’
Three days later, the magistrates of Leith ordered all the dogs of their town to be
put to death. Accordingly, the curs were driven into the harbour, and drowned, or
else knocked on the head. ‘Several gentlemen and others,’ it is reported, ‘have sent
off their dogs to the country, and a certain writer has despatched his favourite
Tipsy to Haddington in a cloak-bag. Patrick Kier in Multries-hill having tied up his
dog, the beast gnawed the rope, and getting loose, rushed into the room on his
master, and bit him severely. The dog was immediately killed, and Mr Kier carried
to the sea and dipped.’—C. M.
Lord Lovat having occasion at this time to travel 1740. July 30.
from his house of Beaufort, in Inverness-shire, to
Edinburgh, with his two daughters, made an effort to get his coach ready, and,
after two or three days spent in its repair, set out on 1740.
his journey. Passing through Inverness without
stopping, he came the first night to Corriebrough. To pursue his own narrative, as
given in a letter to a friend:[772] ‘I brought my wheel-wright with me the length of
Aviemore, in case of accidents, and there I parted with him, because he declared
that my chariot would go safe enough to London; but I was not eight miles from
the place, when on the plain road, the axle-tree of the hind-wheels broke in two, so
that my girls were forced to go on bare horses behind footmen, and I was obliged to
ride myself, though I was very tender, and the day very cold. I came with that
equipage to Ruthven late at night, and my chariot was pulled there by force of men,
where I got an English wheel-wright and a smith, who wrought two days mending
my chariot; and after paying very dear for their work, and for my quarters two
nights, I was not gone four miles from Ruthven, when it broke again, so that I was
in a miserable condition till I came to Dalnakeardach, where my honest landlord,
Charles M‘Glassian, told me that the Duke of Athole had two as good workmen at
Blaire as were in the kingdom, and that I would get my chariot as well mended
there as at London. Accordingly, I went there and stayed a night, and got my
chariot very well mended by a good wright and a good smith. I thought then that I
was pretty secure till I came to this place. I was storm-stayed two days at Castle
Drummond by the most tempestuous weather of wind and rain that I ever
remember to see. The Dutches of Perth and Lady Mary Drummond were
excessively kind and civil to my daughters and to me, and sent their chamberlain to
conduct me to Dumblain, who happened to be very useful to us that day; for I was
not three miles gone from Castle Drummond, when the axle-tree of my fore-wheels
broke in two, in the midst of the hill, betwixt Drummond and the bridge of Erdoch,
and we were forced to sit in the hill, with a boisterous day, till Chamberlain
Drummond was so kind as to go down to Strath, and bring wrights, and carts, and
smiths to our assistance, who dragged us to the plain, where we were forced to stay
five or six hours till there was a new axle-tree made, be that it was dark night
before we came to Dumblain, which is but eight miles from Castle Drummond, and
we were all much fatigued. The next day, we came to Lithgow, and the day after
that we arrived here, so that we were twelve days on our journey by our
misfortunes, which was seven days more than ordinary.’
‘Friday [Jan. 7], died William Mackintosh of 1743. Jan. 10.
Borlum, Esq., aged upwards of 80 years of age. He
has been prisoner in the Castle these 15 years for his accession to the Rebellion
1715.’—E. E. C.
‘On Thursday last [Jan. 13], died the Honourable Jan. 17.
Colonel John Erskine of Carnock. He was a True Old
Whig.’—E. E. C.
‘Friday, the place of one of the Principal Clerks of Jan. 17.
this city was conferred on Mr William Forbes, writer,
he paying, as a consideration for the same, in room of Mr Home deceased, £1410
sterling.’—E. E. C.
Apr. 14.
‘Thursday last, died at Sanquhar, William Kelloch, aged 111 years. He served the
town as one of their common officers 96 years, and his son, now living, has served
in the same station 70 years. He was a very honest man, had his senses to the last,
and never made use of spectacles.’—E. E. C.
‘Notwithstanding the late execution of Margaret May 9.
Stewart for child-murder, yet we are told that two
more new-born children have since been found dead, with marks of violence on
them.’—E. E. C.
 INDEX.

Aa-na-Mullich, skirmish at, between the government troops and the

Mackenzies, 463.
Aberdeen, King’s College, grants a diploma to a quack doctor, 262.
Aberdeen, pope burned in effigy at, 4;
disturbances at Church of, on account of doxology, 103;
woollen manufactures at, 156;
popish meeting dispersed at, 203.
Abernethy forest, cutting of, superintended by Aaron Hill, 547.
Adair, John, mathematician, engaged in making maps of Scotland,
42.
Advertisements, curious, in Edinburgh Gazette in 1707, 325.
Advocates’ Library, established under Parliament House, 245.
African Company, established, 121;
expedition to Darien, 206;
restitution of its losses, 259.
Agricultural improvements, introduced into Scotland by Elizabeth
Mordaunt, an English lady, 419;
promoted by a society, 484.
Agricultural Improvers, Society of, 484;
implements invented, 503.
Aikenhead, Thomas, tried and executed for blasphemy, 160.
Allardice, Catharine, a misspelled letter by, 595.
Anatomy first proposed to be taught in Edinburgh, 105.
Ancrum Bridge rebuilt by kirk collection, 134.
Anderson, James, editor of Diplomata Scotiæ, encouraged in his
work, 318;
appointed postmaster for Scotland, 400;
lets a house to Sir R. Steele, 418.
Anderson, Mrs, printer of the Bible, 364.
Angus, an Episcopal clergyman, deposed, 78.
Apostasy from Protestant faith punished, 214.
Apparel, act of parliament for restraining expenses of, 149;
old fashions of dress enumerated, 148;
extravagances of, denounced, 448, 482;
cost of various articles, 571.
Arbuthnot, Lady, her jointure, 57.
Archbishop of Glasgow imprisoned, 12;
permitted to live at certain places, 167.
Archers, Royal Company of, 495.
Argyle, John, Duke of, takes command of government troops (1715),
389.
Argyle, seventh Earl, and first Duke of, 1;
his debauched life, 191;
befriends the Master of Lovat, 187.
Arithmetic, a mechanical invention for, 210.
Arms being got from abroad, James Donaldson proposes to
manufacture them at home, 311;
edict against carrying arms, 497.
Arnot, Sir David, assault by, 157.
Assembly, General, clergy of, at first plainly dressed, 148.
Assembly in Edinburgh for dancing purposes, 480.
Aston’s company of players, 518, 544, 550.
Astrology practised by John Stobo, 85.
Atheistical books imported into Edinburgh, 160.
Atmospherical phenomena, 366, 442, 480.
Auchensaugh, covenant renewed at, in 1712, 376.
Auchterarder, riot at, on reading of funeral-service, 366.

Baillie, Captain William, imprisoned debtor, liberated by Privy

Council, 28.
Baird, Archibald, imprisoned for housebreaking, 64.
Balcarres, Earl of, imprisoned at Revolution, 11;
replaced in confinement, 19;
story of Dundee’s ghost having appeared to, 19.
Baldoon park for rearing cattle, 152.
Balfour of Denmill, mysterious disappearance of, 346.
Bane, Donald, a prize-fighter, 522.
‘Bangstrie’ at Earlshall, Croshlachie, Ellieston, &c., 157–159.
Banishment petitioned for by various culprits, 116.
Bank-notes for twenty shillings commenced, 212.
Bank of Scotland established, 128;
temporarily suspends payment in 1704, 306;
run upon in 1715, 402;
last stoppage in 1728, 544;
sets up four branches, 577.
Bank, Royal, of Scotland, established, 537;
causes a stoppage in the Bank of Scotland, 544.
Banking, primitive style of, by a shopkeeper in Glasgow, 577.
Baptism, inconsistencies regarding, 370.
Barbreck’s Bone, for cure of madness, 262.
Bargarran’s daughter (Christian Shaw), her case, 167;
thread spun by her, 510.
Barrisdale, Macdonell of, 615.
Bass, siege of, 95.
Bath of hot air (a hummum) established at Perth, 260.
Bayne, James, wright, ruined by his concern in rebuilding Holyrood
Palace, 29.
Beardie [Walter Scott]‘s marriage, 37;
attends a funeral at Glasgow, 387.
Bell, Sir John, of Glasgow, episcopal worship at his house disturbed,
273.
Bible in Irish language, first printed, 39.
——, printing of, in Scotland (1712), 364.
Bills of Exchange, treatise upon, printed, 278.
Births, ceremonies at, 572.
Bishops expelled from the Convention in 1689, 5.
Black-foot, a, litigation by one for remuneration, 191.
Black Mail in the Highlands, 498, 612, 614.
—— Watch, the, 498, 581, 610.
Blackwell, a preceptor, libels Lady Inglis of Cramond, 89.
Blair of Balthayock and Carnegie of Finhaven, 190.
‘Bloody Baillie,’ a witness on Porteous Mob, 601.
Blythswood, Campbell of, cousinred with Sir Walter Scott, 37.
Boig, Adam, starts the Edinburgh Courant, 314.
Books burnt at Cross, 276.
——, licenses for printing, 52, 220.
Boswell of Balmouto, a rash Jacobite, 84.
Botanic Garden established in Edinburgh, 81;
extension of, 142.
Brand, Alexander, in trouble for making ‘donatives’ to Privy Council,
176;
proposes scavengering of Edinburgh, 592.
Brewers of Edinburgh in rebellion, 509.
Bride’s clothes, their cost, 240.
Bridge, William, an English coppersmith, 33.
Bridgman, or Evory, a pirate, seizes a man-of-war, 150.
Broich, James, sad tale of his ship taken by a privateer, 22.
Brown, Dr Andrew (Dolphington), is licensed to print a treatise of
his own on fevers, 52.
Brown, Jean, of Potterrow, a religious visionary, 430.
Brown, Rev. George, his Rotula Arithmetica, 210.
Browny, a spirit, 284.
Bruce, Captain Henry, imprisoned for defending Holyroodhouse, 13.
Bruce, David, and other boys, carried out to sea in an open boat,
355.
Bruce, Peter, confined at the Revolution, 12;
transfers right of making playing-cards, 34.
Buchanan, David, servant of Lord Dundee, 15.
Bugs in Glasgow, 542.
Bullock, fat, at Dalkeith, 479.
Burghs, royal, convention of, curious details, 51.
Burleigh, Master of, murders Stenhouse, a schoolmaster, 326.
Burnet, Captain, of Barns, his unscrupulous recruiting, 43.
Bute, Earl of, his law-case against his stepmother, 375.

Cairns, a boy, murdered, 547.

Caldron, a copper, law-case about, 77.
Callender, John, master-smith, his account against exchequer, 47
note.
Cambuslang, religious demonstrations at, 607.
Cameron, Sir Evan, of Locheil, 288.
Cameronian regiment raised in 1689, 8.
Cameronians, the, proceedings of, 376, 532.
Campbell of Cessnock’s parks for rearing cattle, 153;
his plan for shot-casting, 155.
Campbell of Lawers, murdered at Greenock, 473.
Campbell of Lochnell’s funeral, 387.
Canongate, duels in, 466.
—— Tolbooth, mutiny of prisoners in, 71;
petition from keeper of, 80;
mutinies of recruits in, 182, 601.
Card-playing, law against, 296.
Cards, playing, manufacture of, a monopoly, 34.
Cardross, Lord, and Sir John Cochrane, case between, 191.
Carmichael of Bonnyton, his quarrel with opposite neighbours, 73.
Carstares, William, the king’s adviser, 107;
his death, 403.
Catarrh, infection of, at St Kilda, 181.
Catholics, troubles of, after the Revolution, 25;
severe treatment of priests, 82;
act against in 1700, 205;
worship interrupted in Edinburgh, 108;
at Aberdeen, 203;
again in Edinburgh, 204, 466;
Catholic priest banished, 362;
gentlemen troubled, 295;
priests numerous and bold, 383;
seminary for priests at Scalan, 205;
Catholic books seized and burned, 146.
Cattle, breeds of, efforts to improve, at Baldoon and elsewhere, 152.
Cattle fair of Crieff, 338.
—— ‘lifting’ in the Highlands, 30, 420, 486, 498, 610, 614.
Cayley, Captain John, shot by Mrs M‘Farlane, 412.
Cess, evasion of, in the Highlands, 91.
Chancellor of Shieldhill fined for a riot, 73.
Charteris, Colonel Francis, gambling anecdote of, 296;
his death, 579.
Child-murder, imputed, cases of, 19, 27, 625.
Children of the upper classes, provision for, in various instances, 55.
Choille Van, skirmish at, 468.
Christian Knowledge, Society for Propagation of, 252.
Claim of Right, some articles violated, 10.
Claret, &c., price of in Scotland, at beginning of 18th century, 183,
270.
Cleland, William, appointed lieutenant-colonel of Cameronian
regiment, 9.
Clerical uniform recommended, 147.
Cloth-manufacture, woollen, 155.
Clubs of a censurable character, 521, 543.
Cluny Macpherson establishes a guard in lieu of ‘Black Watch,’ 611.
Coal-pits at Tranent, mode of draining, 472.
—— -works, railway at Prestonpans, 472.
Cockburn, Andrew, post-boy, robbed, 32.
—— ——, an Episcopalian minister at Glasgow, his chapel destroyed
by a mob, 367.
Cockburn, Justice-clerk, quarrels with Earl of Ilay and Sir David
Dalrymple, 402.
Cockburn, Mr, of Ormiston, an improver of agriculture, 485.
Cock-fighting introduced, 266.
Coin of Scotland at the Union, 330.
Coldingham, kirk discipline of, 92;
episcopal meeting-house, 93;
 witches of Coldingham, 94.
Collegium Butterense at Aberdeen, 230.
Colliers in Fife and Lothian, as slaves, 248.
Combats with swords in public, 522.
Commerce as affected by the Union, 336, 338.
—— and Manufactures in Scotland, subsequent to Revolution, 336,
416.
Common Prayer, Book of, two clergymen maltreated for using, at
Dumfries, 65;
Rev. James Greenshields prosecuted for using, 350.
Companies formed for manufactures, 88.
Concert of music in Edinburgh in 1695, 89;
by Edinburgh amateurs, 432.
Condition and habits of Scottish people, change for the better, 568;
hospitality, 570;
dress, &c., 571.
Copyrights of books, granted by Privy Council to printers and
booksellers, 220.
Cornwell, Christopher, servitor, imprisoned, 15.
Coronation of George I., rejoicings at, 414.
Corporation privileges, troubles arising from, 75.
Correction-houses for mendicants built, 219.
Courant, Edinburgh, commenced, 314.
Courant, Edinburgh Evening, newspaper started (1718), 438.
Covenant sworn at Auchensaugh, 376.
Covenanters’ heads, re-interment of, 532.
Cowbin, estate of, ruined by drifted sand, 119;
Kinnaird of Culbin petitions for exemption from cess, 119;
inscription on family tombstone, 120.
Craig, Margaret, a poor girl, drowns her infant, 19.
Craigcrook, romantic story of a murder connected with, 333.
Crawford, Earl of, president of parliament, 1;
superintends torture of a prisoner, 40.
Crawford, John, Morer’s account of, 271.
Crieff, cattle-fair of, described, 338.
Crighton, Captain John, his restraint relaxed and renewed, 67;
liberated, 68.
Criminalities connected with the sexual affections, 59.
Criminals condemned to become soldiers, 64.
—— banished without trial, 115, 211.
Cromdale, dispersion of Highlanders at, 2.
Culloden, Lady, the body forgotten at her funeral, 309.
Culreach, system of in Scotland, 236.
Curiosities, House of, at Grange Park, 99.
Customs, attacks on officers of, 215, 589, 594.

Dalnaspidal, fête at, by General Wade, 561.

Dalrymple, Sir John, his enmity against Highland Jacobites, 61;
his concern in massacre of Glencoe, 62.
Dalyell, Sir Thomas, of Binns, treated for lunacy, 297.
Dancing Assembly established, 479;
meetings for in provincial towns, 590.
Darien Expedition, 107, 206.
Davidson, Robert, of Ellon, Aberdeenshire, petitions Council in
consequence of having had his house destroyed, 108.
Davidson, William, ‘writer,’ incarcerated for false news, 72.
Dearth in Scotland, 136, 195, 348, 606.
Debauchery in Edinburgh, 312.
Dee, bridge over at Black Ford, erected, 277.
Defoe visits Scotland (1706), 322;
conducts the Courant newspaper, 324, 325;
his account of the Equivalent, 328;
quoted regarding trade of Scotland, 336;
his illiberal remark on Greenshields’s case, 351.
Deportment, Rules of Good, by Petrie, 455.
Dickson, Margaret, her trial, execution, and subsequent recovery,
500.
Dickson, Sir R., of Sorn-beg, refuses to pay for wines to gratify the
officers of state, 188.
Dies and punches for coining, 141.
Dingwall, poverty-stricken in 1704, 52;
deputation from Inverness visits the town to report on its trade,
52;
effect of cheap whisky at, 133.
Dirty Luggies in Edinburgh, 593.
Disarming of the Highlanders, 497;
General Wade’s letter to Lord Townsend, 528.
Dogs, mad, 624.
Don river dried up in several places, 442.
Don, Sir James, of Newton, receives permission to travel into
England with horses and arms, 50.
Donaldson, James, commences Edinburgh Gazette (1699), 313;
which stops (1707), but is recommenced, 324;
his invention for manufacture of arms, 311.
Donatives to Privy Council, custom of giving, 177.
Douglas, Cameronian regiment formed at, 8.
Douglas, Captain, convicted of assault, 60.
Douglas, Duchess of, her style of speech, 507.
Douglas, Duke of, murders Mr Ker, 506.
Dow Loch, story of the, 263.
Doxology attempted to be introduced in church, 103.
Dress, old, articles of, enumerated, 148;
a constant fashion of, proposed in parliament, 149;
description of, 269;
changes of, 571.
Drove-road for cattle at New Galloway, 153.
Drum, Lady of, petitions to be left unmolested by Irvine of Murtle,
144.
Drum, Laird of, taken in care for weakness of mind, 22.
Drummond, George, founds the Royal Infirmary, 557.
Drummond, Lord, popish baptism of his child, 383.
Drummond, May, a preaching Quaker lady, affecting case of, 559.
Dudds, Dr, a quack mediciner, 261.
Duel between Matthew M‘Kail and William Trent in King’s Park,
Edinburgh, 149;
other duels, 543, 566.
Duels, military, their prevalence, 405.
Duff, Laird of Braco, checks lawless proceedings of the gipsies of
Moray, 234.
Dumfries, riot at, from reading Book of Common Prayer, 65.
Dun, Lord, a judge, anecdote of, 293.
Dunbar, Sir David, of Baldoon, his breeds of cattle, 152.
Dundee, Jacobitism in, 415;
grain riots at, 452;
dancing assembly at, 590.
Dundee, Lady, 97.
——, Viscount of, 1, 16, 19.
Dundonald, Countess of, her death, 356.
Dunkeld, Bishop of, speaks pathetically of James VII., 5.
Dupin, Nicolas, engaged in the linen-manufacture and paper-
making, 86;
his inventions, 102.
Dutch Guards’ officer, wounded in duel, 543.
Dysart, Rev. John, of Coldingham, his rigorous discipline, 92.

Earlshall, violences at, 157.

Earthenware manufacture, 156.
Earthquake at Selkirk, 543;
at Glasgow, 581.
East Indiaman, loss of, near island of Lewis, 551.
Echo, a literary paper proposed, 621.
Eclipse of the sun, April 22, 1715, 399.
Edie, David, apostate from Protestant faith, 214.
Edinburgh, dirty state of, 593.
——, great fire in (1700), 225.
——, Lord Provost of, inflicts capital punishment, 568.
Edinburgh; see the entire volume passim.
Edmondstone of Newton, banished for concern in murder of the
Master of Rollo, 119.
Edmondstone, William, comes into collision with Row of Inverallan,
49.
Education in practical arts recommended (1726), 530.
Eglintoun, Earl of, beggars at his funeral, 555.
Egyptians, or gipsies, 233.
Election for Ross-shire, on a Saturday, 341;
one at Fortrose, strange proceedings at, 465.
Election of Peers at Holyrood, incident at one, 403.
Elphinstone, Alexander, fights a duel with Lieutenant Swift, 566.
Episcopal clergy, rabbled out at the Revolution, 6;
persecuted, 78, 229, 273, 350, 366, 405;
two relieved by Principal Carstares, 404.
Episcopal meeting-houses at Eyemouth, &c., suppressed, 229;
one at Glasgow destroyed by a mob, 368;
remarkable number of, in Edinburgh, in 1715, 405;
increase of, in the North, 480.
Episcopalians, their troubles regarding Book of Common Prayer, 65,
366.
‘Equivalent Money,’ at the Union, 259, 328;
its disposal, 444.
Equivocating prayers, 78.
Erskine, disgraceful scenes at parish-church of, 69.
Erskine, Mrs, widow of minister of Chirnside, petitions for relief,
181.
Erskine, Thomas, a Quaker brewer, 467.
Exchange Coffee-house (Edinburgh) circulates ‘seditious news,’ and
is shut up in consequence, 72.
Exchequer, Scottish, extreme poverty of, 45.
Excise and Customs, small amount of before Union, 339;
curious anecdote of the transmission of excise revenue to London,
341.
Excise law victims revenge themselves, 594.

Fae, Sergeant, undertakes to catch robbers, 83.

Fairfoul, David, a Catholic priest, confined, 25.
‘Fair Intellectual Club,’ 574.
Fallowing first introduced into Scotland, 419.
Famines in Scotland, 136, 195, 348, 606.
Fast on account of sickness and scarcity, 160;
in apprehension of renewed scarcity, 233.
Fea of Clestran takes Gow, a pirate, 505.
Fearn church roof falls in, 608.
Ferintosh, whisky distilled at, free of duty, 133.
Fife, sickness in, 363.
Fire in Edinburgh, of 1700, 225.
—— Insurance Company first started, 446.
—— raising in Lanarkshire, 578.
Flaikfield, Mary, a poor woman, prosecuted by Merchant
Company, 76.
Fletcher of Salton’s statements and proposals regarding vagrant
poor, 218.
Flogging in schools (1700), boy whipped to death, 222.
Flood in west of Scotland (1712), 381.
Forbes, Duncan, Lord Advocate, suppresses a riot at Glasgow, 509.
Forbes, John, of Culloden, his convivial practices, 184.
Forbes of Culloden obtains permission to distil usquebaugh duty-
free, 133.
Foreigners prohibited from transporting labourers, 211;
distinguished foreigners visiting Edinburgh, 581.
Forfeited estates, commissioners of, meet in Edinburgh, 408;
further proceedings of commissioners, 443.
Forfeited estates in inaccessible situations, difficulty of dealing with,
458.
Forgery on Bank of Scotland by Thomas M‘Gie, 229;
by Robert Fleming, 356.
Forglen, Lord, his eccentric bequest, 533.
Forsyth, Matthew, cook, his miserable imprisonment, 90.
Fortrose, election at, and riot, 465.
Foulis, Messrs, of Glasgow, their elegant printing, 516.
France, gentlemen returned from, objects of suspicion, 216.
Fraser, Captain Simon (afterwards Lord Lovat), his wild
proceedings in Inverness-shire, 186, 254.
See Lovat.
Fraser, John, imprisoned for ridiculing the divine authority of the
Scriptures, 147.
Freebairn, the bookseller, 379.
Freemasonry, 600.
Free-trade hinted at, 243.
French fleet appears in Firth of Forth, 332.
—— Protestants, succour for in Scotland, 9.
French taught by a native, in Edinburgh, 449.
Friendly Society, the, for fire-insurance, 446.
Frost of 1740, 605.
Funeral at Glasgow, described by Walter Scott (‘Beardie’), 387;
of Campbell of Lochnell (1713), 387;
of Robertson of Struan, 526;
convivialities at one, 309,
give rise to a murder, 545.
Funerals conducted on a superb scale, 307;
Lord Whitelaw’s, 308;
Sir Hugh Campbell of Calder’s, 309;
Sir R. Monro’s, 560.

Galloway, Levellers of, 492;

state of tenantry of, 494.
Gambling in Scotland, act regarding, and notable instances of, 296.
Gambling Society, 543.
Gardiner, Colonel James, his pious character, 487.
Gardner, John, minister of Elgin, falls into a trance, 422.