Customized earpiece for precordial stethoscope.

In modem pediatric anesthesiology continuous monitoring of the patient is essential for the safe conduct of the anesthesia. Artificial metering of oxygen, the host of new anesthetic agents and techniques, and assisted or controlled respiration can cause sudden critical changes in the status of the patient. The newer halogenated agents may cause abrupt -cardiac incompetence either through direct myocardial effect or by strong parasympathetic action. Effects on respiratory rate, depth and rhythm must also be watched. Monitoring devices, intelligently used, constitute the anesthesiologist's armamentarium in the detection of effects of anesthetic agents on the patient. Complicated electronic devices with their confusion of wires and machinery may distract the anesthesiologist. Blood pressure readings vary with the age, height and weight of the child. Many temporary variations occur before the more stable levels of adult life are attained. Varying length of the upper arm or thigh make proper determination of cuff width difficult and may result in erroneously high or low readings. The use of a precordial stethoscope is the simplest method of monitoring the changes in the intensity of the sounds, rate and rhythm of cardiac and respiratory function. The pediatric anesthesiologist must observe every heartbeat and every breath if he is to conduct anesthesia safely.