222. Premedications Flashcards
What are the significant stressors for children undergoing surgery?
Factors such as separation from parents, anticipation of surgery, and unfamiliar environments.
These stressors can lead to increased preoperative anxiety.
What are some short- and long-term sequelae associated with perioperative anxiety?
Sequelae include:
* Difficult induction of anesthesia
* Breath holding with risk of laryngospasm
* Increased pain
* Negative postoperative behavioral changes
* Long-term psychological stress
These can affect both children and caregivers.
What typical points of increased anxiety occur in the perioperative period for pediatric patients?
Peripheral intravenous line (PIV) placement and mask induction of anesthesia.
These moments can be particularly distressing.
What is the ideal characteristic of a local/topical anesthetic for PIV placement?
Fast acting, painless/minimally invasive, and effective.
These characteristics help alleviate anxiety.
What are examples of topical anesthetics that can alleviate anxiety during PIV placement?
Examples include:
* EMLA (eutectic mixture of local anesthetics)
* ELA-Max cream
* Jet injection of buffered lidocaine (J-tip injector)
EMLA and ELA-Max require longer onset times, while jet injection is faster.
What routes can premedication be administered to pediatric patients?
Routes include:
* Oral
* Nasal
* Rectal
* Buccal
* Intravenous
* Intramuscular
Each route has different considerations.
What are the general goals of premedication in pediatric surgery?
Goals include:
* Provide anxiolysis
* Facilitate induction
* Reduce parental anxiety
Effective premedication can help prevent postoperative psychological trauma.
What is the most commonly used medication for pediatric premedication?
Midazolam, a benzodiazepine.
It is favored for its fast onset and minimal effect on recovery times.
What are some potential side effects of midazolam?
Potential side effects include:
* Paradoxical drug reaction with agitation
* Inability to prevent emergence delirium
These can impact its effectiveness as a premedication.
What is ketamine and how does it function as a premedication?
Ketamine is an NMDA antagonist that acts as both a sedative and an analgesic.
It has a rapid onset and can be given via multiple routes.
What are the common side effects associated with ketamine?
Common side effects include:
* Excessive salivation
* Psychiatric disturbances
* Postoperative delirium
* Nausea/vomiting
These effects can complicate its use in pediatric patients.
What is dexmedetomidine and what are its effects?
Dexmedetomidine is a short-acting α2-adrenergic agonist that provides cooperative sedation without respiratory depression.
It can also have analgesic effects.
What are the potential side effects of dexmedetomidine?
Potential side effects include:
* Bradycardia
* Hemodynamic fluctuations
* Delayed emergence
Monitoring is necessary during its administration.
True or False: Parental presence during anesthesia induction is strongly supported by literature as a method to reduce anxiety.
False.
Literature suggests distraction techniques or premedication are more effective.
What nonpharmacological interventions can help reduce anxiety in pediatric patients?
Interventions include:
* Distraction techniques (music therapy, video games, cartoons)
These methods are low-cost and have minimal side effects.
