Analgesia/anaesthesia

Question 1

Ketamine dosing

Answer 1

0.5 - 2mg/kg IV for induction
2-4mg/kg IM for analgesia
5-10mg/kg IM for sedation

Question 2

ketamine side effects

Answer 2

N/V 15%
Hypersalivation
Laryngospasm
Emergence phenomenon
Hallucination/nightmares
Resp depression/hypoxia/apnoea

Question 3

Midazolam dosing

Answer 3

IM 0.1-0.2 mg/kg, usual max 5mg

Question 4

Midazolam side effects

Answer 4

Hypotension
Apnoea, resp depression, hypoxia
Paradoxical hyper stimulation
Ongoing drowsiness

Question 5

How does a childs larynx differ from an adults?

Answer 5

Relatively higher and anterior larynx

Question 6

How does an infants head affect their airway?

Answer 6

Their relatively larger head tends to flex their short neck leading to narrowing and obstruction

Question 7

What is the narrowest part of an infants airway?

Answer 7

The cricoid ring

Question 8

How are oropharyngeal airways sized in infants?

Answer 8

Measure from the incisors to the angle of the jaw

Question 9

How is the sniffing position achieved?

Answer 9

Flex the base of the neck (brings head forward) and extend the atlatnoaxial joint (head looks up)

Question 10

How do you size a mask in a child or infant?

Answer 10

Should go over the bridge of the nose and just under the lower lip

Question 11

How do you size an ETT in a young child >1yr?

Answer 11

Uncuffed = (age/4) + 4

Cuffed = (age/4) + 3.5

So a 2yo would have a size 4.5 uncuffed tube or a size 4 cuffed tube

Question 12

How do you size an ETT for a child <1yr?

Answer 12

1 year and under only uncuffed

1yo size 4.5
6 months size 4.0
Neonate <3kg size 3.0 to 3.5

Question 13

How do you estimate length of tube at the lips?

Answer 13

Length (cm) = (age/2) + 12

2yo = 2/2 + 12 = 13cm

Question 14

What is the dosing of intranasal fentanyl?

Answer 14

1.5mcg/kg 1st dose

Repeat doses 0.75-1.5mcg/kg titrated to effect

IN fentanyl only used for children >1yr of age

Question 15

What is the RSI dosing for Suxamethonium in children?

Answer 15

1.5-2mg/kg IV

Risk of bradycardia in children, much higher risk with 2nd dose
Consider the use of atropine as pre-treatment

Question 16

What is the dose of Rocuronium for RSI in children?

Answer 16

1.2 - 1.6mg/kg IV

Question 17

How is Sucrose used as analgesia?

Answer 17

• Used in age group 0-18months
• Provide the dose 2mins prior to a painful procedure
• Max 5ml/day <3months and max 10ml/day >3months
• 0.1 - 0.5ml increments

Question 18

When is Ibuprofen used as analgesia in paeds?

Answer 18

• > 3months of age
• 10mg/kg PO, max 30mg/kg/day

Question 19

What is the dosing of Oxycodone in paediatrics?

Answer 19

• > 1month old
• 0.1mg/kg PO

Question 20

How should anaesthesia be given for a paediatrics patient requiring a minor procedure ie suturing

Answer 20

Question 21

What are the potential indications for nitrous oxide in paediatrics?

Answer 21

Diagnostic
- LP or SPA
- Urinary IDC insertion
- PIVC insertion or blood drawing

Therapeutic
- Suturing
- Foreign body removal
- Simple fracture manipulation
- Simple burns dressings
- Incision and drainage of abscess
- Local anaesthetic injection

Question 22

What are the contraindications to nitrous oxide in paediatrics? What are the potential complications?

Answer 22

Absolute
- Airway or breathing compromise (ie severe asthma)
- Expansion of gas filled airspaces (PTx, recent craniectomy, SBO, air embolus, decompression illness, middle ear disease, surgery with air trapping, obstructive airways disease)
- Pulmonary hypertension severe enough to cause reduced exercise tolerance (worsens pHTN)
- GCS <15 from head injury
- Procedure >30mins
- Very painful procedure
- Certain metabolic disorders (homocystinuria etc

Relative
- Increased risk of airway compromise (obstruction, known difficult airway, URTI)
- Lower risk expansion of gas filled spaces
- Head injury but GCS 15
- Age <6month
- Must be able to generate enough negative pressure (if using on demand entonox 50:50)
- Increased risk of bone marrow suppression (poor nutrition, severe illness, severe infection, extensive tissue damage)

Side effects/Complications
- N/V
- Dizziness, agitation
- Aspiration, airway obstruction
- Diffusion hypoxia
- Hallucinations
- Sedation failure
- Rare (bone marrow suppression, neurotoxicity, increased homocysteine level)