Analgesia/anaesthesia Flashcards
Ketamine dosing
0.5 - 2mg/kg IV for induction
2-4mg/kg IM for analgesia
5-10mg/kg IM for sedation
ketamine side effects
N/V 15%
Hypersalivation
Laryngospasm
Emergence phenomenon
Hallucination/nightmares
Resp depression/hypoxia/apnoea
Midazolam dosing
IM 0.1-0.2 mg/kg, usual max 5mg
Midazolam side effects
Hypotension
Apnoea, resp depression, hypoxia
Paradoxical hyper stimulation
Ongoing drowsiness
How does a childs larynx differ from an adults?
Relatively higher and anterior larynx
How does an infants head affect their airway?
Their relatively larger head tends to flex their short neck leading to narrowing and obstruction
What is the narrowest part of an infants airway?
The cricoid ring
How are oropharyngeal airways sized in infants?
Measure from the incisors to the angle of the jaw
How is the sniffing position achieved?
Flex the base of the neck (brings head forward) and extend the atlatnoaxial joint (head looks up)
How do you size a mask in a child or infant?
Should go over the bridge of the nose and just under the lower lip
How do you size an ETT in a young child >1yr?
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
How do you size an ETT for a child <1yr?
1 year and under only uncuffed
1yo size 4.5
6 months size 4.0
Neonate <3kg size 3.0 to 3.5
How do you estimate length of tube at the lips?
Length (cm) = (age/2) + 12
2yo = 2/2 + 12 = 13cm
What is the dosing of intranasal fentanyl?
1.5mcg/kg 1st dose
Repeat doses 0.75-1.5mcg/kg titrated to effect
IN fentanyl only used for children >1yr of age
What is the RSI dosing for Suxamethonium in children?
1.5-2mg/kg IV
Risk of bradycardia in children, much higher risk with 2nd dose
Consider the use of atropine as pre-treatment
What is the dose of Rocuronium for RSI in children?
1.2 - 1.6mg/kg IV
How is Sucrose used as analgesia?
- 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
When is Ibuprofen used as analgesia in paeds?
- > 3months of age
- 10mg/kg PO, max 30mg/kg/day
What is the dosing of Oxycodone in paediatrics?
- > 1month old
- 0.1mg/kg PO
How should anaesthesia be given for a paediatrics patient requiring a minor procedure ie suturing
What are the potential indications for nitrous oxide in paediatrics?
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
What are the contraindications to nitrous oxide in paediatrics? What are the potential complications?
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)
