Chapter 7 - Postoperative Care and Pain Management Flashcards
All children should be transported to the PACU in what position?
Lateral decubitus
Head extended
Oxygen
Pulse oximitry
T/F
Infants younger than 3 months of age, may not rapidly convert to mouth breathing if the nasal passages are blocked
T
T/F
Laryngospasm occurs most commonly during emergence
T
What is the dose of succinylcholine that will relieve laryngospasm?
Succinylcholine 0.2 mg/kg
T/F
Stridor is more common in children with down syndrome
T
Stridor usually appears within how long after extubation?
30 to 60 min.
What is the treatment for flash pulm edema after laryngospasm?
Positive pressure ventilation 100% O2
furosemide
fluid restriction
Agitation occurs most commonly in children 2 to 6 years of age after what inhaled anesthetic?
Sevoflurane
- Incidence up to 80%
- Transient
- Dissipates within 10 to 20 min.
T/F
Shivering and rigidity may increase the metabolic rate of oxygen requirement
T
What medications can be used to eliminate post op shivering?
Demerol 0.25 mg/kg
or
Dexmedetomidine 0.5 mcg/kg (IV slowly)
What is the leading cause of delayed discharge from PACU?
Nausea & Vomiting
The combination of which two antiemetics provides the optimal PONV prophylactic regimen?
Zofran 0.05 to 0.1 mg/kg
and
Dexamethasone 0.0625 to 0.15 mg/kg
T/F
Biochemical and nervous components of the pain perception pathways are completely formed during fetal life.
T
Even the preterm can feel pain
When should postoperative pain be planned?
In the Preoperative interview
T/F
Optimal postop pain relief:
- minimizes the metabolic rate for oxygen
- reduces cardio respiratory demads
- promotes earl ambulation
- speed recovery
T
T/F
When treating pain at any age, it is essential to monitor the response to therapy with an objective scoring system
T
T/F
Meperidine is recommended for perioperative anlagesia in children?
F
- Potential for seizures
- ONLY indication is to treat shivering
Acetaminophen suppository can reach peak blood levels by how many min?
60 to 180 min
- administer immediately after induction
- not appropriate for brief procedures
The daily dose of acetaminophen should not exceed 90 to 100 mg/kg and repeat doses should be given at what intervals?
6 hour intervals
T/F
Ibuprophen can decrease platelet aggregation
T
Also:
- N/V
- Diarrhea
T/F
Ibuprophen is indicated for treating tonsilectomy pain
F
- Increases bleeding
What is the dose for IV codeine?
MUST NOT be given IV
causes
SEVERE HYPOTENSION
Ketorolac dose for children less than 50 kg?
Ketorolac dose for children more than 50 kg?
Children < 50 kg:
0.5 mg/kg - MAX of 15 mg
Children > 50 kg:
0.5 mg/kg - MAX of 30 mg
Which opioid provides good pain relief after adenotonsillectomy?
Tramadol 1 to 2 mg/kg
T/F
Tramadol can be particulary useful in children with OSA
T
T/F
Children who are recieving vasopressors can have a reduced clearance rate of morphine
T
What age group of children are capable of using a PCA system?
Older than 5 or 6 years of age
T/F
The side effects of opioids are avoided when regional anesthesia is used
T
T/F
Regional blocks established before the surgical incision may modulate total postop pain by preventing “wind up” within CNS
T
What block is useful for inguinal hernia surgery?
Ilioinguinal and iliohypogastric
Block for umblical surgery?
Bilateral T10 intercostal block
Epidural morphine at 33 mcg/kg provides analgesia for up to how many hours?
12 hours
Why is Fentanyl administered via lumber or caudal route is less likely to cause respiratory depression
Because of its
- Increased Lipid Solubility
- More limited distribution
- Decrease rostral spread
What are the most common side effects after regional blocks with opioids in children?
- Urinary rentention
- Pruritus
- N/V
If ventilatory depression does occur with a regional block with opioids, the ventilatory response to CO2 may be depressed for up to how many hours?
up to 24 hours
What are some Common compications after neuraxial opiods?
- Pruritis
- Urinary retention
- N/V
- Respiratory depression
