Children as Surgical Patients Flashcards
How may a child’s weight be estimated
(Age + 4) x 2
Describe the relationship between surface area and weight as the child grows
Ratio decreases with age
List the difficulties with endotracheal intubation in children
- Resting position of the neck is flexion due to large head and short neck
- Glottic aperture is more anteriorly inclined
- Epiglottis is inclined more posteriorly
- Trachea is shorter and narrower
- Trachea lies further to the right of the midline
- Tracheal bifurcation is at T3 not T6
- Large tongue and adenoids obscures view
What type of ET tube should be used in children and why
- Uncuffed ET tube
- Cricoid is the narrowest part of a child’s airway and a cuffed airway can cause pressure necrosis
Until what age are infants obligate nasal breathers and why
2 months (due to large tongues)
What incision is used for laparotomy in children and why
Transverse supraumbilical incision (abdomen is wider than it is long unlike in adults)
When do the caecum and appendix migrate down to the RIF
Age 3-4
Define prematurity
Born before 38 weeks gestation
Define the neonatal period
Birth to 44 weeks post-conceptional age
Why are neonates more susceptible to hypothermia
- Larger surface area to weight ratio
- Less subcutaneous fat
- Cannot shiver and have no voluntary control over temperature regulation
- Smaller stores of brown fat
What must the ambient temperature be for infants in theatre
31.5 degrees
What is circulating blood volume per KG at birth compared to 1 year
- Birth = 100ml/KG
- 1 year = 80ml/KG
How much blood loss requires transfusion in a term neonate
> 30ml
Outline the maintenance fluid requirements for infants
- 0-10KG = 100ml/kg/day
- 10-20 = 50ml/kg/day
- 20+ = 20ml/kg/day
What is the maintenance fluid of choice for children undergoing surgery
0.45% saline/5%dextrose/10mmol potassium
