Fluid & transfusion management pediatric anesthesia

Question 1

MIV for 0-10 kg

Answer 1

4 mL/kg/hr for each kg of body weight

Question 2

MIV for 10-20 kg

Answer 2

40 mL + 2 mL/kg/hr for each kg >10 kg

Question 3

MIV for >20 kg

Answer 3

60 mL + 1 mL/kg/hr for each kg >20 kg

Question 4

Calculating NPO fluid deficits.

Answer 4

in general, multiply the hourly maintenance rate by the number of hours NPO

• replace 50% in the first hour
• Replace 25% in hour 2
• Replace the remaining 25% in hour 3

Question 5

IV fluid needs.

Answer 5

metered chamber (i.e. buretrol)
warming devices
10-20 mL/kg bolus
crystalloid
colloid
albumin

Question 6

Types of fluids for pediatrics.

Answer 6

-Balanced salt solution (LR, NS)- for deficits & evaporative loss

Question 7

For patients at risk for hypoglycemia:

Answer 7

5% dextrose in 0.45% normal saline

• MIV rate
• Half the MIV rate
• boluses

Question 8

IV fluids for pediatrics, includes careful administration

Answer 8

to no fluid overload

• the neonatal kidney is unable to excrete large amounts of excess water or electrolytes
• volume in extracellular fluid space is larger than adults

Question 9

PRBC administration in the pediatric patient should consider

Answer 9

estimated blood volumes
max allowable blood loss
volume of PRBCs to transfuse
always use a filter and warm
citrate preservative
T&S/T&C
indications for special processing

Question 10

The max allowable blood loss calculation is

Answer 10

[EBV x (starting Hct-target Hct)]/starting Hct

Question 11

Volume of PRBCs to be transfused calculation is

Answer 11

[(desired Hct-present Hct) x EBV}/Hct of PRBCs (~60%)

Question 12

Estimated blood volume of premature infant is

Answer 12

100 mL/kg

Question 13

Estimated blood volume of term infant is

Answer 13

90 mL/kg

Question 14

Estimated blood volume of 6 month old is

Answer 14

80 mL/kg

Question 15

Estimated blood volume of children <1 year is

Answer 15

75 mL/kg

Question 16

Estimated blood volume of children >1 year is

Answer 16

70 mL/kg

Question 17

Fresh frozen plasma should be administered to

Answer 17

replenish clotting factors lost during massive transfusion (often when EBL exceeds 1-1.5 times the estimated blood volume)
observed coagulopathy
or prolongation of the PT & PTT or ROTEM

Question 18

For fresh frozen plasma, always use

Answer 18

a filter and warmer

Question 19

Platelets should be used for children whose

Answer 19

platelet count has fallen secondary to idiopathic thrombocytopenic purpura or chemotherapy tolerate platelet counts as low as 15,000 mm3
children whose platelet count is decreased because of dilution (i.e. massive blood transfusions) generally require transfusion when the count is <50,000 mm3

Question 20

For platelets, we should use

Answer 20

only blood filter tubing (no warming device)

Question 21

A cell saver uses the

Answer 21

salvaging of erythrocytes from suctioned blood

Question 22

Large volumes of washed cells used with the cell saver may lead to

Answer 22

coagulopathy of dilution of coagulation factors

Question 23

Rapid & multiple transfusions can lead to

Answer 23

hypocalcemia

Question 24

Severe ionized hypocalcemia leads to

Answer 24

cardiac depression with hypotension

Question 25

________ both contain calcium citrate

Answer 25

FFP & PRBCs

Question 26

_______ have a decreased ability to mobilize calcium and to metabolize citrate

Answer 26

Neonates

Question 27

Irradiated blood products are indicated to prevent

Answer 27

transfusion related graft-versus-host disease important in cancer and immunocompromised patients

Question 28

Filtered blood products are an effective way to

Answer 28

eliminate the risk of CMV infection and are important for cancer and sickle cell patients

Question 29

Washed products are reserved for patients with

Answer 29

life-threatening allergic reactions and it significantly decreases the lifespan and effectiveness of RBCs in the circulation

Question 30

Recommendations to prevent hyperkalemic-associated cardiac arrest or near arrest include

Answer 30

transfuse before significant hemodynamic compromise
use PIVs over CVC and large bore catheters (>23 g)
use “fresh” RBCs and wash RBCs

Question 31

Treatment of significant hyperkalemia

Answer 31

hyperventilation
calcium chloride 20 mg/kg IV or calcium gluconate 60 mg/kg
dextrose 0.25-1 g/kg and insulin 0.1 units/kg IV
sodium bicarbonate 1-2 mEq/kg IV
albuterol
furosemide 0.1 mg/kg IV
cardiac arrest- perform CPR, activate ECMO if arrest >6 min.

Question 32

FFP indication, dose, & notes

Answer 32

indication: massive blood transfusion
Dose: 10-15 mL/kg
factor levels increase by 15-20%

Question 33

PRBCs indication, dose, & notes

Answer 33

indication: 30-40% infants; 25% child
dose: 10-15 mL/kg
notes: increases Hgb by 2-3 g/dL

Question 34

Platelet indication, dose, & notes.

Answer 34

indication: count <100,000
dose: 5-10 mL/kg
notes: increases PLTs by 50,000-100,000 mm3

Question 35

Cryoprecipitate indication, dose, & notes.

Answer 35

indication: persistent bleeding
dose: 10-20 mL/kg
notes: increases fibrinogen by 60-100 mg/dL

Question 36

Calcium chloride indication, dose, and notes

Answer 36

indication: hypocalcemia
dose: 10 mg/kg IV slowly via central line only

Question 37

Calcium gluconate indication, dose & notes

Answer 37

hypocalcemia
30 mg/kg
Iv slowly via peripheral line