Fluid & transfusion management pediatric anesthesia Flashcards
MIV for 0-10 kg
4 mL/kg/hr for each kg of body weight
MIV for 10-20 kg
40 mL + 2 mL/kg/hr for each kg >10 kg
MIV for >20 kg
60 mL + 1 mL/kg/hr for each kg >20 kg
Calculating NPO fluid deficits.
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
IV fluid needs.
metered chamber (i.e. buretrol) warming devices 10-20 mL/kg bolus crystalloid colloid albumin
Types of fluids for pediatrics.
-Balanced salt solution (LR, NS)- for deficits & evaporative loss
For patients at risk for hypoglycemia:
5% dextrose in 0.45% normal saline
- MIV rate
- Half the MIV rate
- boluses
IV fluids for pediatrics, includes careful administration
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
PRBC administration in the pediatric patient should consider
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
The max allowable blood loss calculation is
[EBV x (starting Hct-target Hct)]/starting Hct
Volume of PRBCs to be transfused calculation is
[(desired Hct-present Hct) x EBV}/Hct of PRBCs (~60%)
Estimated blood volume of premature infant is
100 mL/kg
Estimated blood volume of term infant is
90 mL/kg
Estimated blood volume of 6 month old is
80 mL/kg
Estimated blood volume of children <1 year is
75 mL/kg
Estimated blood volume of children >1 year is
70 mL/kg
Fresh frozen plasma should be administered to
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
For fresh frozen plasma, always use
a filter and warmer
Platelets should be used for children whose
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
For platelets, we should use
only blood filter tubing (no warming device)
A cell saver uses the
salvaging of erythrocytes from suctioned blood
Large volumes of washed cells used with the cell saver may lead to
coagulopathy of dilution of coagulation factors
Rapid & multiple transfusions can lead to
hypocalcemia
Severe ionized hypocalcemia leads to
cardiac depression with hypotension
________ both contain calcium citrate
FFP & PRBCs
_______ have a decreased ability to mobilize calcium and to metabolize citrate
Neonates
Irradiated blood products are indicated to prevent
transfusion related graft-versus-host disease important in cancer and immunocompromised patients
Filtered blood products are an effective way to
eliminate the risk of CMV infection and are important for cancer and sickle cell patients
Washed products are reserved for patients with
life-threatening allergic reactions and it significantly decreases the lifespan and effectiveness of RBCs in the circulation
Recommendations to prevent hyperkalemic-associated cardiac arrest or near arrest include
transfuse before significant hemodynamic compromise
use PIVs over CVC and large bore catheters (>23 g)
use “fresh” RBCs and wash RBCs
Treatment of significant hyperkalemia
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.
FFP indication, dose, & notes
indication: massive blood transfusion
Dose: 10-15 mL/kg
factor levels increase by 15-20%
PRBCs indication, dose, & notes
indication: 30-40% infants; 25% child
dose: 10-15 mL/kg
notes: increases Hgb by 2-3 g/dL
Platelet indication, dose, & notes.
indication: count <100,000
dose: 5-10 mL/kg
notes: increases PLTs by 50,000-100,000 mm3
Cryoprecipitate indication, dose, & notes.
indication: persistent bleeding
dose: 10-20 mL/kg
notes: increases fibrinogen by 60-100 mg/dL
Calcium chloride indication, dose, and notes
indication: hypocalcemia
dose: 10 mg/kg IV slowly via central line only
Calcium gluconate indication, dose & notes
hypocalcemia
30 mg/kg
Iv slowly via peripheral line
