Lecture 2-Perioperative Considerations In Pediatrics Flashcards
Literature has indicated that the most effective method for pediatric induction is PO ___ with ___ presence
PO versed with parental presence
Once a ___, always a ___; respiratory effects will last into ___
Once a premie, always a premie; respiratory effects will last into adulthood
Neuro history—history of seizures—increased risk of seizures with ___ (IH), but it is still the drug of choice for pediatric induction
Increased risk of seizures with sevo
Neuro history—neuromuscular disorder (muscular dystrophy, myotonic dystrophy, cerebral palsy)—caution using ___ d/t increased risk of hyperkalemia
Succinylcholine
Respiratory history—recent cough, cold, fever, pneumonia within the past ___ weeks—if yes, risk of ___/___ is very high
Recent cough, cold, fever, pneumonia within the past 6 weeks—if yes, risk of laryngospasm/bronchospasm is very high (because everything is inflamed)
Mask induction—if kid is not crying, put ___ on first, then mask
Monitors on first, then mask
Mask induction—if kid is screaming/crying, put on ___ first, then ___
Mask first, then monitors (they are going to rip off the monitors, so may as well wait until they are asleep before putting them on)
First monitor is ALWAYS ___, then ___, ___
Pulse ox, then EKG, BP
Anesthesia stages—stage 1 = ___; eyes ___
Awake; eyes midline
Anesthesia stages—stage 2 = ___; eyes ___; HR goes ___ during this stage
Hyperexcitable; eyes divergent; HR goes through the roof during this stage
Anesthesia stages—stage 3 = ___; eyes ___; good time to put in an ___
Asleep; eyes midline; good time to put in an IV
Anesthesia stages—stage 4 = CV reflexes are ___; can be ___tensive, ___cardic; turn down ___ (especially in kids with ___); eyes ___
CV reflexes are anesthetized; can be hypotensive, bradycardic; turn down gas (especially in kids with Down Syndrome—as soon as HR goes down, cut down gas to half…these kids are at high risk for cardiac arrest during induction); eyes midline
IV induction is advantageous in pediatric patients because kid goes to sleep without going through stage ___, so risk of ___ is very low
Stage 2, so risk of laryngospasm is very low
Anatomical differences between pediatric and adult airways—pediatric airway = proportionally smaller ___; epiglottis is ___ (shorter/longer) and ___ (narrower/wider); head and occiput are proportionally ___ (smaller/larger); tongue is proportionally ___ (smaller/larger); neck is much ___ (shorter/longer); larynx is more ___ (anterior/posterior) and ___ (cephalad/caudal); adenoids are ___ (smaller/larger)
Proportionally smaller larynx; epiglottis is longer and narrower; head and occiput are proportionally larger; tongue is proportionally larger; neck is much shorter; larynx is more anterior and cephalad; adenoids are larger
The narrowest portion of the pediatric airway is the ___
Cricoid cartilage (below the vocal cords)
Narrowest portion of the adult airway is the ___
Vocal cords
Risk of mainstem intubation is much ___ (higher/lower) in pediatrics d/t short trachea and bronchus
Higher
If you are meeting resistance when inserting ETT in pediatric patient, you need to ___ the ETT
Downsize…do NOT force it!
As soon as you see the ETT pass through the vocal cords in the pediatric patient, you should continue to advance the tube—T/F?
False—don’t bury the tube…as soon as you see the tube pass through the vocal cords, stop there and don’t continue to advance
Kids are at highest risk of laryngospasm when going to sleep and when waking up during stage ___ of anesthesia
2
If child is in stage 2 of anesthesia, do not ___ the child until they are awake
Do not stimulate the child until they are awake
I.e.: if child is extubated deep or LMA is removed deep and he is brought straight to PACU, he will go through stage 2 while in PACU…do not place monitors on the child in PACU when they are still in stage 2
Medication treatment of laryngospasm = ___ + ___
Succinylcholine 0.4 mg/kg IV + atropine 20 mcg/kg IM
If patient is experiencing laryngospasm during stage 2 of anesthesia and you don’t have your IV yet, how should you give medication?
Give meds IM—remember, don’t want to place an IV during stage 2 (hyperexcitable stage)
Why do we give atropine with succinylcholine to break laryngospasm?
Because succs can cause profound bradycardia in children
First line treatment of laryngospasm =
Positive pressure 40 mm Hg
___ allows you to give positive pressure and feel the bag inflate/deflate as patient is spontaneously breathing once you break the laryngospasm (can’t feel the patient spontaneously breathing with regular ambu bag)
Mapelson D
Always bring ___ to PACU in case child laryngospasms—that way, child has been oxygenated prior to the event rather than starting at room air
Oxygen tank
Fatigue can account for ___ of the needed anesthetic in the OR and PACU—___ (increase/decrease) dosing of narcotics, sedatives, and anesthetic gases for fatigued children
1/3–decrease dosing
Opioids—give ___ the dose for fatigued children
1/2
Opioids—give ___ the dose for children with OSA
1/2
Narcan dose in children—___ mcg/kg
0.5 mcg/kg
Zofran dose peds—___-___ mg/kg; black box warning—risk of ___
0.1-0.5 mg/kg; black box warning—risk of prolonged QT
Post-op—if you have adequately dosed child with pain meds and they are still fussy, what should you do?
Feed them! They may be fussy because they are hangry—sugar binky, sugar water, bottle, get mom for breastfeeding infants…food can replace the need for further medication
