OS-general anaesthetic in children

Question 1

What anatomical aspects of a child are relevant to General Anesthetic?

Answer 1

• big head, short neck, large tongue
• narrow nasal passages
• babies breathe through their nose at birth
• High anterior larynx
• Larynx narrowest at the cricoid cartilage
• large floppy Epiglottis
• less alveoli

Question 2

Discuss a child’s respiratory physiology

Answer 2

• Low functional residual capacity.
• Closing volume >FRC causing ventilation perfusion mismatch
• Fixed tidal volume (due to horizontal ribs and weak intercostal muscles)
• Higher oxygen consumption than adults.

Question 3

Describe a child’s temperature regulation.

Answer 3

• Larger surface area to body weight ratio
• Large head surface area and heat loss
• Higher concentration of brown fat (meaning increased oxygen consumption)
• Requires a higher temperature to achieve a thermoneutral environment.
• Immature response to hypothermia (poor ability to shiver and vasoconstrict)
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Question 4

Discuss the nervous system of a child.

Answer 4

• Increased incidence of periodic breathing and apnoeas
• Opiates cause greater depression of the ventilatory response to CO₂
• Increased sensitivity to muscle relaxants due to immature neuromuscular junctions.
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Question 5

What is this?

Answer 5

Laryngeal mask airway.

Question 6

what is this?

Answer 6

Nasal endotracheal intubation (this means that the tube isn’t in the mouth which gives us more access)

Question 7

What is this?

Answer 7

Oral endotracheal intubation.

The tube is in the mouth .

Question 8

What are the four stages of anaesthesia.

Answer 8

1. Induction
2. excitement - patient starts to move around
3. anaesthesia
4. respiratory paralysis (overdose)

Question 9

What are the indications of using General Anaesthetic?

Answer 9

child-

• too young
• too anxious
• too uncooperative

Dentist

• If the patient needs to be completely still
• If the operation is very complex.

Question 10

What are the major and minor risks of General Anaesthetic.

Answer 10

MAJOR - DEATH

minor:

• pain
• headache / nausea/ vomiting
• sore throat
• sore nose and nosebleeds
• drowsiness.
• Upset or increased anxiety.

Question 11

Discuss the complications of using General Anaesthetic.

Answer 11

• Damage to mouth and oropharynx from intubation.
• Malignant hyperpyrexia
• Prolonged apnoea after muscle relaxant
• Awareness (which patient is paralysed but not effectively anaesthetised)
• Laryngospasm (when something irritates the airway causing the patient to throw themselves back as the larynx spasms)
• Coughing or moving during the procedure (if the GA is too light)

Question 12

How do you make the GA as safe as possible?

Answer 12

• It’s use needs to be justifed.
• Minimise the number of GA ( do joint GA with other specialities)
• Ensure mandible is lifted so it does not fall back and block the airway.
• WHO surgical safety checklist.

Question 13

What is the WHO safety checklist for General anaesthetic?

Answer 13

• Brief before the checklist
• debfrief after the checklist (`what did and didn’t go well)
• Every patient is
• Signed in (confirming patient idenity, procedure etc)
• Time out noted
• Signed out.

Question 14

Discuss the discharge criteria for general anaesthetic.

Answer 14

patient needs to be:

• Fully conscious
• Able to maintain a clear airway
• Exhibits protective reflexes.
• Has satisfactory oxygenation and respiration.
• Stable CVS
• controlled pain, nausea and vomiting
• Temperature within normal limits.
• Eaten, drunk and been to the toliet.

Question 15

Discuss the post operative instructions you would provide for a patient after General Anaesthetic.

Answer 15

• pain control
• Travel home
• rest
• Look out for pain or bleeding
• take the next day off
• Eat a soft diet
• Book a follow up appointment.

Question 16

What is a satisfactory oxygenation and respiration?

Answer 16

2-5 years 24-30 breaths/min

5-12 years 20-24 breaths/ min