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Junior Anaesthesia > Paediatric Anaesthesia > Flashcards

Paediatric Anaesthesia Flashcards

1
Q

The provision of safe anaesthesia for the paediatric patient requires a clear understanding of the ________,________,__________ and __________ differences children and adults.

A

psychological, anatomic, physiological and pharmacologic

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2
Q

Span from Newborn to adolescent

Neonates –__________ of life. May be preterm
Infants – ______ to _________
Preschool -__-____yrs
Schoolage – ___-____ yrs

A

first 28 days

1 month to 1 year

1-5

5-12

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3
Q

Neonates further classified as
 Full term
Pre-term <____wks
 Extreme preterm <____ wks
 Post-term >____ wks
 Low Birth Weight < ____g
 Extremely Low Birth Weight <______g

A

37

28

41

2500

1000

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4
Q

Postconceptual age = ______ + _______

A

GA + PNA

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5
Q

Anatomical differences

Anatomy of airway predisposes to obstruction and difficult intubation.
- ________ head, ________ neck, ________ neck muscles, ___ AP diameter→ difficult positioning.
- ________ nares → easily obstructed e.g ________ - ________ tongue readily obstructs ________ → obligate _____________
- Anterior, high larynx C___- C___
- (short or long?), ___-shaped epiglottis at _____ angle

A

large ; short ;underdev

↑; Small ;catarrah

large ;oropharynx ; nasal breathers

C2- C4

long ; U ; 450

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6
Q

Pediatric

_______ shaped larynx with ______ as the narrowest part
The ________ is narrowest part in adults

A

Funnel; cricoid

glottis

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7
Q

(Anterior or Posterior?) , (low or high?) larynx C___- C__ (C__- C__ in adults)

(Short or Long?), _____ epiglottis

Soft tracheal cartilages

Thin lining of airway which easily gets damaged.

A

Anterior ; Hugh

C2- C4

C5- C6

Long; floppy

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8
Q

Paeds

(Vertical or Horizontal?) ribs with loss of ____________ movt does not contribute to resp mechanics→ _________ breathers

Large liver pushes up and flattens diaphragm → ________ tidal volume

____________ intercostal muscles

___________________ of bronchi -___0

A

Horizontal ; bucket-handle

diaphragmatic ; fixed

Poorly developed

Equal bifurcation

55

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9
Q

Anatomical differences

CNS
Spinal cord terminates at _______
Dural sac terminates at _____ in neonates

CVS
_____ veins, extensive _________→ ________ cannulation

A

L3/L4

S3

Tiny; subcut fat

difficult

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10
Q

Physiological differences

Few alveoli → _______

↓FRC, closing volume encroaches on FRC
→ easily ________ with ____

↑alveolar ventilation will req ↑ ________________ 6-8ml/kg/min to meet demands
Response to hypercapnia and hypoxaemia →____________

Surfactant produced at ____wks GA

A

V/Q mismatch

hypoxic with apnoea

O2 consumption

respiratory depression

36

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11
Q

Physiological Cardiovascular

Easily reverts to _______ circulation

↑ cardiac output ←↑_____ reqs ↑ ________

↓ myocardial contractile tissue→ less able to ↑ ___________. Thus Cardiac output is _________ dependent

Normal heart rate – _____-_____ bts/min (neonates)
Predominant _______ innervation of heart ↓ ____- activity → _______ and _______

A

foetal ; BMR ; perfusion

stroke volume ; heart rate

130 -160

parasym ; sym

low BP ; PVR

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12
Q

Haematological

Blood volume

– preterm ____-____ mls/kg
- neonate – ____mls/kg
- infant - ____mls/kg
- child - ___mls/kg

Hb ____ – ___ g/dl at birth
- ‘physiological anaemia’

Hb____ predominant till ________ . ↓2,3 DPG, Lt shift of ODC

A

preterm 95 -100 mls/kg
- neonate – 90mls/kg
- infant - 85mls/kg
- child - 80mls/kg
Hb 18 – 21 g/dl at birth

HbF predominant till 6 months

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13
Q

Pardiatric Neonate

(Mature or Immature?) CNS

___________ myelination →_____ conduction time but _______ interneuron distance for impulse to travel

Blood-brain barrier is (more or less?) permeable

Impaired autoregulation → intraventricular hmg

A

Immature

Incomplete; slower

shorter; more

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14
Q

Paeds Temperature Control

High ______ area : _______ ratio → _____ loose heat esp from _______

Immature __________ centre
Lack of ___________
Unable to ________

Cutaneous vessels do not _________
Non-shivering thermogenesis → hypoxia, acidosis, hypoglycaemia
Thermoneutral temperature (____oC prems, ____oC neonates)

A

body surface area : body weight

rapidly ; head

thermoregulatory ; subcutaneous fat

shiver ; vasoconstrict

34oC ; 32oC

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15
Q

Paeds Renal /Fluid Balance/ Hepatic

TBW = _____% of body wt
↑ ECF (75%) →↑__________ of drugs
→ more accessible to _______

________ renal function, therefore unable to
handle large fluid or Na loads.
Limited ____________________ → easily become hypoglycaemic

A

90

volume of distribution; fluid losses

Immature; carbohydrate stores

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16
Q

Paeds pharmacology

↑ cardiac output → faster ____________

↑ ECF → ↑__________________ of highly
ionised drugs e.g muscle relaxants

Immature liver enzymes → ↓ _______________ especially __________

Immature renal fxn → ↓_____________

MAC – ___es with ____ing age till ____/12 (except _____)

↑ sensitivity to induction agents – immature ________

MR - ↑sensitivity, but ↑ vol of distr → dose

A

circulation time

vol of distribution ; drug metabolism

morphine; drug excretion

↑; ↑; 6; Sevo; BBB

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17
Q

Most anatomical and physiological differences approach adult characteristics by age _________ yrs.

A

8 – 10

18
Q

Neonatal surgery and anaesthesia should be performed in specialized centres

T/F

A

T

19
Q

In paeds, ______ metabolic rate & ______ resp physiology make desaturation and hypoxia more likely

They are (more or less?) able to tolerate changes in temp, glucose homeostasis

A

Higher; immature

Less

20
Q

Pre-op assessment

Should include meeting with _______
PCA – problems of prematurity
Newborn -Congenital abnormalities, metab disturbances
Presch/ sch age – URTI, enlarged adenoids, tonsils
Immunisation
PMH – Asthma, SCD General exam
Investigate all heart murmurs

A

parents

21
Q

Formula to estimate weight from age

0-12 month
1-5 years
6-12 year

A

(0.5 x months )+4

(2 x years )+8

(3 x years )+7

22
Q

Preperation & premedication

Allay anxiety in parents/patient
familiarisation tour of hospital and equipments
Crossmatch blood
_________ or __________ for venepuncture

Preop fasting guidelines- avoid prolonged fast
- clear fluid –____ hrs
- breast milk –___hrs
- formula milk / solid food–____ hrs

A

EMLA or ametop cream

2; 4 ; 6

23
Q

Suitability for Daycase
Very (good or bad?) candidates for day case surgery
Selection criteria as for adults

A

Good

24
Q

Suitability for Daycase

Exclusion includes –
- Former preterm PCA <_____ weeks
- Undiagnosed ________
-_________ dx
- Sleep apnoea

A

60

cardiac murmur

Sickle cell

25
Q

The child with RTI

Children prone to URTI. Many are benign and non-infectious

Important to identify those with significant RTI → _______,________,________

Severe if –________ cough, _______ nasal discharge, fever malaise,_________ , ↑ _______

Postpone till _____ wks after resolution of URTI or _____ weeks after LRTI.
Caution in infants

A

laryngospasm, brochospasm, atelectasis.

productive; purulent; bronchospasm; WCC

2; 4

26
Q

Conduct of Anaesthesia

________ anaesthesia ± _______ technique

__________ as sole anaes techniq is
contraindicated in paeds.

Exception –______ anaes for prems
-___________ for moribund patients

A

General

regional

Regional

spinal; local infiltration

27
Q

Induction

Calculate drug doses, blood volume and fluid req before anaesthesia
? Parental presence
________ techniques
? Anticholinergic –______,________
Inhalational -_______ or ————
IV induction – ________,_________, or ________
IM –________ especially for difficult venous access
Rectal – _________,__________. Irreg absorp

A

Distraction

atropine, glycopyrrolate

halothane or sevoflurane

propofol, thiopentone or ketamine

ketamine

thiopentone, methohexitone

28
Q

Airway mx
Airway complications are common
Head tilt, chin-lift, jaw thurst
Position – ______,______
Intubation – _______,_________ blade
- deep inhalational, relaxant Tube

A

neutral, sniffing

curved, straight

29
Q

Airway management

– size =___________
- length = _______________

  • non-cuffed if age < ____ yrs-tube mandatory in newborn -#3, 3.5 #2.5 (prems)
A

– size = (age/4) + 4
- length = age/2 + 12 (or 15)
- non-cuffed if age < 8 yrs

-tube mandatory in newborn -#3, 3.5 #2.5 (prems)

30
Q

Airway

LMA- size ___-___
Meticulous attention to fixing of tube

A

1-3

31
Q

Ventilation

Spontaneous ventilation

IPPV -–__________ tube with audible____ to prevent ______________ (<10 yrs)

A

uncuffed; leak

subglottic stenosis

32
Q

Ventilation

Equipment
-________________ face masks
- reduced _________ and good anatomical fit
-___________ breathing system – up to ___kg
-_________ system - ____ kg
-_______ circuit -_____kg

A

Rendell-Baker-Soucek

dead space

Mapleson F ; 25

Paed circle; >5

Bain’s; >25

33
Q

Maintenance
Relaxants –_________ _-__mg/kg
- NDMR - ↑ ________

Inhalational + N2O/ Air + O2
TIVA –_______ (> ___yrs), _______

A

Suxamethonium; 1-2

sensitivity

Propofol; 3 ; ketamine

34
Q

Monitoring
________/______ stethoscope
BP, ECG, pulse oximetry, capnography Temp, bld loss, U/O
Constant _____

A

Precordial / oeso

observation

35
Q

Analgesia in paeds
Should not _____________
Combine regional / local with GA to ↓ need for __________

Fentanyl 1-2mcg/kg, morphine 0.1mg/kg, pethidine 1mg/kg

Caution with _________ in infants < ___________

LAA – cau block

A

depress resp sys

peri-op opioids

NSAIDS; 6 mths

36
Q

Temperature control

Compromise between thermo-neutral temp (____prem, ____ neonates, ___ adolescent) and comfortable ambient temp (____o C)
↑ ambient temp

Wrap esp _______, radiant heater, warming blanket
Warm fluids and blood
Humidify gases

A

34; 33; 30; 25

head

37
Q

Reversal
Reverse NMB – __________ + __________ / __________
Pharyngeal toileting
Extubate neonates that are __________, _______thermic, _______glycaemic, _______tensive and breathing __________

Awake / deep extubation.

A

neostigmine + atropine / glyco

fully awake
normothermic
normoglycaemic
normotensive

spontaneously

38
Q

Regional Anaesthesia
Not used as sole anaesthetic tech in children <____ yrs.

_____ /______ – pre-terms and ex-prems

A

12

Spinal; caudal

39
Q

Regional anaesthesia

Spinal/caudal – ________ and ________
- ↓ incidence of _________,————-
- less ____________ to _____________

A

pre-terms and ex-prems

post-op apnoea, bradycardia

disruptive to feeding regimen

40
Q

POST-OPERATIVE

Positioning – airway patency, prevent _______
Supplementary oxygen till ___________
Keep warm
Monitoring
Fluid therapy
Post-op __________ – Pain scores -PCA(>____yrs) or NCA
Commence oral feeds as soon as possible

A

aspiration; fully awake

analgesia

5

41
Q

Postoperative Analgesia

Analgesia – Opioids – morphine, pentazocine
- NSAIDS – only >________
- Paracetamol – IV, oral, rectal - PCA, NCA
Regional anaesthesia, nerve blocks, local infiltration
May require anti-emetics – ondansetron, dexamethasone

A

6 months

Junior Anaesthesia (16 decks)

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