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FRCA Final > Paediatric anaesthesia > Flashcards

Paediatric anaesthesia Flashcards

1
Q

Preterm

A

< 37 weeks post conceptual age

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2
Q

Low birth weight

A

Less than 2.5kg

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3
Q

Very low birth weight

A

Less than 1.5kg

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4
Q

Extremely low birth weight

A

Less than 1Kg

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5
Q

Infant

A

1 month - 1 year

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6
Q

Which studies are the neonatal survival rates derived from?

A

EPICure and EPICure 2 Studies

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7
Q

What is the morbidity and mortality for < 23 weeks

A

Negligible survival. Appropriate to not attempt resuscitation as standard.

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8
Q

What is the morbidity and mortality for 23 - 23+6?

A

80% mortality 54% survivors have moderate to severe disability Reasonable to not attempt resuscitation but decision made with family

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9
Q

What is the morbidity and mortality for 24 - 24+6?

A

66% Mortality Half remaining have moderate to severe disability Resuscitation is generally considered appropriate unless there are other antenatally diagnosed conditions that would further impair survival

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10
Q

What is the morbidity and mortality for > 25 weeks?

A

33% Mortality Resuscitate as standard

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11
Q

When does surfactant secretion begin?

A

24-26th week

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12
Q

When does alveolar development begin?

A

From 32nd week

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13
Q

What are the cut off ages for 24 hour postoperative apnoea monitoring in neonates?

A

Up to 60th PC week if born preterm Up to 44th PC week if born term

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14
Q

How commonly is a patent ductus arteriosus seen in preterm neonates?

A

Up to 50% of extreme preterms

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15
Q

Describe the physiological complications of a PDA

A

Excessive pulmonary blood flow Low systemic pressures Myocardial failure Inability to wean from mechanical ventilation Sequela of low DBP e.g. NEC

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16
Q

List cardiorespiratory complications of ex-premature neonates

A

Bronchopulmonary dysplasia Tracheomalacia (from long term ETT placement) Subpglottic stenosis Persistent pulmonary hypertension of the newborn (PPHN)

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17
Q

Neonate

A

Less than 1 month

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18
Q

Paediatric defibrillation energy

A

4 J/Kg

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19
Q

Paediatric cardiac arrest adrenaline dose

A

10 mcg/kg

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20
Q

Infant estimated weight

A

(0.5 X Months) + 4 in Kg

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21
Q

Child weight estimate

A

weight in kg = 2 x (age in years + 4)

e.g. a 5 y/o = 18 Kg

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22
Q

Uncuffed tube size

A

(Age / 4) + 4

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23
Q

Cuffed tube size

A

(Age / 4) + 3.5

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24
Q

Oral ETT length

A

(Age / 2) + 12

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25
Q

Nasal ETT length

A

(Age / 2) + 15

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26
Q

LMA size for less than 5 Kg

A

1

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27
Q

LMA size for 5 - 10 Kg

A

1.5

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28
Q

LMA size for 10 - 20 Kg

A

2

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29
Q

LMA size for 20 - 30 Kg

A

2.5

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30
Q

LMA size for 30 - 50 Kg

A

3

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31
Q

Normal obs for infant

A

RR 30 - 40 HR 110 - 160 SBP 70 - 90

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32
Q

Normal obs for child 1 - 3

A
  • RR 25 - 35
  • HR 100 - 150
  • SBP 80 - 95
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33
Q

Normal obs for child 3 - 6

A
  • RR 25 - 30
  • HR 95 - 140
  • SBP 80 - 100
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34
Q

Normal obs for child 6 - 13

A
  • RR 20 - 25
  • HR 80 - 120
  • SBP 90 - 110
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35
Q

Normal obs for child 13 - 17

A
  • RR 15 - 20
  • HR 60 - 100
  • SBP 100 - 120
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36
Q

Propofol dose

A

1 - 4 mg/kg

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37
Q

Thiopentone dose

A

4 - 6 mg/kg

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38
Q

Ketamine dose

A

2 mg/kg

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39
Q

Fentanyl dose

A

1 - 2 mcg/kg

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40
Q

Morphine dose

A

0.1 mg/kg

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41
Q

Alfentanyl dose

A

30 - 50 mcg/kg

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42
Q

Paracetamol dose

A

15 mg/kg

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43
Q

Ibuprofen dose

A

5 mg/kg

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44
Q

Codeine dose

A

1 mg/kg

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45
Q

Atracurium dose

A

0.5 mg/kg

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46
Q

Rocuronium dose

A

1 mg/kg

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47
Q

Suzamethonium dose

48
Q

Ondansetron dose

49
Q

Dexamethasone dose

50
Q

Neostigmine / Glycopyrrolate dose

A

1 amp per 50 kg

51
Q

Sugammadex dose

A

16 mg / kg immediate reversal

52
Q

Atropine dose

53
Q

Adrenaline dose

54
Q

Phenylephrine dose

55
Q

Amiodarone dose

56
Q

Naloxone dose

A

100 mcg/kg (2mg in older than 5)

57
Q

Tranexaminc acid dose

A

15 mg/kg (max 1 g)

58
Q

Co-amoxiclav dose

59
Q

Cefuroxime dose

60
Q

Metronidazole dose

61
Q

Flucloxacillin dose

62
Q

Gentamicin dose

A

1 - 2 mg/kg

63
Q

Diclofenac dose

64
Q

Midazolam dose

A

0.1 mcg/kg

65
Q

Oromorph dose

A

200 - 400 mcg/kg

66
Q

Adenosine dose

A

100 mcg/kg then double (max 12g)

67
Q

Noradrenaline infusion

A

0.01 - 0.5 mcg/kg/min (start at 0.1)

68
Q

Adrenaline infusion

A

0.01 - 0/5 mcg/kg/min (start at 0.1)

69
Q

Morphine infusion

A

10 - 40 mcg/kg/hour (start at 20)

70
Q

Midazolam infusion

A

0.1 mg/kg/min

71
Q

Calculate SBP based on age

A

80 + (Age X 2)

72
Q

Define status epilepticus

A

Seizures lasting >30 mins or 2 or more seizures without recovery

73
Q

First line seizure management

A

Lorazepam 0.1 mg/kg IV Diazepam 0.5 mg/kg PR

74
Q

Second line seizure management

A

Phenytoin 15-20 mg/kg over 20 mins Phenobarbital 20 mg/kg if on phenytoin already

75
Q

Third line seizure management

A

GA Thio 4-5 mg/kg Midaz 0.1 mg/kg

76
Q

Common pitfalls in paediatric sedation

A

Inexperience Too much sedation (verbal endpoints different) Too little sedation Poor timing Non-fasting Dose errors Hyperactive delirium (e.g. katamine)

77
Q

Cause of cleft palate

A

Defective palatal growth and fusion in 1st trimester

78
Q

Incidence of pyloric stenosis

A

1:3-400 live births

79
Q

Pyloric stenosis male:female

80
Q

Metabolic resuscitation goals for pyloric stenosis prior to theatre

A

Cl greater than 90 HCO3 = 24 Na = 135

81
Q

O2 consumption differences (Adult and Paed)

A

Paediatric: 6-8 ml/kg/min Adult: 4ml/kg/min

82
Q

Closing volume of lung

A

Within tidal breathing

83
Q

Level of the larynx

84
Q

Narrowest part of paediatric airway

A

Cricoid ring

85
Q

Define laryngospasm

A

A variable upper airway obstruction secondary to partial or complete ADduction of the vocal cords. Due to a primitive reflex to protect the airway from aspiration. Large -ve pressures can cause pulmonary oedema

86
Q

Patient risk factors for laryngospasm

A
  • Increased secretions
  • Anxiety (i.e. increased sympathetic stimulation)
  • Younger age
  • URTI
  • GORD
  • Asthma
  • Smoking
  • Obseity / OSA
87
Q

Anaesthetic risk factors for laryngospasm

A
  • LMA use
  • Light planes of anaesthesia
  • Desflurane / Isoflurane
  • Airway manipulation
  • Inexperience of anaesthetist
88
Q

Surgical risk factors for laryngospasm

A
  • ENT surgery
  • Blood in airway
  • Poor surgical timing - pain at light plane
  • Hypospadias repair
89
Q

Treatment of laryngospasm

A
  • Remove trigger
  • Ensuring a clear larynx
  • Open airway
  • CPAP with 100% oxygen
  • Consider propfol 0.5mg/kg bolus
  • Consider suxamethonium 0.1-2 mg/kg
90
Q

Methods to prevent laryngospasm

A
  • Clear communication on surgery start
  • Avoid moving in light planes
  • Meticulus suctioning
  • Pharmacological
    • Mg 15 mg/kg
    • Lidocaine 1.5 mg/kg IV
    • Lidocaine 4% spray to cords
    • Atropine premed - presumably to dry secretions
91
Q

What is “viral croup?”

A
  • Laryngotracheobronchitis
  • Responsible for 80% of acute stridor in children
  • Usually 2° to parainfluenza, influenza A or B, respiratory syncytial virus or rhinovirus.
92
Q

Assessment priorites when returning to theatre with a bleeding tonsil

A
  • Evaluate blood loss (usually underestimated)
  • Ensure IV access
    • Send blood for x-match
    • Resuscitate
  • Review anaesthetic chart
    • Airway
    • Dentition / Loose teeth
  • Review pt haemodynamics: Cap refil, UO, HR, RR, differential temperature
  • Recent food
  • Stridor or breathing difficulty
  • Recent opiod analgesia
93
Q

Perioperative priorities when returning to theatre with a bleeding tonsil

A
  • Equipment
    • Selection of laryngoscope blades
    • Smaller than expected tracheal tubes
    • 2 suction catheters
  • Induced once the child is haemodynamically stable
  • PreO2 and RSI with slight head-down positioning
  • Consider left lateral if bleeding is excessive
  • Fluid resuscitation and transfusion continue intraoperatively as necessary
  • Following haemostasis, a large-bore OG to emply stomach
  • Extubate the child fully awake in the recovery position
  • After operation, monitor closely for any recurrence of bleeding.
94
Q

Methods to decrease PONV in bleeding tonsils

A
  • OG/NG and thorough suctioning
  • Suctioning of blood from pharynx
  • Dual antiemetics
    • 0.15 mg/kg IV Dex
    • 0.1 mg/kg IV ondansetron
  • Reduce BMV (stomach insuflation)
  • Recude opiate analgesia (LA by surgeons)
95
Q

What are the clinical features of viral croup?

A
  • Barking cough
  • Low-grade fever
  • Inspiratory stridor
  • Increased respiratory effort:
    • Fatigue
    • Hypoxia
    • Hypercarbia
96
Q

Give an example Croup Scoring system and appropraite actions.

A
  • Breath sounds: Normal, Harsh, Delayed
  • Stridor: None, Inspiratory, Biphasic
  • Cough: None, Horse, Bark
  • Recession/Flaring: None, Flaring, Subcostal
  • Cyanosis: None, in air, in 40% O2

​Score 0, 1, 2 in each category

  • 0-3 Mild
  • 4-6 Moderate - transfer to HDU
  • > 7 Severe - consider intubation
97
Q

Treatment options for Viral Croup

A
  • Humifified oxygen
  • Steroids
    • Dexamethasone 0.6 mg/kg IV/PO or
    • Beclomethasone 2 mg NEB
  • Nebulised Adrenaline
    • 0.5ml of 1/1000 (500mcg) diluted to 5 ml
    • Repeated 30-60 minutes as needed
  • Heliox
98
Q

Describe the proceedure for intubation for a child with Viral Croup

A
  • Escort child to theatres
  • Minimal monitoring so as to not upset child
  • Inhalational induction with sevoflurane in 100% O2
  • Maintain SV, apply CPAP via mapleson-F
  • Establish IV acces ASAP following induction
  • Intubate once pupils are small and central
  • Oral intubation preferred (quicker)
  • Be prepared with a number of smaller uncuffed tubes
  • Consider exchange for nasal ETT once stable
  • Maintain sedation
  • Secure lines (consider arm splint)
  • Extubate once a leak is demonstrated
99
Q

What is epiglotitis?

A

a life-threatening emergency caused by bacterial infection of the epiglottis, aryepiglottis, and arytenoids. Typically caused by Haemophilus influenzae type b (Hib), beta-haemolytic streptococci, staphylococci, or pneumococci. Vaccination against Hib has greatly reduced its incidence. Regardless, 10% of those with Hib epiglotitis had the vaccine.

100
Q

How can you clinically distinguish epiglotitis and croup?

A

Epiglottitis Differentiating Characteristics​

  • More Toxic appearance
  • Slightly older children (2–6 yrs)
  • Abrupt onset:
    • high fever
    • sore throat
    • dysphagia
    • stridor
    • drooling
  • Speech muffled/lost
  • Absence of cough
  • Classically forward sitting, open mouth with drooling
  • Unlikely to be relieved by adrenaline nebs
101
Q

Describe the proceedure for intubation for a child with Epiglotitis

A
  • Escort child to theatres
  • Minimal monitoring so as to not upset child
  • Inhalational induction with sevoflurane in 100% O2
  • Maintain SV, apply CPAP via mapleson-F
  • Have ENT standing by for immediate surgical airway
  • Establish IV acces ASAP following induction
  • Intubate once pupils are small and central
  • Oral intubation preferred (quicker)
  • Be prepared with a number of smaller uncuffed tubes
  • Consider exchange for nasal ETT once stable
  • Maintain sedation
  • Secure lines (consider arm splint)
  • Extubate once a leak is demonstrated
102
Q

What technique can you employ if you cannot visualise the airway during epiglotitis intubation?

A
  • Compress the chest slightly but suddenly
  • Bubbles appear at the laryngeal inlet
  • Intubate at the bubbles
103
Q

What is an appropriate dose of antibiotics for epiglotitis?

A
  • extended spectrum cephalosporin
  • e.g. ceftriaxone 80 mg/kg/day max 4 g/day
104
Q

What is bacterial tracheitis?

A

An uncommon bacterial infection of the trachea. Most commonly 2° to: Staphylococcus aureus, Haemophilus influenzae, streptococci or Neisseria spp. Since the Hib vaccine, this has taken over as the leading cause of infective upper airway obstruction in children.

105
Q

What are the clinical features of bacterial tracheitis?

A
  • Midway between viral croup and bacterial epiglotitis
  • URTI 48 hours preceeding
  • Sudden deterioration in condition (8-10 hrs)
  • High fever
  • Respiratory distress
  • Copious purulent secretions
  • No dysphasia or drooling
  • Child can usually lie flat
106
Q

You are about to intubate a case of bacterial tracheitis. Any extra proceedures necessary?

A
  • Inhalation induction and set up as for epiglotitis
  • Bronchoscope ready to remove pus/debris from airway proior to intubation
  • In extremis, intubation must go first, but immediate bronchoscopy and a tube change is very likely
107
Q

Antibiotic treatment in bacterial tracheitis?

A
  • Ceftriaxone
  • Consider vancomycin if MRSA suspected
108
Q

Describe the proceedure for administering caudal anaesthesia.

A
  • SLIMRAG
  • Left lateral position, knees drawn up to the chest
  • Landmarks:
    • Equilateral triangle formed between two posterior superior iliac spines and the cornua
    • Hiatus palbable between cornua
  • Needle introduced slightly cranial through the hiatus
  • A click is felt as the needle pierces the sacrococcygeal membrane
  • Aspirate to confirm the absence of blood/cerebrospinal fluid
  • Inject local anaesthetic while feeling for inadvertent subcutaneous injection
109
Q

What is the armitage dosing guide for caudal anaesthesia?

A
  • 0.5 ml/kg, 0.25% bupivacaine (sacro-lumbar block)
  • 1 ml/kg, 0.25% bupivacaine (upper abdominal block)
  • 1.2 ml/kg, 0.25% bupivacaine (mid-thoracic block)
110
Q

A rough rule to work out a childs SBP

A

systolic blood pressure = (age in years x 2) + 80.

111
Q

Calculate a childs blood volume

A
  • 80 ml/kg up to 2 years
  • 70 ml/kg thereafter
112
Q

Adrenaline in anaphylaxis dose

A
  • >12 years - 500 mcg IM
  • 6-12 years - 300 mcg IM
  • <6 years - 150 mcg IM
  • Can use IV at doses of 1mcg/kg, but IM is the resus council recommended route
113
Q

Cause, incidence, gender distribution and presentation of cleft palate?

A
  • Environmental/genetic factors
  • early failure of fusion of embryoinic palate
    • Typically 1st trimester
  • 1 in 1000 LB
  • Male preponderance
  • Left preponderance
114
Q

Cleft lip/palate disease assocations

A
  • Pierre Roban
  • Treacher Collins
  • Downs
  • EtoH fetal syndrome
115
Q

What is the incidence of MH in children?

A

1 in 15,000

116
Q

Why are neonates prone to respiratory fatigue?

A

disproportionately fewer Type 1 (oxidative) slow muscle fibres in the diaphragm

FRCA Final (21 decks)

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