Paediatric Anesthesia Flashcards
1
Q
Child vs. Adult
A
The child is not a small adult; there are important physiological differences.
2
Q
Blood Volume/Body Weight (Neonate)
A
95 ml/kg
3
Q
Blood Volume/Body Weight (Infant)
A
85 ml/kg
4
Q
Blood Volume/Body Weight (Older Child)
A
75 ml/kg
5
Q
Haemoglobin at Birth
A
20 gm%
6
Q
Haemoglobin at 3 Months
A
8 gm%
7
Q
Haemoglobin at 6 Months
A
11 gm%
8
Q
Haemoglobin at 1 Year
A
13 gm%
9
Q
Blood Pressure at Birth
A
80/50 mmHg
10
Q
Blood Pressure at 1 Year
A
90/60 mmHg
11
Q
Blood Pressure at 10 Years
A
110/60 mmHg
12
Q
Heart Rate at Birth
A
140 bpm
13
Q
Heart Rate at 1 Year
A
120 bpm
14
Q
Heart Rate at 10 Years
A
100 bpm
15
Q
Higher Larynx
A
Positioned higher and more anterior in children.
16
Q
Diaphragmatic Respiration
A
Children rely more on diaphragmatic breathing.
17
Q
Respiratory Rate
A
30-40 breaths per minute
18
Q
Functional Residual Capacity (FRC)
A
Smaller in children, with a tendency for airway closure and lower lung compliance.
19
Q
Blood Gases PCO2
A
35 mmHg
20
Q
Blood Gases PO2
A
65-80 mmHg in room air, indicating a need for more oxygen during anaesthesia.
21
Q
Neuromuscular Junction
A
Not fully developed at birth, matures around 2 months.
22
Q
Temperature Regulation
A
Poor in neonates, leading to rapid hypothermia.
23
Q
Non-Depolarising Muscle Relaxants
A
Increased sensitivity in newborns; normal sensitivity by 28 days.
24
Q
Depolarising Muscle Relaxants
A
Reduced sensitivity in newborns.
25
Narcotics
Newborns are more sensitive to morphine and less sensitive to pethidine.
26
Thiopentone
Increased sensitivity in children.
27
Inhalational Anaesthesia
Uptake is more rapid due to reduced functional residual capacity (FRC).
28
Minimum Alveolar Concentration (MAC)
Higher in children, requiring higher concentrations for maintenance.
29
Premedication in Neonates and Infants
May not be required.
30
Anticholinergic Premedication
Atropine 0.02 mg/kg or hyoscine 0.015 mg/kg given 1 hour before induction.
31
Premedication in Older Children
Diazepam 0.2 mg/kg or trimeprazine 2 mg/kg given 2 hours before surgery.
32
Narcotic Premedication
Pethidine 1 mg/kg or morphine 0.25 mg/kg intramuscularly 1 hour before surgery.
33
Body Weight at Birth
Approximately 3 kg.
34
Body Weight Doubling
Body weight doubles by 6 months.
35
Body Weight Tripling
Body weight triples by 1 year.
36
Estimated Average Weight
(Years + 2) x 3, e.g., a 5-year-old weighs (5+2)x3 = 21 kg.
37
Increased Sensitivity to Anaesthetics
Children have increased sensitivity to inhalational and intravenous anaesthetics.
38
Rapid Uptake of Inhalational Agents
Due to higher alveolar ventilation relative to FRC.
39
Dosage Adjustments
Required due to the differences in body weight and metabolism.
40
Thiopentone Dosage
Requires careful monitoring due to increased sensitivity.
41
Propofol Dosage
Adjusted based on rapid metabolism and sensitivity.
42
Ketamine Intramuscular Dosage
8-13 mg/kg for induction.
43
Preoperative Assessment
Conducted with information from parents or guardians and includes physical examination and relevant investigations.
44
Neonates and Small Infants
Premedication may not be required.
45
Anticholinergic Premedication
Atropine 0.02 mg/kg or hyoscine 0.015 mg/kg, given 1 hour before induction.
46
Premedication for Older Children
Diazepam 0.2 mg/kg or trimeprazine 2 mg/kg, given 2 hours before surgery.
47
Narcotic Premedication
Pethidine 1 mg/kg or morphine 0.25 mg/kg, given intramuscularly 1 hour before surgery.
48
Body Weight at Birth
Approximately 3 kg.
49
Body Weight Doubling
Body weight doubles by 6 months.
50
Body Weight Tripling
Body weight triples by 1 year.
51
Estimated Average Weight Formula
(Years + 2) x 3, e.g., a 5-year-old weighs (5+2)x3 = 21 kg.
52
Preoperative Investigations
Blood tests, imaging studies, and other relevant examinations.
53
Fasting Guidelines
Ensuring appropriate fasting times for solids and liquids before surgery.
54
Assessment of Airway
Checking for any anomalies or conditions that could complicate intubation.
55
Assessment of Cardiovascular Status
Monitoring heart rate, blood pressure, and oxygen saturation.
56
Psychological Preparation
Explaining the procedure to the child in an age-appropriate manner.
57
Consent from Parents
Obtaining informed consent after explaining the risks and benefits of the procedure.
58
Monitoring Requirements
Planning for intraoperative and postoperative monitoring based on the child's condition.
59
Risk Factors
Identifying any pre-existing conditions that could increase the risk of anaesthesia.
60
Anaesthetic Plan
Formulating an anaesthetic plan tailored to the child's needs.
61
Emergency Preparedness
Ensuring availability of resuscitation equipment and medications.
62
Infection Control
Adhering to infection control protocols to prevent postoperative infections.
63
Multidisciplinary Team
Involving pediatricians, anesthesiologists, and surgeons in the preoperative planning.
64
NPO Status
Ensuring the child is nil per os (NPO) for the recommended duration before surgery.
65
Ayre’s T-Piece
Developed by Ayre in 1937 for paediatric anaesthesia.
66
Jackson-Rees Modification
Modified in 1960 by connecting Ayre's T-piece to a 500 ml reservoir bag for easier ventilation.
67
Non-Invasive Monitoring
Preferred as much as possible to reduce trauma and stress.
68
Praecordial Stethoscope
Used to monitor heart sounds and respiratory rate during surgery.
69
Oesophageal Stethoscope
Provides continuous monitoring of heart and respiratory sounds.
70
Pulse Oximeter
Measures oxygen saturation and pulse rate.
71
Sphygmomanometer
Used to measure blood pressure.
72
Electrocardiogram (ECG)
Monitors heart rate and rhythm.
73
End-Tidal CO2 (EtCO2)
Monitors exhaled carbon dioxide to assess ventilation.
74
Inhalational Agents
Halothane and enflurane commonly used for induction.
75
Intravenous Agents
Thiopentone and propofol used for induction and maintenance of anaesthesia.
76
Intramuscular Agents
Ketamine (8-13 mg/kg) used for induction in specific cases.
77
Assisted Ventilation
Mandatory rather than spontaneous ventilation.
78
Muscle Relaxants
Not typically required for paediatric anaesthesia.
79
Tracheal Intubation
Indicated for most procedures, especially those of longer duration.
80
Non-Cuffed Tubes
Preferred for paediatric intubation except for very short procedures.
81
Tube Size Calculation
Tube size = Age in years / 4 + 4; always have one size larger and smaller available.
82
Intraoperative Fluid Management
Use of burettes: 30 ml for infants, 100 ml for older children.
83
Automatic Syringe Pump
Recommended for precise fluid and medication administration.
84
Fluid Requirements
First week of life: 2.5 ml/kg/hr, Up to 10 kg: 4.0 ml/kg/hr, 10-20 kg: 3.0 ml/kg/hr, Above 20 kg: 2.0 ml/kg/hr.
85
Blood Loss Management
Replace blood loss exceeding 10% of total volume.
86
Temperature Monitoring
Important to prevent hypothermia during surgery.
87
Induction Methods
Inhalational induction with agents like halothane and enflurane; intravenous induction with thiopentone and propofol.
88
Intramuscular Induction
Ketamine 8-13 mg/kg used for induction in specific cases.
89
Ventilation
Assisted ventilation is mandatory rather than spontaneous.
90
Muscle Relaxants
Not typically required for paediatric anaesthesia.
91
Tracheal Intubation
Usually indicated, especially for longer procedures; non-cuffed tubes preferred.
92
Tube Size Calculation
Tube size = Age in years / 4 + 4; always have one size larger and smaller available.
93
Inhalational Agents
Halothane and enflurane commonly used for induction.
94
Intravenous Agents
Thiopentone and propofol used for induction and maintenance of anaesthesia.
95
Ketamine
Used intramuscularly for induction; dosage is 8-13 mg/kg.
96
Ventilation Modes
Positive pressure ventilation is commonly used.
97
Anaesthetic Depth
Monitored using clinical signs and devices like bispectral index (BIS) monitors.
98
Maintenance Agents
Includes inhalational agents (e.g., sevoflurane, isoflurane) and intravenous agents (e.g., propofol).
99
Oxygenation
Maintained with high flow rates and monitoring of oxygen saturation.
100
Fluid Management
Careful management with the use of burettes and automatic syringe pumps.
101
Temperature Regulation
Essential to prevent hypothermia, with warming devices used as needed.
102
Monitoring
During surgery, includes ECG, pulse oximetry, capnography, and non-invasive blood pressure measurement.
103
Emergency Preparedness
Availability of resuscitation equipment and emergency drugs.
104
Pain Management
Includes use of narcotics like fentanyl and morphine, adjusted for age and weight.
105
Extubation
Carefully planned and executed based on the child's condition and procedure duration.
106
Recovery
Monitoring in the post-anesthesia care unit (PACU) with attention to airway, breathing, circulation, and pain control.
107
Complications
Promptly managed with appropriate interventions, such as treating laryngospasm or bronchospasm.
108
Parents' Involvement
Ensuring they are informed and prepared for the child's recovery and post-operative care.
109
Post-Operative Nausea and Vomiting (PONV)
Prevented and treated with antiemetics as needed.
110
Documentation
Complete and accurate recording of all drugs administered, vital signs, and any complications.
111
Fluid Management
Meticulous attention to fluid administration during surgery.
112
Burette Size
30 ml for infants, 100 ml for older children.
113
Automatic Syringe Pump
Recommended for precise fluid and medication administration.
114
Fluid Requirements (First Week)
2.5 ml/kg/hr.
115
Fluid Requirements (Up to 10 kg)
4.0 ml/kg/hr.
116
Fluid Requirements (10-20 kg)
3.0 ml/kg/hr.
117
Fluid Requirements (Above 20 kg)
2.0 ml/kg/hr.
118
Blood Loss Replacement
Replace blood loss exceeding 10% of total volume.
119
Types of Fluids
Crystalloids, colloids, and blood products as needed.
120
Blood Transfusion
Indicated when blood loss is significant or when hemoglobin levels drop.
121
Monitoring Fluid Balance
Continuous monitoring of input and output during surgery.
122
Signs of Hypovolemia
Tachycardia, hypotension, decreased urine output.
123
Signs of Hypervolemia
Edema, hypertension, pulmonary congestion.
124
Electrolyte Management
Ensuring balanced electrolyte levels to avoid complications.
125
Hypoglycemia Prevention
Especially important in neonates and small infants.
126
Glucose-Containing Fluids
Used as needed to maintain blood glucose levels.
127
Calcium Management
Administered as necessary, particularly during massive transfusion.
128
Acid-Base Balance
Monitoring and correcting any imbalances during surgery.
129
Intraoperative Blood Pressure
Monitoring closely to assess fluid and blood status.
130
Hematocrit Levels
Monitored to determine the need for blood transfusion.
131
Postoperative Fluid Management
Continued monitoring and adjustment based on the child's condition.
132
Fluid Overload Prevention
Careful calculation and monitoring to avoid complications.
133
Warm Fluids
Used to prevent hypothermia during administration.
134
Vasopressors
Used if necessary to support blood pressure.
135
Volume Expanders
Used in cases of significant blood loss or shock.
