Paediatric Anesthesia Flashcards
Child vs. Adult
The child is not a small adult; there are important physiological differences.
Blood Volume/Body Weight (Neonate)
95 ml/kg
Blood Volume/Body Weight (Infant)
85 ml/kg
Blood Volume/Body Weight (Older Child)
75 ml/kg
Haemoglobin at Birth
20 gm%
Haemoglobin at 3 Months
8 gm%
Haemoglobin at 6 Months
11 gm%
Haemoglobin at 1 Year
13 gm%
Blood Pressure at Birth
80/50 mmHg
Blood Pressure at 1 Year
90/60 mmHg
Blood Pressure at 10 Years
110/60 mmHg
Heart Rate at Birth
140 bpm
Heart Rate at 1 Year
120 bpm
Heart Rate at 10 Years
100 bpm
Higher Larynx
Positioned higher and more anterior in children.
Diaphragmatic Respiration
Children rely more on diaphragmatic breathing.
Respiratory Rate
30-40 breaths per minute
Functional Residual Capacity (FRC)
Smaller in children, with a tendency for airway closure and lower lung compliance.
Blood Gases PCO2
35 mmHg
Blood Gases PO2
65-80 mmHg in room air, indicating a need for more oxygen during anaesthesia.
Neuromuscular Junction
Not fully developed at birth, matures around 2 months.
Temperature Regulation
Poor in neonates, leading to rapid hypothermia.
Non-Depolarising Muscle Relaxants
Increased sensitivity in newborns; normal sensitivity by 28 days.
Depolarising Muscle Relaxants
Reduced sensitivity in newborns.
Narcotics
Newborns are more sensitive to morphine and less sensitive to pethidine.
Thiopentone
Increased sensitivity in children.
Inhalational Anaesthesia
Uptake is more rapid due to reduced functional residual capacity (FRC).
Minimum Alveolar Concentration (MAC)
Higher in children, requiring higher concentrations for maintenance.
Premedication in Neonates and Infants
May not be required.
Anticholinergic Premedication
Atropine 0.02 mg/kg or hyoscine 0.015 mg/kg given 1 hour before induction.
Premedication in Older Children
Diazepam 0.2 mg/kg or trimeprazine 2 mg/kg given 2 hours before surgery.
Narcotic Premedication
Pethidine 1 mg/kg or morphine 0.25 mg/kg intramuscularly 1 hour before surgery.
Body Weight at Birth
Approximately 3 kg.
Body Weight Doubling
Body weight doubles by 6 months.
Body Weight Tripling
Body weight triples by 1 year.
Estimated Average Weight
(Years + 2) x 3, e.g., a 5-year-old weighs (5+2)x3 = 21 kg.
Increased Sensitivity to Anaesthetics
Children have increased sensitivity to inhalational and intravenous anaesthetics.
Rapid Uptake of Inhalational Agents
Due to higher alveolar ventilation relative to FRC.
Dosage Adjustments
Required due to the differences in body weight and metabolism.
Thiopentone Dosage
Requires careful monitoring due to increased sensitivity.
Propofol Dosage
Adjusted based on rapid metabolism and sensitivity.
Ketamine Intramuscular Dosage
8-13 mg/kg for induction.
Preoperative Assessment
Conducted with information from parents or guardians and includes physical examination and relevant investigations.
Neonates and Small Infants
Premedication may not be required.
Anticholinergic Premedication
Atropine 0.02 mg/kg or hyoscine 0.015 mg/kg, given 1 hour before induction.
Premedication for Older Children
Diazepam 0.2 mg/kg or trimeprazine 2 mg/kg, given 2 hours before surgery.
Narcotic Premedication
Pethidine 1 mg/kg or morphine 0.25 mg/kg, given intramuscularly 1 hour before surgery.
Body Weight at Birth
Approximately 3 kg.
Body Weight Doubling
Body weight doubles by 6 months.
Body Weight Tripling
Body weight triples by 1 year.
Estimated Average Weight Formula
(Years + 2) x 3, e.g., a 5-year-old weighs (5+2)x3 = 21 kg.
Preoperative Investigations
Blood tests, imaging studies, and other relevant examinations.
Fasting Guidelines
Ensuring appropriate fasting times for solids and liquids before surgery.
Assessment of Airway
Checking for any anomalies or conditions that could complicate intubation.