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Anesthesiology > Paediatric Anesthesia > Flashcards

Paediatric Anesthesia Flashcards

1
Q

Child vs. Adult

A

The child is not a small adult; there are important physiological differences.

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2
Q

Blood Volume/Body Weight (Neonate)

A

95 ml/kg

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3
Q

Blood Volume/Body Weight (Infant)

A

85 ml/kg

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4
Q

Blood Volume/Body Weight (Older Child)

A

75 ml/kg

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5
Q

Haemoglobin at Birth

A

20 gm%

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6
Q

Haemoglobin at 3 Months

A

8 gm%

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7
Q

Haemoglobin at 6 Months

A

11 gm%

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8
Q

Haemoglobin at 1 Year

A

13 gm%

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9
Q

Blood Pressure at Birth

A

80/50 mmHg

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10
Q

Blood Pressure at 1 Year

A

90/60 mmHg

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11
Q

Blood Pressure at 10 Years

A

110/60 mmHg

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12
Q

Heart Rate at Birth

A

140 bpm

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13
Q

Heart Rate at 1 Year

A

120 bpm

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14
Q

Heart Rate at 10 Years

A

100 bpm

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15
Q

Higher Larynx

A

Positioned higher and more anterior in children.

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16
Q

Diaphragmatic Respiration

A

Children rely more on diaphragmatic breathing.

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17
Q

Respiratory Rate

A

30-40 breaths per minute

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18
Q

Functional Residual Capacity (FRC)

A

Smaller in children, with a tendency for airway closure and lower lung compliance.

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19
Q

Blood Gases PCO2

A

35 mmHg

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20
Q

Blood Gases PO2

A

65-80 mmHg in room air, indicating a need for more oxygen during anaesthesia.

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21
Q

Neuromuscular Junction

A

Not fully developed at birth, matures around 2 months.

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22
Q

Temperature Regulation

A

Poor in neonates, leading to rapid hypothermia.

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23
Q

Non-Depolarising Muscle Relaxants

A

Increased sensitivity in newborns; normal sensitivity by 28 days.

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24
Q

Depolarising Muscle Relaxants

A

Reduced sensitivity in newborns.

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25
Q

Narcotics

A

Newborns are more sensitive to morphine and less sensitive to pethidine.

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26
Q

Thiopentone

A

Increased sensitivity in children.

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27
Q

Inhalational Anaesthesia

A

Uptake is more rapid due to reduced functional residual capacity (FRC).

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28
Q

Minimum Alveolar Concentration (MAC)

A

Higher in children, requiring higher concentrations for maintenance.

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29
Q

Premedication in Neonates and Infants

A

May not be required.

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30
Q

Anticholinergic Premedication

A

Atropine 0.02 mg/kg or hyoscine 0.015 mg/kg given 1 hour before induction.

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31
Q

Premedication in Older Children

A

Diazepam 0.2 mg/kg or trimeprazine 2 mg/kg given 2 hours before surgery.

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32
Q

Narcotic Premedication

A

Pethidine 1 mg/kg or morphine 0.25 mg/kg intramuscularly 1 hour before surgery.

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33
Q

Body Weight at Birth

A

Approximately 3 kg.

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34
Q

Body Weight Doubling

A

Body weight doubles by 6 months.

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35
Q

Body Weight Tripling

A

Body weight triples by 1 year.

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36
Q

Estimated Average Weight

A

(Years + 2) x 3, e.g., a 5-year-old weighs (5+2)x3 = 21 kg.

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37
Q

Increased Sensitivity to Anaesthetics

A

Children have increased sensitivity to inhalational and intravenous anaesthetics.

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38
Q

Rapid Uptake of Inhalational Agents

A

Due to higher alveolar ventilation relative to FRC.

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39
Q

Dosage Adjustments

A

Required due to the differences in body weight and metabolism.

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40
Q

Thiopentone Dosage

A

Requires careful monitoring due to increased sensitivity.

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41
Q

Propofol Dosage

A

Adjusted based on rapid metabolism and sensitivity.

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42
Q

Ketamine Intramuscular Dosage

A

8-13 mg/kg for induction.

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43
Q

Preoperative Assessment

A

Conducted with information from parents or guardians and includes physical examination and relevant investigations.

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44
Q

Neonates and Small Infants

A

Premedication may not be required.

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45
Q

Anticholinergic Premedication

A

Atropine 0.02 mg/kg or hyoscine 0.015 mg/kg, given 1 hour before induction.

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46
Q

Premedication for Older Children

A

Diazepam 0.2 mg/kg or trimeprazine 2 mg/kg, given 2 hours before surgery.

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47
Q

Narcotic Premedication

A

Pethidine 1 mg/kg or morphine 0.25 mg/kg, given intramuscularly 1 hour before surgery.

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48
Q

Body Weight at Birth

A

Approximately 3 kg.

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49
Q

Body Weight Doubling

A

Body weight doubles by 6 months.

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50
Q

Body Weight Tripling

A

Body weight triples by 1 year.

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51
Q

Estimated Average Weight Formula

A

(Years + 2) x 3, e.g., a 5-year-old weighs (5+2)x3 = 21 kg.

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52
Q

Preoperative Investigations

A

Blood tests, imaging studies, and other relevant examinations.

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53
Q

Fasting Guidelines

A

Ensuring appropriate fasting times for solids and liquids before surgery.

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54
Q

Assessment of Airway

A

Checking for any anomalies or conditions that could complicate intubation.

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55
Q

Assessment of Cardiovascular Status

A

Monitoring heart rate, blood pressure, and oxygen saturation.

56
Q

Psychological Preparation

A

Explaining the procedure to the child in an age-appropriate manner.

57
Q

Consent from Parents

A

Obtaining informed consent after explaining the risks and benefits of the procedure.

58
Q

Monitoring Requirements

A

Planning for intraoperative and postoperative monitoring based on the child’s condition.

59
Q

Risk Factors

A

Identifying any pre-existing conditions that could increase the risk of anaesthesia.

60
Q

Anaesthetic Plan

A

Formulating an anaesthetic plan tailored to the child’s needs.

61
Q

Emergency Preparedness

A

Ensuring availability of resuscitation equipment and medications.

62
Q

Infection Control

A

Adhering to infection control protocols to prevent postoperative infections.

63
Q

Multidisciplinary Team

A

Involving pediatricians, anesthesiologists, and surgeons in the preoperative planning.

64
Q

NPO Status

A

Ensuring the child is nil per os (NPO) for the recommended duration before surgery.

65
Q

Ayre’s T-Piece

A

Developed by Ayre in 1937 for paediatric anaesthesia.

66
Q

Jackson-Rees Modification

A

Modified in 1960 by connecting Ayre’s T-piece to a 500 ml reservoir bag for easier ventilation.

67
Q

Non-Invasive Monitoring

A

Preferred as much as possible to reduce trauma and stress.

68
Q

Praecordial Stethoscope

A

Used to monitor heart sounds and respiratory rate during surgery.

69
Q

Oesophageal Stethoscope

A

Provides continuous monitoring of heart and respiratory sounds.

70
Q

Pulse Oximeter

A

Measures oxygen saturation and pulse rate.

71
Q

Sphygmomanometer

A

Used to measure blood pressure.

72
Q

Electrocardiogram (ECG)

A

Monitors heart rate and rhythm.

73
Q

End-Tidal CO2 (EtCO2)

A

Monitors exhaled carbon dioxide to assess ventilation.

74
Q

Inhalational Agents

A

Halothane and enflurane commonly used for induction.

75
Q

Intravenous Agents

A

Thiopentone and propofol used for induction and maintenance of anaesthesia.

76
Q

Intramuscular Agents

A

Ketamine (8-13 mg/kg) used for induction in specific cases.

77
Q

Assisted Ventilation

A

Mandatory rather than spontaneous ventilation.

78
Q

Muscle Relaxants

A

Not typically required for paediatric anaesthesia.

79
Q

Tracheal Intubation

A

Indicated for most procedures, especially those of longer duration.

80
Q

Non-Cuffed Tubes

A

Preferred for paediatric intubation except for very short procedures.

81
Q

Tube Size Calculation

A

Tube size = Age in years / 4 + 4; always have one size larger and smaller available.

82
Q

Intraoperative Fluid Management

A

Use of burettes: 30 ml for infants, 100 ml for older children.

83
Q

Automatic Syringe Pump

A

Recommended for precise fluid and medication administration.

84
Q

Fluid Requirements

A

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
Q

Blood Loss Management

A

Replace blood loss exceeding 10% of total volume.

86
Q

Temperature Monitoring

A

Important to prevent hypothermia during surgery.

87
Q

Induction Methods

A

Inhalational induction with agents like halothane and enflurane; intravenous induction with thiopentone and propofol.

88
Q

Intramuscular Induction

A

Ketamine 8-13 mg/kg used for induction in specific cases.

89
Q

Ventilation

A

Assisted ventilation is mandatory rather than spontaneous.

90
Q

Muscle Relaxants

A

Not typically required for paediatric anaesthesia.

91
Q

Tracheal Intubation

A

Usually indicated, especially for longer procedures; non-cuffed tubes preferred.

92
Q

Tube Size Calculation

A

Tube size = Age in years / 4 + 4; always have one size larger and smaller available.

93
Q

Inhalational Agents

A

Halothane and enflurane commonly used for induction.

94
Q

Intravenous Agents

A

Thiopentone and propofol used for induction and maintenance of anaesthesia.

95
Q

Ketamine

A

Used intramuscularly for induction; dosage is 8-13 mg/kg.

96
Q

Ventilation Modes

A

Positive pressure ventilation is commonly used.

97
Q

Anaesthetic Depth

A

Monitored using clinical signs and devices like bispectral index (BIS) monitors.

98
Q

Maintenance Agents

A

Includes inhalational agents (e.g., sevoflurane, isoflurane) and intravenous agents (e.g., propofol).

99
Q

Oxygenation

A

Maintained with high flow rates and monitoring of oxygen saturation.

100
Q

Fluid Management

A

Careful management with the use of burettes and automatic syringe pumps.

101
Q

Temperature Regulation

A

Essential to prevent hypothermia, with warming devices used as needed.

102
Q

Monitoring

A

During surgery, includes ECG, pulse oximetry, capnography, and non-invasive blood pressure measurement.

103
Q

Emergency Preparedness

A

Availability of resuscitation equipment and emergency drugs.

104
Q

Pain Management

A

Includes use of narcotics like fentanyl and morphine, adjusted for age and weight.

105
Q

Extubation

A

Carefully planned and executed based on the child’s condition and procedure duration.

106
Q

Recovery

A

Monitoring in the post-anesthesia care unit (PACU) with attention to airway, breathing, circulation, and pain control.

107
Q

Complications

A

Promptly managed with appropriate interventions, such as treating laryngospasm or bronchospasm.

108
Q

Parents’ Involvement

A

Ensuring they are informed and prepared for the child’s recovery and post-operative care.

109
Q

Post-Operative Nausea and Vomiting (PONV)

A

Prevented and treated with antiemetics as needed.

110
Q

Documentation

A

Complete and accurate recording of all drugs administered, vital signs, and any complications.

111
Q

Fluid Management

A

Meticulous attention to fluid administration during surgery.

112
Q

Burette Size

A

30 ml for infants, 100 ml for older children.

113
Q

Automatic Syringe Pump

A

Recommended for precise fluid and medication administration.

114
Q

Fluid Requirements (First Week)

A

2.5 ml/kg/hr.

115
Q

Fluid Requirements (Up to 10 kg)

A

4.0 ml/kg/hr.

116
Q

Fluid Requirements (10-20 kg)

A

3.0 ml/kg/hr.

117
Q

Fluid Requirements (Above 20 kg)

A

2.0 ml/kg/hr.

118
Q

Blood Loss Replacement

A

Replace blood loss exceeding 10% of total volume.

119
Q

Types of Fluids

A

Crystalloids, colloids, and blood products as needed.

120
Q

Blood Transfusion

A

Indicated when blood loss is significant or when hemoglobin levels drop.

121
Q

Monitoring Fluid Balance

A

Continuous monitoring of input and output during surgery.

122
Q

Signs of Hypovolemia

A

Tachycardia, hypotension, decreased urine output.

123
Q

Signs of Hypervolemia

A

Edema, hypertension, pulmonary congestion.

124
Q

Electrolyte Management

A

Ensuring balanced electrolyte levels to avoid complications.

125
Q

Hypoglycemia Prevention

A

Especially important in neonates and small infants.

126
Q

Glucose-Containing Fluids

A

Used as needed to maintain blood glucose levels.

127
Q

Calcium Management

A

Administered as necessary, particularly during massive transfusion.

128
Q

Acid-Base Balance

A

Monitoring and correcting any imbalances during surgery.

129
Q

Intraoperative Blood Pressure

A

Monitoring closely to assess fluid and blood status.

130
Q

Hematocrit Levels

A

Monitored to determine the need for blood transfusion.

131
Q

Postoperative Fluid Management

A

Continued monitoring and adjustment based on the child’s condition.

132
Q

Fluid Overload Prevention

A

Careful calculation and monitoring to avoid complications.

133
Q

Warm Fluids

A

Used to prevent hypothermia during administration.

134
Q

Vasopressors

A

Used if necessary to support blood pressure.

135
Q

Volume Expanders

A

Used in cases of significant blood loss or shock.

Anesthesiology (1 decks)

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