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Anaesthesiology > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Where does spinal cord end in children as compared to adults? (3)

A

• Premature infants: L2-L3
• newborns: L3
. Adults: L1

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2
Q

Name 7 factors that increase the risk of intraventricular haemorrhage in paediatrics

A

. Decreased oxygen
• increased c02
• increase sodium
• decease haematocrit
• awake airway manipulation
• rapid bicarbonate administration
• changes in blood pressure and cerebral flow

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3
Q

Why are children at high risk of high spinal block?

A

Lack of lordosis

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4
Q

Why may intubation be difficult in children? (6)

A

• Short neck
. Large tongue
• larynx high and anterior
• epiglottis long, stiff, u-shaped
• air way funnel shaped, narrowest at cricoid
• May have no or loose teeth

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5
Q

What is best way to intubate children? (4)

A

• Head in neutral position for ventilation. Head tilt chin lift may cause obstruction (sniffing position)
• use a straight blade
• ETT size uncuffed : premature <1kg 2; 1 kg - 3 months size 3; 3-18 months size 3,5 ; > 18 months =(age÷4) +4 (half a size smaller for cuffed or add 3 instead of 4)
• ETT depth: length at gums or incisors. Premature 8cm, neonate 10cm, thereafter (age ÷2) +12 (add 3cm for naso)
• raised shoulders help

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6
Q

What are children’s cardiac output dependent on?

A

Relatively fixed. Rely on heart rate. Can’t compensate with stroke volume.

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7
Q

At what age do infants present with physiological anaemia and why?

A

3 months.

Hbf, which has higher affinity for oxygen, being replaced by hba

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8
Q

How do paediatric patients respond to suxamethonium?

A

Require higher dose

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9
Q

Which ventilator setting/mode should be used for smaller paediatric patients eg neonates?

A

Pressure control 16-20 cm H2O because avoids barotrauma

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10
Q

Which ventilator setting/mode should be used for larger paediatric patients eg children?

A

Volume control tidal volume 5-7 ml /kg because can monitor lung compliance
Most ventilators minimum vt 20ml so make sure child weighs enough. Otherwise use pressure control

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11
Q

What should RR be on ventilator for patient aged 0-12 months?

A

30-36

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12
Q

What should RR be on ventilator for patient aged 12 months to 2 years?

A

25-45

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13
Q

What should RR be on ventilator for patient aged 2-6 years?

A

20-30

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14
Q

What should RR be on ventilator for patient aged 6-12 years?

A

20-25

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15
Q

How to calculate what minute ventilation should be for paediatric patients?

A

For first 10 kg, 200 ml/kg
For next 10-15kg, add 150 ml/kg
Then for every Kg there after, add 100 ml/kg

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16
Q

Indication for intraosseous line insertion?

A

Circulatory arrest or decompensated shock with failure to gain iv access

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17
Q

Name 2 contraindic to intraosseous line insertion

A

• fracture or vascular injury of that limb
• osteogenesis imperfecta

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18
Q

Name 3 sites an intraosseous line can be inserted

A

• Proximal tibia: anteromedial surface 2-3 cm below tibial tuberosity
• distal tibia: proximal to medial malleolus
• distal femur: midline, 2-3 cm above external condyle

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19
Q

What premedication should be given to children for uncooperation and separation anxiety

A

Only if absolutely necessary! Monitor strictly
• midazolam 0,5 mg/kg ( with paracetamol because very bitter taste) po 45 min pre-op (or 0,2 - 0,3 mg/kg nasally 20 min pre-op)
• ketamine 5 mg/kg IM only if very uncooperative

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20
Q

Which agents are preferred for paediatric induction?

A

• Volatile preferred: sevoflurane with or without n20
• if contraindicated, iv and emla cream (1h preop)

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21
Q

Which maintenance fluids and dose are given to paediatric patients?

A

• Ringer’s lactate. Only add dextrose 1% if risk hypoglycaemia, otherwise avoid hypertonic solutions! Many complications eg seizures
• maintenance: 421 rule
First 10 kg : 4 ml / kg / h
Next 1o - 2okg: 2 ml / kg / h
For every Kg above 2okg, add 1 ml / kg / h

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22
Q

Formula for maximum allowable blood loss (mabl)? NB

A

Mabl= EBV (estimated blood vol) x [ ( Hct initial - Hct final/trigger) ÷ Hct mean ]

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23
Q

Formula for blood volume to be transfused?

A

Weight Kg x increment (desired) in hb (g/dl) x ( 3/ hct of rbc)

Hct RBC =60%

In general 10 ml /kg raise hb by 2 g / dL!
Monitor calcium!

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24
Q

What can be used for post operative analgesia for Paeds? (6)

A

• regional technique
• Paracetamol 20mg/kg PO
• NSAIDs: diclofenac suppositories
• valaron (tilidine) drops (good option)
• ketamine for severe pain 0,25 mg/kg
• opiates last resort with intense monitoring in ICU

25
Q

Describe the colds score

A

Score for child with URTI surgery risk. Higher score = higher risk

Based on current signs and symptoms, onset symptoms, lung disease, device used for airway, Surgery type

26
Q

How should child with URTI be managed pre and intra op? (6)

A

• Nebulised beta 2 agonist pre-op
• consider antisialogogue
• nasal decongestant
• avoid airway instrumentation and anything in nose
• chest physio post-op
• glucocorticoids reserved for severe asthma
Avoid sedatives

27
Q

Tidal volume used for children?

A

6-8 ml/kg/min (same as adults)

28
Q

Formula to estimate weight in child?

A

(Age x2)+9

29
Q

Oxygen consumption of infants as compared to adults?

A

VO2 infant: 6,5 to 8,5
VO2 adult: 3,5

30
Q

Minute volume of infants as compared to adults?

A

Infants 100-150 ml/kg/min
Adults 70-100

31
Q

Functional residual capacity of infants as compared to adults?

A

Same (30 ml/kg)

32
Q

Dead space of infants as compared to adults?

A

Infants 2-2,5 ml/kg
Adults 2

33
Q

PAO2 breathing room air of infants as compared to adults?

A

Infants 65-85 mmHg
Adults 85-100

34
Q

paCO2 breathing room air of infants as compared to adults?

A

Infants 30-36 mmHg
Adults 35-45

35
Q

ETT size premature babies <1 kg?

A

Cuffed 1,5
Uncuffed 2

36
Q

ETT size babies > 1 kg up to 3 months?

A

Cuffed 2,5
Uncuffed 3

37
Q

ETT size babies 3-18 months?

A

Cuffed 3
Uncuffed 3,5

38
Q

ETT size kids > 18 months?

A

Uncuffed: (age ÷ 4)+4

cuffed: (age ÷ 4)+ 3 (or half a size smaller)

39
Q

Depth ETT premature babies?

A

8 cm

40
Q

Depth ETT neonates?

A

10 cm

41
Q

Depth ETT > 28 days child?

A

(Age ÷2)+12

42
Q

Depth nasotracheal tube > 28 days child?

A

(Age÷2) +15

43
Q

Why are children at risk of aspiration?

A

Delayed emptying

44
Q

Name 5 difficulties that can be expected during attempted paediatric intubation

A

• Identification of vocal cords more difficult: more anterior airway, larynx hidden behind large tongue
• desaturate, hypoxia, resp failure more quickly: decreased functional residual capacity, increased dead space, increased oxygen consumption and c02 production
• hypoxia leads to bradycardia quickly
• prone to laryngospasm
• upper airway prone to obstruction, blocking access to lower airway due to anatomical differences eg short neck

45
Q

Name 11 anatomical factors that make the paediatric upper airway more prone to obstruction

A

• Short neck
• higher larynx
• vocal cords slant anteriorly
• epiglottis floppy
• large tongue
• occiput large and round , flexing head forward when supine
• larynx and tracheal cartilage soft and easily compressed
• narrow cricoid
• short trachea
• adenoids and tonsils fill past pharynx
• baby teeth can loosen

46
Q

Name 5 advantages cuffed endotracheal tubes

A

. Better protection against aspiration
• allow higher ventilation pressures with poor pulmonary compliance
• more precise monitoring of ventilation
• provide more accurate tidal volume
• release less pollution from leaking and decrease risk fire

47
Q

Name 2 disadvantages cuffed endotracheal tubes

A

• Higher risk plugging smaller lumen with secretions
• suctioning more challenging in because tubes are smaller

48
Q

Maintenance fluids for children?

A

Ringers only. Only add dextrose 1% if risk hypoglycaemia
4:2:1 rule
4 ml/kg/h for the first 10 kg
2 ml/kg/h for the next 11-20 kg
1 ml/kg/h for each kg after 20

49
Q

Name 8 physiological changes in paeds respiratory system

A

• nose breathers
• limited reserve
• Lower FRC
• minute ventilation rate dependent
• closing volume > FRC
• muscles easily fatiguable
• premature prone to apnoea
• high oxygen consumption (6-8 ml /kg/min): desaturate quickly, hypoxia → bradycardia

50
Q

Most common cause bradycardia in paeds?

A

Hypoxia

51
Q

Is muscle relaxant necessary to intubate children?

A

Long procedure: yes. If use high dose opioids required that long → bradycardia
Shorter :no. High concentration volatile and opioid good

52
Q

How long should surgery be postponed in child with bad urti?

A

4 weeks

53
Q

Name 3 anatomical cardiac differences in children

A

• Neonate: less contractile myocardium
• transitional circulation
• non-compliant, relatively fixed cardiac output

54
Q

Name 4 physiological cardiac differences in children

A

• rate dependent cardiac output (prone to bradycardia)
• higher relative blood volume
• lower peripheral vascular resistance
• immature SNS and baro receptors

55
Q

Name 2 renal system differences in children and consequences

A

•Immature kidney function: glomerular filtration better developed than tubular function (can handle volume loads better than solute loads); decreased clearance drugs
• dehydration poorly tolerated: large surface area relative to weight

56
Q

Name a hepatic system differences in children and consequences

A

Immature with decreased function: drugs may accumulate

57
Q

Name 2 haematological system differences in children and consequences

A

For survival in hypoxic intrauterine environment:
• HbF higher affinity for 02. Replaced by hba→physiological anaemia at 3 months
• less 2,3 DPG

58
Q

Name 4 pharmacological differences and considerations in children

A

• immature renal and hepatic function: caution when drug dosing
• inhalation agents: require higher MAC. Quicker induction due to increased co
• opiates: more sensitive
• muscle relaxants: sux requirements higher

Anaesthesiology (24 decks)

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