Pediatric Flashcards
How are pediatric airways different than adults?
1) Larger tongue (oral airway helpful)
2) Pharynx smaller
3) Epiglottis is larger and floppier
4) Larynx more ANTERIOR and SUPERIOR
Narrowest portion of pedi airway?
Cricoid cartilage
How to calculate ETT size?
(Age/4) + 4
Subtract 0.5 if CUFFED
In terms of cardiac physiology, what component is fixed in kids?
*Stroke volume is FIXED
If you want to increase CO, you can ONLY increase the heart rate
What are triggers for vagal reactions and subsequent bradycardia in children?
What can you use to pretreat?
Abdominal insufflation Anal manipulation ET tube placement Hypoxia Volatile anesthetics
Tx: glycopyrrolate (anti-ACh)
What pulmonary components are different in kids?
- Smaller diameter of airways = more resistance and less flow
- Increased chest wall compliance = increased airway collapse and **DECREASED FRC
- Diaphragm + intercostals are Type II fibers until 2 yo –> this means an increased work of breathing will cause earlier respiratory fatigue and failure
What lung volume component is important to consider in kids?
DECREASED FRC (doesn’t take long to desat + they have high O2 consumption rates)
How is liver physiology affected in kids?
- Increased blood flow to liver = increased drug delivery
- Impaired liver conjugation until 1 yo (**prolonged T1/2 of benzo’s, morphine)
- Decreased drug binding b/c decreased albumin levels
Rules of NPO?
8-6-4-2 rule
8 hrs = full meal (fats, meats)
6 hrs = light solids (FORMULA, toast, tea)
4 hrs = BREAST MILK
2 hrs = Clears (water, apple juice, jello)
Estimated blood volumes for:
- Premature?
- Term infant?
- 3-12 months?
- Child > 1 yo?
- Adult female?
- Adult male?
Premature: 100-120 mL/kg Term: 90 mL/kg 3-12 months: 80 mL/kg Child > 1 yo: 70 mL/kg Adult female: 60 mL/kg Adult male: 50 mL/kg
Formula for allowable blood loss (ABL)?
EBV x [(Hct start - Hct target) / Hct start]
What is the rate of fluid loss into the open abdomen (3rd spacing)?
10 mL/kg/hr
How much crystalloid, colloid, and PRBC do you need to replace 1 mL of blood loss?
3 mL crystalloid per 1 mL blood loss
1 mL colloid per 1 mL blood loss
1 mL PRBC per 1 mL blood loss
Maintenance fluid resuscitation formula?
4-2-1 rule
4ml/kg/hr for first 10kg
2ml/kg/hr for second 10kg
1ml/kg/hr for each additional kg
Easy way to calculate maintenance fluid requirements?
If OVER 20kg –> Weight + 40 = mL/hr
List and describe the 4 types of heat transfer to the environment?
1) Radiation: all surfaces radiate head and absorb heat
2) Convection: still air over skin serves as insulator - if this layer is disturbed, heat loss will increase
3) Evaporation: from skin and open wounds
4) Conduction: heat loss proportional to temp differences b/w 2 adjacent surfaces
During 1st hour of surgery, what is the most important contributor to heat loss?
Redistribution of blood –> vasodilation from anesthetic agents cause blood to travel peripherally resulting in heat transfer to environment
What precautions are taken when MH is suspected?
Flush system with 10L/min O2 for 10-30 minutes pre-op
Replace etCO2 absorbant
Perform complete TIVA
Risk factors for MH?
All volatile agents (NOT nitrous oxide)
Succinylcholine
Fam Hx
MSK disorders
S/S of MH?
Increasing etCO2 w/ constant ventilation Tachycardia Increasing temperature (late sign) Tachypnea Arrhythmias Masseter muscle spasm
Tx of MH?
Stop anesthesia and surgery
Call for help
Hyperventilate with 100% O2 (emergency O2 tank and BVM off back of machine)
Dantrolene (bolus 2.5mg/kg IV)
Aggressive cooling
Treat hyperkalemia (NO calcium! Use HCO3)
