pediatric Flashcards
main take away from peds population
if something bad is going to happen – it happens much quicker in children so need to respond at a good time
main thing with GA
complete or partial loss of reflexes
like have to brethe for them - inability to maintain a patent airway or respond to verbal or physical stimulus
minimal sedation
respond everything basically the same
respond NORMALLY
type given before GA
moderate sedation
response purposefully to verbal commands and maintain airway
cardio and resp adequate and maintained
when can peds patient take the oral med for minimal
once arrive at the office
deep sedation
aroused with repeated verbal or painful stimulus
partial or complete loss of protective airway
- assistance to airway may be necessary
cardio function maintained !
response = purposeful to pain airway = +/- interventon ventilation= +/- inadequate cardio = +/- maintained
narrowest part in peds airway
cricoid ring - narrowest
child talking what age
under age of 12
- when referring to anatomics
large ___ in kids ?
tracheal lenght?
large tongue and epiglottis
enlarged adenoids and tonsils
- reach max at 6-8
short neck
anterior placed airway and is funnel shaped
narrow nasal pasasges
trachea is 4-5.5 cm
- every mm of trauma = 60% decrease in size
cranial vault to airway in child
rapid cause upper airway oobstruction
breathing differnces
children - see more abdominal movement
FRC in children
5:1
reserve is small
so get hypoxemia faster - respiratory arrest faster then bradycardia then death
physiological differences in children
higher metabolic rates
- need more oxygen
greater frequency of breathing
FRC = 5:1
smaller reserve
more suceptible to hypoxemia
intermittent asthmatic patient?
mild persistent
moderate persistent
severe persistent
symptoms no more than 2 / days a week
mild = greater than 2 days
moderate = daily
severe = throughout the day have symptoms
range of age neonates infants children adolescents
0-30 days
1-12 months
1-12 years
13-18 years
Cardiac output it ___ dependent
rate dependent and by vagal parasympathetic tone predominates
cardiac output is 300-400 ml/kg min @ birth
200-300 ml /kg/ min - infants and children
blood volume in newborn
6 weeks to 2 years
2 years - puberty
85-90 ml/kg
85 ml/kg
80 ml/kg
smaller blood volume in
children
- rate dependent
so vasovagal attack is cardio
HR is higher
blood volume of adult
5 liters
HR in peds
naturally higher
new born is 120 average
10 years is 90
so what would bradycardia be in a younger child
age dependent
less than 16 average can be 75 - 80
how to decide technique to help with anxiey with child
age
level
urgency of tx
type of procedure
typical under sedation with pedo
oral prophylaxis
dental restortions
dental extractions
dento alveolar sugical procedures . pathology, trauma, impaacted teeth removal
make sure airway is patent
GA use?
when more severe
pre operative assessment
age, body weight
last meal or drink?
- can vomit easily
medical history – important to ask
- CHD?
- asthma?
- bleeding disorders?
recent ilnness like URI?
allergies?
previous exerience with anesthesia?
family history?
- like malignant hyperthermia
recent URTI?
airway narrow
more likel to have upper airway obstruction faster
can be contraindication
monitor if going to sedate?
HR, pulse oximiter SPO2, BP, Resp rate
examination of head and neck
- airway, size of tongue, tonsils, patency of nares, range of motion of neck, mouth opening
chest exam and auscultation
- shape, breath sounds, heart sounds, murmers
last meal - solids, and liquids
6-36 monhts
over 3 years?
6-36 months greater than 6 hrs for solids, 2 hrs for liquids
over 3 years 6-8 hours for solids, 2 hrs for clear liquids
T/F aspiration is an independent risk factor
True
measure a nasal laryngoscope
nose to angle of the mandible
airway in terms of stiff and collapsable
nasal segment - cartilage and palate
pharyngeal segment – soft portion - is collapsable
tracheal segment
can get pharyngeal collapse during sedation
posture of patient is important
- giving positive pressure - able to open up the collapsed portion
monitoring equipment
pre-cordial stethescope
pulsoximeter
BP monitor
capnograph
ECG
Local anesthesia
weight based
wait till anesthetic takes effect
max LA for child
7.0 mg/kg for articaine
anxiolytics / sedatives used in children
benzo = midazolam (most likely to use) , valium
antihistamines - hydrocyzine (vistarill)
sedative / hypnotics
- chloral hydrate
narcotics
- fentanyl, meperidine
N20 use
inhalation
- good one to use with children
dissociates quickly
enteric
goes through GI
ora, rectal, intranasal
parenteral
IM and IV
dose of midazolam in child
.25 -.5 mg/kg PO or .2 to .3 mg/kg IV
better amnesia than valium**
can be reversed with flumazenil
water soluble – makes it not as painful on injection
opioid use in pediatric sedation
pediatric mortality and morbidity incresed when opiates + other sedatives used
snoring indicates
hypopharngeal obstruction
stridor means
laryngospasm
what is a sign of hypoxeia
bradycardia
what is a sign of hypoxeia
bradycardia
biggest emergency when sedating patietn
emesis, and aspiration
