Pediatric Anest

Question 1

1. Differences between adult and pediatric airways.

Answer 1

peds- cricoid cartilage is the narrowest part
kids proprotionally larger head and tongue with long floppy epiglotis with anterior and cephalad larynx

in children use a flat blade and cuffless ET tube

Question 2

2. LIst standard required NPO times for infants and childrenrs

Answer 2

2 hours clear liquids
4 hours breast milk
6-8 hours with cows milk, solids and formula

Question 3

3. Calculate fluid requirements and estimated blood loss for cases.

Answer 3

4cc/hr for 10kg, 2cc/hr 10-20kg and 1cc/kg thereafter
when giving fluids- first half in first hour, quarter in 2nd hour, quarter in 3rd hour

3 cc crystalloid for 1cc blood lost
3rd spacing up to 10cc/kg for abdominal and thoracic cases

10mg/kg blood to raise Hgb by 2 points

Question 4

4. List normal vital sign ranges for children.

Answer 4

100-150 in newborn, by 6 yo HR= adult

BP newborn 60/40, by 16 BP= adult, RR in infant 30-50 bpm

Question 5

4. ET tube for child?

Answer 5

ETT size = age/4 + 4

Question 6

5. Define a rapid sequence intubation.

Answer 6

RSI invovles rapidly inducing paralysis and sedation to allow for intubation

indications: swelling or trauma to the airway, aspiration, anticipated clinical deterioration, failure to ventilate, failure to oxygenate (PE, pneumonia, CO toxicity)

Question 7

6. Discuss the implications of upper respiratory tract infection for anesthesia.

Answer 7

URI increas incidence of resp complications– increase the risk of laryngospasm, bronchospasm and desaturation (wait 4-6 wks)

Question 8

7. List physiologic differences between adults and children in CV, resp and temp regulation.

Answer 8

CV: higher HR and lower BP ** CO and oxygen consumption per kilo are higher; if stressed they respond with bradycardia and decreased CO

Resp: minute volume is increased by increased RR, kids desaturate more quickly; children have decreased FRC

Temperature regulation: increased surface area, leading to losing heat more quickly– hypothermia can lead to respiratory depression (kids need a warm OR)

Question 9

8. Discuss methods of induction of anesthesia for pediatric patients. (3)

Answer 9

1. inhalational- method of choice <10 yo; use NO2+ O2 then sevoflurane or halothane
2. IV- for older kids and full stomachs (EMLA cream to min IV pain)
3. rectal methohexital or IM ketamine (rare)

Question 10

9. Discuss anxiety in children preparing for surgery, along with sedative premedication and other methods to reduce anxiety.

Answer 10

9mo separation anxiety, hospital tours can reduce, non-anxious parents sometimes in induction

premedication with midazolam for sedation and anxiolysis and amnesia

**babies have higher vagal tone, can cause brady down during intubation; peritoneum or gas insufflation can cause vagal stimulation – premedicate with atropine

Question 11

Pain control options for kids? Antiemetics?

Answer 11

0.1-0.15 mg/kg morphine
tylenol
nerve block
local field block

zofran best (ODT at home)
dexamethasone
benedryl
phenergan (suppository)