Pediatric Pain Management - Final Wrap Up Flashcards
What are the Advantages of using Regionals on Kids?
↓Gas & Opioid Use
↓Post-Op Apnea
↓Vascular Insufficiency
↓Clots
Supresses Neuroendocrine Response
↑GI Function
What are Contraindications for Neuraxial Blocks on Kids?
Parent Refuse
Coagulopathy
Severe Infection
Neuro Problems
Hemodynamic Instability
On Chemo
What are the concerns r/t Neuraxial Blocks on Kids?
Neurotoxicity
Infection
Masking of Compartment Syndrome
Kid Needs to be Anesthetized/Held for Placement
Why must a test dose be used when placing a Neuraxial Block on kids?
Anesthetized kids CANNOT tell you symptoms of intravascular injection
What precautions are needed when prepping a kid w/ Iodine or Chlorhexidine?
Iodine can be harmful to neonatal skin - must let dry & wash off when done
&
CHG good for indewlling catheters, but dont use if kid < 2 months old
What meds can prolong Post-Op pain relief to a Spinal?
Epi Wash
Morphine: 5-10 mcg/kg
Clonidine: 1-2 mcg/kig
Which procedures are Spinals indicated?
Hernia Repair
Genital Procedures
Ex-Lap
Muscle Biopsy
Lower Extremity Surgery
Where is the Conus Medellaris & Dural Sac of an Infant vs. an Adult?
Infant:
Conus - L3
Dural Sac - S3
Adult:
Conus - L1
Dural Sac - S1
How much CSF is Neonates?
> 10 mL/kg
How much CSF is in Infants < 15kg?
4 mL/kg
How much CSF is in children?
3 mL/kg
How much CSF is in Adolescents & Adults?
1.5 - 2 mL/kg
What position should the kid be in for placing a Neuraxial Block?
Sitting or Lateral w/ Neutral Neck to maintain airway
Where should the LA be injected for kids?
L4-L5 Space @ the Iliac Crest using a 1.5 in. needle
What is the Pediatric Spinal Dosing of Tetracaine or Bupivacaine?
0.5 - 1 mg/kg
What are the complications w/ Pediatric Spinals?
Difficult to Place
10-25% Failure
Short Duration w/o Morphine
Total Spinal
In regards to Spinals, PDPH is very _____ in kids younger than 8
In regards to Spinals, PDPH is very RARE in kids younger than 8
What is the most common regional used in kids?
Caudal Blocks - good for lower thoracic to lower extremities
What are the Contraindications for Caudals?
Pilonidal Cyst
Abnormal Superficial Landmarks
Neuro Problems
Parent Refuse
What forms the Sacral Hiatus?
Lack of fusion of S4 & S5 Arches
What is the Sacral Hiatus?
V-shaped Aperture covered by sacrococcygeal membrane
What type of needles are used for Pediatric Caudals?
Blunt Caudal Needle
Tuohy
22g Angiocath
What is the positioning for Caudal Placement?
Lateral in Fetal Position
or
Prone
What is the goal of Single Shot Caudals?
To provide intraoperative & prolonged post-operative analgesia
The caudal epidural space in children need a _____ volume to fill the packed space & spread to the appropriate dermatomes
The caudal epidural space in children need a HIGH volume to fill the packed space & spread to the appropriate dermatomes
How much LA is needed for the Pediatric Sacral Level?
0.5 - 0.75 mL/kg
How much LA is needed for the Pediatric Lumbar Level?
1 - 1.2 mL/kg
How much LA is needed for the Pediatric Low Thoracic Level?
1.2 - 1.5 mL/kg
What is the Max Volume & Dose of LA for kids?
Max Volume: 25 mL
Max Dose: 3 mg/kg
What is the treatment for LA Toxicity in Kids?
20% Intralipid
Bolus 1.5 mL/kg x 3 if needed
Then Infuse @ 0.25 mL/kg/min x 30-60 min
True or False: When placing a Caudal, the absence of blood is a reliable indicator of not being in a blood vessel.
FALSE
What is the Caudal Test dose of Epinephrine w/ Sevoflurane?
0.1 mL/kg of LA + 5 mcg/mL of Epi
Max: 3 mL
When using a Test dose for Caudals, what indicates changes indicate Intravascular Injection?
↑HR by 10 bpm
↑BP by 15 mmHg
↑T-Wave by 25%
Bradycardia
Why are kids more at risk for LA Toxicity?
They have ↑CO & ↑Systemic Uptake
What are signs of LA Neurotoxicity?
HA
Somnolence
Vertigo
Paresthesias
Tremors/Twitching
Shivering
Convulsions
What are signs of LA CV Toxicity?
Dysrhythmias
Wide QRS
Torsades
V-Tach
CV Collapse
What should be avoided to prevent LA Toxicity?
Hypothermia
Hypercarbia
Acidosis
Hyperkalemia
Fast Injection
How should the Max Infusion Rate of LA be adjusted for Neonates & Infants younger than 3-5 months?
Reduce by 50% of recommended dose for Older Infants & Children
Besides Opioids, what meds can be used for Pediatric Pain Control?
Oral/Rectal Tylenol
&
Toradol
What is the concern when giving Codeine to kids w/ abnormal levels of CYP2D6?
Too Little CYP2D6 = No Analgesia
Too Much CYP2D6 = Respiratory Depression & Death
What is the result of using a PCA for kids 7 and older for Post-Op Pain, Vaso-Occlusive Crises, & Cancer Pain?
Safe & Effective
What can Topical Eutectic Mixture of Lidocaine + Prilocaine be used for?
Reduces pain for Venepunctures
More = More Pain Relief
What is a S-Caine (Synera) Patch?
Lidocaine + Tetracaine + Oyxgen-Activated Heat used for Venous Cannulation pain
What is the main indication for an Ilio-Inguinal Iliohypograstric Block?
Hernia Repairs
