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N934: Advanced Principles of Anesthesia > Pediatric Pre-operative Evaluation, Set-up and anesthetic induction > Flashcards

Pediatric Pre-operative Evaluation, Set-up and anesthetic induction Flashcards

1
Q

What pediatric population has the highest rate of adverse events?

A

infants

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2
Q

List possible adverse events

A

bradycardia s/c to hypoxia and high VA concentrations
respiratory complications (bronchospasm, laryngospasm, apnea)
cardiac arrest (8/10 from hyperkalemia d/t transfusion)
medication related
equipment related (CVC insertion, pnemothorax, hemothorax)

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3
Q

What is the age of a newborn?

A

1-28 days

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4
Q

What is the age of an infant?

A

less then 1 year

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5
Q

what is the age of a small child?

A

2-5 years

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6
Q

What is the age of school aged children?

A

6-14 years

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7
Q

What ages are adolescents?

A

> 14 years- 18 years

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8
Q

Describe the stage of development for a 0-6month old

A

not usually upset by separation from parents
prolong separation may impair parent-child bonding

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9
Q

Describe the psychological aspect between 6 months and 4 years

A

separation anxiety, fear of hospitalization, may show regressive behavior

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10
Q

Describe the psychological aspect of school aged children

A

less upset by separation from parents
asks questions involved
wants choices, more concerned with surgical procedure and its possible affects on body image

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11
Q

Describe the psychological aspect of adolescents

A

fear the process of narcosis, the loss of control, walking up during surgery, and pain of surgery, value modesty, HCG testing in females

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12
Q

Describe the psychological aspect of parents

A

provide explanation of what to expect

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13
Q

What are two drugs where HCG testing in adolescents needs to be recongized?

A

aprepitant (4 weeks)
sugammedex (2 weeks)

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14
Q

When is it not approprirate to bring the parent back for inductions?

A

adeqaute preoperative sedation
the parent’s level of anxiety
language barrier
emergency RSI cases
anticipated difficult airway or unstable patient
pregnant mother (due to N20)

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15
Q

What are important aspects of the pre-op interview?

A

sources of information
NPO status
current weight
ausculation of the lungs and heart
evaluation of the airway, inquire about loose teeth
PMH, previous anesthetics, MH
recent URIs or fevers
cigaretter exposure in the home
possibility of pregnancy
allergies and current medications

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16
Q

What are the NPO guidelines?

A

clears- 2 hours
breast milk 4 hours
formula, non human milk, light meal 6 hours
fatty food 8 hours

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17
Q

Important history questions regarding patients age

A

gestational, conceptulal, birth history, maternnal pregnancy history

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18
Q

Important history questions regarding patients CNS

A

seizures, hydrocephalus, neuromuscular disorders, head trauma, autism

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19
Q

Important history questions regarding patients CV

A

murmur, cyanosis, dyspnea, sweating, hypertension, exercise tolerance, congential heart defects, indications for subacute bacterial endocarditis

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20
Q

Important history questions regarding patients respiratory status

A

prematurity, respiratory distress syndrome, apnea, recent respiratory infection (URI), cough, croup, asthma, cystic fibrosis, need for pre-op oxygen therapy

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21
Q

Important history questions regarding patients GI

A

NPO status
reflux
vomiting
diarrhea
liver

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22
Q

Important history questions regarding patients GU

A

renal failure, bladder surgery

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23
Q

Important history questions regarding patients endocrine

A

diabetes, thyroid, pituitary, adrenal steroid therapy

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24
Q

Important history questions regarding patients Hematology

A

anemia, bruising, bleeding, sickle cell

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25
Q

Important history questions regarding patients immunology

A

allergies, immunocompromised

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26
Q

Consider collecting a hemoglobin on

A

neonates, premature infants, cardiopulmonary disease, known hematologic dysfunction, and anticipated blood loss during the surgical procedure

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27
Q

What are irritable airways at an increased risk for?

A

laryngospams, bronchospasms, post-intubation croup, ateletasis, pneumonia, and desaturations

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28
Q

What should be considered in an child with an URI

A

LMA over an ETT

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29
Q

What are reasons to postpone surgery?

A

elective, febrile, elevated WBC, productive and purulent sputum, getting worse, acutely ill, malaise, tachypnea, wheezing

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30
Q

What are the increased risk of an URI with GA?

A

need for ETT
asthma reactive airway
tracheal mucocillary flow and pulmonary bactercidal activity is decreased by general anesthesia
PPV may help spread the infection from upper to lower airways

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31
Q

How do you manage anesthesia with a URI

A

adequate hydration, oxygenation
reduce secretions, limit airway manipulation
bronchodilators (beta 2 for wheezing)
anticholinergics (prevents bronchospasm)
muscle relaxants for laryngospasm

32
Q

When does a cardiologist need to evaluate a murmur prior to induction of anesthesia?

A

difficult feeding, SOB, poor exercise tolerance, can’t match peers, family history of CHD, cyanotic episodes, abnormal peripheral pulses, unequal blood pressures in upper and lower extremities

33
Q

What the max dose of PO versed?

A

20mg

34
Q

What are the special considerations for premedication?

A

careful sedating a child with congenital heart disease, increase ICP, OSA, sepsis, trauma or suspected difficult airway

35
Q

What do you need for set up in pediatrics?

A

blood pressure cuff
ECG (5 lead for cards)
pulse oximeter
capnography
temperature
neuromuscular function
shoulder roll

36
Q

What is the normal VSS for premature baby?
HR
SBP/DBP
MAP

A

120-170
55-75
35-45
40-55

37
Q

What is the normal VSS for 0-3month?
HR
SBP/DBP
MAP

A

100-150
65-85
45-55
52-65

38
Q

What is the normal VSS for 3-6 months?
HR
SBP/DBP
MAP

A

90-120
80-100
55-65
63-77

39
Q

What is the normal VSS for 1-3 years?
HR
SBP/DBP
MAP

A

70-110
90-105
55-70
67-82

40
Q

How do you prepare for an induction?

A

warm the operating room and check warming devices
pre-induction checklist of equipment, suction, emergecny airway devices, ventilator default and monitoring setting
consider a chair or stool
ensure a quiet calm operating room environment
a variety of induction techniques exist
(technique utilized will depend on several factor including the past medical and surgical history, the child’s developmental level, ability to cooperate and previous experiences

41
Q

When do you commonly use a straight blade?

A

< 1 year

42
Q

What is the appropriate ETT size for a premature child?

A

2-2.5 uncuffed

43
Q

what is the appropriate ETT size for a term infant?

A

3

44
Q

What is the appropriate ETT size for a 3-9 month old

A

3-3.5

45
Q

What is the appropriate ETT for 9-18 months

A

3.5-4

46
Q

What is the appropriate ETT for 18-36

A

4-4.5

47
Q

What is the appropriate ETT for > 36 months

A

(age/4) + 3.5 = cuffed size

48
Q

What is the depth calculation

A

< 3 kg 1-2-3kg= 7-8-9 cm at lips
> 3kg ID x3

49
Q

What is require at Duke for set up?

A

atropine
succinylcholine
epi 100mcg/ml and 10mcg/ml if under 10kg 1mg/ml
propofol
muscle relaxant
analgesic
lidocaine
flush syringes
masks x2, oral airways x2 temp probe blade x2 warmer og/ng
peds anesthesia circuit <30kg
fluids

50
Q

What gauge is an IM needle?

A

22g

51
Q

What size syringe does succinylcholine go into ?

A

3ml syringe

52
Q

What should sevoflurane be reduced after general anesthesia is induced?

A

4-5%

53
Q

When do you place the IV on inhalation induction?

A

following stage 2 prior to manipulation of the airway
consider 100% during IV placement

54
Q

What is the most reliable and rapid method of induction?

A

IV induction

55
Q

WHen is an inhalation induction contraindicated?

A

difficult airway, full stomach, cardiac instability

56
Q

Can you place an IV during N20?

A

yes

57
Q

When do you obtain an IV?

A

patient is at risk for aspiration requiring an RSI, an anticipated difficult airway, or those potential cardiac instability, an IV should be placed prior to induction

58
Q

What is the max recommended volume in an infant vastus lateralis?

A

0.5ml

59
Q

What is the max recommended volume in a toddler’s deltoid

A

0.5ml

60
Q

what is the max recommended volume in a toddler’s vastus lateralis?

A

0.5-1ml

61
Q

what is the max recommended volume in a pre-school age vastus lateralis?

A

1ml

62
Q

what is the max recommended volume in a school age vastus lateralis?

A

1.5ml-2ml

63
Q

What is the max recommended volume in a pre-school age deltoid

A

0.5ml

64
Q

What is the max recommended volume in a school age deltoid

A

0.5-1ml

65
Q

Where are common IV placement sites?

A

back of hands, feet (including top, sides and saphenous, inside wrist, avoid AC IVs if possible
EJ scalp veins

66
Q

What are the two most accessed veins?

A

superficial dorsal hand veins off the basilic vein
saphenous vein at the ankle

67
Q

What size catheter is needed for an arterial line?

A

22g >2 years
24g <2 yrs

68
Q

What are the baby wires?

A

wires to float in an arterial line
baby wire is 0.12in, used in 24g IV
0.15ins as well

69
Q

What are the benefits of caudal anesthesia?

A

intraoperative and postoperative anesthesia
reduction in systemic opioid requirements and side effects
reduction in anesthesia requirements

70
Q

What procedures is caudal anesthesia beneficial?

A

circumcision
inguinal hernia
hypospadias
anal surgery
clubfoot repair
other sub umbilical procedures

71
Q

When is caudal anesthesia contraindicated?

A

infection, patient refusal, coagulopathy, anatomic abnormalities

72
Q

What are the caudal landmarks?

A

sacral hiatus and 2 PSIS

73
Q

What is caudal dosing for genital and anal surgery?

A

0.5-0.75ml/kg

74
Q

What is caudal dosing for lower abdomen and extremitiy?

A

1ml/kg

75
Q

What is caudal dosing for abdominal incision

A

1-1.25ml/kg

76
Q

What is needed for pediatric post-anesthesia care?

A

appropriate ambu bag
oxygen source
monitoring
emergency medications
pain medications
treatment for emergence delirium
lateral position

N934: Advanced Principles of Anesthesia (16 decks)

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