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AS - N934 Advanced Principles II > Pediatric Preop, Set-up, & Induction > Flashcards

Pediatric Preop, Set-up, & Induction Flashcards

1
Q

What pediatric population has the highest adverse events rate?

A

Infants < 1mos

  • Bradycardia
  • Respiratory complications
  • Cardiac arrest (hyperkalemia)
  • Medicated related
  • Equipment related
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2
Q

Pediatric Anesthesia M&M

A

Adverse events 35%

Adults only 17%

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3
Q

Newborns

A

1-28 days

Up to 1mos

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4
Q

Infants

A

1mos up to end 1st year

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5
Q

Children

A

2-5yo

Toddlers

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6
Q

School-Age

A

6-14yo

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7
Q

Adolescents

A

14-18yo

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8
Q

Psychological Aspects

0-6mos

A

Not usually affected by separation from parents
Prolonged separation potential to impair parent-child bonding
Minimal premedication requires

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9
Q

Psychological Aspects

6mos-4yo

A

Separation anxiety
Fear hospitals/hospitalization
Regressive behaviors common

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10
Q

Psychological Aspects

School-Age Children

A

Less upset by separation from parents

Ask questions, involved, want choices, more concerned w/ surgical procedure & potential affects on body image

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11
Q

Psychological Aspects

Adolescents

A

Fear narcosis process, loss control, waking-up during surgery, and pain
Value modesty
HCG testing in females (> 14yo)

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12
Q

Psychological Aspects

Parents

A

Provide what to expect explanations

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13
Q

Assent vs. Consent

A

Assent - agree to take part when unable to give legal consent to participate (< 18yo)
Consent - to give permission for something to happen (informed surgical consent given by parents or legal guardian)

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14
Q

Parental Presence at Induction

Considerations

A 
Prepare parents what to expect
Adequate preop sedation
Parental anxiety level
Language barriers
Emergency or RSI 
Anticipated difficult airway
Unstable patient
Pregnant mother
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15
Q

Patients to check preop Hgb:

A 
Neonates
Premature infants
Cardiopulmonary disease
Known hematological dysfunction
Anticipated blood loss
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16
Q

URI

A

Common viral infection or more serious RSV/COVID
Irritable airway ↑laryngospasm, bronchospasm, post-intubation croup, atelectasis, pneumonia, & desaturation risk
LMA > ETT
Reschedule elective surgery 2-4 weeks
Lower respiratory infection 6-8 weeks

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17
Q

When to postpone surgery?

A 
Elective
Febrile
↑WBC
Productive/purulent sputum
Worsening or acutely ill
Malaise
Tachypnea
Wheezing
Lethargy
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18
Q

URI Anesthetic Management

A 
Adequate hydration & oxygenation
↓secretions
Limit airway manipulation
Bronchodilators β2 agonist
Anticholinergics
Muscle relaxants to treat laryngospasm
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19
Q

URI Complications Associated w/ GA

A

ETT
Asthma or reactive airway
↓tracheal mucociliary flow & pulmonary bactericidal activity
PPV potential to spread the infection from upper to lower airways

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20
Q

Still’s Murmur

A

2-6yo functional systolic murmur

Outgrow w/o intervention

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21
Q

When to follow-up undiagnosed murmur w/ cardiac evaluation?

A 
Difficulty feeding
SOB
Poor exercise tolerance
Family history CHD
Cyanotic episodes
Abnormal peripheral pulses
Unequal BPs in upper vs. lower extremities
22
Q

Midazolam

A

Most common oral premedication
0.5mg/kg PO
Max 20mg
Concentration 2 or 5mg/mL

23
Q

What patients to avoid premedication?

A 
CHD
↑ICP
OSA
Sepsis
Trauma
Suspected difficult airway
24
Q

Nasal Premedications

A

Midazolam 0.2mg/kg
Ketamine 3mg/kg
Dexmedetomidine 1-2mcg/kg (delayed onset)

25
Q

MAP Formula

A

[(DBP x 2) + SBP] / 3

26
Q

Pediatric patients w/ potential unstable cervical spine:

A

Down syndrome - subluxation risk

Trauma

27
Q

Straight Blade

A

Miller < 1yo

28
Q

ETT Sizing

A 
Premature 2-2.5 uncuffed
Term 3
3-9mos 3-3.5
9-18mos 3.5-4
18-36mos 4-4.5
>36mos → (Age/4) + 3.5 = cuffed size
29
Q

ETT Depth

A

< 3kg 1-2-3kg → 7-8-9cm @ lips

> 3kg internal diameter x3 (4.0 ETT @ 12cm)

30
Q

Emergency Medications

A

Atropine 0.4mg/mL
Succinylcholine 20mg/mL
Epinephrine 1-100mcg/mL

31
Q

What emergency medications require IM needles?

A

Atropine 22G

Succinylcholine 22G

32
Q

Atropine

A 
Dose 0.02mg/kg
0.4mg/mL
< 10kg 1mL TB syringe
> 10kg 3mL syringe
22G IM needle
33
Q

Succinylcholine

A

Dose 0.25-2mg/kg
20mg/mL
3mL syringe
22G IM needle

34
Q

Epinephrine

A

100mcg/mL 1:1,000 g:mL (Omnicell)
10mcg/mL 1:100,000 g:mL (pharmacy)
Neonate 1mcg/mL

35
Q

Fluids < 30kg

A

Buretrol fill to 10mL/kg

Double stopcock, extension, & T-piece

36
Q

Fluids > 30kg

A

Macro drip tubing

37
Q

UNC Fluids

A

0-2yo → Buretrol
3-9yo → micro drip tubing
> 10yo → macro tubing

38
Q

Anesthesia Circuit

A

Small enough to sense small Vt & large enough to administer vital capacity breath
Neonatal 0.5L
1L reservoir bag < 30kg
3L reservoir bag > 30kg

39
Q

Inhalational Induction

A

Pacifiers okay (size-up mask)
1-2min N2O + O2
Then introduce Sevo & rapidly ↑6-8%
Reduce to 4-5% to prevent overdose & assist ventilation
Consider oral airway
Place IV after stage 2 & prior to airway instrumentation
100% FiO2 during IV placement

40
Q

IV Anesthesia Induction

A

Most reliable & rapid
Necessary when inhalation induction contraindication (difficult airway, full stomach, or cardiac instability)
N2O w/ IV placement to provide analgesia
Topical anesthetics EMLA or ethyl-chloride spray
Ideal to pre-oxygenate w/ 100% FiO2 prior to IV induction, but not always possible w/ uncooperative patients

41
Q

Maximum IM Administration Volume

A

Infant 0.5mL (vastus lateralis)
Toddler 0.5mL (deltoid) or 0.5-1mL (vastus lateralis)
Pre-school 0.5mL (deltoid) or 1mL (vastus lateralis)
School-age 0.5-1mL (deltoid) or 1.5-2mL (vastus lateralis)

42
Q

IV Gauges

A

Neonate 24G
Infants 22-24G
Children 20-22G

43
Q

Arterial Line

A

IV catheter vs. A-line device
> 2yo 22G
< 2yo 24G
Babywire 0.012 (24G)

44
Q

Caudal Anesthesia +

A

Epidural

  • Intra/postop analgesia
  • ↓systemic opioid requirements & associated side effects
  • ↓anesthesia requirements
45
Q

Caudal Anesthesia

Procedures

A 
Circumcision
Inguinal herniorrhaphy
Hypospadias
Anal surgery
Clubfoot repair
Sub-umbilical procedures
46
Q

Caudal Anesthesia

Contraindications

A

Infection around the site
Coagulopathy
Anatomic abnormalities
Parent refusal

47
Q

Caudal Dosing

A

Genital & anal surgery 0.5-0.75mL/kg
Lower abdomen or extremity 1mL/kg
Abdominal incision 1-1.25mL/kg

48
Q

Caudal Local Anesthetics

A

Lidocaine 5mg/kg or 7mg/kg + Epi
Bupivacaine 2.5mg/kg or 3mg/kg + Epi
Ropivacaine 2.5mg/kg or 3mg/kg + Epi

Epinephrine 5mcg/kg

49
Q

Caudal + Clonidine

A

1-2mcg/kg
↑DOA 2-3hrs
Sedation, hypotension, respiratory depression
Avoid co-admin w/ Dexmedetomidine

50
Q

PACU

A 
Ambu-bag
Oxygen source
Monitoring
Emergency medications
Pain medication
Emergence delirium
Lateral position
51
Q

Emergence Delirium

Treatment

A

Dexmedetomidine
Propofol
Fentanyl

AS - N934 Advanced Principles II (18 decks)

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