Pediatric Preoperative Evaluation, Set Up, and Anesthetic Induction Techniques Flashcards
infants less than ___ months have highest rate of adverse events
one month
what encompasses the adverse events experienced by the pediatric population (5)
bradycardia secondary to hypoxia and high inhalation anesthetic concentration
respiratory complications (bronchospasm, laryngospasm, apnea)
cardiac arrest
medication related
equipment rerlated
wake up safe initiative
dedicated to better outcomes for children receiving anesthetic care and to the education of our members in improvement science
newborns are classified as
1-28 days old
infants are classified as
up to end of first year
small children are classified as
2-5 years
school aged children are classified as
6-14 years
adolescents are classified as
14-18 years
preoperative psychological preparation for the surgery can include
child life specialists, videos, hospital tours. basic objective is to explain to child and parents proceedings and bond with child
psychological aspects of anesthesia for children 0-6 months
not usually upset by separation from parents, prolonged separation may impair parent child bonding
psychological aspects of anesthesia for children 6 months to 4 years
separation anxiety, fear of hospitalization. may show regressive behavior
psychological aspects of anesthesia for children that are school aged
less upset by separation from parents, asks questions, involved, wants choices, more concerned with surgical procedure and its possible effects on body image
psychological aspects of anesthesia for adolescents
fear the process of narcosis, the loss of control, waking up during surgery, pain of surgery. value modesty, HCG testing in females
psychological aspects of anesthesia for parents
provide explanation of what to expect
assent versus consent
assent is the minor agreeing with what the parents are consenting to. if the patient does not want the spine surgery and is in her teens, but the parents do- and she is old enough to understand the implications-cancel that case so they can talk more
what two medications should you consider alternatives or patient education for with young females
aprepitant and sugammadex
parental presence during induction may not be appropriate in certain circumstances including
adequate preoperative sedation achieved
parents level of anxiety is too high
language barrier
emergency/RSI cases
anticipated difficult airway or unstable patient
pregnant mother (due to nitrous oxide exposure)
-bunny suits, hat, shoe covers, and masks are required for the patients entering the OR’s
interview and physical exam preoperatively includes
information from EMR, parents, child NPO status current weight lungs/heart auscultation evaluation of airway, inquire about loose teeth PMH/previous anesthetics/MH recent URI's or fevers cigarette exposure in home possibility of pregnancy allergies and current medications
NPO guidelines
clear liquids 2h
breast milk 4h
formula/non human milk/light meal 6h
fatty foods 8h
review of childs history: age
gestational, conceptional, birth history, maternal pregnancy history
consider preoperative hemoglobin on
neonates, premature infants, cardiopulmonary disease, known hematologic dysfunction, anticipated major blood loss during surgical procedure
the child with URI is at increased risk for
laryngospasm, bronchospasm, post intubation croup, atelectasis, PNA, and desaturations
for a child with a URI, consider which airways
ETT if possible, LMA considered.
for a child with a URI, consider rescheduling how far out:
2-4 weeks for URI’s and 6-8 weeks for lower respiratory infections
some reasons to postpone elective surgery includes
febrile, elevated WBC, productive/purulent sputum, getting worse, acutely ill, malaise, tachypnea, wheezing
PPV and infection spreading
may help spread infection from upper to lower airways
what happens to tracheal mucociliary flow under GA
that and pulmonary bacteriocidal activity decreased by GA
management of child under anesthesia with URI
adequate hydration and oxygenation
reduce secretions, limit airway manipulation
bronchodilators (beta 2 agonists) for wheezing
anticholinergics (inhibits cholinergic mediated bronchospasm)
muscle relaxants for laryngospasm
heart murmur may be detected in up to ____ of pediatric patients
50%
children ages 2-6 have what kind of murmur?
stills murmur, a functional systolic murmur
if the patient has a new onset murmur our murmur that is creating one of the following symptoms, a cardiologist should see the patient before proceeding with surgery
difficulty feeding, SOB
poor exercise tolerance, cant match peers
family hx of CHD
cyanotic episodes
abnormal peripheral pulses
unequal blood pressures in upper versus lower extremities (coarctation)
oral premedication and infants younger than 6-12 months
not usually necessary because they usually separate from their parents just fine
midazolam PO dose and max dose, and onset
.5mg/kg PO (usual max dose 20mg)
15-30 minutes prior to induction
midazolam PO special considerations
may prolong time to discharge, careful sedating a child with congenital heart disease, increased ICP, OSA, sepsis, trauma, or suspected difficult airway
nasal premedication meds and doses include
midazolam .2mg/kg nasal
ketamine 3mg/kg nasal
dexmedetomidine 1-2mcg/kg nasal
pediatric monitoring set up
BP, ECG (3 lead, 5 lead if cards patient), pulse ox weight based, capnography, temperature, neuromuscular function, SHOULDER ROLL
BP cuff sizes range from
1-5
normal vital signs for a premature infant
HR 120-170
BP 55-75/25-45
MAP 40-55
