Pediatrics Part 3 Flashcards
Risk of aspiration is increased with this population
developmentally delayed GERD previous esophageal surgery difficult airway obese traumatic injury
Dose for bicitra (antacid)
30mL (0.5-1mL/kg up to 30mL)
dose for metoclopramide (prokinetic)
0.1-0.15 mg/kg
dose for cimetidine (H2 antagonist)
5-10mg/kg
dose for ranitidine (H2 antagonist)
2-2.5 mg/kg
dose for famotidine (H2 antagonist)
0.3-0.4 mg/kg
factors that affect FA/FI ratio
inspired anesthetic concentration inhalation agent blood gas partition coefficient alveolar ventilation cardiac output distribution of CO to vessel rich organs
neonates have a ___ MAC
lower
infants (1-6mo) have a ____ MAC
higher
MAC ____ with ____ age
MAC decreases with increasing age
Inhalation induction is more ___ in pediatrics
rapid
inhalation induction is associated with a ___ incidence of myocardial depression than in aduts
higher
MAC of sevo for 0-6 mo
3-3.2% in O2
MAC of sevo 6mo-1yr
2.5-2.8%
what is the inhalation agent of choice for pediatrics
sevo
sevo has what effect on respirations
depresses MV; at deeper levels depresses RR
myocardial depression is dependent on what in Sevo
concentration
inhaltion induction with Iso is associated with what?
breath holding, coughing, laryngospasm
there is a dose dependent decrease in these parameters in infants
HR, BP, MAP
MAC of Iso in infants and children
1.6% in O2
MAC of Des for infants
9%
MAC of Des for children
6-10%
What has the lowest blood gas coefficient?
Des (0.42)
What is inhalation induction with Des associated with?
breath holding, laryngospasm, coughing, increased secretions (too pungent for inhalation)
When is des appropriate in children?
maintenance
which IV anesthetic has a rapid onset, short duration of action and decreases the incidence of post op N/V
propofol
dose for propofol in infants
2.5-3mg/kg
dose of propofol for children
2-2.5 mg/kg
ED50 for propofol for infants (1-6mo)
3 +/- 0.2 mg/kg
ED50 for propofol for children (1-12 yrs)
1.3-1.6 mg/kg
ED50 for children (10-16 yrs)
2.4 +/- 0.1 mg/kg
what is appropriate for pretreating pain associated with injection of propfol?
lidocaine
propofol infusion syndrome is associated with what?
lactic acidosis
rhabdo
hyperkalemia
lipidemia
which induction drug is associated with lipid solubility and rapid distribution?
ketamine
onset of anesthesia with ketamine after IV doses?
30 seconds
IV dose of ketamine for induction
1-3mg/kg
IM dose of ketamine for induction
5-10mg/kg
duration of action of ketamine
5-8 minutes
sedation dose for ketamine IV
0.25-0.5 mg/kg
sedation dose for ketamine IM
1-2mg/kg
contraindications for ketamine
intracranial hypertension
corneal laceration
induction dose of etomidate
0.2-0.3 mg/kg IV
injection of etomidate is associated with what?
pain
what is the induction agent of choice for critically ill infants?
etomidate
nondepolarizing paralytics are associated with what pharmacokinetic properties?
highly ionized
low lipophilicity
nondepolarizers are associated with a ____ release of acetylcholine
slower
acetylcholine receptors are ____ sensitive to nondepolarizers
more
when does the NMJ mature?
after 2 months
___ plasma level is required to achieve clinical level of blockadge with nondepolarizers
lower (does not mean lower dose)
onset of action of nondepolarizers is ____ in neonates
faster
what contributes to less redosing of nondepolarizers?
large volume of distribution and slower clearance
what muscle is the most reflective of diaphram activity?
adductor pollicis
infants are ___ resistant to succinylcholine than adults
more
onset of action of succs in infants
3 mg/kg (30-40 seconds)
onset of action of succs in children
1 mg/kg (35-55 seconds)
what is recommended to avoid arrhythmias with the administration of succs
vagolytic
what is recommended as a rescue drug (laryngospam) or emergency intubation of children < 8 years old?
succs
intubating dose of succs for infants
3 mg/kg
intubating dose of succs for children
1.5-2 mg/kg
intubating dose of cisatracurium for infants
0.1 mg/kg
intubating dose of cisatracurium for children
0.1-0.2 mg/kg
intubating dose of atracurium for infants
0.5 mg/kg
intubating dose for atracurium for children
0.5 mg/kg
intubating dose for roc in infants
0.25-0.5mg/kg
intubating dose for roc in children
0.6-1.2 mg/kg
intubating dose for pan in infants
0.1 mg/kg
intubating dose for pan in children
0.1mg/kg
intubating dose for vec in infants
0.07 - 0.1 mg/kg
intubating dose for vec in children
0.1 mg/kg
clinical signs of recovery from neuromusclar blockade
flexing of arms
lifting legs and flexing thighs to abdomen
normal response to nerve stimulation
-32 H2O inspiratory force = leg lift
what corresponds to leg lift?
-32 H2O inspiratory force
dose for neostigmine for TOF with fade
20-25 mcg/kg + atropine 10-20 mcg/kg or glyco 5-10 mcg/kg
neostigmine dose may be repeated up to what dose?
70 mcg/kg
what physical findings should be considered when evaluating for difficult airway
mouth, neck, head facial skeletal features size and shape of mandible and maxilla absence of dentition size of tongue in relation to oral cavity presence of loose dentition ROM of neck
what history should be considered when evaluating for difficult airway
snoring
difficulting breathing with feeding
current or recent URI
past history of croup
should previous anesthesia records be evaluated for difficult airway?
duh.
guidelines for potential difficult airways
avoid NMBs
have variety of equipment ready
consider awake fiberoptic, sedation, anesthetizing spray, inhalation induction
after deep plane of anesthesia- O2 100%
glyco or atropine to decrease secretions
maintain SV
use external manipulation of trachea to improve view
have glidescope, fast-track LMA, light want (?), blind nasal, cricothyrotomy ready
use difficult airway algorithm
what are signs of alertness for emergence and extubation
grimacing, eye opening, purposeful movement
when are patients more prone to laryngospasm?
extubation
when is it best to extubate children?
after fully awake
when should deep extubations be performed?
after suctioning of oropharynx and stomach in patients with normal airway and empty stomach
how should child be positioned after extubation?
lateral
what is recommended for transfer of children to PACU?
supplemental O2
early stage of awake extubation
intermittent cough and gag; nonpurposeful movement
middle stage of awake extubation
unresponsive, apneic, agitated, breathholding, desaturate
late state of awake extubation
quitet, spontaneous breathing, purposeful movement, coughing, grimacing, opening eyes
deep extubation requires what MAC level?
1.5-2 & regular respirations
deep extubation with sevo should be performed at what %?
3.6-5% end tidal & regular respirations
true or false, timing of LMA removal affects the incidence of upper airway adverse events
false; does not affect adverse events
what increases risk of upper airway adverse events with LMA removal?
URI
specific volatile agent
surgery
Who recommends removal of LMA when pt is fully awake
Barash
emergence delay could be the result of what?
drug overdoses
increased sensitivity to drugs
failure to reduce anesthetic
presence of hypothermia
