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N934 Advanced Principles of Anesthesia II > Peds Anesthesia > Flashcards

Peds Anesthesia Flashcards

1
Q

adverse events in infants <1 getting anesthesia

A
  • bradycardia secondary to hypoxia and high inhalation anesthetic concentration
  • respiratory complications like bronchospasm, laryngospasm, apnea
  • cardiac arrest (8 out of 10 result from hyperkalemia following transfusion)
  • medication related
  • equipment related (CVC placement)
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2
Q

psychological preparation for kids

A
  • IMPORTANT
  • may have child-life, videos, tours etc
  • basic objective = explain to child and parents in respectful, simple, understandable and reassuring terms
  • bond with child to reduce their anxiety as well as their parents
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3
Q

0-6 months psychological aspect

A

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

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4
Q

6 months-4 years psychological aspect

A

separation anxiety, fear of hospitalization; may show regressive behavior

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5
Q

School age children psychological aspect

A

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

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6
Q

adolescents psychological aspect

A

fear of the process of narcosis, loss of control, waking up during surgery, and pain of surgery; value modesty; HCG test in females

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7
Q

parents psychological aspect

A

provide an explanation of what to expect

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8
Q

parental presence on induction not appropriate when…

A
  • adequate preop sedation
  • parent’s level of anxiety
  • language barrier
  • emergency/RSI cases
  • anticipated difficult airway or unstable patient
  • pregnant mother (due to N2O exposure)
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9
Q

interview and physical exam peds

A
  • sources of information include the EMR, parents, and the child
  • NPO status
  • current weight
  • auscultate heart and lungs
  • evaluation of the airway, inquire about loose teeth
  • PMH/previous anesthetics/MH
  • recent URIs or fevers
  • cigarette exposure in the home
  • possibility of pregnancy
  • allergies and current meds
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10
Q

preop lab considerations for peds

A
  • often not necessary
  • consider if the labs could wait until they are under anesthesia
  • Hgb on certain patients
  • glucose in prolonged fasting and metabolic disorder
  • pregnancy test in females
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11
Q

patient who may need Hgb

A
  • neonate
  • premie
  • cardiopulmonary disease
  • known heme dysfunction
  • anticipated major blood loss during procedure
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12
Q

child with URI

A
  • may be simple infection or much more serious
  • LMA over ETT if appropriate
  • consider rescheduling surgery for 2-4 weeks or 6-8 weeks if lower resp tract
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13
Q

URI is more irritable and at increased risk for

A
  • laryngospasm
  • bronchospasm
  • post-intubation croup
  • atelectasis
  • pneumonia
  • desats
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14
Q

reasons to post-pone surgery for URI

A
  • elective
  • febrile
  • elevated WBC
  • productive/purulent sputum
  • getting worse
  • acutely ill
  • malaise
  • tachypnea
  • wheezing
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15
Q

anesthetic management with URI

A
  • adequate hydration and oxygenation
  • reduce secretions
  • limit airway manipulation
  • bronchodilators (beta-2-agonists) for wheezing
  • anticholinergics (inhibits cholinergic mediated bronchospasm)
  • muscle relaxants for laryngospasm
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16
Q

what symptoms combined with a murmur might mean something more

A
  • difficulty feeding, SOB
  • poor exercise tolerance, can’t match peers
  • family history of CHD
  • cyanotic episodes
  • abnormal peripheral pulses
  • unequal blood pressures in upper vs lower extremities
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17
Q

oral premedication

A
  • individualize (not everyone needs it esp <6-12 months because they don’t get separation anxiety)
  • may prolong time to discharge
  • midaz 0.5 mg/kg PO max 20 mg
  • careful sedating child with congenital heart defect, increased ICP, OSA, sepsis, trauma, or suspected difficult airway
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18
Q

nasal premeds

A
  • midaz 0.2 mg/kg
  • ketamine 3 mg/kg
  • precedex 1-2 mcg/kg
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19
Q

set-up and monitoring

A
  • BP cuff (appropriate size)
  • ECG (often 3 lead, but 5 for cardiac patients)
  • pulse ox
  • capnography
  • temperature
  • neuromuscular function
  • temperature
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20
Q

prep for induction of anesthesia in peds

A
  • warm room
  • pre induction checklist
  • chair or stool if parent is present
  • ensure quiet, calm OR
  • variety of techniques exist
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21
Q

set up of peds case

A
  • mask x2-3 (one bigger/one smaller)
  • ETT x3 (onse size above and below)
  • blades (several)
  • appropriately sized breathing circuit, BP cuff, ECG, SpO2
  • appropriate syringe sizes for weight based dosing
  • IM needles (for succ and atropine)
  • warming devices
  • shoulder roll
  • sevo in line and filled
  • IV set ups
  • soft ETT suction appropriate for ETT size
  • appropriate sized OGT
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22
Q

LMA size 1

A

neonate/infant up to 5 kg

max cuff volume 4 mL

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23
Q

LMA size 1.5

A

infant 5-10 kg

cuff volume 7 mL

24
Q

LMA size 2

A

infants/children 10-20 kg

cuff volume 10 mL

25
Q

LMA size 2.5

A

children 20-30 kg

cuff volume 14 mL

26
Q

LMA size 3

A

children 30-50 kg

cuff volume 20 mL

27
Q

LMA size 4

A

adults 50-70 kg

cuff volume 30 mL

28
Q

premie ETT size

A

2-2.5 mm uncuffed

29
Q

term infant ETT size

A

3 mm

30
Q

3-9 months ETT size

A

3-3.5 mm

31
Q

9-18 months ETT size

A

3.5-4 mm

32
Q

18-36 months ETT size

A

4-4.5 mm

33
Q

> 36 months ETT size

A

age/4 + 3.5 = cuffed size

34
Q

ETT depth calculation < 3 kg

A

1-2-3 kg –> 7-8-9 cm depth at lips

35
Q

ETT depth calculation > 3 kg

A

internal diameter of ETT (ID) x 3

36
Q

emergency meds for peds case

A
  • atropine –> 0.4 mg/mL [<10 kg place in 1 cc syringe; > 10 kg place in 3 cc syringe]; with 22G IM needle
  • succ - 20 mg/mL in 3 cc syringe; 22G IM needle
  • epi - 100 mcg/mL (abboject), 10 mcg/mL, 1 mcg/mL (for neonates)
37
Q

pediatric breathing circuits

A
  • small enough for sensitivity to small tidal volume
  • big enough to give a vital capacity breath
  • neonatal circuit
  • peds circuit 1 L bag < 30 kg
  • adult circult 3 L bag > 30 kg
38
Q

inhalation induction

A
  • most common method of inducing anesthesia in kids
  • sevo = agent of choice
  • paci OK to leave in
  • OK to have child lay down, sit up, or sit in someones lap
  • mask gently placed over child’s face, with admin of N2O and O2 for 1-2 minutes, sevo introduced and rapidly increased to 6-8%
  • after GA induced, sevo should be decreased to around 4-5% to prevent OD
  • IV then placed following stage 2 and prior to instrumentation of airway; consider 100% FiO2 during IV (ie d/c the nitrous)
39
Q

mask induction aids and distraction techniques

A
  • scented mask
  • bubble
  • playing video games or watching a movie
  • use of elbow without a mask and tenting with the hand
  • music
  • jokes
  • steal induction in asleep child
  • single-breath induction
40
Q

IV induction for peds

A
  • most reliable and rapid
  • main disadvantage is starting IV can be painful and traumatic for child (reserved for age 8 or older)
  • necessary when inhalation induction is contraindicated
  • may place IV under N2O
  • topical anesthetic (EMLA, or spray)
  • ideally all children preoxygenated with 100% oxygen before IV induction, but this is not always possible
41
Q

when to do IV induction

A
  • at risk for aspiration requiring RSI (full stomach)
  • anticipated difficult airway
  • potential cardiac instability
42
Q

intramuscular induction

A
  • preferred that all IM injections are avoided in kids
  • may be indicated in uncooperative children who refuse other routes of sedation
  • also may need rescue meds if patient develops laryngospasm during inhalation induction
43
Q

infant IM max recommended volume

A
  • deltoid - not recommended

- vastus lateralis - 0.5 mL

44
Q

toddler IM max recommended volume

A
  • deltoid - 0.5 mL

- vastus lateralis - 0.5-1 mL

45
Q

preschool age IM max recommended volume

A
  • deltoid - 0.5 mL

- vastus lateralis - 1 mL

46
Q

school age IM max recommended volume

A
  • deltoid - 0.5-1 mL

- vastus lateralis - 1.5-2 mL

47
Q

mask anesthesia

A
  • always have age and size appropriate equipment for intubation/LMA placement
  • appropriately sized mask
  • oral airways and tongue blade
  • avoid applying pressure over soft tissue of the chin and neck during mask anesthesia
  • monitor breath sounds, ETCO2, movement of reservoir bag
  • precordial!!!!
48
Q

two most commonly used veins for IVs in kiddos

A
  • superficial dorsal hand veins off the basilic vein

- saphenous vein at the ankle

49
Q

IV catheter sizes for art lines

A
  • 22g for > 2 years

- 24g for < 2 years

50
Q

caudal anesthesia

A

-caudal space, continuous caudal catheters

51
Q

benefits of caudal

A
  • intraop and postop analgesia
  • reduction in systemic opioid requirements and side effects
  • reduction in anesthesia requirements
52
Q

procedures that could use a caudal

A
  • circumcision
  • inguinal hernia repair
  • hypospadias
  • anal surgery
  • clubfoot repair
  • other sub umbilical procedures
53
Q

contraindications to caudal

A
  • infection around the site
  • coagulopathy
  • anatomic abnormalities
  • parental refusal
54
Q

caudal landmarks

A
  • sacral hiatus

- 2 posterior superior iliac spine (PSIS)

55
Q

caudal dosing

A
  • genital and anal surgery = 0.5-0.75 mL/kg
  • lower abdomen, extremity = 1 mL/kg
  • abdominal incision = 1-1.25 mL/kg
56
Q

caudal additives

A
  • epi –> intravascular test dose 0.5 mcg/kg; increase duration; theoretical neurologic complications
  • clonidine –> 1-2 mcg/kg; increase DOS
  • narcotics
57
Q

things to bring when taking peds patient to PACU

A
  • appropriately sized ambu bag
  • oxygen source
  • monitoring (pulse ox, ECG, BP)
  • emergency meds (at the least atropine, succ, epi)
  • pain meds
  • treatment for emergence delirium (precedex, propofol, fentanyl)
  • lateral position

N934 Advanced Principles of Anesthesia II (17 decks)

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