Peds Anesthesia Flashcards
Exceptions for dextrose in IVF
-
Cortisol level
Higher in am than pm
Greater hypoxia brain damage has been found in relation to
High blood glucose level
What are the daily fluid requirements based on
- Metabolic demand (high in peds)
2. High ratio of BSA to weight
Maintenance fluid requirements
0-10 kg = (4ml/kg)
11-20 kg = (40ml + 2ml/kg)
>20 kg. = (60 ml + 1ml/kg)
NPO deficit
Maintenance IVF x NPO hrs
Replace half in 1st hr and 1/4 over next two hours
Blood loss replacement
3: 1 w/crystalloids
1: 1 w/ colloids or blood
Very Minor surgery
IVF
BMT, frenulectomy
0.2 ml/kg/h
Minor surgery
IVF calculation
Hernia
2-4 ml/kg
Moderate surgery
4-6 ml/kg
ENT, lap
Major surgery
6-10 ml/kg
Bowel ressection, intra abd surgery
Massive 3rd space fluid loss
10-20 ml/kg/hr
Cranialfacial, spinal bifida
ETT size
Length of insertion
Age/4 + 4 = ETT
3x tube size = length
Double black lines of ETT should line up with vocal cords
Confirm by auscultation
RBC replacement
10-20 ml/kg
FFP replacement
10-15 ml/kg
Platelets
1unit/10kg
Cryoprecipitate replacement
0.1 units/kg (up to 3 units)
Symptoms of hypovolemia
Dec urine output Tachy Mottled skin Cold extremities Dec BP late sign
Peds can maintain BP until what % reduction in volume status
25%
What is the bolus dose
5-20 ml/kg LR
5-10 ml/kg Albumin
NPO
CL diet
Milk & solids
Breast milk
CL : 2 hrs for all ages
Solid/milk: 4 (3yr)
Breast milk: 3-4 hrs
Why uncuffed ETT
- funnel shaped trachea
- narrowest cricoid
- risk of subglottic stenosis dec
- allows for lg diameter ETT - dec in airway resistance
Uncooperative or infant induction
70% N2O (2L O2+ 6L N2O)
Sevo 8%
What age group does not need pre op med
0-8/10 months, no separation anxiety
Waht are the pitfalls of induction
- Breath holding: don’t assist respirations
- Laryngospasm: partial vs complete
- Anesthetic overdose
Partial laryngospasm
Stridor:
- gentle positive pressure
- PEEP on a bag
- deepen pt: Propofol 1-2 mg/kg
Complete laryngospasm
Rocking of chest/abd but NO air exchange
Deepen pt
If no improvement: Positive pressure & Tighten APL
Propofol IV
Sux: IV/IM if pt continues to desat or become Brady & spasm does not break
Anesthetic Overdose
Bradycardia, listen to pulse Ox , dec agent
Which age group has the easiest intubation
What blade to use
Toddlers
Miller 2, WIS 1, MAC 2 blade
Infants intubation
Shoulder roll
Stylet available
Larynx more anterior
Assessing for correct tube size
Pt should have audible leak @ 20cm H2O, but not much less than that
Lg leak at
Which VA increases post op delirium
Sevo
When would u use LTA
Planning for deep extubation when case is
Rx for emergence delirium
Narcotics: fentanyl: .05-1 mcq/kg or morphine 0.025-0.1 mg/kg
Dexmedetomidine: .1-.3 mcq/kg
Narcotics more effective than benzo
Stridor Rx
Decadron 0.25-1mg/kg
Racemic epi 0.25-0.5 ml 2.25% solution nebulizer in 2.5 ml NS
POC for urologic procedures
Caudal block w/light GA, superior to local nerve block or GA alone
Where does caudal space lie
Under sacrococcygeal ligament that runs through the sacral hiatus under the skin
Where does the dural sac ends
Ends at S1-2, May extend to S3 in neonates
What are some additives that can be added to caudal anesthesia
Morphine 50-70 mcq/kg
Clonidine 1-2 mcq/kg
Dilaudid 15 mcq/kg
What is used in caudal
Marcaine 0.25% , typically 1ml/kg up to 10 ml, may dilute to 15 ml max w/PF saline
With or without epi
What is used in TAP
0.5 ml/kg 0.25% bupivicane with epi
What is programmed cell death that’s induced by anesthesia
Apoptosis
