Peds I Flashcards
1
Q
This instrument should always be used in Pediatrics:
- Detects airway compromise
- Obstruction
- Heart rate
- RR
A
- Precordial or esophageal stethoscope
2
Q
Describe how to calculate a child’s weight?
A
- 50th percentileweight (kg)= (Age X 2) + 9
3
Q
What correlates with intracranial volume and brain weight?
A
- Head circumference
4
Q
What assessment finding may signal abnormal brain development and should alert the anesthesia provider to neurological problems?
A
- Abnormally large or small head
5
Q
For how long is head circumference larger than thorax/
A
- First 6 months of life
6
Q
What is a common cause of a large head in pediatrics?
A
- Hydrocephalus
7
Q
What is a common cause of a small head in pediatrics?
A
- Craniosynostosis
- Abnormal brain development (premature closing of sutures)
8
Q
What is the anesthesia provider looking for when assessing the anterior fontanel?
A
- Dehydration (sunken fontanel)
- Bulging (hydrocephalus, infection, hemorrhage, increased PaC02)
9
Q
When does the anterior fontanel close?
A
- 9-18 months
- Posterior closes by 4 months
10
Q
When does the first tooth come in?
A
- 6 months
- Normally lower incisor
11
Q
When do deciduous teeth come in?
A
- 28 months
12
Q
When do permanent teeth come in?
A
- 6 years
13
Q
In what age of children is it appropriate to check for loose teeth?
A
- 5-10 years
- Careful with DL and placement of OPA
14
Q
What is the appropriate intervention if a pediatric patient has very loose teeth?
A
- Tell parents that teeth will be removed before DL tp avoid aspiration
- Save tooth for the tooth fairy
15
Q
What is the water content of a fetus?
A
- 90%
16
Q
What is the water content of a preterm patient?
A
- 80%
17
Q
What is the water content of a Full-term patient?
A
- 70%
18
Q
What is the water content of a 6-12-month-old pediatric patient?
A
- 60%
- Adult levels at 1 y/o
19
Q
What is the effect of a greater volume of distribution in drug administration?
A
- An increased volume of distribution
- Larger dose for loading dose but increased sensitivity. Titrate carefully
20
Q
- Pediatrics have increased chest wall compliance, but the risk of lung over-expansion and apnea is increased due to what physiologic finding?
A
- Pliable ribs
21
Q
Why are pediatrics more prone to desaturation?
A
- Smaller airways
- Reduced number of alveoli
- Less gas exchange area
- Less lung tissue compliance (less snap back)
- Higher closing volumes (closing capacity approaches tidal volume)
- Small airways collapse at higher volume (closing capacity greater than residual volume)
22
Q
What is a consequence of the reduced FRC in pediatrics?
A
- Increased chance for alveolar collapse
- No gas exchange
- The relative increase of intra-abdominal contents
23
Q
What is the oxygen consumption rate in pediatrics?
A
- 6-8 cc/kg/min
- 3-4 cc/kg/min in adults
- Twice as much as adults!
24
Q
When is RSI utilized in pediatrics?
A
- Rarely
- Pyloric stenosis
- Small bowel obstruction
25
What is the lung volumes in pediatrics?
- Total lung capacity decreased because of LARGER residual volume
-
26
What is the lung capacity of pediatric patients compared to adults?
- Smaller
- 160 mL in peds
- 6 L in adults
27
What is the FRC status of a newborn?
- Decreased due to LARGER residual volume
- Apneic lung volume less than FRC
- Smaller store of 02 to draw from when apneic
28
Pediatric lung volumes are disproportionately _______?
- Small relative to body size
29
What is the most important factor in airway flow resistance?
- Poiseuille's Law
- Change in the radius of the tube is inversely proportional to the resistance to the 4th power
- Ex. inflammation, secretions increase resistance
30
What is airways resistance of the newborn?
- 19-28 cmH20/L/sec
- 2 cmH20/L/sec in adults
- Central airway resistance increased until 5 y/o
31
What is a consequence of the immature tracheal cartilage of the neonate?
- Compliant
| - Collapse can occur w/ inspiration or expiration
32
Decreased pulmonary gas diffusion of the pediatric patient is a consequence of what physiologic finding?
- Small surface area
| - Diffusion capacity increased w/ age
33
Venous and oxygenated mixing in an R-L shunt is described as what in the neonate?
- Venous admixture
| - Higher in infants
34
What is a consequence of the immature neonatal myocardium and how does it compensate?
- Less organized myocytes
- 30% Contractile elements vs. 60% in adults
- Dependent on the influx of Ca++ to initiate and terminate contraction
- Watch for decreased Ca++ w/
- Gas will decrease HR, and thus CO and then SVR/BP
35
What is a consequence of the low compliance of ventricles?
- Fixed SV
| - CO is HR dependent
36
Why is the neonate prone to Bradycardia?
- PNS more mature than SNS and dominant in utero
- Systemic vascular tone is low up to 8 y/o
- Caudal/epidural block will not affect BP
37
What is mean HR at birth?
- 120
38
What is mean HR @ 1 month?
- 160
39
What is mean HR in adolescents?
- 75
40
What level of bradycardia do you treat in the infant? Toddler? Adolescent?
- 100
- 80
- 60
41
How do children often respond to noxious stimuli?
- Bradycardia
42
What is the hallmark of intravascular fluid depletion in infants?
- Hypotension without tachycardia
| - Consider hypocalcemia and corrected
43
How much oxygen does the neonatal brain consume relative to adults?
- 50% greater than adults
| - Cerebral blood flow greater by 50-70% from 6 months to three years
44
What neonatal problem is caused by:
- hypoxia
- fluid loss
- hypovolemia
- Anaphylaxis
- Vagal response
- Hyperkalemia, and how does it manifest?
- Bradycardia Hypotension Syndrome (BHS)
- 40% decrease in HR and BP
- Systolic arterial circulation closely related to circulating blood volume (BP good guide for the adequacy of blood replacement)
45
What is the dose of fluid replacement in PALS protocol?
- 10-20 mL/kg
46
What are the PALS, NRP epinephrine doses?
- 0.01 mg/kg- 0.03 mg/kg
| - 5 mcg/kg also listed
47
When does normal kidney function present in pediatrics? What are their GFR levels? What effect does this have physiologically?
- 6 months, adult levels at 2 years
- GFR 15-30% adult values at one year
- Negatively affects neonatal excretion of saline, water loads, and drugs
- Metabolic acidemia, and a reduced renal tubular threshold for sodium bicarbonate
48
What is urine osmolality in the neonate?
- 700-800
- 1300-1400 in adults,
- Limited urine concentrating ability (also prolongs the duration of action)
- Concentrating ability matures at 3-5 weeks of age
- Decreased response to ADH
- Homeostatic mechanisms normal at one year
49
What can the low GFR in neonates be attributed to?
- Low systemic BP and high renal vascular resistancve
| - Less blood flow
50
What is the most important organ to eliminate water-soluble drugs and metabolites?
- Kidneys
51
What are the differences in the neonatal liver compared to the adult?
- Increased total body water
- Reduced plasma protein (more free drug)
- Total protein and albumin not normal until 10-12 months
- It takes years for CYP-450 enzymes to mature
- Minimal glycogen stores
- Use an isotonic balanced salt solution for fluid resuscitation
52
How much weight does a neonate lose in the first few days of life?
- 5-15% of body weight
| - Due to isotonic water loss
53
What are fluid requirements in the neonate based on?
- Weight
- U/O
- Serum Na+ levels
54
Describe glucose treatment in the hypoglycemic neonate?
- Should not go below 45 mg/dL in the first few hours of life
- D10W is treatment
- Bolus 2-4 mL/kg
- Continuous infusion 4-6 mg/kg/min (mL?)
55
What is the primary serum protein in fetal life?
- Alpha fetoprotein
| - Albumin by 6-12 months (synthesis begins at 3-4 months)
56
What fluids do you hang for infants? Young children?
- Buretrol w/ 250 mL
- Young children (500 mL IVF, Use 1L, avoids accidental fluid overload)
- Non-glucose-containing fluid unless < 6 months, LR
- No NS, hyperchloremic metabolic acidosis
57
What is a consequence of the low albumin levels in the neonate?
- Clotting factors low in the first few days of life
- Drug metabolism not effective in the first few days of life (less drug)
- Less protein binding, more free drug
- Normal liver metabolism by 4-6 months
58
What is a consequence of the breakdown of red blood cells and impaired conjugation by the liver?
- Increased bilirubin
| - Jaundice
59
What is a consequence of the immature pharyngoesophageal sphincter in the neonate?
- Frequent regurgitation, 40% of newborns
| - Lower Esophageal Sphincter pressures normalize after 3-6 weeks
60
What GI issue is associated w/ Apnea and Bradycardia?
- GERD
61
What endocrinologic condition is common in neonates undergoing elective surgery and GA?
- Hyperglycemia (may be caused by surgical stress, lipid infusions, glucose solutions, hypoxemia, sepsis)
- Infants given glucose-containing solutions to avoid hypoglycemia
- Check BS intra-op
62
What is the normal hemoglobin level at birth? 9-12 weeks? 3 mo.- 2 years?
- 14-20 g/dL
- 10-11 g/dL
- 11.5-12 g/dL
63
Why are neonates at increased risk for infection?
- Immature leukocyte function
64
What is a hematologic consequence of the immature liver?
- Vit. K factors low at birth
| - Administer Vit. K to all neonates
65
What is the circulating blood volume in:
- Preterm infant
- Full-term neonate
- 3-mo-1 yr
- 3-6 yr
- >6 yr
- 90-100 mL/kg
- 80-90 mL/kg
- 75-80 mL/kg
- 70-75 mL/kg
- 65-70 mL/kg
66
Why are electrolyte disturbances more common in neonates?
- Small size
- Large surface area to volume ration
- Immature homeostatic mechanism
67
What is normal serum osmolality?
- 280-300 mOsm/L
68
The blood volume to weight ratio does what with growth?
- Decreases
69
Why are neonates at increased risk for hypothermia and what are the consequences of hypothermia?
- Larger body surface area
- Thin skin
- Nonshivering thermogenesis (metabolism of brown fat)
- Consequences:
- Delayed awakening
- Cardiac irritability
- Respiratory depression
- Increased pulmonary resistance
- Altered drug response
70
What are the reasons for altered pharmacokinetics in the neonate?
- Reduced protein binding (Reduced albumin, competition with bilirubin for binding sites)
- A larger volume of distribution
- A smaller proportion of fat and muscle
- Immature hepatic and renal function
71
What is an absorption concern when administering versed to the neonate?
- Poorly absorbed in stomach
| - Well absorbed in nares
72
How is acetaminophen best absorbed?
- Well absorbed in stomach
| - Poorly absorbed in the rectum
73
How do you calculate IBW in children < 8 y/o?
- 2(Age)+9
74
How do you calculate IBW in children > 8 y/o?
- 3(Age)
75
How do you calculate LBW? When would it be used?
- IBW+1/3(TBW-IBW)
| - Propofol calculated by LBW and opioids utilize TBW
76
What are the two major plasma proteins and what is their status in pediatric circulation?
- Albumin
- Alpha-1-acid-glycoprotein
- Both reduced
- Decreased albumin means more free drug in pediatric circulation
- Decreased Alpha-1-acid-glycoprotein means more free lidocaine and increases risk of LA overdose
77
What is a concern with propofol in pediatrics?
- Propofol Infusion Syndrome (PRIS)
| - No propofol gtt in peds for long-term sedation
78
What is the volume of distribution in pediatrics in relation to water-soluble drugs?
- An increased volume of distribution
- Peds have higher H20 content
- May necessitate higher doses, titrate carefully
79
What is the volume of distribution in pediatrics in relation to lipophilic drugs?
- A smaller volume of distribution
| - Less body fat
80
What is the status of the half-lives of medications in relation to pediatrics? Why?
- Prolonged half-lives
- Reduced total CYP-450
- Reduced in patients b/w 4-10 y/o.
- Reaches adult hepatic clearance rates in adolescents
81
What is the status of glucuronidation in the neonate and what consequences does this have?
- Decreased glucuronidation
- Reaches adult levels from 6-18 months
- Affects drug metabolism and may lead to increased bilirubin
82
Why are neonates particularly sensitive to sedatives, hypnotics, and hypnotics?
- Increased brain permeability
| - Immature BBB
83
What is neonatal Fa/Fi relative to adults?
- More rapid Fa/Fi rate of rise
| - Greater alveolar ventilation to FRC ration (5:1 in neonates and 1:5 in adults)
84
Regarding inhalational agents, what is the solubility of neonatal blood relative to adults?
- Less solubility (decreased albumin)
- Less delivery to vessel poor group
- More delivery to vessel rich group, most imporantly the brain
85
Relative to adults, what is the speed of inhalational induction w/ neonates? What are the factors involved?
- Faster inhalational induction
- Smaller FRC (more concentration of the inhalational agent in the alveolus)
- Increased minute ventilation (a faster increase of alveolar partial pressure)
86
What is the intubating dose of Succinylcholine for neonates?
- IV 3-4 mg/KG
87
What is the intubating dose of Succinylcholine for infants?
- IV 2 mg/kg
88
What is the intubating dose of Succinylcholine for adolescents?
- IV 1 mg/kg
89
What is the IM dose of succinylcholine in pediatrics?
- 4 mg/kg
90
What is the laryngospasm dose of succinylcholine?
- 0.1 mg/kg
91
What is the IV OR IM dose of atropine when given with succinylcholine?
- 0.01- 0.02 mg/kg
92
What is an important consideration of Vecuronium w/ neonates?
- A long-acting muscle relaxant with neonates and infants.
| - ONLY RECOVER 10% OF NEUROMUSCULAR FUNCTION AT 60 MINUTES.
93
What are the important developmental pediatric airway differences with the tongue?
- LARGER TONGUE
- difficult view of the larynx, difficult to stabilize during DL (shortened distance between tongue and epiglottis)
- Important note: narrow nasal passages, often described as nasal breathers but in truth, most infants are able to breathe through the nose and mouths
94
What are the important pediatric developmental differences of the larynx?
- MORE CEPHALAD IN NECK
- PREMATURE- C3
- NEWBORN- C3-C4
- ADULTS- C5
- HYOID BONE- C2-C3
95
What are the important pediatric developmental differences of the epiglottis?
- NARROW, OMEGA-SHAPED, ANGLED AWAY FROM AXIS OF TRACHEA
| - MORE DIFFICULT TO LIFT WITH TIP OF LARYNGOSCOPE
96
What are the important pediatric developmental differenceS of the vocal cords?
- LOWER ANTERIOR ATTACHMENT
- ALTERS ANGLE ANGLE OF ETT REACHING THE LARYNX
- ETT MAY GET CAUGHT IN ANTERIOR COMMISSURE OF THE VOCAL CORDS
97
What is the narrowest part of the infant larynx? What is a consequence of edema at this level?
- CRICOID CARTILAGE
- EDEMA AT THIS LEVEL CAN CAUSE REDUCTION OF LUMINAL DIAMETER AND INCREASED AIRWAY RESISTANCE (poiseuille's law)
- Reaches adult proportions by 10-12
98
What are important aspects of the infant respiratory system regarding:
- Nares
- Trachea
- Airway resistance in the small airways
- Factors that can affect the work of breath?
- Obligate nose breathers
- More compliant trachea, easily compressible
- Increased airway resistance in bronchioles and small airways (account for most of the work of breathing)
- Long ETT w/ small diameter, obstructed ETT, narrowed airway all effect work of breath to a greater degree than w/ adults
99
What is an important aspect of the pediatric pre-anesthesia assessment that can increase the risk of bronchospasm or laryngospasm of the neonate?
- Upper Respiratory Infection (URI)
100
In the pediatric assessment, what may snoring in the neonate indicate?
- Obstructive Sleep Apnea
101
In the pediatric assessment, what may repeated pneumonia indicate in the neonate?
- GERD
| - Cystic fibrosis
102
When observing the global appearance of a neonate during a pediatric assessment, what is among the most important things to look for?
- RECOGNITION OF A CONGENITAL ANOMALY OR SYDROME
103
What are the important factors in mask ventilation technique of the neonate?
- DO NOT OCCLUDE TRACHEA WITH FINGERS
- ENSURE FINGERS ARE ON MANDIBLE
- HAND ON RESERVOIR BAG AT ALL TIMES
104
When selecting oropharyngeal airways in pediatrics, what are the most important aspects?
- HELPS AVOID TONGUE FROM OBSTRUCTING THE AIRWAY
- ENSURE APPROPRIATE SIZE (larger OPA can obstruct the airway, a small OPA can push tongue down and also cause an obstruction)
- HAVE ONE SIZE LARGER AND SMALLER
105
Why are NPAs generally avoided in children?
- The may cause:
- Trauma
- Bleeding
- Hypertropied adenoids
106
Identify the important aspects of ETT size selection in pediatrics
- Based on the child's height and weight
| - Have a size above and below planned ETT size
107
Is an air leak desirable when ETT is in place in the pediatric patient?
- Must have air leak
- Should have air leak at about 20-25 cmH20 pressure
- Approximates capillary pressure of tracheal mucosa (ensures that necrosis will not occur to the tracheal mucosa)
108
When can you begin to use cuffed ETT in pediatrics?
- 8 years old
109
What size ETT is used for a preterm neonate up to 1000 g?
- 2.5
110
What size ETT is used for a preterm infant between 1000-2500 g?
- 3.0
111
What size ETT is used for a neonate up to 6 months old?
- 3.0-3.5
112
What size ETT is used for an infant from 6 mo.- 1-year-old?
- 3.5-4.0
113
What size ETT is used for a neonate b/w 1-2 years old?
- 4.0-5.0
114
What is the formula to determine uncuffed ETT size in the pediatric patient older than 2 years old?
- 4 + (Age/4)
115
What is the formula to determine cuffed ETT size in the pediatric patient older than 2 years old?
- 3.5 + (Age/4)
116
What is the "1,2,3,4" mnemonic for size selection of anesthesia equipment in pediatrics?
- 1 x ETT= (Age/4) + 4 UNCUFFED ETT
- 2 X ETT= NG/OGT/Foley
- 3 x ETT= Depth of ETT insertion
- 4 x ETT= chest tube size MAX
117
"0,1,2" mnemonic for ETT distance for children under 2 years of age?
- Newborn- 10
- 1 year old- 11
- 2 year old- 12
118
Formula for ETT distance for children over 2?
- (Age/2) + 12
119
When can you begin to use curved blades in pediatrics?
- 2-6 years old
| - MAC 1-2
120
What blade is appropriate for a preterm or neonate?
- MIL-0
121
What blade is appropriate for a neonate- 2-year-old?
- MIL-1
122
What are 2 key interventions during laryngoscopy of the neonate?
- INSERTION AND SUBSEQUENT WITHDRAWAL OF THE BLADE CAN CAUSE DAMAGE TO THE ARYTENOIDS AND ARYEPIGLOTTIC FOLDS (DON'T DO!)
- PLACE A ROLL UNDER SHOULDERS OF NEONATE TO FACILITATE TRACHEAL INTUBATION
123
What are 2 common complications of endotracheal intubation in pediatrics?
- POST-INTUBATION CROUP (too large an ETT, multiple attempts, age 1-4, surgery > 1 hour)
- LARYNGOTRACHEAL STENOSIS (90% due to prolonged intubation, caused by ischemic injury from lateral wall pressure, scar tissue narrows airway)
124
How is post-intubation croup treated?
- Humidified mist
- Nebulized Epi
- Dexamethasone
125
What anatomical feature in the neonatal airway makes the placement of an LMA difficult?
- POSTERIOR PHARYNX
| - LMA CAN GET HUNG UP HERE
126
LMA can be used w/ infants that are how small?
- 3-5 KG
127
Describe LMA sizing in pediatrics
- < 5 kg- 1
- 5-10 kg- 1.5
- 10-20 kg- 2
- 20-30 kg- 2.5
- 30-50 kg- 3
128
What part of anesthesia care is most stressful in the pediatric population and what physiologic manifestation may it present with?
- INDUCTION (50-75%)
| - AUTONOMIC NERVOUS SYSTEM ACTIVITY (associated apprehension, nervousness, worry, and vigilence)
129
What are the reported benefits of parental presence during induction? Objections?
- REDUCED CHILD ANXIETY, REDUCED NEED FOR SEDATION
- DELAYS OR SCHEDULE, CROWDS OR, ADVERSE REACTION FROM PARENT DURING INDUCTION
- MOST PARENTS PREFER TO BE PRESENT DURING INDUCTION
130
What is an anesthesia consideration with midazolam in the pediatric population?
- INCREASES EMERGENCE DELIRIUM
131
Asking for:
- Last dose of Tylenol
- Family history of MH
- Whether the baby was born pre- or full term
- OSA w/ loud snoring
- Smoking in the household
- PARENTAL CONSENT
- Are all important aspects of what part of anesthesia care?
- Preanesthetic visit
132
What are routine preop labs in the pediatric population?
- Routine preop labs are not indicated in the pediatric population
133
Describe critical components of the assessment of the pediatric asthmatic patient
- Home meds schedule
- Known triggers
- Ability to control
- Prior to ER visits
- ICU or ETT intubations
- Corticosteroid use (MOSTLY IN SEVERE DISEASE)
- ENSURE HOME MEDS ARE TAKEN PREOPERATIVELY EVEN WHEN PATIENT IS ASYMPTOMATIC
134
What preoperative finding is associated with increased risk for:
- 02 desaturations
- Breath holding
- Laryngospasm
- Bronchospasm
- Coughing
- Upper Respiratory Infection
135
What is the best practice regarding adolescents performing a preoperative pregnancy test?
- Disclose to parents that examine is being performed
| - ONLY DISCLOSE POSITIVE RESULT TO PARENTS
136
Pediatric patient with syndromes or congenital anomalies are at increased risk for what type of physiologic complications?
- Congenital heart defects
137
Describe assessment for the neonate with a congenital heart defect:
- ECG
- ECHO
- HCT
- Baseline Sp02 (pre- and post-ductal if indicated)
- CXR
- Cardiology consult
138
What is the most common genetic abnormality worldwide?
- Down Sydrome
139
What are some common abnormalities that are associated with Down Syndrome?
- Atlantoaxial instability
- Airway instability
- Airway narrowing
- Respiratory and cardiac malformations
140
A genetic abnormality that is four times more common in males and is associated:
- Qualitative impairments in social interactions
- Verbal and nonverbal communication impairment
- Restricted range of interests
- and resistance to change?
- Autism
141
A disorder associated with:
- Inattention
- Hyperactivity
- Overrepresented in boys by 3:1
- Impulsivity
- May be on drugs that interact with anesthesia
- Attention Deficit Hyperactive Disorder
142
What are the implications of drug abuse in the adolescent?
- Increases morbidity and mortality
- May interact with anesthetic drugs
- Drug use may have anesthetic implications
143
What are NPO guidelines in pediatrics?
- Clear liquids- 2 hours
- Breast milk- 4
- Formula, Milk, or juices- 6
- Solid food- 8 hours
144
What is the best pharmacologic intervention for an uncooperative child for pre-op sedation?
- IM Ketamine
145
What is an important consideration in the use of pre-op PO midazolam?
- EMERGENCE DELIRIUM
- But it is the gold standard for preoperative sedation
- Short 1/2 life: 2 hours
- PO (0.25-0.75 mg/kg) (usually 0.5), Nasal (0.2mg/kg), Rectal (1 mg/kg)
146
What is an important consideration with morphine on neonates?
- NOT USED ON NEONATES
| - RESPIRATORY DEPRESSANT EFFECTS
147
What are the important considerations of Fentanyl in pediatrics?
- IV, ORAL, ORAL, NASAL, TRANSDERMAL ROUTES
| - IV: 1-2 mcg/kg
148
- Increased oral secretions
- Nystagmus
- Hallucinations
- Post-op N/V
Are important anesthetic considerations with what pediatric anesthetic drug?
- KETAMINE
- GIVE ATROPINE OR GLYCOPYRROLATE TO AVOID SECRETIONS THAT CAN LEAD TO LARYNGOSPASM
- MIDAZOLAM TO AVOID HALLUCINATIONS
- KETAMINE DART: 2mg/kg IM
149
When are anticholinergics indicated in pediatrics?
- ROUTINE USE NOT WARRANTED
- When given with Succ., Ketamine
- Before laryngoscopy and intubation of neonates
- GLYCO MORE EFFECTIVE ANTISIALOGOGUE (0.01 mg/kg)
- ATROPINE; 0.01-0.02 mg/kg IV (Given before Bradycardia
150
When is tylenol given in pediatric anesthesia?
- Rectally in the OR after induction
- Can be given PO, IV, or rectally
- Used for postoperative pain
151
What are the considerations of Ketorolac in the pediatric population?
- Given only after hemostasis and completionof surgery
| - Discuss use with surgeon
152
When should the anesthesia provider consider antiemetics for the pediatric patient?
- Tonsillectomies
| - Strabismus surgery (Both surgeries associated with high incidence of PONV)
153
When is premedication of corticosteroids indicated in pediatrics?
- Given as supplement in children who are on chronic steroids or if they have been on steroids in the last 6 months
- Stress corticoid coverage- 1 HOUR BEFORE INDUCTION or when IV access is established
- Stress dose: (Hydrocortisone: 1-2mg/kg IV)
- Stress dose: (Dexamethasone: 0.05-1.0 mg/kg)
