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Pediatrics > Peds I > Flashcards

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
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2
Q

Describe how to calculate a child’s weight?

A
  • 50th percentileweight (kg)= (Age X 2) + 9
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3
Q

What correlates with intracranial volume and brain weight?

A
  • Head circumference
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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
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5
Q

For how long is head circumference larger than thorax/

A
  • First 6 months of life
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6
Q

What is a common cause of a large head in pediatrics?

A
  • Hydrocephalus
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7
Q

What is a common cause of a small head in pediatrics?

A
  • Craniosynostosis

- Abnormal brain development (premature closing of sutures)

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8
Q

What is the anesthesia provider looking for when assessing the anterior fontanel?

A
  • Dehydration (sunken fontanel)

- Bulging (hydrocephalus, infection, hemorrhage, increased PaC02)

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9
Q

When does the anterior fontanel close?

A
  • 9-18 months

- Posterior closes by 4 months

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10
Q

When does the first tooth come in?

A
  • 6 months

- Normally lower incisor

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11
Q

When do deciduous teeth come in?

A
  • 28 months
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12
Q

When do permanent teeth come in?

A
  • 6 years
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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

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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
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15
Q

What is the water content of a fetus?

A
  • 90%
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16
Q

What is the water content of a preterm patient?

A
  • 80%
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17
Q

What is the water content of a Full-term patient?

A
  • 70%
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18
Q

What is the water content of a 6-12-month-old pediatric patient?

A
  • 60%

- Adult levels at 1 y/o

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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

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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
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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)
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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
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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!
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24
Q

When is RSI utilized in pediatrics?

A
  • Rarely
  • Pyloric stenosis
  • Small bowel obstruction
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25
Q

What is the lung volumes in pediatrics?

A
  • ## Total lung capacity decreased because of LARGER residual volume
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26
Q

What is the lung capacity of pediatric patients compared to adults?

A
  • Smaller
  • 160 mL in peds
  • 6 L in adults
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27
Q

What is the FRC status of a newborn?

A
  • Decreased due to LARGER residual volume
  • Apneic lung volume less than FRC
  • Smaller store of 02 to draw from when apneic
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28
Q

Pediatric lung volumes are disproportionately _______?

A
  • Small relative to body size
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29
Q

What is the most important factor in airway flow resistance?

A
  • 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
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30
Q

What is airways resistance of the newborn?

A
  • 19-28 cmH20/L/sec
  • 2 cmH20/L/sec in adults
  • Central airway resistance increased until 5 y/o
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31
Q

What is a consequence of the immature tracheal cartilage of the neonate?

A
  • Compliant

- Collapse can occur w/ inspiration or expiration

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32
Q

Decreased pulmonary gas diffusion of the pediatric patient is a consequence of what physiologic finding?

A
  • Small surface area

- Diffusion capacity increased w/ age

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33
Q

Venous and oxygenated mixing in an R-L shunt is described as what in the neonate?

A
  • Venous admixture

- Higher in infants

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34
Q

What is a consequence of the immature neonatal myocardium and how does it compensate?

A
  • 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
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35
Q

What is a consequence of the low compliance of ventricles?

A
  • Fixed SV

- CO is HR dependent

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36
Q

Why is the neonate prone to Bradycardia?

A
  • 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
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37
Q

What is mean HR at birth?

A
  • 120
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38
Q

What is mean HR @ 1 month?

A
  • 160
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39
Q

What is mean HR in adolescents?

A
  • 75
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40
Q

What level of bradycardia do you treat in the infant? Toddler? Adolescent?

A
  • 100
  • 80
  • 60
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41
Q

How do children often respond to noxious stimuli?

A
  • Bradycardia
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42
Q

What is the hallmark of intravascular fluid depletion in infants?

A
  • Hypotension without tachycardia

- Consider hypocalcemia and corrected

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43
Q

How much oxygen does the neonatal brain consume relative to adults?

A
  • 50% greater than adults

- Cerebral blood flow greater by 50-70% from 6 months to three years

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44
Q

What neonatal problem is caused by:

  • hypoxia
  • fluid loss
  • hypovolemia
  • Anaphylaxis
  • Vagal response
  • Hyperkalemia, and how does it manifest?
A
  • 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)
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45
Q

What is the dose of fluid replacement in PALS protocol?

A
  • 10-20 mL/kg
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46
Q

What are the PALS, NRP epinephrine doses?

A
  • 0.01 mg/kg- 0.03 mg/kg

- 5 mcg/kg also listed

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47
Q

When does normal kidney function present in pediatrics? What are their GFR levels? What effect does this have physiologically?

A
  • 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
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48
Q

What is urine osmolality in the neonate?

A
  • 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
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49
Q

What can the low GFR in neonates be attributed to?

A
  • Low systemic BP and high renal vascular resistancve

- Less blood flow

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50
Q

What is the most important organ to eliminate water-soluble drugs and metabolites?

A
  • Kidneys
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51
Q

What are the differences in the neonatal liver compared to the adult?

A
  • 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
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52
Q

How much weight does a neonate lose in the first few days of life?

A
  • 5-15% of body weight

- Due to isotonic water loss

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53
Q

What are fluid requirements in the neonate based on?

A
  • Weight
  • U/O
  • Serum Na+ levels
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54
Q

Describe glucose treatment in the hypoglycemic neonate?

A
  • 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?)
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55
Q

What is the primary serum protein in fetal life?

A
  • Alpha fetoprotein

- Albumin by 6-12 months (synthesis begins at 3-4 months)

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56
Q

What fluids do you hang for infants? Young children?

A
  • 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
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57
Q

What is a consequence of the low albumin levels in the neonate?

A
  • 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
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58
Q

What is a consequence of the breakdown of red blood cells and impaired conjugation by the liver?

A
  • Increased bilirubin

- Jaundice

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59
Q

What is a consequence of the immature pharyngoesophageal sphincter in the neonate?

A
  • Frequent regurgitation, 40% of newborns

- Lower Esophageal Sphincter pressures normalize after 3-6 weeks

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60
Q

What GI issue is associated w/ Apnea and Bradycardia?

A
  • GERD
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61
Q

What endocrinologic condition is common in neonates undergoing elective surgery and GA?

A
  • 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
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62
Q

What is the normal hemoglobin level at birth? 9-12 weeks? 3 mo.- 2 years?

A
  • 14-20 g/dL
  • 10-11 g/dL
  • 11.5-12 g/dL
63
Q

Why are neonates at increased risk for infection?

A
  • Immature leukocyte function
64
Q

What is a hematologic consequence of the immature liver?

A
  • Vit. K factors low at birth

- Administer Vit. K to all neonates

65
Q

What is the circulating blood volume in:

  • Preterm infant
  • Full-term neonate
  • 3-mo-1 yr
  • 3-6 yr
  • > 6 yr
A
  • 90-100 mL/kg
  • 80-90 mL/kg
  • 75-80 mL/kg
  • 70-75 mL/kg
  • 65-70 mL/kg
66
Q

Why are electrolyte disturbances more common in neonates?

A
  • Small size
  • Large surface area to volume ration
  • Immature homeostatic mechanism
67
Q

What is normal serum osmolality?

A
  • 280-300 mOsm/L
68
Q

The blood volume to weight ratio does what with growth?

A
  • Decreases
69
Q

Why are neonates at increased risk for hypothermia and what are the consequences of hypothermia?

A
  • 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
Q

What are the reasons for altered pharmacokinetics in the neonate?

A
  • 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
Q

What is an absorption concern when administering versed to the neonate?

A
  • Poorly absorbed in stomach

- Well absorbed in nares

72
Q

How is acetaminophen best absorbed?

A
  • Well absorbed in stomach

- Poorly absorbed in the rectum

73
Q

How do you calculate IBW in children < 8 y/o?

A
  • 2(Age)+9
74
Q

How do you calculate IBW in children > 8 y/o?

A
  • 3(Age)
75
Q

How do you calculate LBW? When would it be used?

A
  • IBW+1/3(TBW-IBW)

- Propofol calculated by LBW and opioids utilize TBW

76
Q

What are the two major plasma proteins and what is their status in pediatric circulation?

A
  • 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
Q

What is a concern with propofol in pediatrics?

A
  • Propofol Infusion Syndrome (PRIS)

- No propofol gtt in peds for long-term sedation

78
Q

What is the volume of distribution in pediatrics in relation to water-soluble drugs?

A
  • An increased volume of distribution
  • Peds have higher H20 content
  • May necessitate higher doses, titrate carefully
79
Q

What is the volume of distribution in pediatrics in relation to lipophilic drugs?

A
  • A smaller volume of distribution

- Less body fat

80
Q

What is the status of the half-lives of medications in relation to pediatrics? Why?

A
  • Prolonged half-lives
  • Reduced total CYP-450
  • Reduced in patients b/w 4-10 y/o.
  • Reaches adult hepatic clearance rates in adolescents
81
Q

What is the status of glucuronidation in the neonate and what consequences does this have?

A
  • Decreased glucuronidation
  • Reaches adult levels from 6-18 months
  • Affects drug metabolism and may lead to increased bilirubin
82
Q

Why are neonates particularly sensitive to sedatives, hypnotics, and hypnotics?

A
  • Increased brain permeability

- Immature BBB

83
Q

What is neonatal Fa/Fi relative to adults?

A
  • More rapid Fa/Fi rate of rise

- Greater alveolar ventilation to FRC ration (5:1 in neonates and 1:5 in adults)

84
Q

Regarding inhalational agents, what is the solubility of neonatal blood relative to adults?

A
  • Less solubility (decreased albumin)
  • Less delivery to vessel poor group
  • More delivery to vessel rich group, most imporantly the brain
85
Q

Relative to adults, what is the speed of inhalational induction w/ neonates? What are the factors involved?

A
  • 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
Q

What is the intubating dose of Succinylcholine for neonates?

A
  • IV 3-4 mg/KG
87
Q

What is the intubating dose of Succinylcholine for infants?

A
  • IV 2 mg/kg
88
Q

What is the intubating dose of Succinylcholine for adolescents?

A
  • IV 1 mg/kg
89
Q

What is the IM dose of succinylcholine in pediatrics?

A
  • 4 mg/kg
90
Q

What is the laryngospasm dose of succinylcholine?

A
  • 0.1 mg/kg
91
Q

What is the IV OR IM dose of atropine when given with succinylcholine?

A
  • 0.01- 0.02 mg/kg
92
Q

What is an important consideration of Vecuronium w/ neonates?

A
  • A long-acting muscle relaxant with neonates and infants.

- ONLY RECOVER 10% OF NEUROMUSCULAR FUNCTION AT 60 MINUTES.

93
Q

What are the important developmental pediatric airway differences with the tongue?

A
  • 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
Q

What are the important pediatric developmental differences of the larynx?

A
  • MORE CEPHALAD IN NECK
  • PREMATURE- C3
  • NEWBORN- C3-C4
  • ADULTS- C5
  • HYOID BONE- C2-C3
95
Q

What are the important pediatric developmental differences of the epiglottis?

A
  • NARROW, OMEGA-SHAPED, ANGLED AWAY FROM AXIS OF TRACHEA

- MORE DIFFICULT TO LIFT WITH TIP OF LARYNGOSCOPE

96
Q

What are the important pediatric developmental differenceS of the vocal cords?

A
  • LOWER ANTERIOR ATTACHMENT
  • ALTERS ANGLE ANGLE OF ETT REACHING THE LARYNX
  • ETT MAY GET CAUGHT IN ANTERIOR COMMISSURE OF THE VOCAL CORDS
97
Q

What is the narrowest part of the infant larynx? What is a consequence of edema at this level?

A
  • 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
Q

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?
A
  • 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
Q

What is an important aspect of the pediatric pre-anesthesia assessment that can increase the risk of bronchospasm or laryngospasm of the neonate?

A
  • Upper Respiratory Infection (URI)
100
Q

In the pediatric assessment, what may snoring in the neonate indicate?

A
  • Obstructive Sleep Apnea
101
Q

In the pediatric assessment, what may repeated pneumonia indicate in the neonate?

A
  • GERD

- Cystic fibrosis

102
Q

When observing the global appearance of a neonate during a pediatric assessment, what is among the most important things to look for?

A
  • RECOGNITION OF A CONGENITAL ANOMALY OR SYDROME
103
Q

What are the important factors in mask ventilation technique of the neonate?

A
  • DO NOT OCCLUDE TRACHEA WITH FINGERS
  • ENSURE FINGERS ARE ON MANDIBLE
  • HAND ON RESERVOIR BAG AT ALL TIMES
104
Q

When selecting oropharyngeal airways in pediatrics, what are the most important aspects?

A
  • 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
Q

Why are NPAs generally avoided in children?

A
  • The may cause:
  • Trauma
  • Bleeding
  • Hypertropied adenoids
106
Q

Identify the important aspects of ETT size selection in pediatrics

A
  • Based on the child’s height and weight

- Have a size above and below planned ETT size

107
Q

Is an air leak desirable when ETT is in place in the pediatric patient?

A
  • 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
Q

When can you begin to use cuffed ETT in pediatrics?

A
  • 8 years old
109
Q

What size ETT is used for a preterm neonate up to 1000 g?

A
  • 2.5
110
Q

What size ETT is used for a preterm infant between 1000-2500 g?

A
  • 3.0
111
Q

What size ETT is used for a neonate up to 6 months old?

A
  • 3.0-3.5
112
Q

What size ETT is used for an infant from 6 mo.- 1-year-old?

A
  • 3.5-4.0
113
Q

What size ETT is used for a neonate b/w 1-2 years old?

A
  • 4.0-5.0
114
Q

What is the formula to determine uncuffed ETT size in the pediatric patient older than 2 years old?

A
  • 4 + (Age/4)
115
Q

What is the formula to determine cuffed ETT size in the pediatric patient older than 2 years old?

A
  • 3.5 + (Age/4)
116
Q

What is the “1,2,3,4” mnemonic for size selection of anesthesia equipment in pediatrics?

A
  • 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
Q

“0,1,2” mnemonic for ETT distance for children under 2 years of age?

A
  • Newborn- 10
  • 1 year old- 11
  • 2 year old- 12
118
Q

Formula for ETT distance for children over 2?

A
  • (Age/2) + 12
119
Q

When can you begin to use curved blades in pediatrics?

A
  • 2-6 years old

- MAC 1-2

120
Q

What blade is appropriate for a preterm or neonate?

A
  • MIL-0
121
Q

What blade is appropriate for a neonate- 2-year-old?

A
  • MIL-1
122
Q

What are 2 key interventions during laryngoscopy of the neonate?

A
  • 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
Q

What are 2 common complications of endotracheal intubation in pediatrics?

A
  • 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
Q

How is post-intubation croup treated?

A
  • Humidified mist
  • Nebulized Epi
  • Dexamethasone
125
Q

What anatomical feature in the neonatal airway makes the placement of an LMA difficult?

A
  • POSTERIOR PHARYNX

- LMA CAN GET HUNG UP HERE

126
Q

LMA can be used w/ infants that are how small?

A
  • 3-5 KG
127
Q

Describe LMA sizing in pediatrics

A
  • < 5 kg- 1
  • 5-10 kg- 1.5
  • 10-20 kg- 2
  • 20-30 kg- 2.5
  • 30-50 kg- 3
128
Q

What part of anesthesia care is most stressful in the pediatric population and what physiologic manifestation may it present with?

A
  • INDUCTION (50-75%)

- AUTONOMIC NERVOUS SYSTEM ACTIVITY (associated apprehension, nervousness, worry, and vigilence)

129
Q

What are the reported benefits of parental presence during induction? Objections?

A
  • 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
Q

What is an anesthesia consideration with midazolam in the pediatric population?

A
  • INCREASES EMERGENCE DELIRIUM
131
Q

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?
A
  • Preanesthetic visit
132
Q

What are routine preop labs in the pediatric population?

A
  • Routine preop labs are not indicated in the pediatric population
133
Q

Describe critical components of the assessment of the pediatric asthmatic patient

A
  • 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
Q

What preoperative finding is associated with increased risk for:

  • 02 desaturations
  • Breath holding
  • Laryngospasm
  • Bronchospasm
  • Coughing
A
  • Upper Respiratory Infection
135
Q

What is the best practice regarding adolescents performing a preoperative pregnancy test?

A
  • Disclose to parents that examine is being performed

- ONLY DISCLOSE POSITIVE RESULT TO PARENTS

136
Q

Pediatric patient with syndromes or congenital anomalies are at increased risk for what type of physiologic complications?

A
  • Congenital heart defects
137
Q

Describe assessment for the neonate with a congenital heart defect:

A
  • ECG
  • ECHO
  • HCT
  • Baseline Sp02 (pre- and post-ductal if indicated)
  • CXR
  • Cardiology consult
138
Q

What is the most common genetic abnormality worldwide?

A
  • Down Sydrome
139
Q

What are some common abnormalities that are associated with Down Syndrome?

A
  • Atlantoaxial instability
  • Airway instability
  • Airway narrowing
  • Respiratory and cardiac malformations
140
Q

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?
A
  • Autism
141
Q

A disorder associated with:

  • Inattention
  • Hyperactivity
  • Overrepresented in boys by 3:1
  • Impulsivity
  • May be on drugs that interact with anesthesia
A
  • Attention Deficit Hyperactive Disorder
142
Q

What are the implications of drug abuse in the adolescent?

A
  • Increases morbidity and mortality
  • May interact with anesthetic drugs
  • Drug use may have anesthetic implications
143
Q

What are NPO guidelines in pediatrics?

A
  • Clear liquids- 2 hours
  • Breast milk- 4
  • Formula, Milk, or juices- 6
  • Solid food- 8 hours
144
Q

What is the best pharmacologic intervention for an uncooperative child for pre-op sedation?

A
  • IM Ketamine
145
Q

What is an important consideration in the use of pre-op PO midazolam?

A
  • 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
Q

What is an important consideration with morphine on neonates?

A
  • NOT USED ON NEONATES

- RESPIRATORY DEPRESSANT EFFECTS

147
Q

What are the important considerations of Fentanyl in pediatrics?

A
  • IV, ORAL, ORAL, NASAL, TRANSDERMAL ROUTES

- IV: 1-2 mcg/kg

148
Q
  • Increased oral secretions
  • Nystagmus
  • Hallucinations
  • Post-op N/V
    Are important anesthetic considerations with what pediatric anesthetic drug?
A
  • KETAMINE
  • GIVE ATROPINE OR GLYCOPYRROLATE TO AVOID SECRETIONS THAT CAN LEAD TO LARYNGOSPASM
  • MIDAZOLAM TO AVOID HALLUCINATIONS
  • KETAMINE DART: 2mg/kg IM
149
Q

When are anticholinergics indicated in pediatrics?

A
  • 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
Q

When is tylenol given in pediatric anesthesia?

A
  • Rectally in the OR after induction
  • Can be given PO, IV, or rectally
  • Used for postoperative pain
151
Q

What are the considerations of Ketorolac in the pediatric population?

A
  • Given only after hemostasis and completionof surgery

- Discuss use with surgeon

152
Q

When should the anesthesia provider consider antiemetics for the pediatric patient?

A
  • Tonsillectomies

- Strabismus surgery (Both surgeries associated with high incidence of PONV)

153
Q

When is premedication of corticosteroids indicated in pediatrics?

A
  • 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)

Pediatrics (3 decks)

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