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Pediatric Anesthesia > Perioperative Considerations > Flashcards

Perioperative Considerations Flashcards

1
Q

Pre op: fear atnd anxiety, what does the parent and child fear?

A

The unknown

Start by introducing yourself to the parents, establish a bond of trust, then the child will trust you

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2
Q

What does giving options to the child do?

A

Gives them a sense of choice/control

*Should I listen to heart or lungs first? Giving them them a choice but not able to say No

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3
Q

What do many of them fear?

A

Receiving a shot or experiencing pain

**Important to be HONEST with kids but not to further intensify their fears
Offer mask induction although some children prefer IV

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4
Q

What considerations are taken with older children/ adolescents?

A

Fear of loss of control

-Explain the steps of induction

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5
Q

What does parental presence for induction indicate ?

A

The most effective method is PO versed with Parental Presence

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6
Q

History can include which two things?

A

Dental Care

Radiology Studies

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7
Q

What type of familial history problems do we want to be aware of??

A

Unexpected fevers/deaths in the family after anesthesia
MH
Nausea/Vomiting/Allergies

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8
Q

What is significant about premature birth?

A

Once a premie, always a premie
Respiratory effet will last into adulthood
-Surgeries during NICU stay

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9
Q

What neurological symptoms are need to knows?

A 
Development Delay 
-Down Syndrome 
-Autism 
Head injury/intracranial hemorrhage 
Seizures vs febrile seizures 
Neuromuscular Disorder
-Muscular Dystrophy
-Myotonic Dystrophy
-Cerebral Palsy
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10
Q

What are appropriate cardiovascular questions?

A

Congenital Heart Disease

Previous Cardiac Surgery

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11
Q

What are the pre op respiratory considerations?

A

Preemie?
-(weeks/nicu stay/ intubation/ Length of time)
-Recent cough, cold, fever, PNA in past 6 weeks
Asthma
Cystic Fibrosis

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12
Q

Important GI/Renal issues?

A

Reflux
Bladder/Kidney Surgery
Bowel Issues

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13
Q

How do we get Pre-op consent?

A

-From parent/guardian

ASSENT from children/adolescents

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14
Q

What are the best ways to give pre-medication and what medications do we give?

A

TLC/ distractions can be effective

  • Midazolam (PO,IV,Nasal/trans-mucosal)
  • Fentanyl/Morphine - (IV nasal/trans-mucosal)
  • Ketamine (PO, IV, IM- usually IM with developmentally delays patients )
  • Clonidine/ Dex ( PO/IM can take up to 45 mins to work, Intranasal)
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15
Q

Intra op: How do we generally induce pediatrics?

A

Mask Induction- if not crying monitors placed first than mask

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16
Q

T/F: Small children/infants just the pulse ox is ok?

A

True

17
Q

If child is screaming and crying what is the sequence of induction?

A

Mask first than monitors

FIRST monitor is ALWAYS PULSE OX, then EKG, BO

18
Q

What is Stage 1 anesthesia?

A

Awake

Eyes midline

19
Q

Stage 2 anesthesia?

A

Hyper-excitable

Eyes Divergent

20
Q

Stage 3

A

Asleep

Eyes Midline

21
Q

Stage 4 anesthesia?

A

Cardiovascular reflexes are anesthetized, can be hypotensive, bradycardic
Eyes midline

22
Q

What are advantages of IV induction?

A

Asleep without going through Stage 2
Very LOW risk laryngospasm

Review Slide 8

23
Q

Adults vs pediatric airway?

A

Slide 10

24
Q

Major Anatomical Differences of the Pediatric airway

A

Proportionally Smaller Larynx

  • Narrowest is the cricoid cartilage
  • Epiglottis is LONGER and NARROWER
  • Head and occiput are proportionally LARGER
  • Tongue is proportionally LARGER
  • Neck is much SHORTER
  • Larynx is ANTERIOR and CEPHALAD
  • Adenoids are LARGER
  • HIGHER risk of mainstream intubation d/t short trachea and bronchus
25
Q

What are intra op pain medications that are given?

A

Non-potty trained - rectal acetaminophen

  • IV fentanyl, morphine, dilaudid, toreador, ofirmev
  • IM demerol
  • Local at the surgical site
26
Q

What meds do we administer for N/V prophylaxis?

A

Decadon and Zofran > 2 years old

IV fluid administration 10-20 ml/kg bolus than 4-2-1 maintenance

27
Q

What temperature to children need to be kept above and what complications may arise if this is not maintained?

A

>

  1. 0
    Cold infants become bradycardia, hypotensive and are slow to awaken
    *Remember infants cannot shiver to increase their body heat
    -Keep norms-thermic for metabolism of medications, especially muscle relaxants
28
Q

What cardiovascular signs post operatively are seen in children and older children/ teenagers?

A

Children: Tachycardia, excitement, emergence from anesthesia, pain, fear
Older children/teenagers: hypotension

29
Q

Post op respiratory, when is the risk of Laryngospasm the highest?

A

During Stage 2

-If extubated or LMA removal deep , brought to PACU they will endure stage 2 during PACU

30
Q

**T/F: DO NOT STIMULATE THE CHILD UNTIL AWAKE?

A

TRUE

31
Q

What do you administer if a child laryngospasms?

A
  • **Succinylcholine IM 4mg/kg or IV 0.4 mg/kg
  • Bring ORAL airway to PACU
  • Possitive pressure 40mHg - This is the reason you bring the mask and oral airway with every child- and why you transport with O2 in the event of spasm the kid ha been oxygenated prior to event rather thank starting at room air
32
Q

List 4 reasons why children hypoventilate/obstruct?

A

1-OSA
2-Tonsils/adenoids post op sweeping
3-Obesity
4-Central Sleep Apnea ( common in premie)

33
Q

When do we see fatigued children that contribute to respiratory failure?

A

Emergency Surgeries
Late Surgeries

-Fatigue can account for 1/3 the needed anesthetic in the OR and PACU

34
Q

How do we administer opioids to children with respiratory compromise?

A
  • 1/2 dose for fatigued children
  • 1/2 dose for children with OSA
  • Narcan 0.5 mcg/kg
35
Q

How do we treat post-op Nausea and Vomiting?

A

Zofran 0.1-0.5mg/kg

36
Q

How do we deal with hungry (hangry) children?

A

Feed them!
Sugar pinky, sugar water bottle, mom breast feed infants

-Food can replace the need for further medication .

Pediatric Anesthesia (3 decks)

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