Perioperative Considerations Flashcards
Pre op: fear atnd anxiety, what does the parent and child fear?
The unknown
Start by introducing yourself to the parents, establish a bond of trust, then the child will trust you
What does giving options to the child do?
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
What do many of them fear?
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
What considerations are taken with older children/ adolescents?
Fear of loss of control
-Explain the steps of induction
What does parental presence for induction indicate ?
The most effective method is PO versed with Parental Presence
History can include which two things?
Dental Care
Radiology Studies
What type of familial history problems do we want to be aware of??
Unexpected fevers/deaths in the family after anesthesia
MH
Nausea/Vomiting/Allergies
What is significant about premature birth?
Once a premie, always a premie
Respiratory effet will last into adulthood
-Surgeries during NICU stay
What neurological symptoms are need to knows?
Development Delay -Down Syndrome -Autism Head injury/intracranial hemorrhage Seizures vs febrile seizures Neuromuscular Disorder -Muscular Dystrophy -Myotonic Dystrophy -Cerebral Palsy
What are appropriate cardiovascular questions?
Congenital Heart Disease
Previous Cardiac Surgery
What are the pre op respiratory considerations?
Preemie?
-(weeks/nicu stay/ intubation/ Length of time)
-Recent cough, cold, fever, PNA in past 6 weeks
Asthma
Cystic Fibrosis
Important GI/Renal issues?
Reflux
Bladder/Kidney Surgery
Bowel Issues
How do we get Pre-op consent?
-From parent/guardian
ASSENT from children/adolescents
What are the best ways to give pre-medication and what medications do we give?
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)
Intra op: How do we generally induce pediatrics?
Mask Induction- if not crying monitors placed first than mask
T/F: Small children/infants just the pulse ox is ok?
True
If child is screaming and crying what is the sequence of induction?
Mask first than monitors
FIRST monitor is ALWAYS PULSE OX, then EKG, BO
What is Stage 1 anesthesia?
Awake
Eyes midline
Stage 2 anesthesia?
Hyper-excitable
Eyes Divergent
Stage 3
Asleep
Eyes Midline
Stage 4 anesthesia?
Cardiovascular reflexes are anesthetized, can be hypotensive, bradycardic
Eyes midline
What are advantages of IV induction?
Asleep without going through Stage 2
Very LOW risk laryngospasm
Review Slide 8
Adults vs pediatric airway?
Slide 10
Major Anatomical Differences of the Pediatric airway
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
What are intra op pain medications that are given?
Non-potty trained - rectal acetaminophen
- IV fentanyl, morphine, dilaudid, toreador, ofirmev
- IM demerol
- Local at the surgical site
What meds do we administer for N/V prophylaxis?
Decadon and Zofran > 2 years old
IV fluid administration 10-20 ml/kg bolus than 4-2-1 maintenance
What temperature to children need to be kept above and what complications may arise if this is not maintained?
>
- 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
What cardiovascular signs post operatively are seen in children and older children/ teenagers?
Children: Tachycardia, excitement, emergence from anesthesia, pain, fear
Older children/teenagers: hypotension
Post op respiratory, when is the risk of Laryngospasm the highest?
During Stage 2
-If extubated or LMA removal deep , brought to PACU they will endure stage 2 during PACU
**T/F: DO NOT STIMULATE THE CHILD UNTIL AWAKE?
TRUE
What do you administer if a child laryngospasms?
- **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
List 4 reasons why children hypoventilate/obstruct?
1-OSA
2-Tonsils/adenoids post op sweeping
3-Obesity
4-Central Sleep Apnea ( common in premie)
When do we see fatigued children that contribute to respiratory failure?
Emergency Surgeries
Late Surgeries
-Fatigue can account for 1/3 the needed anesthetic in the OR and PACU
How do we administer opioids to children with respiratory compromise?
- 1/2 dose for fatigued children
- 1/2 dose for children with OSA
- Narcan 0.5 mcg/kg
How do we treat post-op Nausea and Vomiting?
Zofran 0.1-0.5mg/kg
How do we deal with hungry (hangry) children?
Feed them!
Sugar pinky, sugar water bottle, mom breast feed infants
-Food can replace the need for further medication .
