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Principles III > Pharmacology Pediatric Anesthesia > Flashcards

Pharmacology Pediatric Anesthesia Flashcards

1
Q

Do pediatric patients have larger or smaller volume of distribution for water soluble drugs?

A

higher TBW

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2
Q

How are the half-lives of drugs different for pediatric patients?

A

longer due to immature hepatic/renal function

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3
Q

How is pediatric dosing done?

A

per kg

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4
Q

How can weight be roughly estimated?

A

50th percentile weight (kg) = (age x 2) + 9

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5
Q

How is the ECF volume of distribution different in pediatrics?

A

ECF volume of distribution proportionately higher than that of adult

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6
Q

What does it mean for certain drugs given if pediatric patients have an increased volume of distribution?

A

larger initial doses of water soluble drugs are required

delayed excretion

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7
Q

Do pediatric patients have increased or decreased volume of distribution for fat soluble drugs?

A

decreased due to decreased fat and muscle mass

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8
Q

How is protein binding different in pediatric patients?

A

reduced total serum protein concentrations so more of the administered drug is free in the plasma to exert a clinical effect

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9
Q

Which drugs may need decreased dosing due to decreased serum protein concentrations?

A

barbituates and local anesthetics

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10
Q

How is the concentration of volatile agents different in pediatric patients?

A

concentration of inhaled anesthetics in the alveoli increase more rapidly with decreasing age: infants > children > adults, more rapid inhalation induction

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11
Q

What are some benefits and disadvantages of inhalation agents in pediatric patients?

A

more rapid inhalation induction
excretion and recovery of inhaled anesthetics is also more rapid
overdose can occur quickly and leading cause of serious complications

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12
Q

What factors allow pediatric patients to have a rapid rise in alveolar anesthetic concentration that rapidly equilibrates with blood concentrations?

A
  • Increased respiratory rate (higher minute ventilation)
  • Decreased FRC
  • Increased cardiac index/high blood flow to vessel rich organs
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13
Q

Besides increased RR, decreased FRC, and increased CI/high blood flow, what other possible explanations are there to explain the fast rise of alveolar anesthetic conentration?

A
  • age-related differences in blood-gas partition coefficient
  • state of hydration/dehydration
  • type of anesthesia circuit
  • vaporizer design
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14
Q

Why are pediatric patients at increased risk of overdose from inhalation anesthetics?

A

faster induction & immature cardiac development

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15
Q

Why is blood pressure very sensitive to volatiles?

A
  • lack of compensatory mechanisms
  • immature myocardium
  • reduced calcium stores
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16
Q

How does MAC change with age?

A

infants have a higher MAC than older children or adults and peaks around 3 months of age

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17
Q

What are the approximate MAC value of Sevo for infants?

A

3.2

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18
Q

What is the approximate MAC value of Iso for infants?

A

1.8

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19
Q

What is the approximate MAC value of Des for infants?

A

10

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20
Q

Why is N2O contraindicated in patients with a pneumothorax?

A

Can double the size of a pneumothorax in about 12 minutes

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21
Q

What is the agent of choice for inhalation inductions?

A

Sevo because least irritating to the airway

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22
Q

What is the blood gas solubility of Sevo?

A

0.68

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23
Q

What are some side effects of Sevo?

A

dose-related depression in RR and TV

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24
Q

What can increase your production of compound A when using Sevo?

A

FGF

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25
Q

What is the blood gas coefficient of Iso?

A

1.43

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26
Q

What is a major disadvantage of Iso?

A

slower onset and more pungent

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27
Q

When is it appropriate to use Iso in pediatrics?

A

after inhalation induction

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28
Q

What is the blood gas coefficient of Des?

A

0.42

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29
Q

What are some disadvantages of Des?

A

most pungent, causes airway irritation

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30
Q

What is the percent incidence of laryngospasm if using Des during induction?

A

50%, why it is controversial to use with LMAs

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31
Q

What is an advantage of Des?

A

rapid emergence

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32
Q

Why do pediatric patients need a larger induction dose of Propofol?

A

increased volume of distribution and decreased fat/muscle

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33
Q

How does the elimination half life of propofol differ in pediatric patients?

A

elimination half life is shorter, higher rates of plasma clearance

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34
Q

What is a disadvantage of Propofol?

A

high risk for infection, discard after 6 hours

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35
Q

What are the IV induction doses of Propofol?

A

2-3 mg/kg

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36
Q

What is the infusion rate for propofol?

A

25-200 mcg/kg/min

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37
Q

What is the infusion dose for Propofol if you are doing intraoperative nerve monitoring?

A
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38
Q

What are some side effects of Ketamine?

A

secretions, vomiting, hallucinations (consider giving 0.01mg/kg glyco to prevent excessive secretions)

39
Q

What are some benefits of giving Ketamine?

A

preserves spontaneous respirations and aids to maintain a patent airway, however apnea and laryngospasm may still occur

40
Q

What is the dose of Ketamine given orally?

A

6-10 mg/kg

41
Q

What is the dose of Ketamine given IM for sedation?

42
Q

What is the IV induction dose of Ketamine?

43
Q

What is the dose of IV Ketamine given for pain?

A

0.5 mg/kg bolus

4 mcg/kg/min infusion

44
Q

Why is etomidate not commonly used in children?

A

pain on injection, myoclonus, anaphylactoid reactions, suppression of adrenal function, and laryngospasm

45
Q

Why do opioids have more potent effects in children?

A

immature BBB and immature sensitivity of the respiratory centers

46
Q

What is the dose of morphine?

A

0.025-0.05 mg/kg IV

47
Q

Why is a disadvantage of morphine?

A

profound histmine release in kids causing them to turn red

48
Q

What is the dose of hydromorphone?

A

5-10 mcg/kg IV, often used in PCAs for post-op pain

49
Q

What is the induction and infusion dose of Fentanyl?

A
  1. 5-1 mcg/kg/IV

0. 5-2 mcg/kg/hr infusion

50
Q

Why is the dose for fentanyl decreased in pediatrics compared to adults?

A

slowly metabolization, increased duration of action in high doses related to decreased fat/muscle

51
Q

When can dependence occur with the administration of fentanyl in pediatric patients?

A

as little as 7 days

52
Q

What is the dose of Narcan and how should it be administered?

A

0.5-1 mcg/kg, repeat doses until effect

always titrate slowly

53
Q

What is a common premedication used in pediatrics?

54
Q

What is the dose and onset of PO midazolam as a premed?

A

0.5 mg/kg

onset 20 minutes

55
Q

What is the dose of intranasal midazolam as a premed?

56
Q

What is the dose and onset of IV midazolam as a premed?

A

0.05 mg/kg IV

onset 5 minutes

57
Q

What is the PICU sedation dose of midazolam?

A

0.4-2 mcg/kg/min

58
Q

What is the duration of action of midazolam?

59
Q

What is the onset and dose of Flumazenil?

A

2-20 mcg/kg IV

rapid onset of 5-10 minutes

60
Q

When is clonidine used in pediatrics?

A

adjunct to neuraxial anesthesia or oral premed

61
Q

What is the dose of clonidine as an oral premed?

A

4 mcg/kg (60-90 min onset)

62
Q

What is the dose of clonidine in an epidural/caudal?

A

1-2 mcg/kg and prolongs analgesia by approximately 3 hours

63
Q

What is a disadvantage of clonidine?

A

residual sedation post-op

64
Q

What is a benefit of Dexmedetomidine over clonidine?

A

8 times more specific for alpha 2 adrenergic receptor than clonidine with anxiolytic, sedative, and analgesic properties

65
Q

What is the elimination half life of Dexmedetomidine in children?

66
Q

What is the oral, intranasal, or IV dose of precedex?

A

0.25-1 mcg/kg over 15 minutes

67
Q

What is the infusion dose of precedex?

A

0.2-2 mcg/kg/hr

68
Q

What do all muscle relaxants have a shorter onset?

A

shorter circulation time (up to 50% shorter)

69
Q

What muscle relaxant is used most often in pediatrics because it is most predictable?

70
Q

What is the dose of Roc?

A

0.6 mg/kg IV

71
Q

What is the dose of Cis?

A

0.15 mg/kg IV

72
Q

What is the dose of Vec?

A

0.1 mg/kg IV

73
Q

Is it easy or difficult to assess effects of relaxant with a PNS?

A

difficult, utilize other signs of adequate reversal such as legs to chest and curare clefts

74
Q

What is the dose of glyco to reverse?

A

0.01 mg/kg IV

75
Q

What is the dose of Neostigmine?

A

0.05-0.08 mg/kg IV

76
Q

Why do infants need larger doses of Succ?

A

increased ECF volume of distribution

77
Q

What are some side effects of Succ in pediatric patients?

A 
cardiac arrhythmias
hyperkalemia
rhabdomyolysis
myoglobenemia
masseter muscle spasm
malignant hyperthermia
78
Q

What should you consider doing if your patient goes into cardiac arrest after the administration of succ?

A

treat for hyperkalemia, can occur from undiagnosed myopathies or muscular dystrophies, it’s why succ is usually avoided in routine elective pediatric surgeries

79
Q

What is the IV intubating dose of Succ?

A

10 kg = 4 mg/kg

80
Q

What is the IV dose of Succ for laryngospasm?

A

0.25-0.5 mg/kg

81
Q

What is the onset and recovery time of succ in pediatrics compared to adults?

A

fastest onset and recovery time similar to adults

82
Q

Why is there much more variability with dose and response of NMBA?

A

immaturity of the NMJ and increased extra-junctional receptors may results in increased senstivity to drugs, immaturity of hepatic system may result in prolonged duration of action required for the liver to metabolize

83
Q

What is the dose of Acetaminophen PO?

A

10-15 mg/kg

84
Q

What is the dosing of Acetaminophen PR?

A

30-40 mg/kg

85
Q

What is the IV dosing of acetaminophen?

A

1 month but 1 year and 50 kg = 20 mg/kg up to 1,000 mg

86
Q

What is the dose of ketorolac?

A

0.5 mg/kg IV

87
Q

What is the elimination half life of ketorolac?

88
Q

When would ketorolac be contraindicated?

A

impaired renal or hepatic function, increased risk of bleeding, impaired bone healing (some ortho docs don’t want it administered)

89
Q

What glucose level indicates hypoglycemia in pediatric patients?

90
Q

What are symptoms of hypoglycemia in peditric patients?

A

jitteriness, convlusions, apnea

91
Q

What is involved with acute hypoglycemic management?

A

10% dextrose 1-2 mL/kg
Maintenance on supplemental IV dextrose infusions
Minimize preoperative fasting

92
Q

Why should D50 never be used?

A

risk of vessel necrosis and high osmolarity

93
Q

How would you dilute D50 to D10 or D5?

A

take 1 mL of D50 and dilute into 5 mLs for D10 or take 1 mL of D50 and dilute into 10 mLs for D5

Principles III (12 decks)

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