Test 4: Pediatric Anesthesia Pt. 1 (Andy's Cards) Flashcards
Heat is exchanged between the body and its environment in both directions, by what 4 mechanisms?
Of the 4 mechanism, what is the most important factor to heat loss in the OR?
- Conduction
- Convection
- Radiation (most important factor to heat loss in the OR)
- Evaporation
Heat loss d/t the body contacting a cold object.
Conduction
What are ways to mitigate heat loss through conduction for pediatric patients?
- Warm the OR and the OR bed
- Use warming blanket
- Warm fluids (long cases)
- Warm irrigation fluids
- Bair hugger
Heat loss d/t air movement around the body
Convection
What are ways to mitigate heat loss through convection for pediatric patients?
- Warm the rooms
- Close the doors
- Head covers (thermal insulation)
- Bair hugger
- Body covering
Heat loss from an infant’s uncovered head may represent as much as ____% of total heat loss in the OR
60%
Temp for rooms: Newborn
80º F
Temp for rooms: 1-6 months
78º F
Temp for rooms: 6mo - 2yr
76ºF
Temp for rooms: > 2 years old
74ºF
Heat loss d/t infrared radiation being emitted from the body to cooler objects in the environment.
- Radiation
- Radiation is the most important factor to heat loss.
What are ways to mitigate heat loss through radiation for pediatric patients?
- Warm the room
- Use radiant heat lamps
- Body coverings
- Aluminized plastic coverings
Heat loss d/t the heat of vaporization taking place at the skin and lungs.
Evaporation
What are ways to mitigate heat loss through evaporation for pediatric patients?
- Using a heat and moisture exchanger (HME)
- Heated humidifier (Concha-therm)
- Fluid warmers
- Knowledgeable provider
What are potential problems that can occur if a child becomes too cold in the OR?
- Decreased metabolism will affect rate of drug distribution, slow to wake.
- Blood coagulation is slowed with hypothermia
- Shivering in the PACU (may cause bleeding with tonsillectomies)
- Peripheral vasoconstriction (harder to start an IV)
- Cardiac arrhythmias
What percentage of total body heat loss is due to evaporation?
20%
Spontaneous ventilation normally is ____ºC at the pharynx with humidity of ____%.
Spontaneous ventilation normally is 32ºC at the pharynx with humidity of 86%
How does brown fat metabolism increase heat production?
With brown fat metabolism, lipase is released that splits triglyceride into glycerol and fatty acids, which increases heat production
What can cause a baby to have mottled skin after surgery?
A cool OR will increase norepinephrine production, resulting in peripheral vasoconstriction leading to mottled-looking skin on a child in the PACU.
What is the pediatric dose of IV Succinylcholine?
What is the pediatric dose of IM Succinylcholine?
- Succinylcholine IV: 2 mg/kg
- Succinylcholine IM: 4 mg/kg
What is the pediatric dose of IV Atropine?
What is the pediatric dose of IM Atropine?
- Atropine IV: 0.01 mg/kg
- Atropine IM: 0.02 mg/kg
What is the pediatric induction dose of IV Propofol?
What is the infusion dose?
- Propofol IV: 2-3 mg/kg
- Propofol infusion: 50-200 mcg/kg/min
What is the pediatric IV dose of lidocaine?
- Lidocaine IV: 1 mg/kg
List the monitoring equipment needed for a pediatric patient.
- 3 lead EKG
- Precordial stethoscope
- Two pulse oximeters (upper and lower extremities)
- Temp probe (Axillary)
- BP Cuff
- FiO2, ETCO2, and Agent monitors
What is the most common anesthesia delivery system?
What are the benefits of this system?
Circle System
- light weight
- can use LOW gas flows
- resistance in valves and CO2 absorber
What anesthesia delivery system is used to transport a pediatric patient?
- Jackson Rees
- Light weight-no valves so less resistance to breathing feel of respirations
- HIGH gas flows at least 1 to 2.5 X minute volume to ensure no rebreathing
- You will waste gases and loose heat and humidity quickly
What is the difference between a Jackson Rees and a Bain circuit?
Bain circuit has a pop-off valve
According to Dan Ernst, what contributes to deadspace in pediatric patients?
- HME’s
- CO2 adaptors
- Low flow
- Faulty valves
- Exhausted sodasorb or channeling
- Endotracheal Tube/Mask
- Elbow
- First 12-10 inches of the circuit
How many hours must a patient be NPO if they consume clear liquids?
2 hours
How many hours must a patient be NPO if they consume breast milk?
4 hours
How many hours must a patient be NPO if they consume infant formula?
6 hours
How many hours must a patient be NPO if they consume non-human milk (cow milk)?
6 hours
How many hours must a patient be NPO if they consume a light meal?
6 hours
How many hours must a patient be NPO if they consume a meal with fat?
8 hours
What is the dose for PO Versed for pediatric patients?
PO Versed should be given how long before induction?
- 0.5 mg/kg (16 mg max)
- 20-30 minutes before induction
- Need a good strong taste to dilute the Versed in if you don’t have the premade syrup preparation
Factors that contribute to pediatric anxiety?
- 1-5 years-olds
- Shy/sensitive type
- High IQ/ Lack good adaptive ability
- Previous surgeries
- Parental anxiety
Kids are natural ________ breathers
Nasal
GET THE MOUTH OPEN
What is different about pediatric airway anatomy compared to adults?
- Larger tongue relative to the mouth
- The larynx is higher in the neck (superior, not anterior)
- Larger head, prominent occiput, naturally flexed
- Short neck, smaller nare
- Epiglottis is narrower and angled away from axis of the trachea (more difficult to lift epiglottis)
- Vocal cords have a lower attachment anteriorly than posteriorly
What level will the larynx be in a preterm infant?
C3
What level will the larynx be in a full-term infant?
C3-C4 interspace
What level will the larynx be in an adult?
C4-C5
Why do straight blades facilitate better visualization of the infant’s larynx?
The more cephalad location creates difficulty in visualizing the laryngeal structure because of the more acute angulation between the base of the tongue and the glottic opening, making it difficult to use a curved blade.
Compare the tongue of a pediatric patient to an adult patient
Larger tongue relative to the mouth in a pediatric patient
Compare the larynx of a pediatric patient to an adult patient
The larynx is higher in the neck (superior, not anterior)
Compare the head of a pediatric patient to an adult patient
Larger head, prominent occiput, naturally flexed
Compare the neck and nare of a pediatric patient to an adult patient
Short neck, smaller nare
Compare the epiglottis of a pediatric patient to an adult patient
Epiglottis is narrower and angled away from axis of the trachea (more difficult to lift epiglottis)
Compare the vocal cords of a pediatric patient to an adult patient
Vocal cords have a lower attachment anteriorly than posteriorly, causing the tip of the ETT to be held up at the anterior commissure of the cords. (Slanted cords)
What is the narrowest portion of the larynx in a pediatric patient?
Cricoid cartilage
What kind of shape is the pediatric larynx?
Cone shape
Pediatric Airway
Pediatric Airway
ET Tube Size for Preemie 1 kg and under
2.5
ET Tube Size for Preemie 1-2.5 kg
3.0
ET Tube Size for term neonate to 6 months
3.0-3.5
ET Tube Size for 6 months to 1 year
3.5-4.0
ET Tube Size for 1-2 years
4.0-4.5
What is the ET-Tube size formula for pediatric patients older than two years?
(Age + 16)/ 4
If the radius of the tube is halved, how much does resistance increase?
Resistance is increased 16-fold (Poiseuille’s law)
A leak around the tube at _______ cm H20 (range) is the best method in determining the proper size of an ETT for a child.
20-30 cm H2O
When would you want to use a cuff ETT on a pediatric patient?
- Routinely used around 11-12 years old
- Full stomachs
- Very non-compliant lung
- History of reflux of stomach contents
- Hiatal hernia
- Bloody oral surgery (cleft palate repair)
- Cuffed tubes are made down to size 3.0
What is the formula for determining what depth the tube (cm)?
(Age/2) + 12
