Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Basics of Anesthesia > Week 5 - Basics of Pediatric Anesthesia > Flashcards

Week 5 - Basics of Pediatric Anesthesia Flashcards

1
Q

Why is weight important during the Pre-anesthetic evaluation in pediatrics?

A
  • Weight and age are extremely important for selection of appropriately sized equipment (ETT/IV/Laryngoscope)
  • Drug dosages are weight based (difference in a few kg is a big deal)
  • Is the weight appropriate for the child’s age?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some tips on how to complete a pre-anesthetic evaluation in pediatrics?

A
  • Get down to their level
  • Smile and be friendly
  • Acknowledge parents and child
  • Spend time bonding
  • Mom/Dad/Guardian comfort can foster the child’s comfort
  • Find something that may interest them (characters, games, iPhone, sports, school, friends, etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What issues are associated with Prematurity?

A
  • Retinopathy of Prematurity (ROP)
  • Apnea
  • Bronchopulmonary dysplasia (BPD)
  • Intraventricular Hemorrhage (IVH)
  • Necrotizing Enterocolitis (NEC)
  • Patent Ductus Arteriosus (PDA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When does respiratory control mature in infants?

A

Not until 42-44 week post-gestational age

-before this hypoxemia will depress ventilation and after it will stimulate ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

At what age is over night admission for apnea monitoring required?

A

Generally 44 weeks without risk factors and 60 weeks post-conceptual age with risk factors

-treat with caffeine 10mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is included in the review of systems in pediatrics?

A
  • Assess growth and development (ask about pregnancy and birth course)
  • Neurologic (any known issues?)
  • Gastrointestinal (reflux - infant excessively “pukey”?)
  • Hepatic/Renal (focused review… either we know due to previous hx or reason for current visit) – think bilirubin and competition for plasma proteins
  • Respiratory (cough, fever, wheezing, runny nose? work of breathing)
  • Cardiac (able to play hard w/o turning blue? any known hx?)
  • Airway Assessment (ask parent about teeth)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a child at increased risk for during anesthesia if they had a recent URI?

A

Bronchospasm, Laryngospasm, and Arterial Desaturation

  • if URI in the last 4-6 weeks… generally cancel case
  • often proceed if minimal symptoms and minor/non-invasive surgery

*take care to optimize situation, minimal stimulation/airway manipulation, keep deep, LMA vs ETT, deep extubation, albuterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are signs of a lower respiratory tract infection in children?

A
  • Active wheezing on auscultation
  • Coughing up mucus/phlegm of varying colors
  • Shortness of breath, tracheal tugging, increased work of breathing
  • Fever, malaise, decreased activity level
  • Recent pneumonias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should you administer pre-op if a child is recovering from respiratory illness or mild symptoms?

A

Nebulizer
Glycopyrrolate for secretions
Keep the child calm – midazolam?

*have diluted epinephrine ready for bronchospasm (ketamine, magnesium, decadron)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

At what age does separation anxiety begin?

A

generally around 8-9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What medications are typically used as premedication in pediatrics?

A

Oral Midazolam: 0.5-0.75 mg/kg (20mg max) – onset 10-15 min, may last 1-2 hours

Intranasal Midazolam: 0.2-0.6 mg/kg – onset 20-30 seconds (BURNS)

Intranasal Precedex: 2-4 mcg/kg – onset ~30 min

IM Ketamine: 4 mg/kg – onset within minutes, profound sedation quickly w/ combative pts (last resort)
*increased salivation - add 10-20 mcg/kg glycopyrrolate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should you set up your room for a pediatric case?

A
  • Pre-warming: large body surface area to weight ratio causes dramatic heat loss (room temp 72 minimum, infant radiant warmer)
  • IV fluids in room (no bubble no trouble!)
  • Shoulder Roll (w/ head roll)
  • Standard Monitors (pulse ox, 3 lead EKG, appropriate size BP cuff)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why should you use two pulse oximetry monitors in neonates?

A

the ductus arteriosus can reopen

  • R Hand = pre-ductal
  • L Hand/Bilateral Feet = post-ductal

*if the number is very different between the two then it is a clue that the ductus reopened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are machine setup considerations for a pediatric case?

A

ALWAYS check ventilator setting before induction

Change alarm parameters

Set NIBP to cycle 1-3 minutes

Turn pulse ox volume up so it is easily audible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How should you prepare the airway supplies for a pediatric case?

A

Size and age appropriate airway supplies:

  • Bag: 500cc/1L/2L
  • Circuit sizes
  • Mask size
  • Oral airway
  • ETT tubes (microcuff preferred)
  • Laryngoscope blades
  • LMA

*prepare multiple sizes of everything

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the equation of ETT sizing in pediatrics?

A

Age/4 + 4

*uncuffed – for cuffed minus 0.5 size

17
Q

What is the emergency drug dosing for Atropine, Succinylcholine, Epinephrine, and Ephedrine?

A

Atropine: 0.01 mg/kg IV and 0.02 mg/kg IM

SUX: 1-2 mg/kg IV and 4 mg/kg IM (up to 5 mg/kg in neonates)

Epi: 0.5-1 mcg/kg for hypotension/bradycardia and 10 mcg/kg for code

Ephedrine: dilute and titrate for hypotension 1-2.5 mg per dose

18
Q

What are induction considerations for a pediatric case?

A
  • Apply as many monitors as possible (pulse ox first, can wait on cycling BP until child is asleep)
  • Inhalation vs IV (determined by child age and ability to place IV pre-op)
  • Sevo with or without N2O (avoid N2O w/ neonates and small infants)
  • Increase Sevo slowly in cooperative child (increase in 2% increments – if uncooperative/combative, Sevo 8%)
  • Apply remaining monitors/cycle BP once child is asleep
19
Q

What are some considerations of stage 2 anesthesia in pediatrics?

A
  • Prolonged time in stage 2 w/ inhalation induction (tachycardia/tachypnea, deconjugate eyes)
  • Avoid stimulation to child during this time — No IV (wait until stage 2 passes), prone to laryngospasm (treat w/ positive pressure, “laryngospasm notch”, IM/SL SUX
  • Watch for Sevo overdose (bradycardia) – don’t take over breathing until IV is in place and running
20
Q

When should IV induction be done in a pediatric case?

A
  • If you are able to place pre-op IV
  • Chronic uncontrolled GERD
  • Full Stomach
  • Pyloric Stenosis

*place EMLA/LMX cream on child in preop to facilitate IV placement

21
Q

What are the anesthetic maintenance doses for Propofol infusion, Remifentanil infusion, Fentanyl boluses, and Rocuronium?

A

Propofol: 100-500 mcg/kg/min

Remifentanil: 0.1-0.4 mcg/kg/min

Fentanyl: 0.5-1 mcg/kg

Rocuronium: 0.5 mg/kg (as needed for surgical exposure)

22
Q

What should the ventilator settings be for a pediatric case?

A
  • Pressure Control or Volume Control (PCV minimizes chance of over inflation and barotrauma)
  • RR increases with decreasing age – titrate to appropriate ETCO2
  • Tidal Volume: 5-8 cc/kg (possibly up to 8-10 cc/kg)
  • Change I:E ratio to 1:1.5 (if needed) to promote larger tidal volumes without changing PIP
  • PEEP as needed – start at 3-5
  • Utilize minimal FiO2 to reduce change of O2 toxicity, atelectasis, and free radical creation (30-40%)
23
Q

What are the typical fluids used in pediatrics?

A

LR and Plasmalyte are common

*NS can have too high sodium load for neonates to tolerate

24
Q

How do you dose maintenance fluids in pediatrics?

A

4-2-1 Rule

  • 4mL for first 10kg
  • 2mL for next 10kg
  • 1mL for rest of pt’s weight
  • If on maintenance IV from PICU/NICU/Floor usually leave running
  • Assess fluid status before induction (irritability, fontanels, mucus membranes, cap refill, Hct, specific gravity)
25
Q

What is the doses of a Crystalloid bolus, Albumin, and Blood products in pediatrics?

A

Crystalloid Bolus: 10-20 mL/kg

Albumin: 5-10 mL/kg

Blood Products: 10-20 mL/kg
*1:1 with blood loss in some cases

26
Q

What do you treat suspected hypotension in pediatrics with first?

A

Fluids!

-hypotension = late finding and ominous sign (they maintain normotension until 35% of blood volume is lost)

27
Q

What are signs of hypovolemia in pediatrics?

A

Hypotension (late finding)

Tachycardia (sensitive but not specific)

Decreased Urine Output

Weak pulses, cyanosis, pale/cool skin
*check infant’s fontanels and cap refill

28
Q

What are considerations during emergence for a pediatric case?

A
  • Deep vs Awake Extubation — awake in small babies, deep must have easy airway (place oral airway and minimize stimulation)
  • Always suction stomach and oral cavity prior to extubation — test for airway reactivity/stimulation
  • Spontaneous Respirations w. adequate TV and ETCO2 levels
  • Assess infants/neonates awake level – grimace, attempting to cry
  • Long acting narcotic and adjuncts administered
  • Once extubated assure adequate ventilation
  • Swaddle infants/neonates for comfort
  • Take mask and ambu bag with to PACU – quick transport to PACU
29
Q

What is the treatment for laryngospasm and bronchospasm in pediatrics?

A

Laryngospasm: positive pressure, deepening with propofol, succinylcholine is last choice

Bronchospasm: positive pressure, deepening with propofol

  • Epi 1 mcg/kg
  • Ketamine 0.5-1 mg/kg
  • Magnesium Sulfate 25-50 mg/kg
  • Decadron may be as high as 0.6 mg/kg
30
Q

What is a reliable indicator of risk for Emergence Delirium in pediatrics? How do you prevent it?

A

Preop disposition of the child – how the kid got to sleep is an indication of how they may awaken

Prevention with Dexmedetomidine 0.25-1 mcg/kg bolus and 0.5-1 mcg/kg/min infusion if needed

*Most frequent incidence after Sevo administration

31
Q

What are typical PACU orders for pediatrics?

A
  • IVF at maintenance rate
  • Narcotics (morphine or hydromorphone)
  • Ondansetron in OR (generally no Phenergan in young kids)
  • PRN albuterol and racemic epi if post extubation inspiratory stridor
  • Pedialyte when child is awake and patent airway
  • Parents to PACU as soon as child is stable

Basics of Anesthesia (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions