Week 6: Preoperative preparation and Monitoring Flashcards
Preoperative Fasting Recommendations in Infants and Children
Clear liquids
Breast milk
Infant formula
Solids (fatty or fried foods)
- 2 hours
- 4 hours
- 6 hours
- 8 hours
Chewing gum, what is the concern?
- Gum will increase
______ and ______ (mostly from swallowing saliva). - Elective surgery can _______ as long as gum is spit out.
- Elective surgery should be _______ if the child swallows gum.
- Aspirated gum, at body temperature, is difficult to remove from the bronchus or trachea.
- gastric pH and volumes
- proceed
- cancelled
T/F:
Children can never be trusted to fast. During examination of the airway, look for candy, gum or food in the child’s mouth.
True
Most ASA 1 or 2 pediatric patients who aspirate _______ gastric contents have minimal to no sequelae.
If clinical signs of sequelae from an aspiration occur, they will be apparent within _______ hours.
clear; 2
Preoperative assessment
Body piercings- remove them
Primary and secondary smoking- vaping is not harmless
In order to reduce the incidence of postoperative pulmonary complications, really should stop smoking ___-____ weeks prior to surgery.
6-8
Psychological preparation of children for surgery
0–6 months
- Maximum stress for parent
- Minimum stress for infants, have not yet developed stranger anxiety
Psychological preparation of children for surgery
6 months–4 years
- Maximum fear of separation
- Not able to understand processes and explanations
- Significant postoperative emotional upset and behavior regression is possible
- Begin to have magical thinking
- Cognitive development and increased temper tantrums
Psychological preparation of children for surgery
4–8 years
- Begins to understand processes and explanations
- Fear of separation remains
- Concerned about body integrity and fear of mutilation
Psychological preparation of children for surgery
8 years–adolescence
- Tolerate separation well
- Understands processes and explanations
- May interpret everything literally
- May fear waking up during surgery or not waking up at all
Psychological preparation of children for surgery
Adolescence
- Independent
- Issues regarding self-esteem and body image
- Developing sexual characteristics and fear loss of dignity
- Fear of unknown
Psychological Aspects
- A child’s ______ and/or________ is the most important determinant of persistent behavioral disturbances.
- The type and complexity of the surgical procedure is also a factor.
- The postoperative course should be considered.
- The frequency of surgeries should be considered.
- Children respond positively to an honest description of exactly what they can anticipate and have some control over their situation.
- age
- cognitive development
Psychological Aspects
- Meeting with the patient and the parents requires complete explanations and good communication skills in order to diffuse fear of the unknown.
- Decide if the parent will or will not be present at induction. It is important to set limits as occasionally a parent may demand total control of the situation.
- Certified Child Life Specialists (CCLS) hold bachelor or master degrees in _________ and _________.
child psychology or child life development
Table 4.2 possible anesthetic implications
- History of squatting
- Jaundice
- Frequency
- SCD
- Loose or carious teeth
- TOF
- Drug metabolism/ hypoglycemia
- UTI, DM, Hypercalcemia
- Hydration and possible transfusion
- Aspiration of loose teeth; bacterial endocarditis
The child with seasonal or viral rhinitis, who does not have a ________ or ___________ may proceed with surgery on a case-by-case basis.
Most common allergies
fever or lower respiratory symptoms,
The risk of perioperative respiratory complications is increased; however, it may be difficult to find a disease-free window.
Penicillin and Latex
Involvement of minors in medical decision making Table 5.1
Decision making and techniques
- < 6yr
Involvement of minors in medical decision making Table 5.1
Decision making and techniques
- 6 - 12 y/o
Involvement of minors in medical decision making Table 5.1
Decision making and techniques
- 13 - 18
Involvement of minors in medical decision making Table 5.1
Decision making and techniques
- mature minor
Involvement of minors in medical decision making Table 5.1
Decision making and techniques
- Emancipated minor
Why premedicate?
- To allay anxiety
- Block autonomic (vagal) reflexes
- Reduce airway secretions
- Produce amnesia
- Aspiration prophylaxis
- Facilitate induction
- Analgesia
Premedication: Barbiturates
- Methohexital
- Thiopental
- Rectal: 20- 40 mg/kg (10% solution)
- IM: 10 mg/kg (5%)
- 20 - 40 mg/kg (10% solution)
Premedication: Benzos
Diazepam
Lorazepam
Oral: 0.1-0.5
Rectal: 1
mg/kg
PO: 0.025-0.05
Premedication: Benzos
Midozalam
Rectal: 0.5-1
Oral: 0.25-0.75
Nasal:0.2
IM: 0.1-0.15
mg/kg
Premedication: Phencyclidine
Ketamine
Rectal: 6-10
IM:2-10
Oral: 3-6
Nasal: 3
mg/kg
Premedication:
Clonidine
PO:0.004mg/kg
Premedication:Opioids
Morphine
Meperidine
- IM:0.1-0.2
- IM:1-2
mg/kg
Premedication: Opioids
Fentanyl
Sufentanil
Oral: 0.010 - 0.015 mg/kg (10-15mcg/kg)
Nasal: 0.001-0.002 mg/kg (1-2mcg/kg)
Nasal: 0.001 - 0.003 mg/kg (1-3mcg/kg)
Table 4.4 dose and max
- ampicillin-sulbactam
- ampicillin
- 50 mg/kg (max 3g)
- 50mg/kg (max 2g)