157. Peds Sedation and Analgesia

Question 1

SOAP-ME mneumonic for equipment checklist for sedation

Answer 1

suction<br></br>oxygen<br></br>airway - mask and intubation supplies<br></br>pharmacy - life saving meds, antagonists<br></br>monitors<br></br>equipment as needed ie art line etc

Question 2

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Answer 2

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Question 3

Peds dose of propofol for procedural sedation

Answer 3

0.5-1mg/kg, titrate to effect with 0.5mg/kg

Question 4

How to treat laryngospasm (ie se ketamine)

Answer 4

reposition head<br></br>supplemental o2<br></br>gentle suction<br></br>ppv<br></br>succ given at 10% of paralytic dose

Question 5

Does ketamine increase ICP?

Answer 5

no this is dispelled per peds ch

Question 6

Do kids get emergence reactions?

Answer 6

no

Question 7

when do adol age tend to see more emergence reactions with ketamine?

Answer 7

16yoa

Question 8

Why would glycopyrrolate be preferred anticholingergic over atropine for salivation?

Answer 8

anti-sialoguge more potent<br></br>fewer tachy-dysrythmias than with atropine

Question 9

CNS SE atropine

Answer 9

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<div>headache,
nervousness, insomnia, excitement, dizziness, disorientation, hallu-
cinations, and ataxia&nbsp;</div>
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Question 10

SE glycopyrrolate?

Answer 10

headache

Question 11

ketamine and propofol dosing for peds procedural sedation? (combined ketofol)

Answer 11

0.5mg/kg to 0.75mg/kg for each drug in separate syringes<br></br>then usually redose propofol 0.1 - 0,.5mg/kg IV

Question 12

NO for kids procedural sedation - how is this postulated to work?

Answer 12

noncomp inhib of NMDA rec and analgesia via scentral opioid and opioid like receptors

Question 13

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Question 14

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Question 15

What are the best pain scales to use with kiddos?

Answer 15

NRA<br></br>visual analogue scale

Question 16

How to determine pain in nonverbal kiddos?

Answer 16

trust parents knowledge of behaviour pattern<br></br>revised FLACC scale for cognitive impairment

Question 17

List of nonpharm techniques for kids for pain

Answer 17

application of splints or immob to stabilize fractures and disloc<br></br>cold packs<br></br>hypnosis???<br></br>acupuncture???<br></br>distraction techniques!!<br></br>use your child life specialists

Question 18

What does emla stand for?

Answer 18

eutectic mixture of local anesthetics: lido, vapo coolents

Question 19

LET stands for?

Answer 19

lido<br></br>epi<br></br>tetracaine

Question 20

EMLA adverse effects

Answer 20

methemoglobinemia esp if g6pd and on methemo inducing meds<br></br>seizure<br></br>resp depression 

Question 21

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Question 22

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Question 23

**One study
in pediatric patients found that a vibrating cold device showed equal
effectiveness in reducing pain and distress during IV cannulation as 4%
topical lidocaine cream and is an acceptable alternative due to speedy
time to onset

Question 24

Local anesthetic: mechanicsm of action for pain

Answer 24

reversibly block na channels which inhibits propagation of n impulses

Question 25

Local anesthetic: amides - prefex before ending "___" will have letter __

Answer 25

caine
i

Question 26

Which local anesthetics that are tightly pro bound to a receptor in local anesthetic have __ duration of action

Answer 26

bupivicaine and tetracaine
longer

Question 27

Potency defn

Answer 27

degree which ind local anesthetic blocks transmission in neural tissue

Question 28

What does epi do when added a local anesthetic?

Answer 28

lengthens dur of anesthesia
slows systemic absorbtion
aids in controlling bleeding

Question 29

when to avoid using epi for procedural sedation?

Answer 29

no digits where end arterials
pt with vascular pathology
ie risk for ischemia

Question 30

MC adverse effect of local anesthetic

Answer 30

vasoconstrictor reaction

Question 31

Question 32

Early signs of LAST

Answer 32

numbness/tngling of lips
metallic taste
muffled hearing
tinnitus

Question 33

Late findings of LAST

Answer 33

drowsy
seizure
status
coma
MI depression/pump failure

Question 34

Which group of local anesthetics are more at risk for allerggic reactions?

Answer 34

ester

Question 35

Complications of nerve blocks

Answer 35

damage to structors: VAN
neurotoxicity
vascular - hematoma form, intra arterial injection, infection, bleed
LAST

Question 36

What opioids are mc to treat peds pt?

Answer 36

morphine
fentanyl 

Question 37

When to use HM in peds?

Answer 37

sickle cell disease/chronic pain 

Question 38

Answer 38

Question 39

Low dose ketamine vs morphine in acute pain crisis?

Answer 39

LDK actually better - 0.15mg/kg 
more likely se of nystagmus and euphoria LDK

Question 40

Use of flumanzenil -who can this not be given to/need to ensure no:

Answer 40

for patients with an uncomplicated benzodiaze- pine overdose, no evidence of tricyclic antidepressant use (e.g., no electrocardiogram [ECG] findings and no anticholinergic signs and symptoms), no history of seizure disorder, and no history of benzo- diazepine habituation 

Question 41

**For benzodiazepine reversal with procedural sedation or anesthesia, the initial dose of flumazenil for infants, chil- dren, and adolescents is 0.01 mg/kg (maximum 0.2 mg), which may be repeated after 45 seconds and then every minute up to 4 additional doses.

Question 42

1. When do most adverse events associated with emergency depart- ment (ED) procedural sedation occur?
a. During the manipulation or intervention
b. 5 to 20 minutes after the last sedative dose

c. 20 to 30 minutes after the last sedative dose
d. 30 to 60 minutes after the last sedative dose
e. 60 to 90 minutes after the last sedative dose

Answer 42

b

Question 43

2. Which of the following modalities has proven most effective for

monitoring patients undergoing procedural sedation?
a. Capnometry or capnography
b. Cardiac rhythm monitoring
c. Continual direct visual observation of qualitative clinical signs d. Documented respiratory rate

e. pulse ox 

Answer 43

c

Question 44

3. Which of the following agents is matched with the correct associ- ated side effect?
a. Etomidate—longer (>30-minute) duration of sedation
b. Ketamine—laryngospasm

c. Methohexital—venoirritation
d. Pentobarbital—seizures
e. Propofol—myoclonus

Answer 44

b

• Etomidate—myoclonus
• Methohexital—seizures

• Pentobarbital—longer (>30-minute) duration
• Propofol—venoirritation

Question 45

4. Which of the following statements regarding the use of ketamine is

false?
a. Benzodiazepine administration may be useful for emergence

phenomenon in children that are not improved by removing

stimulation and providing calming interventions.

1. Despite increased secretions, airway reflexes are generally well
   maintained.
2. Hypotension is common.
3. Profound analgesic and sedative effects occur with minimal
   respiratory depression.
4. Repeat doses are well tolerated in longer procedures. 

Answer 45

c

Question 46

5. Whichofthefollowingstatementsregardingtheuseofpropofolistrue? a. Propofol has a long duration of action and provides significant

analgesia.

1. Propofol has significant antiemetic properties.
2. Propofol can be easily reversed with a reversal agent.
3. Propofol is well tolerated in volume-depleted patients.
4. The use of “ketofol” (ketamine in combination with propofol) is
   clinically superior to the use of propofol alone

Answer 46

b

Question 47

6. Which of the following statements is true regarding the need for fasting before procedural sedation?
a. A 6-hour period of fasting is required after the ingestion of liq-

uids or solids before procedural sedation.
b. Preprocedural fasting is required in all circumstances.
c. The recommendation for preprocedural fasting is based on con-

trolled trials involving patients undergoing procedural sedation. d. The risk of vomiting and the loss of the airway protective reflexes

is an extremely rare occurrence during procedural sedation.
e. There is an increased risk of aspiration during procedural seda-

tion after a liquid or solid meal.

Answer 47

d