Pediatric Anesthesia pt2.1

Question 1

<5kg: LMA size and inflation volume

Answer 1

• LMA 1
• up to 4 mL

Question 2

5-10kg: LMA size and inflation volume

Answer 2

• LMA 1.5
• up to 7 mL

Question 3

Pediatric circuits typically have what size of reservoir bag?

Answer 3

1L reservoir bag

adult reservoir is 2L

Question 4

10-20kg: LMA size and inflation volume

Answer 4

• LMA 2
• up to 10 mL

Question 5

20-30kg: LMA size and inflation volume

Answer 5

• LMA 2.5
• up to 14 mL

Question 6

30-50kg: LMA size and inflation volume

Answer 6

• LMA 3
• up to 20 mL

Question 7

50-70kg: LMA size and inflation volume

Answer 7

• LMA 4
• up to 30 mL

Question 8

70-100kg: LMA size and inflation volume

Answer 8

• LMA 5
• up to 40 mL

Question 9

What is the purpose of a burette set?

Answer 9

Pre-fills a specific amount of fluid into the burette and stops flowing once that volume has been infused

• prevents overhydration of smaller patients

Question 10

How is fentanyl typically drawn up and prepared for pediatric cases?

Answer 10

Fentanyl 100mcg/2mL diluted in 10mL syringe → 10mcg/mL

Question 11

How is propofol typically drawn up and prepared for pediatric cases?

Answer 11

5-10mL syringes depending on child size

Question 12

Emergency pediatric meds should always have what with them?

Answer 12

IM needles in case pt does not have an IV

Question 13

What is the emergency dosages for pediatric epinephrine?

Answer 13

Epinephrine: 0.01 mg/kg

Question 14

What is the emergency dosages for pediatric succinylcholine? (IV and IM)

Answer 14

Succinylcholine

• IV: 2mg/kg
• IM: 4mg/kg

Question 15

What is the emergency dosages for pediatric atropine?

Answer 15

Atropine

• 0.02 mg/kg

Question 16

What is the emergency dosages for pediatric glycopyrrolate?

Answer 16

0.01 mg/kg

Question 17

What are typical premedications for pediatric anxiety? (&routes)

Answer 17

• Midazolam PO (most common)
• Dexmedetomidine IN
• Ketamine IM

Question 18

What is the PO premedication dose of Midazolam for pediatrics?

Answer 18

Midazolam

• PO: 0.25 - 1 mg/kg

Question 19

What is the IN premedication dose of Precedex for pediatrics?

Answer 19

Precedex

• IN: 1 - 2 mcg/kg

Question 20

What is the IM premedication dose of Ketamine for pediatrics?

Answer 20

Ketamine

• IM: 5-10 mg/kg

Question 21

Inhalation induction is common in what pediatric population?

Answer 21

children under 12 yrs

Question 22

What are primary indicators for necessary IV induction in pediatrics?

Answer 22

• RSI / full stomach / GERD
• Known difficult airway

need preoperative IV which may be traumatic

Question 23

What is the volatile of choice for pediatric inhalation induction?

Answer 23

Sevoflurane (typically 8%)

may often be mixed with N₂O or O₂

Question 24

If N₂O is used with an inhalation induction, when should it be turned off?

Answer 24

Turn off N₂O following loss of consciousness and prior to intubation and administer sevo with 100% O₂

Question 25

With an inhalational induction, when is the IV placed?

Answer 25

IV placed after patient is through stage 2, prior to airway placement

Question 26

What options are available to help mitigate IV placement in an awake pediatric pt?

Answer 26

* Premedication (PO versed) * EMLA cream

Question 27

What is the process for induction of a full stomach pediatric pt?

Answer 27

* Premedication * Equipment ready * Attempt PreO₂ * RSI with cricoid pressure *succinylcholine choice of NMB*

Question 28

What is the process of a mask induction with a pediatric patient?

Answer 28

* Premedication * Place monitors * Sevo +/- N₂O * IV placement * Medications * Airway *all monitors may not be able to be placed, need SpO₂*

Question 29

What is the process of an IV induction with a pediatric patient?

Answer 29

* IV Premedication * Place monitors * Preoxygenation * Medications * Airway

Question 30

Pediatric airway obstruction may be mitigated with what maneuvers?

Answer 30

* Head extension * Chin lift * jaw thrust * mouth opening * CPAP * Side positioning * OPA/NPA * Deepen anesthetic

Question 31

When positioning for adequate airway patency, what structures should be aligned?

Answer 31

Horizontal alignment of the external auditory meatus and the suprasternal notch

Question 32

What consideration should be made regarding ETT depth insertion?

Answer 32

Insert ETT balloon just past the vocal cords and stop, the pediatric trachea is much shorter and risk of main stem *dont let go of tube prior to tape/secure*