Pediatric Anesthesia pt2.2 Flashcards
(33 cards)
3 goals for perioperative fluid management?
- Maintenance requirements
- Replace preop deficit
- Compensate for ongoing loss
What is the 4-2-1 fluid maintenance calculation?
- 4mL/kg for first 10kg
- 2mL/kg for second 10kg
- 1mL/kg for remaining kg
Ex: 50kg = 90mL/hr
How timely should fluid volume be replaced? (maintenance x NPO time)
- 1st hour: 1/2 fluid deficit
- 2nd hour: 1/4 fluid decifit
- 3rd hour: 1/4 fluid deficit
Ex: 500mL total deficit: 250 1st in hour, 125 in 2nd hr, 125 in 3rd hr
How much fluid replacement should be avoided in pediatric patients?
Don’t give more than 20mL/kg in any given hour (when doing 4-2-1 replacement)
For third-space fluid losses, what rates should be replaced for minimal/moderate/severe?
- Minimal: 3-4 mL/kg/hr
- Moderate: 5-6 mL/kg/hr
- Severe: 7-10 mL/kg/hr
Glucose-containing fluid replacement is warranted in which pediatric populations?
Critically ill infants and those weighing <10kg
prone to hypoglycemia with prolonged fasting periods
What fluid replacement should be utilized for symptomatic hypoglycemia?
IV 10% Dextrose 2mL/kg
If seizures present: 4mL/kg
What is the EBV of a premature infant? Full-term neonate?
Premature: 90-100 mL/kg
Full-term: 80-90 mL/kg
What is the EBV for a 3mo - 3 yr old?
75-80 mL/kg
What is the EBV for a child 3-6yrs? What about >6yrs?
3-6yr: 70-75 mL/kg
>6 yr: 65-70 mL/kg
What formula is used for maximum allowable blood loss (MABL)?
MABL = EBV x (initial Hct - target Hct) / initial Hct
typical target Hct = 30%
What ratio should blood loss be replaced with crystalloids? What about with PRBCs?
- Crystalloids:
3:1 replacement - PRBCs:
1:1 replacement
How is PRBC volume replacement calculated?
PRBC volume = (desired Hct - current Hct) x EBV / PRBC Hct
PRBC Hct = 60%
What volume of PRBC administration is needed to raise the Hgb by 1g/dL?
4mL/kg PRBC raises Hgb by 1g/dL
Pediatric population at high risk of postoperative apnea and that must stay overnight in hospital? (contraindicated for outpatient anesthesia)
Infants born premature <35 weeks or those <60 weeks of post-conceptual age
What are major contributors to perioperative hypothermia?
- Cold OR
- Anesthetic-induced vasodilation
- cool IV fluids
- Evaporative heat loss
- Irrigating solutions
- cool/dry anesthetic gas inspiration
What primary interventions can be made to prevent perioperative heat loss in pediatrics?
- Radiant heat lamps
- Bair-hugger
- warm IV fluids
keep head warm
What considerations should be made with deciding for deep vs awake extubation in pediatrics?
- difficult airway = awake
- RSI = awake
- reactive airway = deep
- surgery specifics (prevent post surgical coughing)
What are anesthetic contributors to postoperative apnea?
- Residual anesthetic
- Opioids
- Muscle relaxants
- Sedatives
- Prolonged intubation/ventilation
What are metabolic contributors to postoperative apnea?
- Hypothermia
- Hypoglycemia
- Hypocalcemia
- Acidosis
What primary treatment can be used to stabilize respiratory rhythm with an apneic premature infant?
Caffeine 20mg/kg
CPAP
maintenance caffeine ~5mg/kg/day
Emergence agitation and delirium has an incidence of ____ in pediatric populations?
Emergence agitation and delirium has an incidence of 10-80% in pediatric populations?
Some common causes of agitation in pediatric patients are?
- Pain
- Cold
- Full bladder
- fear/anxiety
- parental separation
What are primary risk factors for emergence delirium in pediatric patients?
- Age 2-9
- Anesthetic gas
- Pre-existing Hx
- anxiety or parental anxiety
- pain
