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AS - N934 Advanced Principles II > Pediatric Preop, Set-up, & Induction > Flashcards

Pediatric Preop, Set-up, & Induction Flashcards

(51 cards)

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1
Q

What pediatric population has the highest adverse events rate?

A

Infants < 1mos

  • Bradycardia
  • Respiratory complications
  • Cardiac arrest (hyperkalemia)
  • Medicated related
  • Equipment related
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2
Q

Pediatric Anesthesia M&M

A

Adverse events 35%

Adults only 17%

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3
Q

Newborns

A

1-28 days

Up to 1mos

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4
Q

Infants

A

1mos up to end 1st year

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5
Q

Children

A

2-5yo

Toddlers

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6
Q

School-Age

A

6-14yo

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7
Q

Adolescents

A

14-18yo

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8
Q

Psychological Aspects

0-6mos

A

Not usually affected by separation from parents
Prolonged separation potential to impair parent-child bonding
Minimal premedication requires

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9
Q

Psychological Aspects

6mos-4yo

A

Separation anxiety
Fear hospitals/hospitalization
Regressive behaviors common

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10
Q

Psychological Aspects

School-Age Children

A

Less upset by separation from parents

Ask questions, involved, want choices, more concerned w/ surgical procedure & potential affects on body image

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11
Q

Psychological Aspects

Adolescents

A

Fear narcosis process, loss control, waking-up during surgery, and pain
Value modesty
HCG testing in females (> 14yo)

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12
Q

Psychological Aspects

Parents

A

Provide what to expect explanations

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13
Q

Assent vs. Consent

A

Assent - agree to take part when unable to give legal consent to participate (< 18yo)
Consent - to give permission for something to happen (informed surgical consent given by parents or legal guardian)

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14
Q

Parental Presence at Induction

Considerations

A 
Prepare parents what to expect
Adequate preop sedation
Parental anxiety level
Language barriers
Emergency or RSI 
Anticipated difficult airway
Unstable patient
Pregnant mother
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15
Q

Patients to check preop Hgb:

A 
Neonates
Premature infants
Cardiopulmonary disease
Known hematological dysfunction
Anticipated blood loss
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16
Q

URI

A

Common viral infection or more serious RSV/COVID
Irritable airway ↑laryngospasm, bronchospasm, post-intubation croup, atelectasis, pneumonia, & desaturation risk
LMA > ETT
Reschedule elective surgery 2-4 weeks
Lower respiratory infection 6-8 weeks

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17
Q

When to postpone surgery?

A 
Elective
Febrile
↑WBC
Productive/purulent sputum
Worsening or acutely ill
Malaise
Tachypnea
Wheezing
Lethargy
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18
Q

URI Anesthetic Management

A 
Adequate hydration & oxygenation
↓secretions
Limit airway manipulation
Bronchodilators β2 agonist
Anticholinergics
Muscle relaxants to treat laryngospasm
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19
Q

URI Complications Associated w/ GA

A

ETT
Asthma or reactive airway
↓tracheal mucociliary flow & pulmonary bactericidal activity
PPV potential to spread the infection from upper to lower airways

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20
Q

Still’s Murmur

A

2-6yo functional systolic murmur

Outgrow w/o intervention

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21
Q

When to follow-up undiagnosed murmur w/ cardiac evaluation?

Study These Flashcards
A 
Difficulty feeding
SOB
Poor exercise tolerance
Family history CHD
Cyanotic episodes
Abnormal peripheral pulses
Unequal BPs in upper vs. lower extremities
22
Q

Midazolam

Study These Flashcards
A

Most common oral premedication
0.5mg/kg PO
Max 20mg
Concentration 2 or 5mg/mL

23
Q

What patients to avoid premedication?

Study These Flashcards
A 
CHD
↑ICP
OSA
Sepsis
Trauma
Suspected difficult airway
24
Q

Nasal Premedications

Study These Flashcards
A

Midazolam 0.2mg/kg
Ketamine 3mg/kg
Dexmedetomidine 1-2mcg/kg (delayed onset)

25
MAP Formula
[(DBP x 2) + SBP] / 3
26
Pediatric patients w/ potential unstable cervical spine:
Down syndrome - subluxation risk | Trauma
27
Straight Blade
Miller < 1yo
28
ETT Sizing
``` Premature 2-2.5 uncuffed Term 3 3-9mos 3-3.5 9-18mos 3.5-4 18-36mos 4-4.5 >36mos → (Age/4) + 3.5 = cuffed size ```
29
ETT Depth
< 3kg 1-2-3kg → 7-8-9cm @ lips | > 3kg internal diameter x3 (4.0 ETT @ 12cm)
30
Emergency Medications
Atropine 0.4mg/mL Succinylcholine 20mg/mL Epinephrine 1-100mcg/mL
31
What emergency medications require IM needles?
Atropine 22G | Succinylcholine 22G
32
Atropine
``` Dose 0.02mg/kg 0.4mg/mL < 10kg 1mL TB syringe > 10kg 3mL syringe 22G IM needle ```
33
Succinylcholine
Dose 0.25-2mg/kg 20mg/mL 3mL syringe 22G IM needle
34
Epinephrine
100mcg/mL 1:1,000 g:mL (Omnicell) 10mcg/mL 1:100,000 g:mL (pharmacy) Neonate 1mcg/mL
35
Fluids < 30kg
Buretrol fill to 10mL/kg | Double stopcock, extension, & T-piece
36
Fluids > 30kg
Macro drip tubing
37
UNC Fluids
0-2yo → Buretrol 3-9yo → micro drip tubing > 10yo → macro tubing
38
Anesthesia Circuit
Small enough to sense small Vt & large enough to administer vital capacity breath Neonatal 0.5L 1L reservoir bag < 30kg 3L reservoir bag > 30kg
39
Inhalational Induction
Pacifiers okay (size-up mask) 1-2min N2O + O2 Then introduce Sevo & rapidly ↑6-8% Reduce to 4-5% to prevent overdose & assist ventilation Consider oral airway Place IV after stage 2 & prior to airway instrumentation 100% FiO2 during IV placement
40
IV Anesthesia Induction
Most reliable & rapid Necessary when inhalation induction contraindication (difficult airway, full stomach, or cardiac instability) N2O w/ IV placement to provide analgesia Topical anesthetics EMLA or ethyl-chloride spray Ideal to pre-oxygenate w/ 100% FiO2 prior to IV induction, but not always possible w/ uncooperative patients
41
Maximum IM Administration Volume
Infant 0.5mL (vastus lateralis) Toddler 0.5mL (deltoid) or 0.5-1mL (vastus lateralis) Pre-school 0.5mL (deltoid) or 1mL (vastus lateralis) School-age 0.5-1mL (deltoid) or 1.5-2mL (vastus lateralis)
42
IV Gauges
Neonate 24G Infants 22-24G Children 20-22G
43
Arterial Line
IV catheter vs. A-line device > 2yo 22G < 2yo 24G Babywire 0.012 (24G)
44
Caudal Anesthesia +
Epidural - Intra/postop analgesia - ↓systemic opioid requirements & associated side effects - ↓anesthesia requirements
45
Caudal Anesthesia | Procedures
``` Circumcision Inguinal herniorrhaphy Hypospadias Anal surgery Clubfoot repair Sub-umbilical procedures ```
46
Caudal Anesthesia | Contraindications
Infection around the site Coagulopathy Anatomic abnormalities Parent refusal
47
Caudal Dosing
Genital & anal surgery 0.5-0.75mL/kg Lower abdomen or extremity 1mL/kg Abdominal incision 1-1.25mL/kg
48
Caudal Local Anesthetics
Lidocaine 5mg/kg or 7mg/kg + Epi Bupivacaine 2.5mg/kg or 3mg/kg + Epi Ropivacaine 2.5mg/kg or 3mg/kg + Epi Epinephrine 5mcg/kg
49
Caudal + Clonidine
1-2mcg/kg ↑DOA 2-3hrs Sedation, hypotension, respiratory depression Avoid co-admin w/ Dexmedetomidine
50
PACU
``` Ambu-bag Oxygen source Monitoring Emergency medications Pain medication Emergence delirium Lateral position ```
51
Emergence Delirium | Treatment
Dexmedetomidine Propofol Fentanyl

AS - N934 Advanced Principles II (18 decks)

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