Pediatrics Part 2 Flashcards
what should be included on preoperative evaluations of the pediatric population
all illnesses review of organ systems previous hospitalization childhood syndromes medication list herbal remedies allergies (abx, latex)
herbal remedies are associated with what?
CV instability
coagulation disturbances
prolonged anesthesia
immunosuppression
common uses for Echinacea
prophylaxis and treatment of virla, bacterial and fungal infection
pharmacologic effects: stimulation of the immune system, long term use may be immunosuppressive
potential perioperative complications with Echinacea
reduced effectiveness of immunosuppressants
potential for wound infection
hepatoxicity
common use for ginseng
used to protect the body against stress and restore homeostasis; pharmacologic effects: possible potentiation of y-aminobutyric acid (GABA) transmission
potential perioperative complications with ginseng
potentiates sedative effects of anesthetic agents. possible withdrawal syndrome after sudden abstinence; kava-induced hepatoxocity
common use of garlic
antihypertensive, lipid lowering agent, anti-thrombus forming; pharmacologic effects: inhibits platelet aggregation (partially irreversibly) in a dose dependent manner. lowers serum lipid and cholesterol levels.
potential perioperative complications with garlic
may potentiate other platelet inhibitors, concerns for perioperative bleeding.
common use for st. johns wort (goat weed, amber, hard hay)
treatment of depression and anxiety; pharmacologic effects potentiation of GABA neurotransmission
potential perioperative complications with st. johns wort
potentiates sedative effects of anesthetic agents. withdrawal-type syndrome with sudden abstinence.
when should herbal remedies be discontinued?
2 weeks prior to surgery
active or resolving URI results in what potential complications?
increased airway reactivity
risk of atelectasis
mucus plugging
postop hypoxemia
if procedure is emergent and patient has active URI, what is the appropriate course of action?
must proceed
if procedure is elective and non urgent, what would alert you to the need to postpone for 4-6 weeks?
fever >38.4 C malaise productive cough wheezing rhonchi
if patient displays mild symptoms such as nonproductive cough, sneezing, nasal congestion what is the appropriate course of action?
proceed if regional or GA with mask; if requires ETT, wait 2-4 weeks
what should be evaluated preop for URI patients
hydration status
airway humidification
drugs like anticholinergic and beta agonists (helps airway secretions and hyperreactivity)
proceed with caution in these situations
child just has runny nose or is ‘much better’
active and happy child
clear rhinorrhea
clear lungs and symptoms that have leveled off
older child
hardship for parents to be away from work or insurnace will run out
no fever
outpatietn procedure that wont expose child to infectious agent
consider cancellation in these situations
parents confirm symtoms: fever, malaise, cough, poor appetitite, new symptoms
lethargic or ill appearing
purulent nasal discharge
wheezing, rales that don’t clear
<1 yr or ex premie
history or reactive airway disease, major operation, oett required
fever >38.5 C
inpatient procedure that exposese child to infection
are routine Hgb and UA indicated for most elective procedures?
no
when should Hgb levels be obtained?
procedures with potential for blood loss
specific risk factors for hemoglobinopathy
formerly preterm infants
<6mo of age
when should coags be obtained
major reconstructive surgeries
T&A
are routine CXRs necessary?
no
is pregnancy testing necessary?
yes; all those of childbearing age
what are some pharmacokinetic/dynamic considerationsf or the pediatric population?
TBW composition immaturity of metabolic degradation pathways reduced protein binding immaturity of BBB greater blood flow to vessel rich organs reductions in GFR smaller FRC increased MV immature receptor responses
