Procedural sedation PAEDS Flashcards
(31 cards)
If an IVC is not sited for sedation. What must be readily available in the room?
IVC equiptment including IO access
What can happen if ketamine is given as a quick push instead of over 60 seconds?
Risk of respiratory depression
Is emesis more likely with IV or IM ketamine?
IM
Is still a safe option
Preventative ondansetron does help
Bu
In what age group is ketamine sedation an absolute contraindication?
- < 1 month
- < 3 months
- < 6 months
- < 12 months?
< 3 months
Relative contraindication < 12 months
Does fasting
1) fasting a child
2) pretreatment with ondansetron
3) neither
reduce risk of emesis with nitrous oxide sedation?
Neither
2.6% risk of emesis no matter what you do
Three adverse reactions to ketamine sedation?
- vomiting (aspiration)
- laryngospasm
- emergency phenomena
Also increased tone, may not be best agent for joint reduction or for CT imaging
Also contraindication if raised intra-occular pressure
Starting dose for propofol sedation?
- 0.5 - 1mg/kg
What is the starting dose for ‘ketofol’ (does of each each)
- ketamine 0.5mg/kg IV
- propofol 0.5mg/kg IV
Halve the dose for each
You are doing propofol sedation and your pt becomes hypotensive. They are 6 years old (20kg). What can you do to increase the BP?
- fluid bolus 10 - 20 ml/kg = 200 - 400ml
- adrenaline bolus 10 IV
Adrenaline bolus dose 0.1mcg/kg but 20mcg probably a bit much
Also stop giving any further propofol
Your pt has an active asthma flare and also a laceration needing repair. What is the risk with nitrous oxide sedation?
Gas trapping in lungs. Use alternative agent
What age is nitrous oxide contraindicated in?
- < 1 month
- < 3 months
- < 6 months
- < 12 months
Age < 12 months
Anaglesic dose for oral oxycodone?
0.1 - 0.2mg/kg PO
analgesic oral dose for tramadol? What age group is ok to use in?
0.5 - 2mg/kg PO/IV
Age > 12
oral dose same as IV
What is the dose of 25% sucrose for a painful procedure?
0.1 - 0.5ml PO repeat up to 2ml
Max 5ml daily
Young infants
Intranasal anaglesic dose for ketamine?
1mg/kg intranasal/NEB
tastes unpleasant
Anaglesic dose of intranasal dexmedotomidine?
1mcg/kg IN/NEB
sedation dose is 3-4mcg/kg IN
Analgesic dose IV morphine?
0.05 - 0.1mg/kg IV age < 3 months
0.1 - 0.2mg/kg age < 3 months
Analgesic dose IV fentanyl?
1 -2 mcg/kg IV/IM
Anaglesic dose of ketamine IV
0.25 - 0.5mg/kg IV
Dose for analgesic infusion of ketamine?
0.1 - 0.3mg/kg IV / hour
Dose of IV naloxone?
10mcg/kg IV
Dose of topical laceraine?
0.1ml/kg
Age 1-3 years max 2ml
age 3- 18 max 3ml
Needs > 20 minutes of good wound contact
May require supplemental subcut lignocaine
Contains: 4% lidocaine, 0.5% tetracaine and adrenaline 1:1000
Max dose lignocaine sub sut? with and without adrenaline?
3mg/kg without
7mg/kg with
1ml 10% = 10mg/ml
Dose regional block 0.25 - 0.5% bupivacaine?
2mg/kg
Volume 0.8ml/kg of 0.25% if < 20kg
Volume 0.4ml/kg 0.5% if > 20kg
Max 30ml
Onset 15- 30 min
Duration 7 -14 hours
More cardiotoxic than ropivacaine
