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xD3 Pedo Midterm > Sedation and GA > Flashcards

Sedation and GA Flashcards

1
Q

Do kids have a higher or lower drug requirement than adults and why?

A

Higher due to greater volume of distribution

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2
Q

Do kids have a higher or lower drug requirement than adults and why?

A

Higher due to greater volume of distribution

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3
Q

What is a consideration as far as drug metabolism for children?

A

They have a lower concentration of liver enzymes

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4
Q

What makes a sedation more challenging on a child?

A

Airway

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5
Q

What are 3 differences of a pediatric airway?

A
  1. Larynx more anterior
  2. Vocal cords have anterior slant
  3. Epiglottis is stiff
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6
Q

Are children small adults?

A

No

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7
Q

What does the high surface are to weight ratio mean for children?

A

They lose heat more easily

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8
Q

Why do children desaturate faster than adults?

A

A smaller thorax has less expansive capacity, therefore have less functional reserve

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9
Q

What produces a minimally depressed state of consciousness but the patient is still able to maintain patent airway independently and continuously (patient is able to respond appropriately to physical stimulation and verbal commands)?

A

Sedation

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10
Q

Does sedation make an uncooperative child cooperative?

A

No

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11
Q

What are goals of sedation?

A
  1. Quality care
  2. Minimize disruptive bheavior
  3. Patient welfare and safety
  4. Physiologic state with safe discharge
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12
Q

What is an axiolytic level of sedation where the patient can respond normally to verbal commands with possible cognitive function and coordination impairment, but ventilation and cardio is unaffected?

A

Minimal sedation

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13
Q

What is conscious sedation of drug-induced depression of consciousness where patients respond purposefully to verbal commands, can expect age-appropriate behavior in conscious sedated child (e.g. crying)?

A

Moderate sedation

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14
Q

What is a drug-induced depression of consciousness where patient cannot easily be around but responds purposefully after repeated verbal / painful stimuli (ventilatory function may be imparied)?

A

Deep sedation

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15
Q

What is a drug-induced loss of consciousness during which the patient is not arousable, even by painful stimuli, cannot maintain ventilator function?

A

General anesthesia

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16
Q

If doing sedation, what level of sedation should you be prepared for?

A

Deeper level than intended

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17
Q

What are 5 routes of drug administration?

A
  1. Oral
  2. Rectal
  3. Intramuscular
  4. Inhalational
  5. IV
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18
Q

What is a major disadvantage of oral route for sedation?

A

Cannot titrate dose once given, so deal with the level you get

19
Q

A child with pharyngeal space that occupies more than 50% (Brodsky III or IV?) is at increased risk of what during sedation?

A

Respiratory obstruction

20
Q

What are 3 things children are more susceptible to with respect to cardiovsacular function and sedation?

A
  1. Bradycardia
  2. Decreased Cardiac output
  3. Hypotension
21
Q

What Brodsky class is it where the tonsils occlus the pharyngeal space less than 25%?

A

Brodsky Class I

22
Q

What Brodsky class is it where the tonsils occlus the pharyngeal space 25-50%?

A

Brodsky Class II

23
Q

What Brodsky class is it where the tonsils occlus the pharyngeal space 50-75%?

A

Brodsky Class III

24
Q

What Brodsky class is it where the tonsils occlus the pharyngeal space more than 75%?

A

Brodsky Class IV

25
Q

What is the risk if NPO is not followed prior to sedation?

A

Pulmonary

26
Q

How close to sedation can the patient have clear liquids?

A

2 hours

27
Q

How close to sedation can the patient have breast milk?

A

4 hours

28
Q

How close to sedation can the patient have infant formula?

A

6 hours

29
Q

How close to sedation can the patient have a light meal such as toast and clear liquids?

A

6 hours

30
Q

What is the most common serious complication with pediatric sedation?

A

Compromised airway or depressed respirations

31
Q

Why would antihistamine be given in a sedation?

A
  1. Aide sedation

2. Combat nausea (antiemetic)

32
Q

What are the sedation drug classes?

A
  1. Choral hydrate
  2. Benzodiazepines (Diazepam)
  3. Narcotics (Meperidine)
33
Q

What is the oral sedation success rate?

A

60%

34
Q

Should a patient expect to get a sedation on their first appointment?

A

No. First will be a consultation. The second will be the sedation.

35
Q

Would a patient with extensive operative needs be a good candidate for sedation and why?

A

No. Length of treatment might exceed time of sedation effects. Patient is better served via general anesthesia (GA)

36
Q

What is an inherited disorder of skeletal muscle triggered by depolarizing muscle relaxants and inhalational agents, particularly succinylcholine (paralytic for intubation (symptoms are tachycardia, increased end tidal CO2, decreased O2 saturation, dysrhytmia, masseter rigidity)?

A

Malignant hyperthermia

37
Q

What are 4 stages of general anesthesia?

A
  1. Analgesia and Amnesia
  2. Dreams and Delirium
  3. Surgical Anesthesia
  4. Medullary Paralysis
38
Q

What is the GA stage where a patient experiencing blurry thoughts after administration of anesthetic fo GA?

A

Stage I analgesia and amnesia

39
Q

What is the GA stage where patient loses consciousness, patient may appear to struggle?

A

Stage II dreams and delirium

40
Q

GA stage where the patient has progressive loss of reflexes with gradual paralysis of muscles?

A

Stage III surgical anesthesia

41
Q

What is the GA stage where a patient is in the time between respiratory arrest and cardiac collapse?

A

Stage IV medullary paralysis

42
Q

What is the difference with induction of GA for pedo and adult?

A

Pedo give inhalational first, then start IV. Reversed in adults?

43
Q

What is the risk of cardiac arrest with GA?

A

1.4 in 10,000

44
Q

What inhalation has an increased risk associated so it is not used?

A

Halothane, we use Sevo or Desflurane

xD3 Pedo Midterm (8 decks)

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