Sedation and GA Flashcards
Do kids have a higher or lower drug requirement than adults and why?
Higher due to greater volume of distribution
Do kids have a higher or lower drug requirement than adults and why?
Higher due to greater volume of distribution
What is a consideration as far as drug metabolism for children?
They have a lower concentration of liver enzymes
What makes a sedation more challenging on a child?
Airway
What are 3 differences of a pediatric airway?
- Larynx more anterior
- Vocal cords have anterior slant
- Epiglottis is stiff
Are children small adults?
No
What does the high surface are to weight ratio mean for children?
They lose heat more easily
Why do children desaturate faster than adults?
A smaller thorax has less expansive capacity, therefore have less functional reserve
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)?
Sedation
Does sedation make an uncooperative child cooperative?
No
What are goals of sedation?
- Quality care
- Minimize disruptive bheavior
- Patient welfare and safety
- Physiologic state with safe discharge
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?
Minimal sedation
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)?
Moderate sedation
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)?
Deep sedation
What is a drug-induced loss of consciousness during which the patient is not arousable, even by painful stimuli, cannot maintain ventilator function?
General anesthesia
If doing sedation, what level of sedation should you be prepared for?
Deeper level than intended
What are 5 routes of drug administration?
- Oral
- Rectal
- Intramuscular
- Inhalational
- IV
What is a major disadvantage of oral route for sedation?
Cannot titrate dose once given, so deal with the level you get
A child with pharyngeal space that occupies more than 50% (Brodsky III or IV?) is at increased risk of what during sedation?
Respiratory obstruction
What are 3 things children are more susceptible to with respect to cardiovsacular function and sedation?
- Bradycardia
- Decreased Cardiac output
- Hypotension
What Brodsky class is it where the tonsils occlus the pharyngeal space less than 25%?
Brodsky Class I
What Brodsky class is it where the tonsils occlus the pharyngeal space 25-50%?
Brodsky Class II
What Brodsky class is it where the tonsils occlus the pharyngeal space 50-75%?
Brodsky Class III
What Brodsky class is it where the tonsils occlus the pharyngeal space more than 75%?
Brodsky Class IV
