Pedi Anesthesia 2

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Author:
ariadne9
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265815
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Pedi Anesthesia 2
Updated:
2014-03-13 16:04:47
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BC Nurse Anesthesia
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Adv principles
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  1. Avg EBL for tonsillectomy
    4 ml / kg
  2. considerations r/t T+A
    • OSA
    • speech d/o
    • obligate mouth breathing
    • dental abn
    • FTT
    • upper airway narrowing
  3. T+A pre-op assessment
    • BMI
    • h/o URI
    • med use (aspirin)
    • physical exam
    • mouth breathing
    • chest retractions
    • swallowing issues
    • OSA symptoms
    • speech / hearing difficulties
  4. T+A anesthetic management
    • calm controlled induction
    • deep intubation
    • prevent bleeding
    • deep vs. awake extubation
    • possible severe pain post-op- steroids may decrease pain from swelling
  5. T or F, deep extubation is associated with fewer airway complications?
    F, there's no difference
  6. What type of airway circuits are commonly used for pedi?
    Semi closed circuits, like normally used for adults
  7. Disadvantages in using semi closed circuits with small infants
    • increased rx with spontaneous breathing (insp and exp valves)
    • large volume of absorber system acts as a reservoir for anesthetic agents
    • large compression volume of tubing
  8. Reservoir bag volume for a child
    Should accommodate child's VC
  9. Newborn reservoir bag volume
    500 ml
  10. Child 1-3 yo reservoir bag volume
    1L
  11. Child > 3 yo reservoir bag volume
    2L
  12. Components of the ideal pedi breathing circuit
    • No CO2 rebreathing
    • Low rx to breathing
    • Lightweight
    • Unidirectional valves or high gas flows
    • Conserve heat and moisture as much as possible
  13. The Mapleson D circuit is recommended for kids < ____ kg.
    10 as it is more sensitive to gas change flows and humidification and actual volume delivered is greater than other circuits
  14. Pedi pre-op assessment
    • Gestational age and weight- (L or R of normal)
    • Events during L+D, APGAR scores
    • Neonatal illness and hospitalizations
    • congenital anatomic and metabolic issues
    • prev surgeries / anes issues
    • family h/o anes issues
    • recent URI / croup / asthma
  15. T or F, a child < 1 year old with a URI has an increased risk of respiratory related adverse events intra-op and post-op
    T
  16. Symptomatic infants with URI have an increased time to desat during apnea
    F, decreased time to desat
  17. Temporary airway hyper reactivity may exist for ____ after a viral infection
    6 weeks
  18. Most complications seen in older kids (> 1 y.o.) with mild, non acute, non purulent URI are mild and easily treatable, T or F?
    T
  19. Interventions for a child with non purulent rhinitis and URI
    • Pretreat with atropine for muscarinic blockade
    • Warm humidified air
    • Avoid DL if possible
  20. Fasting guidelines 
    < 6 mo
    milk and solids
    4 hours
  21. Fasting guidelines 
    < 6 mo
    clear lix
    2 hours
  22. Fasting guidelines 
    6-36 mo
    milk and solids
    6 hrs
  23. Fasting guidelines 
    6-36 mo
    clear lix
    3 hrs
  24. Fasting guidelines 
    >36 mo
    milk and solids
    8 hours
  25. Fasting guidelines 
    >36 mo
    clear lix
    3 mo
  26. Formula is considered a liquid, T or F?
    F, solid
  27. What types of fears r/t surgery do grammar school kids typically have?
    Fear of mutilation, blood, gore, death
  28. Child related risk factors for post-op delirium
    • ages 1-5 years
    • bad previous experiences
    • shy and inhibited children
    • lack of development- maturity and social adaptability
    • high cognitive levels
    • isolated
  29. Parent related risk factors for post-op delirium
    • anxiety, high strung
    • divorced
    • multiple surgical procedures
  30. Environment related risk factors for post-op delirium
    • Sensory overload
    • Conflicting messages
    • OR
  31. T or F, infants < 6 mo frequently need sedation
    F, rarely require sedation
  32. Strategy for participation with school age kids
    games / participation
  33. Mapleson D and Bain circuits are examples of _____ circuits
    open
  34. Mapleson D and Bain circuits are useful for small infants b/c ?
    allows them to breath spontaneously with minimal rx
  35. Separation anxiety occurs between what ages?
    1-3 yo
  36. Strategies for dealing with induction for a school age child
    • encouraging
    • supportive
    • complementary
    • positive comments
  37. Teen concern with surgery
    fear of embarrassment / being seen naked
  38. Goal of pre-op sedation
    smooth separation from parents and ease the induction of anesthesia
  39. When does sep anx begin to develop
    6-9 mo
  40. Infants < 6 mo, how to ease transition into OR / induction
    keep warm, cuddle, pacifier
  41. Is it acceptable to give school age kids details about their surgeries?  
    • Avoid too much detail as they are very literal thinkers
    • Avoid similes/ metaphors
  42. contra-ind to pre-op sedation
    • altered mental status (acute- trauma)
    • elevated ICP
    • difficult airway (unless part of difficult airway strategy)
    • hypovolemia
    • respiratory dysfunction
  43. Midaz pre-op sedation dose
    PO
    IM
    max dose of each
    • PO 0.5-1 mg (peaks in 30 mins), max 20 mg
    • 0.1-0.3 mg IM, max 10 mg
  44. Fent pre-op sedation dose
    • 10-15 mcg/ kg (onset 5-20 mins)
    • Intranasal 2 mcg /kg
  45. Ketamine pre-op sedation dose
    IM
    PO
    IV
    • IM 4-10 mg / kg
    • PO 8 mg / kg 
    • IV 1-2 mg / kg
  46. What meds should be given with pre-op ketamine
    midaz and glyco
  47. Atropine IM/ PO dose and IV dose
    • IM/ PO 0.02 mg/ kg
    • IV 0.01 mg/ kg (onset 2 mins)
  48. What size bag of IVF should be used for kids < 3 yo
    250 cc
  49. Laryngoscope blade sizes:
    preterm / neonate
    neonate to age 1.5 years
    age 1.5 - 4
    age 3 and over
    • preterm / neonate Miller 0
    • neonate to age 1.5 years Miller 1
    • age 1.5 - 4 Wis-Hippel 1.5
    • > 3 yo Miller 2 or MAC 2
  50. Formula to calculate ETT size
    ETT diameter (uncuffed) = 16 + age (years) / 4
  51. How should tube size derived from the formula be modified if a cuffed tube is desired?
    Go down a half size
  52. Formula to determine ETT length at lip in cm
    age + 10
  53. Adv to using a non cuffed ETT
    • Cuffs increase risk of airway mucosal injury
    • Cuffs unnecessary b/c appropriately sized uncuffed tubes seal well at cricoid ring
    • Adding a cuff necessitates a smaller tube, which increases airway rx and WOB
  54. Describe how to perform a slow mask induction
    • Child selection- cooperative and will breathe when instructed
    • Give 70% N20 until child relaxes
    • Then increase sego by 1/2 % per breath
  55. Describe how to perform a "single breath" mask induction
    • Child selection (ages 1-3 yo) or uncooperative child
    • Close APL
    • Sevo up to 8%, 70% N20
    • Obstruct circuit and fill with agent
    • Open APL
    • Have child breath agent
  56. T or F, mask inductions are typically used for intubation?
    F, for IV placement, then intubated is performed with IV agents
  57. Pedi epi dose
    0.01 mg/ kg
  58. Pedi atropine dose
    0.02 mg / kg
  59. When masking a child CPAP of __ to __ cmH20 is desired.
    10 to 15
  60. What factors account for kids faster inhalation induction
    • Rapid rise in Fa/Fi
    • Lower FRC
    • Higher alveolar ventilation
    • Higher blood flow to VRG
  61. T or F, a slight tube leak is desired?
    T
  62. What effects can head movement have on ETT position in infants and small children?
    • Head extension can cause extubation
    • Neck flexion may cause right main stem intubation
  63. In general, kids <___ yo get (cuffed or uncuffed?) tubes?
    • 8
    • uncuffed
  64. Describe emergence delirium in pedi
    Dissociative state of consciousness in which the child is irritable, uncompromising, uncooperative, incoherent, inconsolable crying, moaning, kicking, thrashing
  65. How long does ED typically last in pedi?
    5-15 mins, usually self limiting
  66. Factors that may contribute to ED
    • rapid emergence
    • anesthetic choice
    • pain
    • surgery type (tonsils, thyroid, middle ear)
    • age 2-5
    • pre-op anxiety
    • temperament
  67. Newborn O2 consumption
    5-8 ml / kg/ min
  68. Child O2 consumption
    4-6 ml / kg/ min
  69. Adult O2 consumption
    3-5 ml / kg / min

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