What are the anesthesia considerations for ENT surgery?
Assess for difficult airway and mask
Consult with surgeon and family
Smooth, deep induction (communicate effectiveness of ventilation)
Minimize narcotics and optimize non narcotic pain management
Discuss emergence with surgeon (effective communication with OR personnel).
Awake vs deep extubation.
Strict monitoring while transporting and reporting to PACU
What are the anesthetic considerations for a T & A?
Calm controlled induction (caution with preoperative medications)
Assess ability to ventilate. May need to reposition or utilize another provider.
Gentle, deep intubation.
Prevent bleeding. (4ml/kg)
Maintain correct level of anesthetic depth and prepare for incision.
Actively communicate with surgeon and plan for emergence.
Recognize proper emergence criteria:Establish plan for deep vs. awake extubation.
Post operative pain may be severe after tonsillectomy (laser or electrocautery).
Steroids have been found to be efficacious in decreasing pain from swelling.
Local infiltration is more beneficial for blood loss reduction rather than pain reduction
What are the disadvantages with small infants and a semi closed circuit?
Increased resistance with spontaneous breathing (inspiratory and expiratory valves)
Large volume of absorber system acts as a reservoir for anesthetic agents
Large compression volume of tubing
What type of breathing circuit is used for small infants?
Nonrebreathing, open circuit (Mapelson D or Bain)
Rebreathing is prevented with high flows (2-2.5 x MV)
Useful for very small infants to breath spontaneously. (Capnography essential)
Reservoir bag volume should accommodate child’s Vital Capacity. What are the guidelines for bag sizes?
500 ml bag for newborns
1000ml bag for 1-3 years
2000 ml bag for children older than 3
What are our concerns with URI in pediatrics?
Children with URI, particularly less than 1 year of age, have an increased risk of respiratory related adverse events intraoperatively and postoperatively
Symptomatic infants with URI have a decreased time to desaturation during apnea.
Endotracheal intubation seems to be a major risk factor for hypoxemia, bronchospasm, and atelectasis in children with URI.
Temporary airway hyperreactivity may exist for 6 weeks after a viral infection. Most complications seen in older children (> 1 year of age), with mild, nonacute, nonpurulent URI are mild and easily treatable.
What are the NPO guidelines for breastmilk?
BM is a solid but for kids younger than 6M it’s 4 hours, for those older than 6M to 3yr, it’s 6hr and then it’s 8 hours.
How do you prepare each age for induction ?
Infant < 6months rarely need sedation
Separation anxiety for children 1-3 years old. (stormy inductions)
Incorporate play or active participation with preschool age children (3-6y). (Mastery and participation)
Encouraging, supportive, complementary, positive comments with school age child.
Protection from harm and embarrassment in older children.
What are some contraindications for pre-op sedation?
altered mental status (acute), elevated ICP, difficult airway, hypovolemia, or respiratory dysfunction.
What is the dosing for pre-op sedation Midazolam?
0.5-1 mg/kg po not to exceed 20 mg( peak effect in 30 minutes)
0.1- 0.3 mg/kg IM not to exceed 10mg.
What is the dosing for pre-op sedation for Methohexital?