Pediatric Anesthesia

Front 1

A childs NPO status prior to surgery

Back 1

Solids are prohibited within 6 to 8 hours of surgery (generally after midnight), formula within 6 hours, breast milk within 4 hours of surgery, and clear liquids within 2 hours of surgery.

Front 2

Uncuffed ET sizing for children older than 1 yr

Back 2

(16 + age)/4

Front 3

most common regional technique in kids?

Back 3

caudal block, GU and lower abd surgeries

Front 4

Kids v. adults
- head size
- airway

Back 4

Larger head size relative to body
Narrowest diameter is below the glottis at cricoid

Front 5

Kids v. adults
- resp physiology

Back 5

Oxygen consumption is 2 to 3 times greater in infants than adults. FRC ranges from 8–13 mL/kg < 1/3 as large as adults

Front 6

Kids v. adults
- cardiovascular physiology

Back 6

Relatively fixed stroke volume in neonates and infants
Bradycardia must be treated aggressively in young age groups; consider atropine prior to airway management; heart rates less than 60 require circulatory support

Front 7

Kids v. adults
- renal physiology

Back 7

Limited GFR at birth; does not reach adult levels until infancy; total body water and % extracellular fluid are increased in the infant
Prolonged duration of action for hydrophilic drugs, particularly those that are renally excreted

Front 8

Kids v. adults
- hepatic physiology

Back 8

P450 system not fully developed in neonates and infants; liver blood flow decreased in newborns

Front 9

Kids v. adults
- BSA

Back 9

Larger surface-to-body ratio in newborns/infants/toddlers
heat loss more of a problem

Front 10

Kids v. adults
psychological function w/ age

Back 10

0–6 mo—stress on family
8 mo–4 yr—separation anxiety
4–6 yr—misconceptions of surgical mutilation
6–13 yr—fear of not “waking up”
≥13 yr—fear of loss of control, body image issues

Front 11

Current URI in kids predisposes them to?

Back 11

to develop laryngospasm, bronchospasm, oxygen desaturation, postextubation croup, and postoperative atelectasis

Front 12

what labs do healthy children need before anesthesia?

Back 12

none

Front 13

what percentage of children do not respond to oral midazolam and which group of children is it?

Back 13

14% to a dose of 0.5 mg/ kg. This unresponsive group of children is reported to be younger (4.2 ± 2.3 vs. 5.9 ± 2.0 years) and to have high levels of preoperative emotionality. Higher doses of midazolam (0.75 mg/kg) may be more appropriate in these nonresponders

Front 14

dose of IM midaz and ketamine for premed

Back 14

0.3 mg/kg for midaz
3-5 mg/kg for ketamine

Front 15

how does MAC differ in children?

Back 15

There is actually a small increase in MAC between birth and 2 to 3 months of age, which represents the age of highest MAC requirement. After that time MAC slowly decreases with age. For sevoflurane the change in MAC is marked, with a value of approximately 2.5% for young infants compared with 2% for adolescents and adults

Front 16

Effect of L-R and R-L shunt on mask induction?

Back 16

A right-to-left shunt slows the inhaled induction of anesthesia because anesthetic concentration in the arterial blood increases more slowly. A left-to-right shunt should have the opposite effect; volatile agent induction is more rapid because the rate of anesthetic transfer from the lungs to the arterial blood is increased.

Front 17

Sevo on emergence in peds

Back 17

more agitation, can be pre-medicated.

Front 18

problem w/ halothane for mask induction?

Back 18

slower than sevo and causes myocardial suppression

Front 19

Disadvantage of iso for mask induction?

Back 19

pungent odor and high incidence of laryngospasm when this agent is used for inhaled induction of anesthesia
slow emergence. should not be used

Front 20

propofol induction for children?

Back 20

3 to 4 mg/kg for children younger than 2 years to approximately 2.5 to 3 mg/kg for older children.

Front 21

induction dose of ketamine IV for ped patients?

Back 21

1 mg/ kg

Front 22

side effects on emergence from ketamine anesthesia?

Back 22

diplopia, occasional disturbing dreams, and nausea/vomiting, although these are less common in children than adults

Front 23

side effect of opioid bolus?

Back 23

chest wall rigidity

Front 24

age when PCA can be used?

Back 24

over 5 yr of age

Front 25

Succinyl choline for intubation?

Back 25

When given in a dose of 1.5 to 2.0 mg/kg it produces excellent intubating conditions (reliably) in 60 seconds. Recovery occurs in 6 to 7 minutes. Succinylcholine can also be given intramuscularly at 4 mg/kg in emergencies when intravenous access is not available.

Front 26

Contraindication of succinylcholine?

Back 26

muscular dystrophy, recent burn injury, spinal cord transaction, and/or immobilization, as well as any child with a family history of malignant hyperthermia because of the risk of rhabdomyolysis, hyperkalemia, masseter spasm, and malignant hyperthermia

Front 27

worry w/ use of succinylcholine?

Back 27

children with risk factors that are not clinically apparent or unappreciated

Front 28

non-depolarizing blockers in children

Back 28

pharmacokinetic and pharmacodynamic profile in which the recommended doses of these agents are identical for children and adults but the duration of action tends to be slightly longer . larger volume of distribution but more sensitive to the drug

Front 29

Clinical signs of adequate strength for ventilation in children?

Back 29

ability for hip flexion

Front 30

Use of pancuronium in children?

Back 30

causes tachycardia, good for neonates ( vagolytic ) , longer duration of action due to renal excretion.

Front 31

Roc in kids

Back 31

slight tachycardia, can be injected IM for RSI

Front 32

Rate of nause occurence in children?
which surgeries?

Back 32

increased
orchidopexy, strabismus surgery, and tonsillectomy

Front 33

is droperidol used in children for PONV?

Back 33

No b/c of prolonged QT syndrome and possible torsades de pointes with its use, and suggesting prolonged monitoring (6 hours) for patients given this drug. A black box warning has been placed on this medication to this effect

Front 34

fluid deficit =

Back 34

hours NPO X maintenance

Front 35

Maintenance fluids for peds

Back 35

<10kg = 4 mL/kg
11–20 kg = 40 mL+2 mL/kg > 10 kg
>20kg = 60 mL+1 mL/kg > 20 kg

Front 36

how many ml of saline for each ml of blood lost must be replaced?

Back 36

3 mL of solution for each milliliter of blood lost.

Front 37

estimated blood volume in children

Back 37

blood volume is estimated at 100 mL/kg for the preterm infant, 90 mL/kg for the term infant, 80 mg/kg for the child 3 to 12 months of age, and 70 mg/kg for the patient older than 1 year.

Front 38

what is maximum allowable blood loss (MABL) in peds

Back 38

Estimated blood volume X (starting hematocrit - target hematocrit ) / starting hematocrit

Front 39

what is the hematocrit of PRBCs and how much does 1 ml/kg of it increase the hematocrit?

Back 39

Packed red blood cells have a hematocrit between 55 and 70%. On the average, 1 mL/kg of packed red blood cells increases the hematocrit by 1.5%

Front 40

after apid administration of citrated blood products (particularly fresh-frozen plasma) ped patient is at risk for?

Back 40

hypocalcemia and hypothermia

Front 41

airway management for Cases in which recent oral intake or pathology (such as pyloric stenosis or intestinal obstruction

Back 41

intubation, due to risk of aspiration

Front 42

air leak parameters for intubated kids

Back 42

Air should leak out at no lower than approximately 10 cm H2O (to allow adequate ventilation) and no higher than 25 to 30 cm H2O (to minimize risk of postextubation croup).

Front 43

choosing a correct CUFFED tube?

Back 43

0.5 mm smaller in internal diameter than the uncuffed choice

Front 44

advantages of non-rebreathing circuits for peds patients?

Back 44

Nonrebreathing circuits minimize the work of breathing because they have no valves to be opened by the patient's respiratory effort. In addition, because the total volume of the circuit is less, the partial pressure of inhaled agent increases faster. Compression volumes are also decreased compared with a standard breathing circuit.

Front 45

what is the Jackson-Rese system?
when should you use Mapelson A vs. D system?

Back 45

The Jackson-Reese modification is functionally identical to the Mapleson D, as are coaxial systems. Carbon dioxide is removed most effectively in the D configuration when controlled ventilation is used, whereas spontaneous ventilation is most effective in the A system.

Front 46

max dose of tylenol in kids?

Back 46

90 mg/kg for older children, 75 mg/kg per day for infants, 60 mg/kg per day for term neonates and preterm neonates of more than 32 weeks of postconceptional age, and 40 mg/kg per day for preterm neonates 28 to 32 weeks of postconceptional age. Fever, dehydration, hepatic disease, and lack of oral intake may all increase the risk of hepatotoxicity.

Front 47

Dural sac position in children

Back 47

It is important to note that the dural sac migrates cephalad during the first year of life and in a neonate it is at S3 while over the age of 1 year it is at the S1 level.

Front 48

Effects of hypothermia in children

Back 48

increased oxygen consumption, cardiovascular manifestations of hypothermia, prolonged metabolism, and excretion of anesthetic drugs and delayed wound healing.

Front 49

Sings of emergence agitation
who's at risk?

Back 49

thrashing, crying, screaming, and disorientation that can accompany emergence from anesthesia in any age group, but is particularly common in children.
younger children are more at risk, as are children who have had strabismus surgery or tonsillectomy or adenoidectomy. As mentioned in the section on anesthetic agents, many reports have linked a higher incidence of agitation with the use of pure sevoflurane anesthesia.
lasts up to 30-45 min after surgery.