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88 Cards in this Set
- Front
- Back
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Who has the highest anesthetic requirment?
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Infants!
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Give what to counteract myocardial depressant action of anesthetics?
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Vagolytic
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What inhibits HPV?
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Inhaled anesthetics
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Why do inhalation agents equilibrate more rapidly in peds?
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increased alveolar minute ventilation. decreased FRC. increased CO to vessel rish group. reduced blood gas, and tissue gas partition coeficients.
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Halothane 6 month old
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MAC 1.2%
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1:100,000
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1gm in 100,000mL
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Limit the use of epi with halothane why and to what?
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10mcg/kg/20minutes. sensitizes myocardium to catecholamines
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Isoflurane MAC
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pre-term 1.3-1.4%, Full term 1.6%, infant 1.8%.
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Sevoflurane MAC
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neonates and infants <6months 3.3%, infants>6months and children 2.5%
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Significance of emergence delerium
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increased bleeding, loss of iv or drain, post op pain, injury to PACU, and delay
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Prevent emergence delirium?
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iso or des, pain control, pre-medicate? propofol 1mg/kg up to 30mg. precedex
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Desflurane mac
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Full term= 9.1, infant 9.4, children 8.5.
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Nitrous
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60%= 25% reduction in MAC
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Adverse effects of oxygen
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pulmonary vasodilatation, atelectasis, & Oxygen toxicity.
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Hyperoxia causes patients less than 44 weeks postconceptual age.
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Retinopathy of prematurity. Goal O2 Sat of 89-94%
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why pharmacodynamics of infant differ from adult.
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altered protein binding, Larger volume of distribution, smaller proportion of fat and muscle stores, immature renal function, and immature hepatic function.
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Protein binding neonates and infants.
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diminished due to decreased total plasma protein and albumin levels
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Acidic drugs examples, bind to
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Phenytoin, barbituarates, theophyline, benzos and abx. bind to albumin
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Reduced protein binding increases....
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the free =drug fraction== greater pharmacological effect
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preterm and infants have a _____ proportion of body water
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greater
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Vd of preterm and infants
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greater with water soluble meds, more water
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drugs that depend on redistribution into muscle and fat will have a ____
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greater/prolonged duration of action
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Decreased quantity of hepatic enzymes leads to....
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decreased clearance and prolonged half-life
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Phase 1 metabolism (oxidation, reduction, hydrolosis.)
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cytochrome p450s 50% of adult values at term.
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Phase II
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poorly developed at birth mature @ 6 monts-3years of age
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Highest percent of cardiac output to liver occurs between...
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4-10 years of age-- equals decreased half life of drugs durring this time of life
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Excretion
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prolonged half-life of drugs that are excreted by the kidneys. matures around 1 year of age. accumulation and toxicity can occur
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estimation of weight
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(age x2) +10
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Methohexital
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rectal 20-30mg/kg lower in rectum eliminate 1rst pass metabolism
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Thiopental
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IV neonates 3-4mg/kg
IV infants and children 5-7mg/kg Rectal25-30mg/kg |
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Ketamine
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IV 1-3mg/kg
IM 5-6mg/kg Rectal 5-10mg/kg Administer anticholinergic |
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Propofol
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IV infants 2.5-3.5 mg/kg
IV children 2-2.5 mg/kg |
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Midazolam
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IV 0.01-0.02mg/kg
PO 0.25-1mg/kg prolonged half life neonates (6-12) Diminished half life in kids 4-10 |
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Versed bolus= preterm and term neonates can have
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profound hypotension after a bolus
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Chloral hydrate
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PR 20-40mg/kg give in upper rectum (first metabolite is active form)
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Morphine
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IV 0.05-0.2mg/kg--- not used often greater respiratory depression, and prolonged half life
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Fentanyl
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IV 1-3mcg/kg
Nasal 1-2mcg/kg |
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rapid administration of fentanyl can cause
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chest wall and glotic rigidity. bradycardia
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anything that delays liver blood flow
delays |
fentanyl clearance. Omphalocele
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alfentanil
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IV bolus 3-10/mcg/kg--- highly protein bound can have a prolonged action in neonates and peds with renal and hepatic failure
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remifentanil
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IV infusion 0.05-2mcg/kg/min
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atropine
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IV 0.01-0.02mg/kg min dose 0.1mg
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does glyco cross the BBB
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no= no sedation
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cardiovascular accelerator effects:
Antisialogogue: Sedation: |
atropine>glyco>scop
scop>glyco>atropine Scop>atropine>glyco |
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Succinylcholine:
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IV Neonates and infants 2-3mg/kg
IV Children 1-2mg/kg IM neonates and infants 5mg/kg Im children 4mg/kg can be given sublingually in IV dosing. Fasciculations do not occur under 3 years of age. |
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Why do neonates and infants need more succ?
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1)larger Vd, water soluble
2)NMJ is immature |
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NDMR
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Same dosage. increased Vd is offset by increased sensitivity to NDMR
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Cisatricurium
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IV 0.1-0.2mg/kg
Maint 0.08-0.1mg/kg |
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Vecuronium
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IV 0.07-0.2mg/kg
Maint 0.01mg-0.02mg/kg 70 min duration of action in neonates and infants |
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Rocuronium
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IV 0.6-1.2mg/kg
Maint 0.08-0.12mg/kg IM 1-1.8mg/kg long duration of action >1hr |
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Clinical signs of reversal
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ability to fex arms and legs, bring thighs up to abdomen, return of abdominal muscle tone, return of normal TOF, sustained tetanus, and VC of 15-20mL/kg
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Neostigmine
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IV 0.02-0.07 mg/kg glyco may not prevent bradycardia
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ketorolac
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IV 0.5-0.8 mg/kg (30mg max dose)
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Acetaminophen
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PR 20-40mg/kg
IV 15mg/kg (2yrs of age or older) |
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Hydromorphone
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IV 0.01mg/kg
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Odansetron
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IV 0.05-0.15mg/kg (max of 4mg)
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Dexamethasone
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IV 0.1-0.15mg/kg (max of 8mg)
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Ancef
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20-40mg/kg
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Clindamyacin
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5-10mg/kg
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Gentamyacin
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2mg/kg
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Vancomyacin
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10mg/kg
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Epinephrine dose hypotension, arrest
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1mcg/kg IV
10mcg/kg IV |
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Atropine
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0.02mg/kg/iv min dose 0.1mg
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Calcium chloride
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10-20mg/kg IV
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Calcium Gluconate
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30-60mg/kg IV
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magnesium
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25-50mg/kg max 2g
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Cardioversion
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0.5 joules/kg up to 2 joules
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Defibrillation
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2 joules/kg up to 4 joules
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major source of heat loss in the anesthetized patient is
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radiation!
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Room temps for peds
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Neonates 27-29, infants 25-27, children 21
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NPO solid food, formula, milk, citrus, breast milk, clear liquids
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8,6,6,6,4,2
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aspiration risk meds
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bicitra 0.5mL/kg, Metoclamporide 0.1mg/kg, & ranitidine 2.5mg/kg.
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Full stomach
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delay cancel, or RSI
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URI,
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delay postpone elective increased risk of laryngospasm
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fever of 38 degrees
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is not a reason to cancel surgery. without other symptoms
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asthma attack
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delay surgery for 4-6 weeks
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where to put the precordial
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to the left of the sternal border in the 2nd ot 4th intercostal space
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when do you administer sevo
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when nystagmus comences with 2:1 nitrous oxygen
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Endotracheal tube sizes
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premature 2.5-3.0, term (3.0-3.5), 6-12 (3.5-4.0), 12-24 (4.0-4.5)
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2 yr and older cuffed, and uncuffed
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uncuffed: (Age/4)+4.... cuffed:(Age/4)+3.5
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Depth of ET tube
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1234/78910 rough 3x the tube size.
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greater than 2 years old
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(age/2) +12
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whats another way to find the half way between cords and carina
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deliberate mainstem intubation/technique
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LMA size chart
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LMA--1--neonates-5kg--cuff 4mL
LMA--1.5--5-10kg--cuff 7mL LMA--2--10-20Kg--cuff 10mL LMA--2.5--20-30Kg--cuff 14mL LMA--3--30-50Kg--cuff 20mL |
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Hgb of 2-3 month old
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10-11
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when to treat blood glucose?
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<40mg/dL
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treat blood sugar with
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200-500mg/kg of D5 or D10
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Treatment of hyperglycemia
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decrease glucose containing solution. insulin 0.01-0.1unit/kg/hr
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