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Anaesthesiology
Pediatric Anesthesia
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
10 sections · 188 slides
Overview
- Scope of this topic
- Structure of the topic
- Key messages of the topic
- Key messages of the topic, continued
Anatomy and Physiology
- Head, neck and nose features that shape the airway
- Laryngomalacia
- Syndromes that make airway management difficult
- Two contrasting patterns of syndromic airway difficulty
- Funnel-shaped infant larynx versus cylindrical adult larynx
- The cricoid ring lining and why it swells
- Airway radius and resistance
- Consequences of narrowing at the cricoid ring
- Short trachea and rapid desaturation
- Chest wall and diaphragm mechanics in the child
- Anatomic features of the upper airway in infants compared with adults
- Cardiac output depends on heart rate in the young child
- Blood pressure interpretation in children
- Normal range of resting heart rates and blood pressure in children
- Brain oxygen use and blood flow in children
- Anesthetic neuroapoptosis in animal studies
- Food and Drug Administration warning of December 2016
- Human evidence on anesthesia and the developing brain
Pharmacology
- Plasma protein binding in the infant
- From low protein binding to greater drug effect
- Liver metabolism of drugs in children
- Genetic variation in drug-metabolising enzymes
- Inhaled agents used in children today
- Factors that set the speed of inhaled anesthetic uptake
- Exponential wash-in equation for inhaled anesthetics
- The time constant and why children equilibrate faster
- Faster halothane wash-in in children than adults
- Four reasons halothane washes in faster in infants
- Four contributors to faster wash-in in infants
- Vessel-rich group and modern low-solubility agents
- Keeping spontaneous ventilation during a gas induction
- Cardiac depression when ventilation is controlled too early
- Effect of cardiac shunts on inhalational induction
- Minimum alveolar concentration of isoflurane across ages
- Airway effects of the inhaled agents
- Propofol as the standard induction agent
- Propofol doses in children
- Propofol infusion for painless procedures
- Propofol infusion syndrome
- Ketamine and its many routes
- Ketamine doses by route
- Side effects and cautions with ketamine
- Succinylcholine and how it works
- Succinylcholine dosing by age and route
- Side effects of succinylcholine
- Rocuronium dosing in children
- Sugammadex and how it works
- Fentanyl in children
- Acetaminophen dosing and overdose risk
- Dexmedetomidine and its receptor profile
- Dexmedetomidine dosing by route
- Clinical uses of dexmedetomidine
Preoperative Assessment and Preparation
- Consent, permission and assent
- Decision-making capacity by age band
- The Harm Principle and parental refusal of blood
- Purpose of preoperative fasting
- American Society of Anesthesiologists preoperative fasting guidelines
- Evidence on shortening the clear fluid fast
- Upper respiratory tract infection and airway reactivity
- The COLDS score for deciding whether to proceed
- Obstructive sleep apnea in children
- Treatment of pediatric obstructive sleep apnea
- Opioid sensitivity in obstructive sleep apnea
- Anesthetic choice in the former preterm infant
- Malignant hyperthermia
- Sequence of a malignant hyperthermia crisis
- Locations of mutations in malignant hyperthermia susceptibility
- Trigger-free technique and crisis treatment
- Duchenne muscular dystrophy
- Duchenne reaction compared with malignant hyperthermia
- Mitochondrial disease
- Anesthetic inhibition of respiratory chain complexes
- Sickle cell disease
- Approaches to reduce the impact of racism in sickle cell disease
- Transfusion strategy before surgery in HbSS disease
- Anterior mediastinal mass
- Recommended approaches for children with autism
- Perioperative anaphylaxis in children
- Organ-specific elements of the examination
Induction of Anesthesia and the Airway
- Laryngeal mask airways in children
- Cuffed tracheal tubes in children
- Depth and size of the tracheal tube
- Guidelines for endotracheal tube sizing in infants and children
- Standard monitors during anesthesia
- Sidestream compared with mainstream capnography
- Temperature monitoring sites and their limits
- Four routes of heat loss under anesthesia
- Emergency drugs and how they are organised
- Anesthesia medication template layout
- What a full stomach means
- Preoxygenation before rapid sequence induction
- Drug choice in pediatric rapid sequence induction
- Key points of the updated difficult airway guidelines
- Devices for the pediatric difficult airway
- The fire triad in airway surgery
- Steps of a cooperative inhalational induction
- Reasons to avoid nitrous oxide
- Oxygen desaturation during induction
- Laryngospasm
- Clinical signs of laryngospasm
- First-line treatment of laryngospasm
- Escalating management of laryngospasm
- If laryngospasm does not break
- Bradycardia in the anesthetised child
Maintenance of Anesthesia
- Where total intravenous anesthesia is preferred
- Choice and volume of maintenance fluid
- Estimated blood volume by age group
- Maximum allowable blood loss
- Replacing blood loss
- Risk of postoperative vomiting in children
Regional Anesthesia
- Benefits of regional anesthesia in children
- Local anesthetic handling by age
- Caudal volume by desired dermatomal level
- Maximum continuous epidural infusion rates by age
- Safety record of pediatric regional anesthesia
- Complication rates from the Pediatric Regional Anesthesia Network
- Spinal block in infants and neonates
- Epidural indications, cautions and caudal anatomy
- Performing a caudal block
- Groups of truncal nerve blocks
Emergence and Recovery from Anesthesia
- Choosing between awake and deep extubation
- Five predictors of successful tracheal extubation
- Predictors of extubation success and failure
- Advantages of deep extubation
- Performing a deep extubation
- Deep compared with awake extubation
- Causes of delayed emergence from anesthesia in children
- Recovery position after tracheal extubation
Complications in the Recovery Unit
- What counts as a perioperative respiratory adverse event
- Risk factors for perioperative respiratory adverse events
- Preparing recovery and first-line treatment
- Postoperative apnea and monitoring practice
- Stridor in the child and its causes
- Treating postextubation stridor
- Negative pressure pulmonary edema
- Mechanism of negative pressure pulmonary edema
- Emergence delirium and the PAED scale
- The five criteria of the Pediatric Anesthesia Emergence Delirium scale
- Pediatric Anesthesia Emergence Delirium scoring system
- Risk factors for emergence delirium
- Preventing emergence delirium
- Frequency and preoperative risk factors for vomiting
- Antiemetic prophylaxis matched to risk factor count
- Assessing pain in the recovery unit
- Pain assessment tools by ability to self-report
- Patient-controlled analgesia in children
Summary and References
- Takeaways on airway and physiology
- Takeaways on pharmacology
- Takeaways on preoperative assessment
- Takeaways on induction and maintenance
- Takeaways on regional anesthesia and recovery
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- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition