Child (1 to 12 yrs) : Colligative - Practical Wisdom in Anesthesia, Surgery, and Medicine.

Oct 15, 2012

Weight Estimates:
Child <9yo = (age x 2) + 9kg.
Child >9yo = (age + 4) x 2kg

refl.in/g3

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Nov 18, 2014

Periprocedural medication management

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Investigations

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Associated conditions

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Relevant procedures

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Disease management

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Preprocedure optimisation, Postponement

The Talking Carl iPhone/iPad is an effective distraction tool during pediatric induction refl.in/hc

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Aug 31, 2011

Explanation, Patient Instructions

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Premedication

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Premedication:
In their favorite drink add Ketamine 7-10mg/kg +/- Clonidine 1mcg/kg

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Nov 06, 2014

Preoperative sedation. Midazolam as sole agent.

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Nov 18, 2014

0.5mg/kg oral max dose 20mg. (RCH)

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Preoperative sedation. Ketamine as sole agent.

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Nov 18, 2014

Oral 5mg/kg. Intramuscular 2-4mg/kg (RCH)

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Preoperative sedation. Combined oral ketamine and oral midazolam.

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Nov 18, 2014

Ketamine 5mg/kg + Midazolam 0.2mg/kg. #rch

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Analgesia, Anesthesia, Antiemesis

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IV access

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Monitoring

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Positioning, Protection

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Temperature

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Airway, Ventilation

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Assess depth of ETT by ballotting for cuff above supratentorial notch & feeling for transmitted pressure in pilot balloon. Pull back until felt, but consider the risk of extubation.

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Jun 04, 2011

(RB MMC)

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Depth/distance to pass endotracheal tube ETT past vocal cords is internal diameter (in mm) in cm

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May 18, 2011

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Estimated endotracheal tube diameter (mm) = (age/4) + 4. Average term neonate = 3.5, average 1yr old = 4.0.

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Nov 18, 2014

Airways:
-ETT: uncuffed size (Age/4)+4cm, Length (Age/2)+12cm
-LMA: 1 (0-5kg), 1.5 (5-10kg), 2 (10-20kg), 2.5 (20-30kg), 3 (30-50kg), 4 (50-70kg), 5 (>70kg)

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Nov 05, 2011

Beware of laryngospasm at insertion of block or local anaesthetic infiltration

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May 18, 2011

Breathing:
-TV 7mls/kg;
-T Piece Flows 3x MV (approx 100ml/kg)

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Nov 05, 2011

Might consider modifying your MV given magnitude in difference between infants (RR 40-60) & teens (RR 15-20) refl.in/gf. If MV =7ml/kg x 40/min = 350ml/kg for infants and 100ml/kg for teens

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Consider the risk of laryngospasm at emergence and avoid stimulating the patients airway (eg suctioning, removing airway devices) whilst the is partially emerged. Removing the airway device once the patient is fully awake or deep will help minimise this risk.

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Nov 25, 2011

Depth to insert ETT (cm) = age/2 +12. This is only a guide, ensure clinical confirmation

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May 18, 2011

If <8yo, extubate deep in theater if no concerns about mask ventilation or aspiration. If >8yo, manage extubation as per adult.

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May 18, 2011

If removing an airway device under deep anesthesia, do this in an area with adequate airway equipment and drugs to manage laryngospasm.

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Nov 24, 2011

Laryngeal mask LMA size estimate. Weight 0-5kg = size 1, 5-10kg = size 1.5, 10-20kg = size 2, 20-30kg = size 2.5, >30kg = size 3.

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May 18, 2011

Use smaller volume ventilation bag to improve sensitivity to airway obstruction

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May 18, 2011

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Cardiovascular, Fluids

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Circulation:
- SBP: (Age*2) + 70mmHg
- Fluids: 10-20ml/kg Bolus, then 4/2/1 rule

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Nov 05, 2011

Estimating dehydration. Mild (0-4%): no signs. Moderate (4-7%): Cap refill 2-3 secs; increased respiratory rate. Severe (>7%): Capillary refill >3secs; signs of shock (irritable, tachycardia, hypotension, mottled skin). RCH Clinical Practice Guidelines refl.in/hq

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Sep 01, 2011

Haematological, Blood products

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Endocrine, Electrolytes

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Special drug considerations

2.5 mcg/kg of fentanyl is sufficient to prevent "emergence agitation" in children undergoing adenoidectomy with desflurane. dx.doi.org/10.1097/000005...

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2 comments

Nov 18, 2014

In this study desflurane is used. The effect may not be as significant if more soluble volatile anaesthetics such as isoflurane or sevoflurane are used

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In the context of emergence from a rapid offset volatile anaesthetic this is not a surprising finding.

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Have propofol and/or suxamethonium drawn up beforehand so that in event of laryngospasm there is less delay if they are required

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Aug 26, 2011

Paed drug doses MMC crocodoc.com/At5oSa0

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Jul 06, 2011

Reveral of muscle relaxant/neuromuscular blockade in paeds. 2.5mg neostigmine + 1.2mg atropine drawn up to 5 ml normal saline. Give 1ml per 10kg

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Nov 06, 2011

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Ward Disposition

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Guidelines, Protocols

Lucile Packard Guidelines for Paediatric Regional Anaesthesia pedsanesthesia.stanford.e...

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Nov 18, 2014

Paediatric normal values table refl.in/paedtable

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Mar 12, 2012

SS RCH

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Pediatric BLS protocol from www.apls.org.au/algorithm...

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Mar 12, 2012