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    Pediatric Anesthesia

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    michael
    This document discusses pediatric anesthesia. It notes key anatomical and physiological differences between children and adults that impact anesthesia techniques. These include differences in airway anatomy, respiratory and cardiac function, thermoregulation, and renal and hepatic development. The document outlines pediatric anesthesia terminology, preoperative evaluation considerations, common coexisting health conditions, and guidelines for fasting. It also reviews anesthetic agents commonly used in pediatric anesthesia including inhalation agents, intravenous medications, opioids, and muscle relaxants. Fluid and blood product management is also briefly mentioned.

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    Pediatric Anesthesia

    Uploaded by

    michael
    2K views33 pages
    This document discusses pediatric anesthesia. It notes key anatomical and physiological differences between children and adults that impact anesthesia techniques. These include differences in airway anatomy, respiratory and cardiac function, thermoregulation, and renal and hepatic development. The document outlines pediatric anesthesia terminology, preoperative evaluation considerations, common coexisting health conditions, and guidelines for fasting. It also reviews anesthetic agents commonly used in pediatric anesthesia including inhalation agents, intravenous medications, opioids, and muscle relaxants. Fluid and blood product management is also briefly mentioned.

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    This document discusses pediatric anesthesia. It notes key anatomical and physiological differences between children and adults that impact anesthesia techniques. These include differences in airway anatomy, respiratory and cardiac function, thermoregulation, and renal and hepatic development. The document outlines pediatric anesthesia terminology, preoperative evaluation considerations, common coexisting health conditions, and guidelines for fasting. It also reviews anesthetic agents commonly used in pediatric anesthesia including inhalation agents, intravenous medications, opioids, and muscle relaxants. Fluid and blood product management is also briefly mentioned.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    2K views33 pages

    Pediatric Anesthesia

    Uploaded by

    michael
    This document discusses pediatric anesthesia. It notes key anatomical and physiological differences between children and adults that impact anesthesia techniques. These include differences in airway anatomy, respiratory and cardiac function, thermoregulation, and renal and hepatic development. The document outlines pediatric anesthesia terminology, preoperative evaluation considerations, common coexisting health conditions, and guidelines for fasting. It also reviews anesthetic agents commonly used in pediatric anesthesia including inhalation agents, intravenous medications, opioids, and muscle relaxants. Fluid and blood product management is also briefly mentioned.

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    You are on page 1of 33

    PEDIATRIC ANESTHESIA

    MICHAEL ARITONANG MD

    CHILDREN VS ADULT
    1. Specific anatomic
    2. Developing physiologic
    3. Physiologic issues
    This distinctive features form the basis for
    the techniques and pharmacologic outline

    TERMINOLOGY

    Newborn: 1st 24 hours


    Neonates : 1st month
    Infants : 1st 12 months
    Toddler: 1st 3 years
    Small children: 4th 12 years
    Child : 1st - 12 years
    Adolescent : 13 - 16 years

    ANATOMIC AND
    PHYSIOLOGIC DISTINCTIONS
    BETWEEN ADULT AND
    PEDIATRIC PATIENT

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    1. Head size : much larger head size to
    the body and prominent occiput
    2. Tongue size: Larger size relative to
    mouth
    3. Retrognathic chin/ obtuse angle of jaw
    4. Narrow nares: 50% of airway resistance
    is from the nasal passages
    5. Obligatory nasal breathers
    6. Non ossified palate

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    7. Epiglottis: omega shaped (large, narrow
    and short)
    8. Glottis: anterior and cephalad
    Full term: C4
    Preterm infant: C3
    3 years: C4 - C5
    Adult: C6

    9. Vocal cords are slanted


    10. Airway shape: Narrowest diameter is
    below the glottis at cricoid level in children.

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    11.
    12.
    13.
    14.

    Tracheal length : 2-5cm (compliant)


    Sternum and Thoracic cage: Compliant
    Horizontally place pliable ribs
    Diaphragm:
    Type I fibers
    Adult 55%, full term infant 25%,premature 15%
    15. Pulmonary surfactant
    insufficient (premature) and delayed (DM
    mother)

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    16. Alveoli:
    Newborn 20-50million
    8 years old: 300 million (adult)
    Atelectasis common-underdeveloped alveoli
    -less surfactant
    -compliant chest wall
    17. Respiratory physiology:
    O2 consumption is 2 3x in infants >
    adults.

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    Fetal circulation:
    Inc pul vas resistant
    Dec pul blood flow
    Dec systemic vas
    resistance
    Right to left blood
    flow through FO and
    PDA

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    After birth circulation:
    Dec pul vascular
    resistant
    Increase pul blood flow
    Increase systemic
    vascular resistance
    Left to Right blood flow
    and closure FO and
    PDA

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    Fetal Hemoglobin
    At 36wk gestation: 90-95%
    Birth: 75-80%
    6mths-negligible
    High hb & hct
    Full term: 18-19g/dl
    Preterm:
    Estimate Blood Volume
    Preterm 90ml/kg
    Fullterm 80ml/kg
    Infant 70-80ml/kg
    Adult 55-65ml/kg

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    18. Cardiac physiology:
    The neonatal cardiac myocyte has less
    organized contractile elements
    1st 3 months of life, PNS influence on
    the heart is more mature than the SNS
    Relatively fixed stroke volume in
    neonates and infants

    EVALUATION OF
    CARDIOPULMONARY FUNCTION
    Physical examination:
    Skin
    Capillary filling time
    Trends in blood pressure
    Heart rate
    Intensity of peripheral pulses
    Presence of murmur
    Respiratory rate and effort
    Breath sounds
    Urine output
    Metabolic acidosis

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    19. Renal function:
    Limited GFR at
    birth; does not reach
    adult levels until
    infancy; TBW and %
    ECF are inc in the
    infant.

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    20. Hepatic function:
    P450 system not
    fully developed in
    neonates and
    infants; liver blood
    flow decreased in
    newborns.
    Few gylcogen store
    and prone to
    hypoglycemia

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    21. Thermoregulation
    Newborns and infants have a large surface area
    to weight ratio with minimal subcutaneous fat.
    They have poorly developed shivering, sweating
    and vasoconstriction mechanisms.
    Heat loss:

    Conduction
    Radiation
    Evaporation
    Convection
    Respiration

    ANATOMIC AND PHYSIOLOGIC


    DISTINCTIONS
    23. Psychological development
    06 mostress on family
    8 mo4 yrseparation anxiety
    46 yrmisconceptions of surgical mutilation
    613 yrfear of not waking up
    13 yrfear of loss of control, body image
    issues

    PREOPERATIVE
    EVALUATION

    Pertinent maternal history


    Birth and neonatal history
    Review of systems
    Physical examination: height, weight,
    and vital signs.
    Preoperative home use of
    medications
    Existence of malformations in the
    child and family

    PREOPERATIVE
    EVALUATION
    Issues such as anesthetic risks,
    anesthetic plans, recovery
    phenomena, postoperative
    analgesia, and discharge criteria
    have to be discussed in detail.

    PREOPERATIVE
    EVALUATION
    COEXISTING HEALTH CONDITION
    1. Upper Respiratory Infection
    2. Obstructive Sleep Apnea
    3. Asthma
    4. The Former Preterm Infant

    PREOPERATIVE
    EVALUATION
    Laboratory Evaluation
    Current standard of care dictates that
    healthy children undergoing elective minor
    surgery require no laboratory evaluation
    Hb : 10 g/dL ( for infant > 3 months of age)

    Routine versus selective testing is a matter


    of policy at individual facilities.

    PREOPERATIVE
    EVALUATION
    Preoperative Fasting Period (ASA GUIDELINES)

    Solids: 6 - 8
    Formula: 6 hours
    Breast milk: 4 hrs
    Clear liquids: 2 hrs

    Clear liquids such as apple or grape juice, flat cola, and


    sugar water may be encouraged up to 2 hours prior to
    the induction of anesthesia as their consumption has
    been shown to decrease the gastric residual
    volume.

    PREOPERATIVE
    EVALUATION

    ANESTHETIC AGENTS
    Potent Inhalation Agents
    Mask Induction Pharmacology
    most common used

    Minimal Alveolar Concentration


    higher MAC in infant compare than adult

    Intracardiac Shunts
    R-L shunt : slow induction time
    L-R shunt : fasten induction time

    Inhaled Agents for Induction of Anesthesia


    Sevofluraine vs Halothane
    sevofluraine:
    3.3% for neonates, 3.2% for infants 1 to 6 months old, and 2.5% for
    children older than 6 months

    ANESTHETIC AGENTS

    ANESTHETIC AGENTS
    Intravenous agents
    Sedative hypnotic
    Propofol, thiopental, methohexital,
    etomidate, midazolam, and ketamine
    Propofol is the most widely used agent for
    induction and maintenance of anesthesia or
    sedation in children.
    Ketamine are useful in hypovolemic pt and to
    preserve spontaneous respiration

    ANESTHETIC AGENTS
    Opioids
    use for surgical anesthesia will decrease MAC of inhaled
    agents, smooth hemodynamics during airway management,
    or stimulating procedures, and provides postoperative
    analgesia.
    Chest wall rigidity is not uncommon when administering bolus
    opioids
    Opioids are also well known to depress central respiratory
    effort. Newborns and infants younger than 6 months are
    particularly susceptible to this effect because of the immature
    bloodbrain barrier and increased levels of free drug.

    ANESTHETIC AGENTS
    Muscle Relaxants
    Succinylcholine
    Dosage: 1.5 to 2.0 mg/kg IV in 60 seconds.
    Recovery: 6 to 7 minutes.
    Emergency: 4 mg/kg IM
    Non depolarizing NMD
    Rocuronium has fastest onset of action 60 seconds for a 1mg/kg dose and goodchoice for rapid-sequence intubation.
    Atracurium and cis-atracurium are eliminated by Hofmann
    elimination, a process only dependent on pH and temperature.

    FLUID AND BLOOD PRODUCT

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