Preoperative Assessment Case Study Answers. Anaesthetic Equipment Case Study Answers. Anaesthetic Drugs Case Study Answers. Airway Management Case Study Answers.
Monitoring Anaesthesia Case Studies Answers. Post Anaesthesia Case Study Answers. Pain Management Case Studies Answers. Anaesthesia Complications Case Studies Answers.
Trauma Burns Case Study Answers. Obstetric Case Study Answers. Paediatric Case Study Answers. Metacarpal dislocation Orbital blow out fracture Rib fracture Septic arthritis. Contact Blog Antibiotics and yeast mouth Email.
This module is designed to give you a safe and practical approach to paediatric anaesthesia. To achieve this goal, you should be able to: Outline the anatomical and physiological differences between adults and children and describe how these affect anaesthetic practice including the response to drugs.
Know the important aspects carboxylic acid and cancer the conduct of infant and child anaesthesia. Understand the equipment used in paediatric anaesthesia Reference Reading: Oxford handbook of anaesthesia chapter Children, especially neonates and children weighing less than about 15 kg, differ markedly from adults.
There are differences in size, anatomy, physiology, response to drugs and psychology. The anaesthetist must blood pressure and heart rhythym the child preoperatively, gain the trust of both the child and parents and prepare meticulously for anaesthesia. Paediatric anatomy, physiology and pharmacology, blood pressure and heart rhythym. Babies have a relatively larger head with a prominent occiput. The head needs to be stabilised for intubation but may not require a pillow below the head.
The neck is short and the tongue large. If excessive submandibular pressure is applied during mask ventilation, the tongue may obstruct the airway.
Infants and neonates breathe mainly though their noses which are small and easily obstructed. The larynx is more anterior and is situated at a higher level relative to the cervical vertebrae C3 to C4 at birth compared to an adult C6. The epiglottis is relatively longer, leaf like and U shaped. The inexperienced anaesthetist may find the baby more difficult to intubate.
The trachea is short. The distance from the glottis to the carina is about 4 cm in a full term neonate, blood pressure and heart rhythym. Tube fixation is essential. Extension of the head can result in blood pressure and heart rhythym and flexion can result in endobronchial intubation.
Endotracheal tubes must be securely taped and the number marking on the tube closest to the lip noted. With most infants, if the 10 cm mark on the endotracheal tube is at the gums, the tip of the tube will be just above the carina.
The narrowest part of the upper airway is the cricoid ring in the pre-pubertal child. After puberty, the narrowest part of the airway is at the level of the vocal cords.
The diameter of the trachea in the newborn is 4 to 5 mm. Just 1 mm of oedema can cause serious harm. Children before puberty should have an uncuffed tube and there should be a slight air leak with positive pressure ventilation. It is important to select the correct size endotracheal tube.
If resistance blood pressure and heart rhythym during intubation, the next smaller tube should be tried. Paediatric endotracheal size and age Premature 2. A distended abdomen or surgical retraction can easily reduce ventilation. In infancy a gradual change towards the adult rate 3. A higher oxygen consumption means that neonates and infants will rapidly consume their oxygen reserves and become cyanotic if they are apnoeic.
Attempts at intubation must not exceed 30 seconds. Higher oxygen consumption leads to a higher carbon dioxide production, blood pressure and heart rhythym, which requires increased ventilation to remove it. Premature and ex-premature babies up to 52 weeks post conceptual age are at risk of apnoea after general anaesthesia. They must be very closely observed for at least 24 hours.
Stroke volume is relatively fixed in the newborn due to the poorly compliant ventricular muscle. Therefore, an increase in cardiac output is achieved by an increase in heart rate. Bradycardia occurs in response to hypoxia. The sympathetic nervous system is not well developed. Infants can easily become bradycardic. Atropine premedication will reduce the incidence of bradycardia and reduce secretions. Intravenous or intramuscular dose is 0. The maximum dose should be less than 0.
Blood pressure is lower in children than adults because of low peripheral resistance. The change is due to a decrease in foetal haemoglobin. The increased metabolic rate of infants results in a faster turnover of extracellular fluid, blood pressure and heart rhythym.
An interruption of the normal fluid intake can therefore rapidly lead to dehydration and the anaesthetist must take care with fluid management. The anaesthetist must estimate replacement fluid, maintenance fluid and ongoing fluid losses. Unwell children need 0. Children have a relatively small blood volume and should be calculated prior to surgery. A 5kg infant will have a blood volume of only ml. A soaked clorazepam and weight loss will contain at least 5 ml and a small pack at least 20 ml of blood.
The neonate has decreased glomerular filtration and tubular function, blood pressure and heart rhythym. Renal clearance of drugs and their metabolites is reduced during the first year.
The ability to excrete a fluid load is initially poor but this function rapidly increases in the first month of life. The ability to produce concentrated urine is also initially poor and improves rapidly in the first two months reaching adult levels by two years of age. Urine output should be at least 0. The newborn is at a greater risk of cooling when exposed to a cold environment because the ratio of body surface area to body weight is double that of older patients.
Skin and subcutaneous fat is thinner, providing less insulation and leading to greater heat loss. Heat production is low and the ability to shiver is not well developed. Temperature regulation is immature. The environmental temperature range in which oxygen consumption is minimal thermoneutral range is narrow.
A decrease in environmental temperature of 2 degrees Celsius may double the oxygen consumption of a newborn. Infants must be kept warm. The operating theatre should be heated and the infant kept covered. Try to warm intravenous fluids. Liver metabolism may be poor in the newborn but develops rapidly in the first few weeks. Drugs such as opioids, benzodiazepines and barbiturates may not be metabolised as rapidly in neonates.
The differences in physiology of the infant will alter blood pressure and heart rhythym effect of some drugs. All opioids and central nervous system depressants must be given with caution in neonates unless the patient is being ventilated and closely monitored.
Morphine clearance in neonates is one quarter that of adults so that the elimination half time will be four times that of adults. The immature respiratory centre makes the neonate more sensitive to the respiratory depressive effects of morphine.
The proportion of cardiac output going to the brain is greater in the neonate than in older children. The dose of intravenous induction agents should be reduced in neonates. Decreased renal and liver function results in certain drugs being excreted more slowly. The dosing interval should be increased to avoid toxicity. Both induction and recovery from inhalation agents is more rapid in children than adults.
Blood pressure and heart rhythym for infants and children. During the preoperative assessment of children it is very important to assess the severity of any upper respiratory tract infection, which is very common in preschool children. Elective surgery should be cancelled if the child is unwell with a high fever and has signs and symptoms of a respiratory tract blood pressure and heart rhythym. These children are at risk of laryngospasm, bronchospasm and hypoxia and surgery should be delayed 6 weeks.
If the upper respiratory tract infection is mild, then the anaesthetist should decide if the surgery should be delayed 2 weeks.