Minor Illnesses & Common Pediatric Procedures

MINOR ILLNESSES AND COMMON   PAEDIATRIC PROCEDURES  Interac6ve Discussion  Dr Moataz Abdelrahman  Consultant Paediatric Anaesthe2st  Central Manchester University Hospitals  Royal Manchester Children’s Hospital, UK 

CANCELLATION  •  Problems with cancella6on of surgery  –  Pa,ent  –  Family  –  System  •  Why postpone  –  Op,mise clinical condi,on  •  Individual basis  –  Be?er resources/equipment  –  ICU  –  Monitoring  –  Inves,ga,on  –  Other 

COMMON ILLNESSES  •  CVS  –  Murmurs  •  Respiratory  –  Cold  –  Cough  –  Laryngi,s/tonsilli,s middle ear  –  Asthma  •  Infec6ons  –  Rashes  –  Temperature  –  Diarrhoea and or vomi,ng  –  Local eye infec,on  –  Urinary tract infec,on 

•  Miscellaneous  –  Immuniza,on  –  Child on an,bio,cs  –  Child on an,epilep,c medica,ons 

Murmurs   The vast majority of children found to have a murmur pre‐opera7vely  have an innocent murmur   •  Innocent murmurs  –  SoK   –  Early systolic    –  No thrill or abnormal cardiac impulses    –  Not associated with cardiac signs or symptoms  •  Pathological murmurs  –  All diastolic murmurs  –  All pansystolic murmurs  –  Late systolic  –  Cardiac signs or symptoms 

Murmurs  •  If a child is found to have a murmur prior to elec6ve surgery  a history and cardiac examina6on should be performed and  an ECG done  •  In the presence of a murmur an echocardiogram and cardiac  opinion is indicated prior to surgery if:  –  The child is younger than a year  –  The murmur ﬁts pathological criteria  –  There are cardiac signs or symptoms  –  Evidence of LVH or RVH 

Upper Respiratory Tract Infec6on  •  GA in URTI is associated with:  –  Hypoxaemia  –  Laryngospasm  –  Bronchospasm  –  Death   Overall risk of events  2‐7 ,mes   With ETT risk of events  10 ,mes 

•  Consider GA in URTI (mild)  –  Not  unwell  –  Clear nasal discharge  –  Clear chest  –  Age ≥ 5 years  –  Age 1‐5 years assess risk/beneﬁt   •  Postpone Surgery in URTI  –  Fever ≥ 38°C (37.5°C)  –  Mucopurulent nasal secre,ons  –  Lower repiratory symptoms/signs  –   WCC  –  Age < 1 year even with mild URTI ? 

VACCINATION  •  Eﬀect of GA on immunity  •  Symptoms and signs interfering with post‐opera,ve  complica,ons clinical picture  •  Recent DOH opinion Paeds guidelines/vaccina,on.pdf  –  Imminent GA  –  Imminent Surgery   "  NOT A CONTRAINDICATION TO VACCINATION 

THANK YOU 

Minor Illnesses & Common Pediatric Procedures

by cairo1957 on Oct 25, 2009

Accessibility

Categories

Upload Details

Usage Rights

2 Embeds 15

Statistics

Minor Illnesses & Common Pediatric Procedures — Presentation Transcript

http://www.slideshare.net	8
http://www.pedsegypt.blogspot.com	7