PROBLEM BASED DISCUSSION<br />Dr Moataz Abdelrahman<br />Consultant Paediatric Anaesthetist<br />Clinical Lead Theatres an...
4 week old Baby<br />The anaesthetic resident has been informed about a 4 week old boy weighing 4.5 kg presenting with bil...
TRIAGE<br />
ASSESSMENT AND EVALEUATION<br />
ASSESSMENT<br />History<br />Examination<br />Investigations<br />Other preparations<br />Parents<br />
History<br />Delivery<br />Neonatal <br />Pervious GA<br />Fluid status<br />BP<br />HR<br />Cap refill<br />Fluid therapy...
PROBLEMS<br />Age 4 weeks<br />Obstructed bowel<br />Fluid shifts and dehydration<br />Full stomach<br />Previous surgery<...
PREPARATIONS<br />Fluid resuscitation strategy<br />Fluid status<br />BP<br />HR<br />Cap refill<br />Fluid therapy<br />
PREPARATIONS<br />FBC  Hb 9.0<br />U&E<br />Glucose <br />Crossmatch blood<br />Prepare HAS<br />
PREPARATIONS<br />Insert NG<br />ICU/HDU<br />Indications for HDU<br />Indications for ICU & Ventilation<br />
PLAN ANALGESIA<br />No opiates only paracetamol/NSAID<br />Morphine IOP dose<br />Nothing IOP &(NCA)<br />Morphine IVI pos...
MONITORING<br />Minimal<br />SpO2<br />ETCO2<br />BP<br />ECG<br />Temp<br />Gas<br />Urine<br />Additional<br />CVP<br />...
ADDITIONAL MONITORING<br />CVP<br />Arterial Line<br />Trans-oesophageal Doppler<br />
PLAN INDUCTION<br />Inhalation <br />IV<br />RSI / cricoid pressure<br />
MAINTENANCE<br />Anaesthesia<br />Intra-operative fluid management<br />Fluid monitoring <br />Capillary gases<br />Fluid ...
CRITICAL CARE<br />Major fluid shifts<br />Changes in temp<br />Tight abdomen with big incision<br />Long duration of surg...
POSTOPERATIVE <br />Analgesia<br />Investigations<br />
Upcoming SlideShare
Loading in...5
×

Problem Based Discussion in Pediatric Anesthesia

1,315

Published on

Presented at Egyptian Anesthesia 2011

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,315
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Problem Based Discussion in Pediatric Anesthesia

  1. 1. PROBLEM BASED DISCUSSION<br />Dr Moataz Abdelrahman<br />Consultant Paediatric Anaesthetist<br />Clinical Lead Theatres and Perioperative Services <br />Royal Manchester Children’s Hospital<br />
  2. 2. 4 week old Baby<br />The anaesthetic resident has been informed about a 4 week old boy weighing 4.5 kg presenting with bilious vomiting for the last 24 hours<br />Neonatal History: Born at 38 weeks NVD<br />He had a laparotomy for malrotation repair 3 weeks ago<br />Surgeons are having a discussion with you about taking the baby to theatre tonight<br />It is 11 pm and the surgeons want to take another child to theatre for circumcision/meatotomy for phymosis in a 5 year old<br />They are asking you to do the baby after the circumcision<br />What is your opinion<br />
  3. 3. TRIAGE<br />
  4. 4. ASSESSMENT AND EVALEUATION<br />
  5. 5.
  6. 6.
  7. 7. ASSESSMENT<br />History<br />Examination<br />Investigations<br />Other preparations<br />Parents<br />
  8. 8. History<br />Delivery<br />Neonatal <br />Pervious GA<br />Fluid status<br />BP<br />HR<br />Cap refill<br />Fluid therapy<br />
  9. 9. PROBLEMS<br />Age 4 weeks<br />Obstructed bowel<br />Fluid shifts and dehydration<br />Full stomach<br />Previous surgery<br />Thermal control<br />Distended abdomen/ventilation<br />Pain management<br />
  10. 10. PREPARATIONS<br />Fluid resuscitation strategy<br />Fluid status<br />BP<br />HR<br />Cap refill<br />Fluid therapy<br />
  11. 11. PREPARATIONS<br />FBC Hb 9.0<br />U&E<br />Glucose <br />Crossmatch blood<br />Prepare HAS<br />
  12. 12. PREPARATIONS<br />Insert NG<br />ICU/HDU<br />Indications for HDU<br />Indications for ICU & Ventilation<br />
  13. 13. PLAN ANALGESIA<br />No opiates only paracetamol/NSAID<br />Morphine IOP dose<br />Nothing IOP &(NCA)<br />Morphine IVI postop<br />Regional <br />TAP block<br />Caudal ---high catheter <br />Epidural <br />Local infiltration<br />
  14. 14. MONITORING<br />Minimal<br />SpO2<br />ETCO2<br />BP<br />ECG<br />Temp<br />Gas<br />Urine<br />Additional<br />CVP<br />Invasive BP<br />Trans-oesophageal Doppler<br />BIS<br />??<br />
  15. 15. ADDITIONAL MONITORING<br />CVP<br />Arterial Line<br />Trans-oesophageal Doppler<br />
  16. 16. PLAN INDUCTION<br />Inhalation <br />IV<br />RSI / cricoid pressure<br />
  17. 17. MAINTENANCE<br />Anaesthesia<br />Intra-operative fluid management<br />Fluid monitoring <br />Capillary gases<br />Fluid shifts<br />HAS<br />Blood transfusion/thresholds<br />
  18. 18. CRITICAL CARE<br />Major fluid shifts<br />Changes in temp<br />Tight abdomen with big incision<br />Long duration of surgery<br />Metabolic status<br />
  19. 19. POSTOPERATIVE <br />Analgesia<br />Investigations<br />

×