NEONATES & INFANTS• Do they really need anaesthesia?• Yes, they do• Precision & accuracy very important for safety
What is new?CURRENT PRACTICES• Pre anaesthetic preparation & medication• Anaesthesia Induction agents Inhalation agents IV Induction agents• Neuromuscular blocking drugs• Reversal agents• Analgesics - Opioids/Non Opioids• Local anaesthetics• Miscellaneous drugs
PRE OPERATIVE PREPARATION• Pre operative checkup / visit• Counseling of patients / parents• General explanation of place, equipment & procedure
PREMEDICATION• Injectables are not preferred• Other routes – Oral :- Triclofos, Promethazine, Midazolam, Ketamine – Sublingual/Trans Mucosal :- Fentanyl – Intra nasal :- Midazolam, Ketamine, Sufentanil – Rectal :- Midazolam, Methohexital, Diazepam, Ketamine – IM :- Ketamine (2 mg/kg)
INDUCTION AGENTS• Inhalational – for routine surgeries, uncooperative patients, incremental induction/ starting with high concentrations.• Intravenous – for rapid sequence induction in emergency surgeries, patients with i.v. lines in situ, cooperative patients.
SEVOFLURANE• Polyflurinated methyl isopropyl ether• Inhalational agent of choice for induction• Rapid induction & recovery - low blood gas solubility• Techniques of induction• MAC• Metabolism• Disadvantages
HALOTHANE• Still used ‘coz of cost restraints• Advantages• Techniques of induction• Disadvantages
KETAMINE• Water soluble, non irritant• Good analgesic, CVS stability• Routes of administration I.V. / I.M. (for induction) Oral, Intra nasal IV infusion Additive in neuraxial, regional blocks• Disadvantages
THIOPENTONE• Still has a place where other IV agents are contraindicated i.e. • Neuroanaesthesia in neonates • Convulsive disorders etc.
NEURO MUSCULAR BLOCKING DRUGS• Paediatric patients are Resistant to depolarizing NMBDs Sensitive to non-depolarizing NMBDs• Metabolism in the liver delayed
• Vecuronium/Pancuronium• Rocuronium• Rapacuronium• Priming with NMBDs
REVERSAL AGENTS• Neostigmine / Edrophonium + Atropine / Glycopyrrolate• Sugmadex – Modified γcyclodextrin sodium salt, specific for reversal of rocuronium. No need to combine with Atropine. Reports of use in adults. Dose: 12-15 mgKg