This document discusses intraoperative management in the pediatric age group, focusing on airway management, induction, ventilation strategies, maintenance, and extubation. It covers pediatric airway anatomy and physiology, techniques for securing the airway such as intubation and use of laryngeal mask airways, and considerations for different agents used for induction and maintenance of anesthesia. Special situations requiring difficult airway preparation are also reviewed.
ANATOMY-PHYSIOLOGY AND IT'S IMPLICATIONS IN PEDIATRIC ANESTHESIA by Dr M.Kart...MKARTHIKEMMANUEL
1.Pediatric Anesthesia
2.Pediatric Anatomy and Physiology
3.Anesthesia implications in pediatric cases
4.Pediatric Anesthesia is different from adult anesthesia
5.why bleeding risk is less ?
6. Why coagulation factors are reduced?
7. Movements of rib cage ?
8. Lung compliance in pediatric age group
The document outlines an agenda and objectives for a training on EMT basic advanced airway management using the pharyngeal esophageal airway device (PEAD), also known as the Combitube. The training will include lessons on respiratory anatomy and physiology, respiratory volumes and management, assessing respiratory problems, basic airway management, suctioning, and dual-lumen airway devices. It will conclude with demonstrations and skills testing on techniques like manual airway maneuvers, ventilation, suctioning, and Combitube insertion.
This document provides an overview of pediatric anesthesiology. It discusses how children's anatomy and physiology differ from adults in ways that are important for anesthesia care. Key points include the large head size and airway structures in young children, differences in breathing, circulation, thermoregulation and pharmacokinetics compared to adults. Special considerations for prematurity, congenital conditions like Down syndrome and tetralogy of Fallot are also reviewed. The document concludes with a discussion of pediatric anesthesia on-call cases such as omphalocele and gastroschisis.
Preterm infants have significant physiological immaturity that impacts anesthesia considerations. Their respiratory, cardiovascular, renal and neurological systems are underdeveloped. Anesthesia can more easily cause apnea, hypothermia, hypoglycemia and other complications in preterm infants. Careful attention must be paid to temperature control, fluid management, glucose levels and minimizing respiratory depressant effects. Regional anesthesia techniques are preferable when possible to reduce medication doses.
This document provides guidance on managing pediatric airways. It discusses signs of airway instability including retractions, nasal flaring, and head bobbing. It describes pediatric airway anatomy and how it differs from adults. The document outlines how to open and maintain an airway manually or with devices. It also discusses techniques for bag-mask ventilation and intubation in pediatric patients, as well as dealing with difficult airways. Complications of airway management are addressed.
Rapid intubation, also known as rapid sequence intubation (RSI), is an emergency airway management technique used to quickly place an endotracheal tube. It involves preoxygenating the patient, administering induction medications to cause unconsciousness followed immediately by paralysis medications. This allows intubation to be performed without having to manually ventilate the patient first. Proper patient positioning, preparation of equipment, and verification of tube placement are important steps in the technique. Potential complications include esophageal intubation, hypotension, and dental trauma. RSI is the preferred method in emergency situations where immediate airway control is needed.
This document discusses the anatomy and physiology of the airway and provides guidance on proper airway management techniques. It describes the structures of the airway from the nose to the trachea. It emphasizes the importance of evaluating each patient's airway, having the proper equipment, and developing adequate skills to successfully manage the airway. Techniques covered include use of oral and nasal airways, laryngoscopy, endotracheal intubation, and developing a backup plan for difficult airways.
management of foreign body inhalation and bronchoscopy in childrenanu_radha1209
This document discusses anesthesia considerations for bronchoscopy procedures to remove foreign body inhalation. It notes that foreign body inhalation is most common in children ages 6 months to 3 years and presents highest risk in that age group due to exploring objects orally and lack of coordination. Rigid bronchoscopy is the standard approach for removal, requiring careful anesthesia to control breathing while the scope is inserted and foreign body extracted. Key goals are maintaining oxygenation and minimizing risks like pulmonary aspiration or dislodging the object during ventilation changes.
ANATOMY-PHYSIOLOGY AND IT'S IMPLICATIONS IN PEDIATRIC ANESTHESIA by Dr M.Kart...MKARTHIKEMMANUEL
1.Pediatric Anesthesia
2.Pediatric Anatomy and Physiology
3.Anesthesia implications in pediatric cases
4.Pediatric Anesthesia is different from adult anesthesia
5.why bleeding risk is less ?
6. Why coagulation factors are reduced?
7. Movements of rib cage ?
8. Lung compliance in pediatric age group
The document outlines an agenda and objectives for a training on EMT basic advanced airway management using the pharyngeal esophageal airway device (PEAD), also known as the Combitube. The training will include lessons on respiratory anatomy and physiology, respiratory volumes and management, assessing respiratory problems, basic airway management, suctioning, and dual-lumen airway devices. It will conclude with demonstrations and skills testing on techniques like manual airway maneuvers, ventilation, suctioning, and Combitube insertion.
This document provides an overview of pediatric anesthesiology. It discusses how children's anatomy and physiology differ from adults in ways that are important for anesthesia care. Key points include the large head size and airway structures in young children, differences in breathing, circulation, thermoregulation and pharmacokinetics compared to adults. Special considerations for prematurity, congenital conditions like Down syndrome and tetralogy of Fallot are also reviewed. The document concludes with a discussion of pediatric anesthesia on-call cases such as omphalocele and gastroschisis.
Preterm infants have significant physiological immaturity that impacts anesthesia considerations. Their respiratory, cardiovascular, renal and neurological systems are underdeveloped. Anesthesia can more easily cause apnea, hypothermia, hypoglycemia and other complications in preterm infants. Careful attention must be paid to temperature control, fluid management, glucose levels and minimizing respiratory depressant effects. Regional anesthesia techniques are preferable when possible to reduce medication doses.
This document provides guidance on managing pediatric airways. It discusses signs of airway instability including retractions, nasal flaring, and head bobbing. It describes pediatric airway anatomy and how it differs from adults. The document outlines how to open and maintain an airway manually or with devices. It also discusses techniques for bag-mask ventilation and intubation in pediatric patients, as well as dealing with difficult airways. Complications of airway management are addressed.
Rapid intubation, also known as rapid sequence intubation (RSI), is an emergency airway management technique used to quickly place an endotracheal tube. It involves preoxygenating the patient, administering induction medications to cause unconsciousness followed immediately by paralysis medications. This allows intubation to be performed without having to manually ventilate the patient first. Proper patient positioning, preparation of equipment, and verification of tube placement are important steps in the technique. Potential complications include esophageal intubation, hypotension, and dental trauma. RSI is the preferred method in emergency situations where immediate airway control is needed.
This document discusses the anatomy and physiology of the airway and provides guidance on proper airway management techniques. It describes the structures of the airway from the nose to the trachea. It emphasizes the importance of evaluating each patient's airway, having the proper equipment, and developing adequate skills to successfully manage the airway. Techniques covered include use of oral and nasal airways, laryngoscopy, endotracheal intubation, and developing a backup plan for difficult airways.
management of foreign body inhalation and bronchoscopy in childrenanu_radha1209
This document discusses anesthesia considerations for bronchoscopy procedures to remove foreign body inhalation. It notes that foreign body inhalation is most common in children ages 6 months to 3 years and presents highest risk in that age group due to exploring objects orally and lack of coordination. Rigid bronchoscopy is the standard approach for removal, requiring careful anesthesia to control breathing while the scope is inserted and foreign body extracted. Key goals are maintaining oxygenation and minimizing risks like pulmonary aspiration or dislodging the object during ventilation changes.
This document discusses anaesthesia considerations for emergency laparotomy in critically ill patients. Key points include:
- Patients often present late with sepsis, dehydration, electrolyte imbalances, and respiratory compromise from abdominal issues.
- Preoperative resuscitation is important to optimize the patient's condition through fluid resuscitation and correction of acidosis over 2-4 hours.
- During resuscitation, airway and breathing are prioritized through oxygen supplementation. Circulation is addressed through IV access and fluid administration while monitoring urine output and electrolytes.
- Full preoperative optimization can improve outcomes, but delays in surgery should be avoided for septic patients once initial resuscitation is underway.
Airway management in polytrauma scenario is highly challenging and requiring special challenges. This presentation covers basic, advanced skills, airway assessment in trauma scenario, special challenges, and management pearls.
This document discusses various types of breathing circuits and airway management devices. It describes Mapleson breathing circuit classifications and notes that the Magill and Bain systems are efficient for spontaneous and controlled ventilation, respectively. The Jackson Rees or Type F circuit has a larger reservoir bag, allowing for assisted or controlled ventilation, especially in children. The document also outlines various airway assessment techniques, predictors of difficult intubation/mask ventilation, and management strategies and devices for securing the airway, including oral/nasal airways, face masks, laryngeal mask airways, and tracheal intubation equipment.
This document discusses recent advances in airway management. It covers new devices like videolaryngoscopes, supraglottic airway devices like LMAs, fiberoptic intubation, and mucosal atomization techniques. It emphasizes the importance of preoxygenation to buy time during difficult airways. New concepts like THRIVE and paroxygenation allow oxygenation without ventilation. While no single solution exists for difficult airways, appropriate assessment, new devices, guidelines, and skills maintenance have increased safety and reduced morbidity and mortality.
This document discusses regional anesthesia techniques for foot and ankle surgery, including digital blocks, ankle blocks, and popliteal blocks. It describes the relevant nerve anatomy, techniques for administering the different blocks, benefits like postoperative pain relief, and potential complications. Popliteal blocks provide long-lasting pain relief but require more setup. Ultrasound guidance and indwelling catheters are discussed as ways to improve popliteal blocks. Overall, regional anesthesia is presented as a safe and reliable option that results in high patient satisfaction and efficient surgery when performed by foot and ankle specialists.
This document provides an overview of pediatric airway management techniques. It discusses various oxygen delivery devices including nasal cannulas, simple oxygen masks, and non-rebreathing masks. Bag-valve mask ventilation is described including proper positioning and techniques. Intubation is covered, including equipment selection, laryngoscopy techniques, and confirmation of proper tube placement. Rescue airway devices like LMAs, Combitubes, and bougies are also summarized. Key rules for managing the pediatric airway emphasize being prepared, having backup plans, using common sense, and individualizing approaches for each patient.
The document discusses post-extubation stridor, which is upper airway obstruction that can occur after a patient is extubated from a ventilator. It defines post-extubation stridor and reviews risk factors such as duration of intubation and cuff pressures. The cuff leak test is presented as a way to identify patients at risk. Studies are reviewed showing steroids given before extubation can reduce the risk of stridor. Clinically, it recommends identifying at-risk patients, performing the cuff leak test, and considering steroid treatment for high-risk patients before extubation.
This document discusses endrotracheal intubation including indications, anatomy, equipment, technique, and confirmation of proper tube placement. Key points include intubation is indicated for airway protection, optimizing gas exchange, decreasing metabolic demand. Proper equipment includes laryngoscope, endotracheal tubes, airways. Technique involves aligning three axes of oral, pharyngeal and laryngeal, lifting epiglottis to view cords, passing tube through cords. Placement is confirmed visually and by auscultation of breath sounds over lungs.
vital role
Pre-oxygenation: vital
Awake intubation: consider
Alternative airway: have ready
Senior help: call early
Cricothyrotomy: know how to do
Postpone if not urgent
Don't panic, think and act
Document: vitally important
Prepare for worst
Train and practice regularly
This document provides information on various advanced airway management techniques including orotracheal intubation, nasogastric tubes, suctioning, and use of alternative airways like Combitubes. It describes how to perform each technique, important anatomy, sizes of equipment to use, potential complications, and considerations for intubating infants and children due to anatomical and physiological differences from adults.
This document provides information on airway management. It discusses anatomy of the airway and considerations for different patient populations like infants and pregnant patients. It describes techniques for assessing and securing the airway including basic maneuvers, airway adjuncts, bag-valve-mask ventilation, and advanced techniques like endotracheal intubation, laryngeal mask airway, combitube, and surgical airways like needle cricothyroidotomy and tracheostomy. Complications of inadequate airway management and securing the airway in difficult situations are also addressed.
The document discusses procedural sedation, including definitions, common procedures it is used for, advantages over general anesthesia, levels of sedation, ideal agents, options for agents, considerations for assessment, preparation, procedure, aftercare, complications and their management, controversies, and conclusions regarding its importance as an essential emergency medicine skill. Procedural sedation refers to administering sedatives with or without analgesics to allow painful procedures while maintaining cardiorespiratory function. A variety of agents like propofol, ketamine, midazolam, nitrous oxide, and opioids are discussed as options for procedural sedation.
This document provides information about the femoral nerve block procedure. It begins with an introduction stating that the femoral nerve block is a simple and low-risk nerve block technique that is effective for anterior thigh procedures. It then discusses the indications, anatomy, distribution of anesthesia, techniques, equipment, ultrasound guidance, and complications of the femoral nerve block. The summary provides essential information about the procedure in 3 sentences:
The femoral nerve block is a nerve block technique for anterior thigh procedures that involves identifying the femoral nerve under ultrasound guidance and injecting local anesthetic near the nerve to anesthetize the anterior thigh and knee. It is a relatively simple procedure to perform with a low risk of complications when using ultrasound guidance to precisely place the needle and
This document provides an overview of key differences in pediatric anesthesia compared to adult anesthesia. It discusses how pediatric patients have different anatomy, physiology, pharmacology, and psychology compared to adults. Some key points summarized are:
1. Pediatric patients have proportionally larger head size, smaller lung volumes, higher heart rates, and different responses to drugs due to immature organ systems.
2. Anesthesia risks for children include higher risks of respiratory issues, hypothermia, hypotension, and emergence delirium compared to adults.
3. Proper fluid management is important due to differences in kidney function and risk of dehydration in pediatric patients.
Rapid sequence induction and intubation (RSII) is a technique used to rapidly secure the airway while minimizing the risk of regurgitation and aspiration. It involves pre-oxygenating the patient, intravenously inducing anesthesia, applying cricoid pressure, and swiftly intubating the trachea. While the classic RSI technique included placing a gastric tube, current modified versions often omit this step. Proper patient positioning, drug preparation, equipment readiness, and team coordination are essential to ensure safe and effective RSII.
1) Anorectal malformations are congenital abnormalities of the rectum and anus that occur due to imperfect fusion during development in utero. They can range from minor stenoses to more severe high abnormalities involving the bladder or genital tract.
2) It is important to determine if the abnormality is high or low through investigations like invertograms in order to plan appropriate treatment. Associated abnormalities in other organ systems must also be ruled out.
3) For anesthesia, special consideration is given to temperature control, ventilation, and careful monitoring due to the vulnerability of infants with anorectal malformations. Regional techniques or low-dose inhalational inductions are preferred.
PAEDIATRIC PHYSIOLOGY & ITS IMPLICATION IN ANEASTHESIA - Muthu.pptxMubshiraTC1
This document discusses paediatric physiology and its implications for anaesthesia. Some key points:
- Children are not small adults and have significant physiological differences, especially neonates.
- Neonates have increased surface area, heat and fluid requirements compared to adults. Their cardiovascular and respiratory systems are also less developed.
- Fetal circulation changes at birth as lungs aerate and ductus arteriosus/foramen ovale close. Transitional circulation can occur if these remain patent.
- The paediatric airway has anatomical differences like a higher larynx that make intubation more challenging.
- Respiratory rate and oxygen needs are higher in children due to lower functional residual capacity and higher metabolic demands.
- Hyp
This document discusses paediatric trauma. It notes that trauma is a leading cause of death and disability in childhood. Unique characteristics of paediatric trauma include a higher risk of airway obstruction and respiratory complications compared to circulatory issues. Proper airway management is especially important, using appropriately sized equipment. Fluid resuscitation should be carefully monitored for adequacy, and hypothermia prevented. Outcomes depend on factors like response to CPR and presence of fixed pupils.
This document discusses anaesthesia considerations for emergency laparotomy in critically ill patients. Key points include:
- Patients often present late with sepsis, dehydration, electrolyte imbalances, and respiratory compromise from abdominal issues.
- Preoperative resuscitation is important to optimize the patient's condition through fluid resuscitation and correction of acidosis over 2-4 hours.
- During resuscitation, airway and breathing are prioritized through oxygen supplementation. Circulation is addressed through IV access and fluid administration while monitoring urine output and electrolytes.
- Full preoperative optimization can improve outcomes, but delays in surgery should be avoided for septic patients once initial resuscitation is underway.
Airway management in polytrauma scenario is highly challenging and requiring special challenges. This presentation covers basic, advanced skills, airway assessment in trauma scenario, special challenges, and management pearls.
This document discusses various types of breathing circuits and airway management devices. It describes Mapleson breathing circuit classifications and notes that the Magill and Bain systems are efficient for spontaneous and controlled ventilation, respectively. The Jackson Rees or Type F circuit has a larger reservoir bag, allowing for assisted or controlled ventilation, especially in children. The document also outlines various airway assessment techniques, predictors of difficult intubation/mask ventilation, and management strategies and devices for securing the airway, including oral/nasal airways, face masks, laryngeal mask airways, and tracheal intubation equipment.
This document discusses recent advances in airway management. It covers new devices like videolaryngoscopes, supraglottic airway devices like LMAs, fiberoptic intubation, and mucosal atomization techniques. It emphasizes the importance of preoxygenation to buy time during difficult airways. New concepts like THRIVE and paroxygenation allow oxygenation without ventilation. While no single solution exists for difficult airways, appropriate assessment, new devices, guidelines, and skills maintenance have increased safety and reduced morbidity and mortality.
This document discusses regional anesthesia techniques for foot and ankle surgery, including digital blocks, ankle blocks, and popliteal blocks. It describes the relevant nerve anatomy, techniques for administering the different blocks, benefits like postoperative pain relief, and potential complications. Popliteal blocks provide long-lasting pain relief but require more setup. Ultrasound guidance and indwelling catheters are discussed as ways to improve popliteal blocks. Overall, regional anesthesia is presented as a safe and reliable option that results in high patient satisfaction and efficient surgery when performed by foot and ankle specialists.
This document provides an overview of pediatric airway management techniques. It discusses various oxygen delivery devices including nasal cannulas, simple oxygen masks, and non-rebreathing masks. Bag-valve mask ventilation is described including proper positioning and techniques. Intubation is covered, including equipment selection, laryngoscopy techniques, and confirmation of proper tube placement. Rescue airway devices like LMAs, Combitubes, and bougies are also summarized. Key rules for managing the pediatric airway emphasize being prepared, having backup plans, using common sense, and individualizing approaches for each patient.
The document discusses post-extubation stridor, which is upper airway obstruction that can occur after a patient is extubated from a ventilator. It defines post-extubation stridor and reviews risk factors such as duration of intubation and cuff pressures. The cuff leak test is presented as a way to identify patients at risk. Studies are reviewed showing steroids given before extubation can reduce the risk of stridor. Clinically, it recommends identifying at-risk patients, performing the cuff leak test, and considering steroid treatment for high-risk patients before extubation.
This document discusses endrotracheal intubation including indications, anatomy, equipment, technique, and confirmation of proper tube placement. Key points include intubation is indicated for airway protection, optimizing gas exchange, decreasing metabolic demand. Proper equipment includes laryngoscope, endotracheal tubes, airways. Technique involves aligning three axes of oral, pharyngeal and laryngeal, lifting epiglottis to view cords, passing tube through cords. Placement is confirmed visually and by auscultation of breath sounds over lungs.
vital role
Pre-oxygenation: vital
Awake intubation: consider
Alternative airway: have ready
Senior help: call early
Cricothyrotomy: know how to do
Postpone if not urgent
Don't panic, think and act
Document: vitally important
Prepare for worst
Train and practice regularly
This document provides information on various advanced airway management techniques including orotracheal intubation, nasogastric tubes, suctioning, and use of alternative airways like Combitubes. It describes how to perform each technique, important anatomy, sizes of equipment to use, potential complications, and considerations for intubating infants and children due to anatomical and physiological differences from adults.
This document provides information on airway management. It discusses anatomy of the airway and considerations for different patient populations like infants and pregnant patients. It describes techniques for assessing and securing the airway including basic maneuvers, airway adjuncts, bag-valve-mask ventilation, and advanced techniques like endotracheal intubation, laryngeal mask airway, combitube, and surgical airways like needle cricothyroidotomy and tracheostomy. Complications of inadequate airway management and securing the airway in difficult situations are also addressed.
The document discusses procedural sedation, including definitions, common procedures it is used for, advantages over general anesthesia, levels of sedation, ideal agents, options for agents, considerations for assessment, preparation, procedure, aftercare, complications and their management, controversies, and conclusions regarding its importance as an essential emergency medicine skill. Procedural sedation refers to administering sedatives with or without analgesics to allow painful procedures while maintaining cardiorespiratory function. A variety of agents like propofol, ketamine, midazolam, nitrous oxide, and opioids are discussed as options for procedural sedation.
This document provides information about the femoral nerve block procedure. It begins with an introduction stating that the femoral nerve block is a simple and low-risk nerve block technique that is effective for anterior thigh procedures. It then discusses the indications, anatomy, distribution of anesthesia, techniques, equipment, ultrasound guidance, and complications of the femoral nerve block. The summary provides essential information about the procedure in 3 sentences:
The femoral nerve block is a nerve block technique for anterior thigh procedures that involves identifying the femoral nerve under ultrasound guidance and injecting local anesthetic near the nerve to anesthetize the anterior thigh and knee. It is a relatively simple procedure to perform with a low risk of complications when using ultrasound guidance to precisely place the needle and
This document provides an overview of key differences in pediatric anesthesia compared to adult anesthesia. It discusses how pediatric patients have different anatomy, physiology, pharmacology, and psychology compared to adults. Some key points summarized are:
1. Pediatric patients have proportionally larger head size, smaller lung volumes, higher heart rates, and different responses to drugs due to immature organ systems.
2. Anesthesia risks for children include higher risks of respiratory issues, hypothermia, hypotension, and emergence delirium compared to adults.
3. Proper fluid management is important due to differences in kidney function and risk of dehydration in pediatric patients.
Rapid sequence induction and intubation (RSII) is a technique used to rapidly secure the airway while minimizing the risk of regurgitation and aspiration. It involves pre-oxygenating the patient, intravenously inducing anesthesia, applying cricoid pressure, and swiftly intubating the trachea. While the classic RSI technique included placing a gastric tube, current modified versions often omit this step. Proper patient positioning, drug preparation, equipment readiness, and team coordination are essential to ensure safe and effective RSII.
1) Anorectal malformations are congenital abnormalities of the rectum and anus that occur due to imperfect fusion during development in utero. They can range from minor stenoses to more severe high abnormalities involving the bladder or genital tract.
2) It is important to determine if the abnormality is high or low through investigations like invertograms in order to plan appropriate treatment. Associated abnormalities in other organ systems must also be ruled out.
3) For anesthesia, special consideration is given to temperature control, ventilation, and careful monitoring due to the vulnerability of infants with anorectal malformations. Regional techniques or low-dose inhalational inductions are preferred.
PAEDIATRIC PHYSIOLOGY & ITS IMPLICATION IN ANEASTHESIA - Muthu.pptxMubshiraTC1
This document discusses paediatric physiology and its implications for anaesthesia. Some key points:
- Children are not small adults and have significant physiological differences, especially neonates.
- Neonates have increased surface area, heat and fluid requirements compared to adults. Their cardiovascular and respiratory systems are also less developed.
- Fetal circulation changes at birth as lungs aerate and ductus arteriosus/foramen ovale close. Transitional circulation can occur if these remain patent.
- The paediatric airway has anatomical differences like a higher larynx that make intubation more challenging.
- Respiratory rate and oxygen needs are higher in children due to lower functional residual capacity and higher metabolic demands.
- Hyp
This document discusses paediatric trauma. It notes that trauma is a leading cause of death and disability in childhood. Unique characteristics of paediatric trauma include a higher risk of airway obstruction and respiratory complications compared to circulatory issues. Proper airway management is especially important, using appropriately sized equipment. Fluid resuscitation should be carefully monitored for adequacy, and hypothermia prevented. Outcomes depend on factors like response to CPR and presence of fixed pupils.
The document provides guidance on airway management in emergency situations. It discusses assessing the need for airway control, oxygen delivery devices, signs of respiratory distress, techniques for difficult intubation like video laryngoscopy, and alternative airway devices like combitubes. Factors like patient comorbidities, anatomy, and mechanism of respiratory failure help determine the best approach. Proper planning, backup devices, and skills are important for managing challenging airways.
This document provides guidelines for endotracheal intubation using rapid sequence intubation (RSI). It outlines indications for RSI including respiratory arrest and compromised airways. It also lists contraindications and complications. The guidelines describe assessing for a difficult airway, preparing equipment and the patient, pre-oxygenating, pre-treating with medications, inducing paralysis, intubating, confirming tube placement, and post-intubation management. The goal is to control the airway while minimizing risks like aspiration, using the appropriate medications, techniques, equipment, and monitoring to intubate safely and effectively.
This document provides guidance on rapid sequence intubation (RSI) for airway management. It outlines indications for RSI including failure to protect or compromise of the airway. Relative contraindications include predictors of a difficult airway and patient conditions like unstable fractures or hypersensitivity. The document describes the preparation, pre-treatment, and technique for RSI, including assessing the airway, pre-oxygenation, induction agents, paralytic agents, intubation procedure, and confirmation of proper tube placement. Complications of intubation are also reviewed.
The majority of pediatric airway emergencies occur in children under 1 year old and are primarily caused by upper airway obstruction from infectious diseases like viral croup. The pediatric airway has unique anatomical features like a higher larynx and narrower subglottic airway that make it more prone to obstruction. Initial management focuses on airway stabilization through suction, positioning, oxygen therapy, and supportive care. Further treatment depends on the specific condition but may include nebulization, intubation, tracheostomy, or endoscopic evaluation and intervention. Outcomes are generally good with resolution of acute issues and management of any underlying structural abnormalities.
This document discusses airway management considerations for various pediatric syndromes. It begins by defining a difficult airway and noting risk factors like age, weight, and Mallampati score. It then summarizes key airway features and management strategies for conditions like Down syndrome, Pierre Robin sequence, mucopolysaccharidoses, and Klippel-Feil syndrome. Specific challenges involve facial anomalies, macroglossia, neck mobility issues. Techniques discussed include fiberoptic intubation, video laryngoscopy, and awake intubation due to increased risk of difficult laryngoscopy. Overall, the document provides an overview of pediatric airway syndromes and their implications for anesthesiologists.
This document outlines procedures for intubation in patients with compromised airways. It indicates that intubation is appropriate for patients in respiratory arrest, with head injuries, who are combative, have altered mental status, hypoxia, seizures, or status asthmaticus. Contraindications include conditions making intubation difficult. Preparation includes assessing the airway, positioning the patient, pre-oxygenating, and administering medications before inducing paralysis and intubating. Placement must be confirmed and the airway secured before providing ongoing care and transport.
ANESTHETIC MANAGEMENT OF TRACHEOESOPHAGEAL FISTULA by Dr.Sravani VishnubhatlaDrSravaniVishnubhatl
Learning Objectives:
Review the clinical presentation of a patient with tracheoesophageal fistula (TEF)
Understand the prevalence of TEF, types, and associated syndrome
Discuss the diagnosis of TEF
Describe the medical and surgical management of TEF
Understand the anesthetic-related implications and develop an anesthetic plan
This document discusses the anaesthetic considerations for premature infants undergoing surgery. It outlines the physiological differences between premature and term infants that impact anaesthesia, including differences in the airway, respiratory, cardiovascular, renal and temperature regulation systems. It provides guidance on pre-operative assessment, appropriate intra-operative monitoring and management, including fluid management and blood product transfusion thresholds. Post-operative care involves close monitoring due to the risks of apnea and other complications in the first 48-72 hours after surgery.
This document discusses respiratory distress in newborns. It begins by defining respiratory distress and listing its common causes such as respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), and pneumonia/sepsis. It then discusses the incidence of respiratory distress and these conditions. For example, it notes that RDS occurs in about 50% of extremely low birth weight infants. The document proceeds to describe the pathophysiology, clinical signs, diagnosis, and management of RDS in more depth. It emphasizes the importance of antenatal steroids in preventing RDS and discusses the use of surfactant replacement therapy for treatment.
1) The document provides guidelines for managing pediatric respiratory distress and failure in 4 parts, with Part 3 focusing on assessment, causes, and treatment of respiratory distress and failure.
2) Key signs of respiratory distress include tachypnea, retractions, and hypoxia; respiratory failure is indicated by bradypnia, cyanosis, and decreased consciousness. Causes include upper airway obstruction, lower airway obstruction, lung disease, and control disorders.
3) For upper airway emergencies like croup and epiglottitis, humidified oxygen, nebulized adrenaline, steroids, and intubation may be needed. For lower airway issues like asthma and bronchiolitis
The document discusses infant respiratory distress syndrome (IRDS), a condition in premature infants caused by a lack of surfactant in the lungs. Some key points: IRDS occurs most often in preterm babies less than 28 weeks gestation. It causes breathing difficulties due to a lack of surfactant, which keeps alveoli open. Symptoms include respiratory distress and cyanosis. Diagnosis involves chest X-ray and blood gas analysis. Treatment requires oxygen, fluids, ventilation support if needed, and administration of surfactant to premature infants. With proper treatment survival rates are high, though complications can include bronchopulmonary dysplasia.
The document discusses respiratory distress in neonates. It describes the clinical presentation of respiratory distress and various scoring systems used to assess severity. It then covers the major causes of respiratory distress including transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia and others. For each cause, it discusses risk factors, clinical features, investigations and management. The management sections provide details on oxygen therapy, CPAP, surfactant administration and mechanical ventilation.
The document discusses the anatomical and physiological differences between paediatric and adult patients that are important for anaesthesiologists to consider, noting differences in the respiratory, cardiovascular, renal and other systems, as well as how these differences impact drug dosing and fluid management during anaesthesia for children. It provides guidance on preoperative assessment, induction, maintenance of anaesthesia, monitoring, fluid requirements and recovery care tailored for paediatric patients from neonates to adolescents.
This document discusses infant respiratory distress syndrome (IRDS), including its causes, signs and symptoms, diagnostic evaluation, treatment and nursing management. IRDS is caused by a lack of surfactant in premature infants' lungs. It can cause respiratory distress seen as tachypnea, retractions and grunting. Diagnosis involves blood tests and chest x-rays showing atelectasis. Treatment includes oxygen therapy, surfactant replacement, ventilation support and ensuring temperature and nutrition. Nursing care focuses on monitoring breathing and oxygen levels, preventing hypothermia and infection, and supporting nutrition and developmental care.
1) The document discusses the key components of trauma care including pre-hospital care, in-hospital care, rehabilitation, prevention, education, and research. It outlines the priorities of airway, breathing, and circulation for pre-hospital care and primary and secondary surveys for in-hospital care.
2) Specific trauma situations are examined like the elderly, pregnant patients, pediatrics, and special injuries involving the brain, chest, abdomen, and long bones. Management approaches are tailored to each group's unique needs.
3) The goals of trauma care and definitive treatment are outlined as preventing early death, minimizing morbidity, and maximizing function through early intervention, cellular protection, and multidisciplinary rehabilitation.
SEMS 2014: Ang Shiang Hu - Life threatening asthma Rahul Goswami
The Critical Care track of the Society for Emergency Medicine in Singapore Annual Scientific Meeting 2014.
For more information and conference videos, go to singem.blogspot.sg
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Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
1. PRESENTER : DR SNIGDHA
MODERATOR : DR AJIT KUMAR
INTRA OPERATIVE MANAGEMENT IN PEDIATRIC
AGE GROUP: AIRWAY MANAGEMENT AND
EVALUATION, INDUCTION, VENTILATORY
STRATEGIES, MAINTENANCE, EXTUBATION
7. THERE IS MARKED DESCENT OF LARYNX BETWEEN BIRTH AND
3YR, REACHING ADULT LEVEL OF C5 – C6 FOLLOWING
PUBERTY
8. Infant’s vocal cords have
more angled attachment
to trachea, adult’s VC are
more perpendicular
Difficulty in nasal
intiubation where blindly
placed ETT may easily
lodge in anterior
commissure rather than in
trachea
13. Alveoli
Small and Limited number ( decrease compliance)
↑ Closing Capacity & ↑ air trapping
Pulmonary Vessels
↑ Pulmonary vascular resistance (PVR)
Very sensitive to constriction by hypoxia, acidosis and
hypercarbia
Chest Wall
Horizontal ribs
↑ A-P diameter
↑ compliance due to cartilagenous rib
Breathing is all diaphragmatic, easily fatigue due to fewer type
1 muscle cells
FRC determined solely by elastic recoil of lungs
Chest wall collapses with negative pressures
14. Lung compliance is less while chest wall compliance is more
than those in adults - Reduced FRC and Atelectasis
Prone to Bradycardia - Laryngeal stimulation and hypoxia
High metabolic rate (5-8 ml/kg/min)
Oxygen consumption of infant (6 ml/kg/min) is twice that of an
adult (3 ml/kg/min) [Less Oxygen Reserve]
Tidal volume is relatively fixed (6-7 ml/kg/min)
Minute Alveolar Ventilation is more dependent on increased
Respiratory Rate than on Tidal Volume
Ratio of Alveolar Minute Ventilation to FRC is doubled under
circumstances of hypoxia, apnea or anesthesia
18. Best to 1st look from far
1. Any facial anomaly?
2. Is the chest moving? Respiratory rate?
3. Are there any abnormal airway sounds (e.g.. Stridor,
snoring)?
4. Is there increased respiratory effort with retractions or
respiratory effort with no airway or breath sounds?
5. Facial expression
6. Nasal flaring
7. Mouth breathing
8. Color of mucous membranes
19. 9. Voice change
10. Mouth opening
11. Size of mouth
12. Loose or missing teeth.
13. Size and configuration of palate.
14. Size and configuration of mandible (side view).
15. Mallampati score
20. URI - coughing, laryngospasm, bronchospasm, desaturation
during anesthesia
Symptoms new or chronic?– Infectious vs allergic
● Viral infection within 2 - 4 weeks of GA with intubation
increases perioperative risk:
Wheezing risk increased 10x
Laryngospasm risk increased 5x
Hypoxemia, atelectesis, recovery room stay, ICU admissions all
increase
Prophylactic bronchodilator treatment should be considered
before induction
Asthamatic pt. may require steroid coverage
21. Congenital heart disease
CHD associated with high risk of SBE:
1. Unrepaired cyanotic lesions
2. Repaired CHD with prosthetic material with 6m of
procedure
3. Repaired chd with residual defects at / adjacent to site of
prosthetic patch
Prophylaxis only recommended for dental procedure and
invasive procedure of resp. tract
Amoxicillin PO/ ampicillin IV 50mg/kg (max. 2g) /clindamycin/
azithromycin 30 to 60 min before procedure
22. Labs:
Laboratory and radiographic evaluation extremely helpful with
pathologic airway -AP and lateral films and fluoroscopy may
show site and cause of upper airway obstruction
MRI/CT more reliable for evaluating neck masses, congenital
anomalies of the lower airway and vascular system
Radiograph exam done only when there is no immediate threat
to the child’s safety and in presence of skilled personnel with
appropriate equipment to manage the airway
Intubation must not be postponed to obtain radiographic
diagnosis when the patient is severely compromised.
Blood gases are helpful in assessing the degree of physiologic
compromise; however, performing an arterial puncture on a
stressed child may aggravate the underlying airway
obstruction
29. ENDOTRACHEAL TUBE
Uncuffed: <3m- 3mm ID
3-9m- 3.5mm ID
>9m- (age in yrs+ 16)/4
TREACHEOSTOMY
TUBE
Age based formula: ID=
age(yrs)/4 +4 mm
Weight based formula: ID=
Wt(kg)/10 +3.5 mm
30. DIFFICULT AIRWAY PREPARATION
anesthesia masks
airway adjuncts (including nasal airways, oral airways, stylets,
intubating guides, tube exchangers, and gum elastic bougies)
ETTs (conventional uncuffed, cuffed, microlaryngoscopy, and
armored), laryngoscope blades (curved, straight, and hybrid),
laryngoscope handles (regular and short)
SGAs (LMAs, classic LMAs as well as intubating and other
LMA hybrids)
indirect video laryngoscopes
different sizes of FOBs
lung isolation devices (bronchial blockers and double lumen
ETTs)
surgical airway access kits
accessory equipment ([ETCO 2 ] detector, (AMBU), and self-
32. AIRWAY
MANAGEMENT
Positioning:- to align oral,
pharyngeal and tracheal axis
Suctioning,supplemental
oxygen
Nebulization with adrenaline
(1:3) or bronchodilators.
Humidification/ steroid
bag and mask ventilation-
Head tilt, chin lift/ jaw thrust
position
Oropharyngeal/
nasopharyngeal airway
33.
34.
35.
36. Monitoring during induction
● Age & size appropriate standard monitors
● Preductal pulse oximetry in neonates– Right extremity or
earlobe
● EtCO2 monitor– Main-stream less accurate in < 10 kg; Side-
stream may falsely elevate iCO2 and falsely lower EtCO2
● ECG Leads
● Temperature
● BP cuff
Invasive monitoring
● Require expertise and caution● CVL most often IJV or
femoral Vein
● A-line most often right radial artery– Preductal; for beat to
beat monitoring of BP. ● Bispectral index
37. METHODS OF ANESTHESIA INDUCTION
INHALATION INDUCTION:
Inhalation of sevoflurane (BG Partition coefficient of 0.68- rapid
onset)
with or without N2O(BG partition coefficient of 0.47-rapid uptake
and distribution) through a mask – M/C used
It is easily reversed when discontinued.
Preffered in patients with known difficult peripheral venous access,
and difficult airways in order to maintain spontaneous ventilation.
LMA inserted untill IV access secured (20- 22G for children, 22-
24G for infants)
Absolute contraindications including malignant hyperthermia,
38. INTRAVENOUS
INDUCTION:
Advantage – speed of induction; avoids unpleasant odors
and sensations of inhalation
Disadvantage - difficulty and fear associated with
venipuncture in young children.
Topical anesthesia, EMLA/ LMX 4 use in Children >6 yrs
Children have larger central compartment and higher
clearance resulting in higher dosing requirements
39. PROPOFOL:
Induction dose of propofol is 2.5 to 3.0 mg/kg in children 3 -12
years
Children <2 years of age require larger dose (2.6 to 3.4 mg/kg),
whereas older children required less.
Induction with propofol in children can cause significant
decreases in blood pressure and inotropy
Advantage - antiemetic properties
Drawback -pain on injection; can be reduced by lidocaine (0.5
mg/kg) IV 30 to 120 seconds before propofol injection or
mixing propofol and lidocaine immediately prior to injection
40. THIOPENTAL
Induction dose in healthy children 5 to 6 mg/kg ; For Infants <2
week- 3.4 mg/kg
Cardiac depressant and vasodilator- should be used with care
in patients suspected of having hypovolemia or decreased
cardiac function.
ETOMIDATE
For patients who have limited hemodynamic reserve
Causes no significant changes in right atrial, aortic, or PAP or
SVR/ PVR after bolus dosing
Induction dose 0.3 mg/kg
Sepsis is relative adrenally insufficient state; not appropriate in
patients with septic shock d/t adrenal suppression
S/E- pain on injection, myoclonic movements
41. KETAMINE
Induction dose of 2 mg/kg IV
Stimulate- release of endogenous catecholamines, elevate
heart rate and blood pressure; used in hemodynamically
fragile patients.
Bronchodilating properties- useful in reactive airway disease
Increases oral and airway secretions; a/w psychological,
behavioral sequelae in children.
Added with antisialogogues (glycopyrrolate 0.1 mg/kg) and
benzodiazepines (midazolam 0.5 mg/kg)
42. RAPID SEQUENCE INDUCTION
Classic rapid sequence induction involves thorough
preoxygenation, application of cricoid pressure, f/b
hypnotic agent -rapid-acting muscle relaxant -intubation
without mask ventilation.
Infants and small children have reduced apnea tolerance
d/t increased oxygen demand and poor adherence with
preoxygenation, making them high risk for hypoxemia
during even brief periods of apnea.
A modified or controlled rapid sequence induction
avoiding cricoid pressure and utilizing gentle mask
ventilation (insufflating pressures <10–12 cm H2O) until
adequate muscle paralysis for intubation performed to
reduce the risk of hypoxemia without increasing the risk of
43. INTUBATION
Technique:
Always enter from the right corner
Tongue control is critical
Lift the epiglottis with the Miller
Slide the Mac into the vallecula- Can lift the epiglottis if needed
Confirmation :Visualize tube passing through cords ;Breath
sounds and epigastric sounds; End Tidal CO2 (EtCO2)
44. MAINTANANCE OF ANESTHESIA
During maintainance phase, anesthesiologist have to provide
analgesia, amnesia,immobility ensuring hemodynamic
stability
INHALED AGENTS :
1. Nitrous oxide-
Odorless with very low solubility (blood-gas partition
coefficient of 0.47) that results in rapid uptake and
distribution
Anesthesia - inhibition of NMDA glutamate receptors in CNS.
Analgesia- release of endogenous opioids that then
stimulate opioid receptors and spinal level GABA receptors.
Anxiolysis - activation of GABA
Accumulates in closed, gas-containing spaces -avoided in
obstructed loops of bowel, pneumothorax, pneumocephalus,
middle ear surgery.
45. SEVOFLURANE
BG Partition coefficient of 0.68- rapid onset
Non-pungent odor and minimal airway irritation- up to 8%
sevoflurane can be delivered without breath-holding,
coughing, and laryngospasm.
MAC - 3.3% in neonates / <6 months old- 2.5% / 6 m- 5
years- 2.0%
No affect on heart rate, cardiac index, myocardial contractility/
MAP- arrhythmias are uncommon; but prolongs the QTc
interval,when combined with ondansetron.
Effective bronchodilator; In child >6m- maintains CBF through
autoregulation( until MAP <40% from baseline)
46. DESFLURANE
BG solubilty coefficient of 0.42, allows for rapid emergence
and recovery.
MAC :newborns is 9.2% / infants is 8% - 9.9%, /older
children and adults it is 6%
Highly irritating to upper airway, increase airway resistance,
airway narrowing - coughing,breath-holding, laryngospasm-
not used for induction of anesthesia.
Provide cardiovascular stability; decrease in SVR and BP, as
well as increases in heart rate, without changes in cardiac
output; Arrhythmias are uncommon.
47. Isoflurane
BG partition coefficientof 1.4
MAC –agedependent-1.3% preterm infants/ 1.7% 6m-12
m/1.6% 1 to 5yrs/ 1.2% in adults
Pungent odor -coughing and laryngospasm- not used for
induction
Bronchodilator at higher concentration.
Decrease SVR – decrease systemic arterial pressure and
increase in heart rate but maintaining cardiac output.
48. INTRAVENOUS AGENTS:
TIVA- for rapid recovery and provide both unconsciousness
and analgesia.
Newborns /young infants -immature hepatic enzyme systems
and renal clearance -can have accumulation of certain
drugs, so TIVA avoided
49. PROPOFOL:
short-acting- fast onset, smooth maintenance, no
emergence delirium and decreased incidence of nausea
and vomiting
highly lipid-soluble, rapidly cleared and redistributed into the
peripheral tissues, with a short context sensitive half-time.
DOSE: 0.125- 0.3 mg/kg/min
Prolonged administration or very high dosing over shorter
periods- propofol-related infusion syndrome (PRIS)
characterized by a lactic acidosis and significant
cardiovascular dysfunction
50. DEXMEDETOMIDINE
Highly selective alpha-2 adrenoreceptor agonist with both
sedative and analgesic properties.
Elimination half-life-2 hours, with a rapid distribution half-life
of only 6 minutes
Context-sensitive half-life- 4 minutes for10-minute infusion
but over 250 minutes for 8-hour infusion
Increase MAP and decrease HR from baseline values after
10-minute loading dose -1 mcg/kg; effects discontinues with
infusion of 0.7 mcg/kg/hr
SA node function is depressed and AV node properties are
prolonged- used to treat junctional and atrial ectopic
tachycardias as well as SVT
51. VENTILATION STRATEGIES
For controlled ventilation in healthy infants and children,
appropriate initial ventilator settings should aim tidal volume-
8-10mL/kg.
Maintenance of PEEP of at least 3-5 cm H2O
End-tidal CO2 between 35 and 40 mm Hg is the goal, I:E
ratio- 1:2/1:3
Inverse ratio ventilation needed mostly in ARDS / ALI patient
to improve oxygenation
52. Initial ventilator settings are as follows:
Ventilator
settings
Premature
neonate
neonate Infant/chil
d
adolescen
t
mode PC PC VC with
pressure
support
VC
Rate 40-50 30-40 20-30 12-15
PEEP 3-5 3-5 3-5 3-5
Inspiratory
time
0.3-0.4 0.3-0.4 0.5-0.6 0.7-0.9
PIP 18-22(if HMD) 18-20 16-18( in
raised ICP);
18-25 (low
compliance)
18-25; 35 (in
severe ARDS)
Fine tuning after initiation is based on blood gases and
oxygen saturation
53. Targeting oxygen saturation of 90% to 95% in preterm/ 94%
to 98% in term infants and older patients
For ventilation: RR, Tidal volume( in volume limited), and PIP
(in pressure limited)
PEEP – to prevent alveolar collapse at end of inspiration, to
recruit collapsed lung spaced or to stent open floppy airways
In case of hypoxia:
1. Check for circuit connections, oxygen supply, any leak
2. Check position of ETT, any kink/ block(suction)
3. Increase FiO2,MAP
4. Increase tidal volume( in VC), PEEP, Inspiratory
time,PEEP( PC)
5. Others- normalize CO (fluids/electrolytes),maintain normal
Hb / hematocrit, normothermia, deepen sedation, consider
neuromuscular block
54. If Hypercarbia:
1. VC- increase tidal volume/ rate; asthma patient- increase
expiratory time( >1:3)
2. PC- increase RR/PIP, decrease PEEP
3. Decrease deadspace- shorten ETT, increase CO, decrease
PEEP,vaodilator
4. Decrease CO2 production- increase seadation,decrease
carbohydrate load
5. Suction /Change ETT if blocked,check placement/any kink
6. Fix leak in circuit, ETT Cuff
55. ADJUVANT AGENTS
Used during maintenance phase- allows pain control,
smoother emergence, and immediate postoperative
period.
1. OPIOIDS:
Morphine
Hydromorphone
Fentanyl
Sufentanyl
Remifentanyl
Methadone
Meperidine
57. 7. REGIONAL ANESTHESIA –
decrease intraop. requirement of inhaled and iv agents and
allow for a more rapid emergence with effective
postoperative analgesia and minimal sedation
caudal anesthesia remains most popular regional technique
in this population, epidural anesthesia, field blocks,
ultrasound-guided peripheral nerve blocks, and neuroaxial
opioids
Drugs used- Ropivicaine 0.2%- 1 mg/kg (up to 2 mg/kg)–
Bupivicaine 0.25%- 1 mg/kg (up to 2.5 mg/kg)
Opioids● morphine 25-50 mcg/kg● Hydromorphone 5-10
mcg/kg– Clonidine 2 mcg/kg
58. PERIOPERATIVE FLUID REPLACEMENT
Maintenance fluid requirements were based on Holliday and
Segar formula-
Infant needs 100ml of water per 100kcal expenditure
●1st 0-10 kg → 4 ml/kg/hr
●2nd 10-20 kg → 2 ml/kg/hr
● > 20 kg → 1 ml/kg/hr
● Calculate preoperative deficit : maintainance fluid requirement
X no. Of hours of restriction– Replace 50% fluid deficit +
hourly maintenance fliud required in first hour – Replace 25%
fluid deficit + hourly maintenance fliud required in second hour
and third hour
●M/C : NS ,RL used
● Major surgery → up to additional 10 ml/kg/hr
● Urethral catheter done to monitor U.O and state of hydration
59. TEMPERATURE REGULATION
Core temperature- measured with an esophageal
probe.
The safe range for a child’s core temperature is
between 35.5° and 37.5° C.
To prevent complications due to hypothermia, active
warming, increasing roomtemperature, using radiant
warming lamps, wrapping the child’s head and other
exposed areas, and using warmed intravenous fluids
60. BLOOD LOSS AND BLOOD PRODUCT
REPLACEMENT
● Replace initially with 3 x BSS
or 1 x colloid
MABL =EBV × (Starting
hematocrit -Target
hematocrit)/Starting hematocrit
Once the MABL is exceeded,
transfuse PRBC
The volume of PRBC needed
to replace calculated as
follows:
PRBC (ml) = [ Blood loss - ABL]
X Desired
hematocrit/Hematocrit of
PRBC
61. EMERGENCE AND EXTUBATION
Emergence from GA should be smooth, safe, and well timed.
While Child is still anesthetized: place an oral airway or bite
block, then do gastric suctioning
Increasing fresh gas flow and rate of controlled or assisted
ventilation- facilitate elimination of anesthetic gases. To avoid
absorption atelectasis, the use of 100% oxygen should be
avoided.
As the depth of anesthesia lessens,respiratory pattern and
rate noted.
A paradoxical breathing pattern- indicate incomplete recovery
from GA, residual paralysis, or upper airway obstruction.
A rapid RR -indicate inadequate analgesia or Stage 2 of
anesthesia
62. Transition from Stage 2 to Stage 1 of GA in pre- or nonverbal
children assessed by:
1. Grimacing, which includes eyebrows and/or forehead
2. Conjugate gaze
3. Spontaneous eye opening
4. Purposeful movement, such as reaching for the endotracheal
tube
5. Spontaneous tidal volume >5ml/kg
If neuromuscular blockers used, recovery of TOF ratio over 0.90
,needed to ensure adequate neuromuscular function
Reversal of neuromuscular blockade- iv atropine (0.02 -0.30
mg/kg) or glycopyrrolate (0.01 mg/kg), followed by neostigmine
(0.06 mg/kg).
Sugammadex, a rapid-acting reversal agent rocuronium and
63. Clinical criteria of neuromuscular recovery in preverbal and
uncooperative children include:
• Nonparadoxic breathing
• Negative inspiratory pressure generation greater than 30 cm
H2O
• Hip flexion, with leg elevation, for 10 seconds
• Head lift for 10 seconds
64. TRACHEAL EXTUBATION
ET tube extubation performed when child is fully emerged from
GA (awake extubation) or well anesthetized (deep extubation)
Awake extubation performed after patient has fully emerged
from Stage 2 of GA -for children with difficult airways and
patients with full stomach precautions.
Deep extubations - performed whose airway well maintained by
mask ventilation during induction of anesthesia and is still in
Stage 3 of GA,done safely using sevoflurane or desflurane to
allow expedient awakening after extubation.
Depth of anesthesia confirmed by absence of any response to
suctioning of oral,pharynx and deflation of ET tube cuff
65.
66.
67.
68. EMERGENCE DELIRIUM
It is a dissociated state of consciousness
characterized by inconsolability,thrashing
and incoherence.
Risk factors include age <5 years ,ENT
and ophthalmologic procedures, use of
isoflurane, rapid emergence (Rapid
awakening in strange environment,
variable recovery of CNS
function,withdrawal from GABA receptors,
inadequately treated pain- major
contributor)
fentanyl 2.5 mcg/kg, clonidine 2 mcg/kg,
ketamine 0.25 mg/kg, nalbuphine 0.1
mg/kg, or propofol 1 mg/kg
Dexmedetomidine(donot compromise
69. PROBLEMS IN POST ANESTHESIA CARE
UNIT
Apnea of prematurity
Airway obstruction
Obstructive sleep apnea
Post obstructive pulmonary edema
Post intubation Croup
Cardiovascular Instability
Nausea / Vomiting
Temperature instability
Pain measurement/ assessment/ management
70. ON
Apnea Oversedation with
opioid
Hypocarbia(EtCO2 <4
0
Oversedation- by
synergism of multiple
anesthetic
agents(preoperative
benzodiazepine and/or
inhalational agent
No spontaneous
ventilatory effort
Able to mask-
ventilate patients
EtCO2 can be
high/low
Small or pinpoint
pupils
↑ End-tidal
inhalational agent
concentration
•Bag mask
ventilation to
maintain
SpO2 >94%
•Allow PaCO2 to
rise
•Consider
flumazenil or
naloxone in
recalcitrant
situations
Bronchospas
m
Preexisting URI
Asthma
exposure to
secondhand smoke
Persistent coughing
No breath holding
Wheezing
↓ SpO2- late sign
↑ CO2
•Albuterol
•Epinephrine 0.05
mcg/kg IV if
extreme
Coughing/
breath-
holding
Preexisting URI
Premature extubation-
in stage 2
Bronchiole constriction
exposure to
Persistent coughing
Breath holding
typically <10
seconds
↓ SpO2
•↑ FiO2 via mask
•Apply CPAP with
10-20 cm H2O
•Attempt to wait for
resolution
71. Laryngospasm Premature
extubation in
stage 2
Glottic closure
from stimulation
by ETT or
secretions
Lack of
oropharyngeal
tone
Usually preceded by
cough
Rigid abdominal
wall
Unable to mask-
ventilate even with
oral airway and
elevated ventilatory
pressures
Breath holding for
>10 seconds
↓ SpO2
• attempt mask
ventilation or
apply CPAP with
100% FiO2
•Propofol 1 mg/kg
IV (repeat or
escalate dose if
needed)
•Succinylcholine 1
mg/kg IV/ 4 mg/kg
IM if IV is pulled
out
•Reintubate If
required
Upper airway
obstruction
Collapse of base of
tongue, soft palate
onto posterior
pharyngeal wall d/t
Oversedation with
opioid/BDZ
Residual
inhalational
agent;Underlying
Patient appears to
attempt to breathe but
no breath sounds are
present
Sternal notch sinks in
with attempts at
inspiration
↓ SpO2
Loud upper airway
•Jaw thrust
•10-20 cm H2O of
CPAP
•Oral airway
•Lateral position
•Consider
flumazenil or
naloxone
•Bag-mask