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.
Hypothyroidism and hyperthyroidism have significant clinical effects. Both should be optimized. Anesthesia providers should be able to diagnose and manage.
new technique for pain management ,described by dr forero ,it can replace epidural anesthesia,paravertebral anesthesia and other regional blocks.it can be used for both acute and chronic painful conditions
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
Hypothyroidism and hyperthyroidism have significant clinical effects. Both should be optimized. Anesthesia providers should be able to diagnose and manage.
new technique for pain management ,described by dr forero ,it can replace epidural anesthesia,paravertebral anesthesia and other regional blocks.it can be used for both acute and chronic painful conditions
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
Eating difficulties in younger children and when to worryPooky Knightsmith
A short presentation for information or training which explores the common eating difficulties seen in younger children along with guidance as to when we should be concerned.
For more support, guidance and resources visit http://www.inourhands.com
N.B. this is guidance I developed to as part of a face to face training session rather than to stand alone. If you require further explanations or would like me to deliver similar training to your colleagues, please email me - pooky@inourhands.com
A short presentation covering most important anatomical differences along with physiological difference of pediatric population from adult. Also covers important aspects of anaesthesia consideration in pediatric patients.
I specifically made this presentation by using morgan and miller books.
11. The parasympathetic system is mature in newborns
Dominant
Vagotonic
50% of apparently healthy babies
24 hours EKG recording
Have shown rhythm changes resembles complete 2:1 Block
16. CO can be assessed clinically by stethoscope
Heart sounds become softer and muffled in low CO states
17.
18.
19.
20. Contractile element is 30%
(60%in adults)
Starling law is at maximum
Cannot tolerate volume overload
21. Thin wall atria and ventricle
Risk of tamponade during central line
insertion
22. Born T wave upright in all chest leads
In few hours T wave isoelectric or
inverted in left chest
In 7 days T wave inverted in the Right
chest leads (V1-V4)
Failure of T wave inversion in V1-V4 is
the earliest sign of RV hypertrophy
31. General anesthesia, FRC and PEEP
PEEP
important in children < 3 years
essential in infants < 9 months
Mean PEEP to resore FRC to normal
infants < 6 months 6 cm H2O
children 6-12 cm H2O
35. No muscle
Higher
relaxants
incidence of
Inadequate
GERD
anesthesia
Short
esophagus
Limited Excessive air
stomach swallowing
compliance during crying
Baby trust
48. Vitamin k dependent factors(II,VII,IX,X)
20-60% of adult values
Infants of mother who have received
anticoagulation may develop severe bleeding like
Vitamin K deficiency
Babies on MV showed significant thrombocytopenia
49. Large surface area relative to body weight(2-2.5x BW)
Thin skin and subcutaneous fat( less insulation)
Neonates no shivering
Immature thermoregulation center
50. Forced air warming systems always available
Fluid warmer
Room temperature
51.
52.
53.
54. Infant kidneys
immature function at birth:
GFR (‘til 2 years old)
concentrating capacity
Na reabsorption
HCO3 /H exchange
free H2O clearance
urinary loss of K+, Cl-
55. What it means:
Newborn kidney has limited
capacity to compensate for
volume excess or
volume depletion
56. Maintenance Fluid Therapy
Term Newborn (ml/kg/day)
Day 1 50-60 D10W
Day 2 100 D10 1/2 NS
>Day 7 100-150 D5-D10 1/4 NS
Older Child: 4-2-1 rule
57. Hourly Maintenance Fluids
4:2:1 Rule
4 ml/kg/hr 1st 10 kg +
2 ml/kg/hr 2nd 10 kg +
1 ml/kg/hr for each kg > 20
58. Rules 1
Always Use volumetric Chambers or
Microdrip
(infusion pumps may continue to infuse
through dislodged catheters with out alarm)
59.
60. Rule 2
Warm up all infused fluid
Crystalloids safe up to 54 C
Blood safe up to 42 C..risk of hemolysis)
61. Rule 3
Include dextrose in the maintenance hydration
fluid (Dextrose 1% or Dextrose 2.5%)
Risk of Hypoglycemia is higher in
Premature
Sick babies(malnutrition,cardiac)
Regional anesthesia
Glucose infusion
67. Short distance between tongue and
the glottis
Tongue easily obstruct the airway
Proximity of tongue to glottis
visualization more difficult
more angulation between the oral
axis and the laryngeal axis
Straight blade preferred more
effectively in tongue lift
68. Epiglottis axis acute angle with airway axis..more
difficult to lift
Stiff
Omega shape ,touch the soft palate(easy airway
obstruction)
78. Radiologic evidence
Airway is oval not circular
Clinical evidence
No difference in incidence of post intubation croup
No complications in cuffed tube
86. 1. Left-molar Approach Improves the Laryngeal View in Patients with
Difficult LaryngoscopyAnesthesiology. 2000 Jan;92(1):70-4 Full Text
2. Comparative Study Of Molar Approaches Of Laryngoscopy Using
Macintosh Versus Flexitip BladeThe Internet Journal of Anesthesiology 2007 : Volume 12
Number 1
3. The use of the left-molar approach for direct laryngoscopy combined
with a gum-elastic bougieEuropean Journal of Emergency Medicine December 2010
;17(6):355-356
87. Another anatomical difference
Spinal cord ends at L3
In adults it ends at……..
Be cautious in neuroaxial anesthesia
Lumbar puncture
90. More free fraction of medication
Greater effect Water soluble Drugs will distribute more
Drugs high protein bound Higher loading dose to achieve desired serum
Altered protein binding
Barbiturates levels
High Volume of Distribution
Bupivacaine Muscle relaxants
Alfentanil Antibiotics
Lidocaine
Drugs that redistribute to fat
Have larger initial peak levels (Opioids)
Small proportion of fat and muscles Immaturemetabolism and excretion
Delayed Kidney and liver functions
Less muscle mass (more sensitive to muscle
relaxants)
96. Greater Alveolar High cardiac out
Reduced tissue
ventilation to FRC put to vessel rich
blood solubility
ratio organs(brain)
Fast inhalation induction
