Pediatric Anesthesia.ppt 663a2b

PEDIATRIC ANESTHESIA MICHAEL ARITONANG MD

CHILDREN ARE NOT SMALL ADULT 1. Specific anatomic 2. Developing physiologic 3. Physiologic issues This distinctive features form the basis for the techniques and pharmacologic outline

TERMINOLOGY • • • • • • • •

Newborn: first 24 hours Neonates –28 days postnatal Infants – a child of up to 12 months of age Toddler-1-3yr Small children:4-12yr Child – 1 to 12 yrs Adolescent – 13 to 16 yrs The differences between paediatric and adult anaesthetic practice are reduced as the patients become older

ANATOMIC AND PHYSIOLOGIC DISTINCTIONS 1. Head size : much larger head size to the body.

ANATOMIC AND PHYSIOLOGIC DISTINCTIONS 2. Tongue size: Larger size relative to mouth. 3. Airway shape: Narrowest diameter is below the glottis at cricoid level in children.

ANATOMIC AND PHYSIOLOGIC DISTINCTIONS 4. Respiratory physiology: Oxygen consumption is 2 to 3 times greater in infants than adults. FRC ranges from 8–13 mL/kg < 1/3 as large as adults. 5. Cardiac physiology: Relatively fixed stroke volume in neonates and infants

ANATOMIC AND PHYSIOLOGIC DISTINCTIONS 6. Renal function Limited GFR at birth; does not reach adult levels until infancy; total body water and % extracellular fluid are increased in the infant. 7. Hepatic function P450 system not fully developed in neonates and infants; liver blood flow decreased in newborns 8. Body surface area Larger surface-tobody ratio in newborns/infants/toddlers

ANATOMIC AND PHYSIOLOGIC DISTINCTIONS 9. Psychological development 0–6 mo—stress on family 8 mo–4 yr—separation anxiety 4–6 yr—misconceptions of surgical mutilation 6–13 yr—fear of not “waking up” ≥13 yr—fear of loss of control, body image issues

PREOPERATIVE EVALUATION • • • •

Pertinent maternal history Birth and neonatal history Review of systems Physical examination: height, weight, and vital signs. • Preoperative home use of medications • Existence of malformations in the child and family

PREOPERATIVE EVALUATION • Issues such as anesthetic risks, anesthetic plans, recovery phenomena, postoperative analgesia, and discharge criteria have to be discussed in detail.

PREOPERATIVE EVALUATION COEXISTING HEALTH CONDITION 1. Upper Respiratory Infection 2. Obstructive Sleep Apnea 3. Asthma 4. The Former Preterm Infant

PREOPERATIVE EVALUATION • Laboratory Evaluation Current standard of care dictates that healthy children undergoing elective minor surgery require no laboratory evaluation Hb : 10 g/dL ( for infant > 3 months of age)

Routine versus selective testing is a matter of policy at individual facilities.

PREOPERATIVE EVALUATION Preoperative Fasting Period (ASA GUIDELINES) • • • •

Solids: 6 - 8 Formula: 6 hours Breast milk: 4 hrs Clear liquids: 2 hrs

Clear liquids such as apple or grape juice, flat cola, and sugar water may be encouraged up to 2 hours prior to the induction of anesthesia as their consumption has been shown to decrease the gastric residual volume.

PREOPERATIVE EVALUATION

ANESTHETIC AGENTS Potent Inhalation Agents • Mask Induction Pharmacology • Minimal Alveolar Concentration • Intracardiac Shunts • Inhaled Agents for Induction of Anesthesia