Home | | Medicine Study Notes | Paediatric Anaesthetics - Emergency Management

Chapter: Medicine Study Notes : Paediatrics

Paediatric Anaesthetics - Emergency Management

Pre-operative assessment of child with a URTI, Pre-operative assessment of child with a murmur, Pain Management in Children

Paediatric Anaesthetics

 

Pre-operative assessment of child with a URTI

 

·        Peri-operative risk variably increased

·        Postpone high risk:

o  Neonates and infants 

o  Existing upper airway/respiratory pathology (eg CF) - ¯ reserve – easy to tip over the edge

o  Systemic symptoms

o  Lower respiratory tract involvement

o  Surgical impact on respiratory function (eg upper abdo surgery)

·        Complications usually manageable

 

Pre-operative assessment of child with a murmur

 

·        Innocent murmurs often detected by anaesthetists

·        Murmurs in up to 95%, but pathology in only 0.5%.  May need referral for investigation

·        3 Common innocent murmurs:

o  Early systolic from ventricular outflow tracts (either pulmonary or aortic)

o  Continuous murmur from SVC

o  Grade 1 – 2

·        Bad murmurs mimicking benign ones:

o  Severe hypertrophic obstructive cardiomyopathy

o  Critical aortic stenosis

o  These develop after birth – so may not have been picked up in post natal checks

·        Postpone and refer if suspicious, esp if < 1 year

·        ECG recommended if echo unavailable (can fax to a paediatric cardiologist for interpretation)

·        SBE prophylaxis may be indicated

 

Risk Factors for Aspiration

 

·        High risk for aspiration: Treat as full stomach

o  Full stomach

o  Regurgitation

o  Impaired protective reflexes 

o  Airway obstruction (big negative pressure in thorax in order to suck air in past obstruction – but this also sucks contents out of stomach)


·        Hazards of fasting:

o  Discomfort

o  Hypovolaemia.  Guidelines are:

§  Clear fluids till 2 hours before

§  Breast milk till 4 hours before

§  Food till 6 hours before (no chewing gum)

o  Hypoglycaemia: only an issue for neonates

 

Assessment for Sedation

 

·        Need to risk assess any child before any sort of sedation – its all too easy for something to go wrong (or more usually, for lots of little things to mount up)

·        Always need to be confident you could ventilate, intubate and get IV access quickly if necessary

 

Pain Management in Children

 

·        Myths:

o  Neonates don‟t experience pain

o  Neonates have no memory of pain (they retract from a needle the 2nd time)

o  Pain is not harmful (it leads to stress response ® ¯healing, etc. ? Impact on the development of pain pathways) 

o  It is dangerous to treat pain


·        Management principles:

o  Mild to moderate pain relief is achieved through oral or rectal doses

o  Children hate needles, especially repeated IM injections

o  Using loading doses and regular maintenance doses to achieve therapeutic effect 

o  Don‟t overdose with paracetamol (may ® hepatotoxicity).  Limit duration

o   Child-friendly environment and parental involvement important


·        Available drugs: 

o   Paracetamol (oral better than rectal). Only use aspiring where specially indicated (eg Rheumatic fever)

o   NSAIDs: Diclofenac, Ibuprofen, Naproxen 

o   Codeine Phosphate (metabolised to morphine): constipation, plus dose related opiod side-effects – sedation, respiratory depression, nausea and vomiting

o   Morphine for serious pain (eg burns and fractures) 

o   Pethidine less used in kids - ­toxicity (including seizures)

o   Tramadol – not often used but less respiratory depression 

o   Nitrous Oxide (always administered with O2). OK for brief analgesia (eg fracture immobilisation). Ensure resuscitation equipment available. Month pieces preferred to masks

 

Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail
Medicine Study Notes : Paediatrics : Paediatric Anaesthetics - Emergency Management |

Related Topics

Medicine Study Notes : Paediatrics


Privacy Policy, Terms and Conditions, DMCA Policy and Compliant

Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.