“anaesthesia for paediatricians” a very practical approach!
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“Anaesthesia for paediatricians” A very practical approach!. Jenny Thomas Paediatric Anaesthesia, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa. Objectives. Recognise who not to tackle How to prepare What to do When to ask for help - PowerPoint PPT PresentationTRANSCRIPT
“Anaesthesia for paediatricians” A very practical approach!
Jenny ThomasPaediatric Anaesthesia,Red Cross War Memorial Children’s Hospital,University of Cape Town,South Africa
Objectives Recognise who not to tackle
How to prepare
What to do
When to ask for help
Document everything
It’s all in the preparation Environment: what do you need? where are you? what do you have
Patient: good, bad, indifferent. Beware syndromes,
other abnormalities
Self: skills, knowledge, confidence, humility
Equipment: functioning (check)
Paediatric sizes: laryngoscopes, masks, LMA, airways, ETTs, cannulae, volume controllers
Suction: functioning Oxygen source: humidified: pre-oxygenate! Bag, mask / ventilator (may be you) Monitoring Drugs
Telephone: in case help /advice is required
Patient factors Airway: profile, ears,
adenoids/ tonsils, mouth-opening, teeth
Breathing Circulation Drugs / disability Environment Fluids / blood Glucose
Intubation “Awake” intubation Oral or nasal Hypnotic / analgesia agent vs not Muscle relaxant vs not Rapid sequence vs not Size of ETT: Age/4 + 4 Cuffed or not How far to place the ETT Local anaesthetic to vocal cords Secure strapping Confirm placement: Capnography?
LMA
AirwayMaskETTLMA
How to make life easier Nose drops: oxymetazoline Lubrication tip of ETT Warm tip of ETT (nasal) Bougie / introducer (very gentle in neonate
or septic child) Position of patient: NB anterior larynx Support behind body (not only shoulders);
neonates, hydrocephalus Do not hyperextend the head Roll ETT through 180º as through cords
Anaesthetic department rules
Call consultant always: Airway problem: regardless of age of patient
Any child under one year of age
Any cardiac, severely systemically ill child, critically ICP
When > 2 hands are necessary
Circulation
Haemodynamics: normal vs compromised
Heart rate: myocarditis vs trauma Vascular access: peripheral vs central
vs none Time available? Resuscitation: easy choices
Drugs Route: Sublingual, oral, nasal, intravenous NPO? Induction agents: sedation vs anaesthesia
Propofol: 1-3 mg/kg/dose Etomidate: 0.3-0.5 mg/kg/dose Ketamine: 0.5 – 2 mg/kg/dose Inhalational agents: only DA or FCA Ketofol: 0.75 mg/kg/ketamine + 1 mg/kg/dose
propofol
Muscle relaxants: do not paralyse if airway control is not guaranteed
My preferences:
Patient condition, line, and time-dependant Oxygenate well, plan, have help Local anaesthetic: EMLA, infiltration: drip,
Macintosh spray (mouth, pharynx) Perfalgan Induction agent: ketamine, etomidate propofol ± ketamine / fentanyl (Muscle relaxant: cisatracurium / sux) Intubate, ventilate, check ABC
Other options
Midazolam Fentanyl: 10mcg/kg for stress-free
intubation Entonox Clonidine, Dexmedetomidine Beware: fentanyl + etomidate+ sux
Conclusion Know yourself (your limitations)
Know your patient (A,B,C)
Know your drugs ( know and use a few drugs well)
Where to after your hard work?
This should not be a hair-raising experience!
The end