Presented by Sally MoonClinical Nurse Specialist

Recovering the Paediatric patient

SESSION OVERVIEW -

• How do Children differ from Adults

• Principles of Post Anaesthetic Nursing Care

• Complications in Recovery

• Recovery discharge criteria

• Practical tips and ideas

HOW ARE CHILDREN DIFFERENT ?

RESPIRATORY SYSTEMSmaller airways

Narrow nasal passages

Large tongue

Larger prominent occiput / short neck

Larynx high & anterior ( level c2-c3)

Cricoid ring narrowest point

Compliant rib cage

CARDIOVASCULAR SYSTEM

Metabolic rate

Cardiac Output

Heart Rate / Oxygen consumption

Fixed stroke volume

Smaller circulating volume

Glucose requirement

TEMPERATURE REGULATION

Surface area per kg

Children lose heat more rapidly

Metabolic rate

Insufficient body fat

Infants cannot shiver

RENAL SYSTEM

Decreased capacity to excrete free water

Neonatal kidney GFR

sodium excretion / concentrating ability

POST ANAESTHETIC CAREConscious state

Oxygen saturations

Heart rate

Respiratory rate

Temperature

Blood pressure

Wound site / iv site

Pain score

COMPLICATIONS IN RECOVERY

Airway obstruction

PONV

Pain

Hypothermia

Hypovolaemia

Emergence Delirium

RESPIRATORY ASSESSMENT

Patency of Airway

Rate / depth respirations

Symmetry of Chest Expansion

Gag protective reflexes

Colour

Presence stridor /wheeze

Oxygen Saturation

SIGNS & SYMPTOMS AIRWAY OBSTRUCTION

Inspiratory stridor

Snoring

Increased work of breathing

Absent /silent respirations

Head bopping

CAUSES…..

MAINTAINING AIRWAY PATENCY

Backward head tilt

Chin lift

Jaw support

Suction airway secretions

Positioning

Oral / nasal airway

Bag & mask

LARYNGOSPASMDefined by forceful closure of vocal

cords which prevents respirationMore common in childrenMore common if URTIMore common if laryngeal stimulationManaged by positive airway

ventilation/100% oxygenRemove stimulusDrugs

PONV

Distressing for paediatric patients

More common after 2 of years age

Prophylactic anti-emetics regularly used

Additional therapy prescribed “just in case”

More common in children who suffer motion sickness

Squint surgery / ENT

PONV -

Metoclopramide

Dexamethasone

Granisetron

Droperidol

Promethazine

Post-operative Nausea & Vomiting guideline available on RCH website/Anaesthesia & Pain Management

PAIN MANAGEMENTPain is subjective and can be

influenced by many factors

AnxietyPrevious experiencePeri operative educationAnaesthetic & pain relief givenChilds age

PAIN

Appropriate pain tools for assessment

Wong-Baker / Flacc

Premedication

Local anaesthetic

Regional block /Epidural

Opioid infusions / pca

PAIN SCALE TOOL

PAIN

HYPOTHERMIA

Children more susceptible

Greater surface area

Can result in delayed awakening, cardiac irritability & respiratory depression

Neonates ,cerebral palsy, extensive surgery at greatest risk

HYPOTHERMIACAUSES –

Intraoperative exposure

Deliberate cooling (Neuro/Cardiac)

Poor thermoregulatory systems (Neonates)

TREATMENT –

Active warming ( Blanket /Bair hugger)

Warm fluids

Constant monitoring

HYPOVOLAEMIAPre op factors

Intra op fluid management

WATCH FOR

Obvious bleeding, wound / drain

Tachycardia (SMALLER CIRCULATING VOLUME)

Hypotension

CRT prolonged

EMERGENCE DELIRIUMState in which the child is

agitated,inconsolable,typically thrashing

Children do not recognise people /familiar objects

Greater incidence in children (1-5 years)

Safety

Carers

PSYCHOSOCIAL Waking up in Recovery can be

frightening

Separation anxiety

Re-orientate / Reassure

Use child’s name

Reunite family as soon as safe to do so

RECOVERY DISCHARGE CRITERIA

Sedation score 2 or less ( UMSS )

Pain under controlNo active vomitingVital sign assessments within

MET Criteria

RECOVERY DISCHARGE CRITERIA

If vital sign assessments are outside MET Criteria then MET discharge Criteria form completed

Oxygen order completed if necessary

Surgeon has spoken to parents

TIPS & TRICKS !!!

Questions