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“Anaesthesia for paediatricians” A very practical approach! Jenny Thomas Paediatric Anaesthesia,...
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![Page 1: “Anaesthesia for paediatricians” A very practical approach! Jenny Thomas Paediatric Anaesthesia, Red Cross War Memorial Children’s Hospital, University.](https://reader031.fdocuments.us/reader031/viewer/2022013122/56649f385503460f94c5521e/html5/thumbnails/1.jpg)
“Anaesthesia for paediatricians” A very practical approach!
Jenny ThomasPaediatric Anaesthesia,Red Cross War Memorial Children’s Hospital,University of Cape Town,South Africa
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Objectives Recognise who not to tackle
How to prepare
What to do
When to ask for help
Document everything
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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
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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
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Patient factors Airway: profile, ears,
adenoids/ tonsils, mouth-opening, teeth
Breathing Circulation Drugs / disability Environment Fluids / blood Glucose
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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
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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
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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
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Circulation
Haemodynamics: normal vs compromised
Heart rate: myocarditis vs trauma Vascular access: peripheral vs central
vs none Time available? Resuscitation: easy choices
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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
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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
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Other options
Midazolam Fentanyl: 10mcg/kg for stress-free
intubation Entonox Clonidine, Dexmedetomidine Beware: fentanyl + etomidate+ sux
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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?
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This should not be a hair-raising experience!
The end