An overview of paediatric anaesthesia
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An Overview of Paediatric Anaesthesia. Dr Anna Englin Paediatric Anaesthetist, MMC. Overview. Equipment/room set up Crises we see in kids. Equipment. A irway B reathing C irculation D rugs E nvironment/ exposure. Anaesthesia checklist. A irway B reathing C irculation D rugs

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An overview of paediatric anaesthesia

An Overview of Paediatric Anaesthesia

Dr Anna Englin

Paediatric Anaesthetist, MMC


Overview
Overview

  • Equipment/room set up

  • Crises we see in kids


Equipment
Equipment

  • Airway

  • Breathing

  • Circulation

  • Drugs

  • Environment/ exposure


Anaesthesia checklist
Anaesthesia checklist

  • Airway

  • Breathing

  • Circulation

  • Drugs

  • Environment/ exposure


Airway
Airway

  • Infants and neonates have anatomical differences cf adults

  • Different sized equipment



Airways
Airways

  • Lift tongue and epiglottis away from upper airway

  • Different sizes: measure from centre of incisors to angle of jaw

  • Nasopharyngeal airways


Lma s
LMA’s

  • Don’t forget in a difficult intubation!

  • Less reliable than in adults


Intubation
Intubation

  • laryngoscopes


Ett size
ETT size

  • ETT size = 4 +age/4

  • Cuffed vs uncuffed


Equipment1
Equipment

  • Airway

  • Breathing

  • Circulation

  • Drugs

  • Environment/ exposure


Breathing
Breathing

  • T piece vs closed circuit

  • Paediatric breathing circuit


Equipment2
Equipment

  • Airway

  • Breathing

  • Circulation

  • Drugs

  • Environment/ exposure


Circulation
Circulation

  • ECG sometimes not used, mainly useful to detect bradycardia

  • Blood pressure lower

  • Arterial line setup is different


Equipment3
Equipment

  • Airway

  • Breathing

  • Circulation

  • Drugs

  • Environment/ exposure


Exposure
Exposure

  • Neonates especially prone to hypothermia

  • Prevention of hypothermia

    • Operating theatre

    • Patient covering esp head

    • Warming blankets/ overhead heaters

    • Fluid warmers

    • Monitoring



Laryngospasm
Laryngospasm

  • Common and can be scary!

  • Risk factors

    • Active or recent URTI

    • Reactive airways

    • Airway surgery

    • Stimulation during light anaesthesia



Treatment of laryngospasm
Treatment of laryngospasm

  • CPAP with 100%O2

  • Propofol

  • Lignocaine: topical or IV 2mg/kg

  • Sux: 2mg/kg IV or 4mg/kg IM


Bradycardia
Bradycardia

  • Risk factors

    • Cardiac disease

    • Hypoxia

    • Drugs esp sux

    • CVP insertion

    • Reflex eg oculo-cardiac reflex

  • Treatment

    • Treat cause

    • Atropine: 20mcg/kg IV or IM

  • Chest compressions if persistent


The end
The end

NB: no children were harmed in the making of this talk


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