Who is a Candidate for Sedation outside of the OR?

1. Who is a Candidate for Sedation outside of the OR?

2. Recognition of Potential Airway Difficulty • Mallampati-Samsoon classification • Thyromental distance • Joint mobility • Head and neck frontal and profile views • Tonsilar separation/obstruction

3. Mallampati-Samsoon Airway Classification • Class I - uvula, faucial pillars, soft palate • Class II - faucial pillars, soft palate • Class III - soft palate • Class IV - hard palate

4. Mallampati-Samsoon Airway Classification

5. Facial Anomalies • Maxillary hypoplasia • Apert’s syndrome • Crouzon’s syndrome • Coronal craniosynostosis (Saethre-Chotzen syndrome) • Rubenstein-Taybi syndrome

6. Facial Anomalies • Mandibular hypoplasia • Treacher Collins syndrome • Hemifacial Microsomia (Goldenhar’s syndrome) • Moebius syndrome (micrognathia 2O to neuromuscular deficit) • De Lange syndrome • Robin sequence

7. Obesity and Sedation • Two thirds of the adult population in the U.S. are obese or overweight • 17% of children ages 2-19 yrs. are overweight • Prevalence has tripled in the past 2 decades • Obesity is a leading cause of restrictive lung disease

8. Body Mass Index [Weight (kg)] [Height (m)] BMI = 2 1 meter = 39.3700787 inches [89 kg] [1.89 m] Ex = = 24.9 2 >25 overweight; ≥30 obese; ≥40 morbidly obese

9. Anesthesia Pre-Operative Report PMHx PSurgHx Sedation / General Anesthesia without complications ??? Any Familial complications w/ anesthesia ??? MH? Head or Neck Surgery? • Patient denies any disease: Example + Asthma → Albuterol prn w/URI, no Hosp.

10. Anesthesia Pre-Operative Report Medications Allergies NKDA PCN → rash/hives Food Allergies – some medications have protein derivatives Example (Egg yolk – lecithin ) • Determine what medications are taken • Last time they were administered • Will it be affected by NPO guidelines?

11. Anesthesia Pre-Operative Report Airway Teeth Intact? Missing? Loose? • MP Classification • Extension of A-O joint • Flexion of Neck • Thyromental Distance • Mandibular Exam • Prognathic / Retrognathic • TMJ • Macroglossia • Thick Neck • Beard • Tonsilar Separation & Obstruction

12. Anesthesia Pre-Operative Report Pulmonary (Lungs) Cardiac RRR Regular Rate & Rhythm Murmur? • CTAB • Clear To Auscultation Bilaterally • Wheezing? Labs NPO Status • H/H – Hemoglobin/Hematocrit • PT, PTT, INR • Chem 7 • BUN: 7 to 20 mg/dL • CO2 (carbon dioxide): 20 to 29 mmol/L • Creatinine: 0.8 to 1.4 mg/dL • Glucose: 64 to 128 mg/dL • Serum chloride: 101 to 111 mmol/L • Serum potassium: 3.7 to 5.2 mEq/L • Serum sodium: 136 to 144 mEq/L • Pediatric Patients • Nothing to Eat/Drink 6 hours prior to start of case (or MN) • Only exception being H2O until 2 hours before case (minimal intake) • To Improve Compliance – Explain Why

13. Anesthesia Pre-Operative Report Patient is ASA __ for (procedure) Final Questions Consent Signed Parent prepared for: Induction Post Operative Behavior Is This Parent Responsible Enough to Handle This?? • B/A/R discussed with patient who fully understands & agrees • All questions answered to satisfaction of patient

14. Consider a Patient’s Options Factors That May Come Into Play Not Appropriate for Office Sedation Asthma requiring daily medication Downs Syndrome Cardiac conditions -(except murmur that does not effect play stamina) Cerebral Palsy - who are unable to walk unassisted • Insurance Coverage • Extent of Treatment Needed & Duration of Time Needed • Parental Choice