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“Anaesthesia for paediatricians” A very practical approach! PowerPoint Presentation
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“Anaesthesia for paediatricians” A very practical approach!

“Anaesthesia for paediatricians” A very practical approach!

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“Anaesthesia for paediatricians” A very practical approach!

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  1. “Anaesthesia for paediatricians” A very practical approach! Jenny Thomas Paediatric Anaesthesia, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa

  2. Objectives • Recognise who not to tackle • How to prepare • What to do • When to ask for help • Document everything

  3. 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

  4. 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 Equipment: functioning (check)

  5. Patient factors • Airway: profile, ears, adenoids/ tonsils, mouth-opening, teeth • Breathing • Circulation • Drugs / disability • Environment • Fluids / blood • Glucose

  6. 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 Airway Mask ETT LMA

  7. 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

  8. 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

  9. Circulation • Haemodynamics: normal vs compromised • Heart rate: myocarditis vs trauma • Vascular access: peripheral vs central vs none • Time available? • Resuscitation: easy choices

  10. 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

  11. 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

  12. Other options • Midazolam • Fentanyl: 10mcg/kg for stress-free intubation • Entonox • Clonidine, Dexmedetomidine • Beware: fentanyl + etomidate+ sux

  13. 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?

  14. This should not be a hair-raising experience! The end