What are the important points to present in Paediatric history?
1) Name
2) Age
3) Weight
4) Diagnosis
5) Operation plan
6) Co-morbidities (including syndromes: may have facial changes)
7) PMH (Previous operations)
8) Anaesthesia complications
What are paediatric cases at risk of developing during intubation?
Laryngospasm
How long should a patient fast from:
1) Food
2) Fluids
before surgery?
1) Food: 6 Hours
2) Clear fluids: 2 hours
What is TIVA?
Total Intravenous Anaesthesia
When is TIVA chosen over Inhalational maintenence of General Anaesthesia? (4)
- Recent upper respiratory tract infection
- Patient with throat pathology
- patient with history of Malignant hyperthermia
- High risk for PONV
What is used to monitor patient awareness during TIVA? AND
What is the range of that device parameter to ensure patient is not aware?
Bispectral index (BIS): form of Electroencephalogram (EEG)
Range: 40-60
1) What does MAC Stand for?
2) Define MAC.
3) What MAC value is appropriate to ensure patient is not aware?
1) Mean Alveolar concentration
2) The MAC value is the concentration of an inhalational agent in the alveoli required to prevent movement in response to a noxious stimulus in 50 percent of subjects after allowing sufficient time for uptake and redistribution of the inhalation agent to reach a steady state
3) MAC 1
Which volatile agent can be used during induction and maintenance phase?
Sevoflurane
What is the formula to calculate ETT size:
1) Without cuff?
2) With cuff?
1) Without cuff: Age/4 +4
2) With cuff: Age/4+ 3.5
What are the formulas to calculate ETT anchor? (2)
1) Age x3
2) Age/2 +12
Analgesia can be divided into two categories! What are they? And give examples for each.
Opioid: Fentanyl, remifentanil, sufentanil, alfentanil, hydromorphine, morphine, methadone
Non- opioid: Ketamine, Lidocaine, Nsaids, Paracetamol
What are the three main types of regional anaesthesia?
1) Peripheral nerve blocks
2) Epidural and spinal anaesthesia (also have combined Spinal epidural aka CSE)
3) Intravenous regional anaesthesia (Bier block)
What is Holliday-Segar rule? And provide the formula.
It is the 4-2-1 rule used to calculate the daily and hourly need of fluid in children.
*4mL/kg for the first 10kg
*2ml/kg for the next 10kg
*1ml/kg for the next 1kg beyond 20kg
When fasted for 6 hours prior to surgery, the fluids missed should be replaced during surgery if patient was not on IV fluids prior, true or false?
True, use 4-2-1 rule to calculate maintenance and multiply it by 6 hours.
How to maintain temperature of patient? (3)
Wrap patient
Bair hugger
Blanket
Muscle relaxants can be divided into two categories (2)
Depolarising muscle relaxants
Non-depolarising muscle relaxants
How do depolarising muscle relaxants work?
- Acts at the neuromuscular junction, at the motor endplate
- They act as Acetylcholine (ACh) receptor agonist
- By binding to ACh receptor, they cause persistent depolarisation of the muscle fibers by keeping the receptor open
- In Phase I: there is transient muscle fasciculation
-In phase II (desensitizing phase): muscles are no more receptive to Ach released by motor neurons
-At this point, the depolarising agent has fully achieved paralysis - They are resistant to and not metabolized by acetylcholinesterase
- Targets nicotinic and muscarinic receptors
What are the adverse effects of depolarising muscle relaxants? (9)
- dysrhythmias (muscarinic effect)
- autonomic symptoms (blocked nicotinic receptors of autonomic ganglia or adrenal medulla)
- hypotension, flushing and tachycardia (histamine release)
- Transient release of potassium (causing hyperkalemia and cardiac arrhythmias)
- Jaw rigidity
- Respiratory depression
- Increased IOP
- Hypersalivation
- Malignant hyperthermia
What are the contraindications of depolarising muscle relaxants? (7)
- Bradycardia patients
- Neurological injury: Cerebral vascular accident, spinal cord injury
- Drug hypersensitivity
- Malignant Hyperthermia
- Ocular surgery
- Myopathy
- Burns; Severe tissue injury (extensive denervation of skeletal muscle or UMN injury)
What is Sugammadex?
- Reversal agent for rocuronium
What are examples of depolarising muscle relaxants
- Succinylcholine
- Atropine
What are examples of non- depolarising muscle relaxants?
- Rocuroniun
- Atracurium
- Vecuronium
- Mivacurium
Reversal agent for succinylcholine and suxamethonium?
- Neostigmine
Why is Rapid Sequence Intubation (RSI) used?
RSI is used to protect the airway from aspiration of gastric contents by minimizing regurgitation during induction of anaesthesia
