An Overview of An Overview of Paediatric AnaesthesiaPaediatric Anaesthesia

Dr Anna EnglinDr Anna Englin

Paediatric Anaesthetist, MMCPaediatric Anaesthetist, MMC

OverviewOverview

Equipment/room set upEquipment/room set up Crises we see in kidsCrises we see in kids

EquipmentEquipment

AAirwayirway

BBreathingreathing

CCirculationirculation

DDrugsrugs

EEnvironment/ exposurenvironment/ exposure

Anaesthesia checklistAnaesthesia checklist

AAirwayirway

BBreathingreathing

CCirculationirculation

DDrugsrugs

EEnvironment/ exposurenvironment/ exposure

AirwayAirway

Infants and neonates have Infants and neonates have anatomical differences cf adultsanatomical differences cf adults

Different sized equipmentDifferent sized equipment

Face masksFace masks

AirwaysAirways Lift tongue and epiglottis away from Lift tongue and epiglottis away from

upper airwayupper airway Different sizes: measure from centre Different sizes: measure from centre

of incisors to angle of jawof incisors to angle of jaw Nasopharyngeal airwaysNasopharyngeal airways

LMA’sLMA’s

Don’t forget in a difficult Don’t forget in a difficult intubation!intubation!

Less reliable than in adultsLess reliable than in adults

IntubationIntubation

laryngoscopeslaryngoscopes

ETT sizeETT size

ETT size = 4 +age/4ETT size = 4 +age/4 Cuffed vs uncuffedCuffed vs uncuffed

EquipmentEquipment

AAirwayirway

BBreathingreathing

CCirculationirculation

DDrugsrugs

EEnvironment/ exposurenvironment/ exposure

BreathingBreathing T piece vs closed circuitT piece vs closed circuit Paediatric breathing circuitPaediatric breathing circuit

EquipmentEquipment

AAirwayirway

BBreathingreathing

CCirculationirculation

DDrugsrugs

EEnvironment/ exposurenvironment/ exposure

CirculationCirculation

ECG sometimes not used, mainly ECG sometimes not used, mainly useful to detect bradycardiauseful to detect bradycardia

Blood pressure lowerBlood pressure lower Arterial line setup is differentArterial line setup is different

EquipmentEquipment

AAirwayirway

BBreathingreathing

CCirculationirculation

DDrugsrugs

EEnvironment/ exposurenvironment/ exposure

ExposureExposure

Neonates especially prone to Neonates especially prone to hypothermiahypothermia

Prevention of hypothermiaPrevention of hypothermia– Operating theatreOperating theatre– Patient covering esp headPatient covering esp head– Warming blankets/ overhead heatersWarming blankets/ overhead heaters– Fluid warmersFluid warmers– MonitoringMonitoring

Paediatric crisesPaediatric crises

LaryngospasmLaryngospasm

•Common and can be scary!•Risk factors

•Active or recent URTI•Reactive airways•Airway surgery•Stimulation during light anaesthesia

FeaturesFeatures

Treatment of Treatment of laryngospasmlaryngospasm CPAP with 100%O2CPAP with 100%O2 PropofolPropofol Lignocaine: topical or IV 2mg/kgLignocaine: topical or IV 2mg/kg Sux: 2mg/kg IV or 4mg/kg IMSux: 2mg/kg IV or 4mg/kg IM

BradycardiaBradycardia

Risk factorsRisk factors– Cardiac diseaseCardiac disease– HypoxiaHypoxia– Drugs esp suxDrugs esp sux– CVP insertion CVP insertion – Reflex eg oculo-cardiac reflexReflex eg oculo-cardiac reflex

TreatmentTreatment– Treat causeTreat cause– Atropine: 20mcg/kg IV or IMAtropine: 20mcg/kg IV or IM

Chest compressions if persistentChest compressions if persistent

The endThe endNB: NB: no children were harmed in no children were harmed in

the the making of this talkmaking of this talk