2005 Pedi Regional -- handout

2005 Pedi Regional -- handout - Pediatric Regional...

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Pediatric Regional Anesthesia Caudal Anesthesia Amr Abouleish, MD, MBA University of Texas Medical Branch Galveston, Texas
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Pediatric Regional Anesthesia How do children differ from adults? Why do regional anesthesia and analgesia in children? Caudal Anesthesia and Analgesia Test dose Single dose local anesthetic or morphine Continuous Caudal/Epidural Infusion Spinal Anesthesia (if we have time)
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How do children differ from adults? Psychologically and Parents Physiology Pharmacology Anatomy
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Physiology Postoperative apnea in former premature infants Implications Immature CNS and BBB Regional alone decreases risk
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Pharmacology General and Implications Distribution CSF Volume Total Body Water Protein Binding Clearance Liver Renal Local Anesthetics Opioids
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Approximate CSF Volume Cote´, A Practice of Anesthesia for Infants and Children 0 2 4 6 8 10 12 14 16 Premature Full Term Child Adult ml/kg
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CSF Volume: Implications Dosage of Drugs tetracaine 1 mg/kg + epinephrine for spinal bupivacaine 0.5-1.0 ml/kg for caudal Duration of action e.g. Spinal Tetracaine with epinephrine 0 50 100 150 200 Infants Adults minutes Cote´, A Practice of Anesthesia for Infants and Children
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Total Body Water 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% ICF ECF % of bodyweight <15 week fetus Full Term 4-6 months Adult Clin Pharm, 14:189, 1988
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Protein Binding and Clearance Protein binding decreased at birth Albumin and α -glycoprotein levels decreased Adult levels at 1 year of age Clearance Liver: Phase I & Phase II decreased Renal: GFR 30% of adult Adult levels by 3-5 months of age Clin Pharm, 14:189, 1988
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General Pharmacology Implications 2200 CSF Volume dose & duration 2200 Total Body Water IV dose, ? toxicity 2200 Protein Binding %drug available toxicity 2200 Clearance t 1/2 toxicity
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Local Anesthetics BE CAREFUL with repeated dosing and
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This note was uploaded on 12/28/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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2005 Pedi Regional -- handout - Pediatric Regional...

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