Preoperative Evaluation of the Pediatric Patient 12 14-04

Preoperative Evaluation of the Pediatric Patient 12 14-04 -...

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Preoperative Evaluation of the Pediatric Patient Marvin S. Cohen MD. UTMB
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Pharmacology of the Newborn TBW: Neonate (80%)>Infant (70%)>Adult (60%) Hydrophillic durgs have greater vol of dist. (sux) Redistribution is less effective (thiopental) Delayed excretion Decreased degradation Less protein binding
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Pharmacology of the Newborn Half life of drugs: Prolonged in neonate Shortened in infants and children. (greater blood flow to liver and kidneys) Becomes normalized in teens and adults
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Induction agents Generally requires slightly elevated dose (STP =5- 6 mg/kg) - larger vol. of dist. Longer half life due to reduced clearance May be more sensitive to resp depressant effects
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Muscle relaxants Non- depolarizers More sensitive Higher volume of distribution Liver/kidney metabolism decreased Succinylcholine Less senstive Higher volume of distribution - hydrophilic Reserve for emergency (hyper K+) Beware bradycardia No phase two block
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Inhalation Agents Inhalation induction is faster in infants and neonates 0 0.5 1 1.5 2 2.5 3 3.5 PREMIE INFANT ELDERLY HALOTHANE SEVOFLURANE
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Risk Adults<children<infants<neonates ASA1<ASA2<ASA3 Low birth weight Incidence of cardiac arrest in children: 1.4/10,000 - POCA STUDY
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Risk 2 Airway Management (68 %) Lanryngospasm Bronchospam Esophageal intubation Aspiration Cardiac Arrests (32% ) Halothane (two from sevoflurane) Medications including caudal bupivicaine
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Caudal Anesthesia Good Technique Catheter over needle Aspirate frequently Inject incrementally Bupivicaine with 1:200,000 epi Tachycardia T wave increase
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URI See Dr. Abouleish’s lecture 12/20
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Asthma Incidence in general population is growing Anestheisa and Surgery increase risk of bronchospasm Good history and physical PFT’s in children under 6 are not reliable. Maximize preop preparation.
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Asthma 2 Severity Recommendations Inhallers – prn Use daily for 3 -5 days preop Inhallers – qD Add steroids: Prednisone 1mg/kg Acute wheezing or URi Postpone surgery Up to 6 weeks
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Apnea Infants born < 37 weeks have increased risk of apneic spells (>15 seconds) All general anesthetics interfere with respiratory drive
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Minimize risk Delay surgery until 48 – 60 weeks
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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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Preoperative Evaluation of the Pediatric Patient 12 14-04 -...

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