Tag Archives: paediatrics

GAT conference take home messages

Tips:
Give IM atropine with IM sux
In obese O2 consumption is significantly greater during SV rather than IPPV
Epidural blood patch recommend 20ml
Dural puncture: inject 20ml normal saline down intrathecal catheter
NSAIDs may affect  platelets and clot strength of EBP
In difficult airway consider nasendoscopy.
AFOI topicalise. Reduce secretions by suction catheter or Yanker (also tests topicalisation)
Legal position: Prudent doctor  -> prudent patient
Coding – appropriately – gets the organisation appropriate money
Quality measures – e.g. length of stay
How to add value ? Outcome or quality / cost
In a report, if used a guideline say so
Detail discussions with patients, including apologies
References to read/watch/review:
‘Perfect storm NHS funding’
Cardiac arrest in neurosurgery patients

Cliff Reid YouTube videos
DOLS
NICE guidelines on trauma
BATLS, ATACC course
Kirkpatrick model (for simulation)

Paediatric foreign body aspiration – recipe for EUA

Gas induction. Maintain spontaneous ventilation. Adequate depth of anaesthesia

(+/- check ventilation – risk of pushing FB distally. Avoid insufflation of stomach)

Direct laryngoscopy

Spray cords with lignocaine

Insert uncuffed nasal (standard) ETT to level just above cords

+/- close mouth as required

Spontaneous ventilation of O2+anaesthetic vapour. PEEP on T-peice

Also see: https://anaesthesiaonreflection.wordpress.com/2014/12/05/paediatric-airway-surgery-recipe/

NB

Remember basic manoeuvres e.g. Abdominal thrusts, Heimlick Manoeuvre, back blows.
In the event of cardiac arrest CPR/chest compressions may dislodge the foreign body.

Caudal tips

Technique:

Identify surface landmark

enter approx 45 degrees

upon entry anlge needle more parallel

advance needle slightly

then keeping needle stable, advance the cannula. Does not need to be to hilt.

Watch/aspirate for CSF or blood

inject LA (+1-2mcg/kg clonidine) as per Armitage regime, visualising the skin/subcut tissue

Tips:

The feel of entering cuadal space is similar to the gentle LOR when piercing rubber bung on antibiotic bottle.

If after inserting needle through sacrococcygeal membrane and resistance is encountered on advancing cannula or needle or injection of LA (likely the dorsal aspect of the ventral plate of the sacrum) then withdraw cannula/needle and redirect cranially, walking off the bone if necessary. Better to enter at caudal aspect of sacral hiatus.

More reliable and consistent than nerve blocks.

Use up to approx 20kg weight/7yr

Blocking the penis

e.g. for circumcision

weight / 3 = mls of 0.75% levy-bupivicane

Sterile precautions. Counter-traction as necessary.

1. Ring block at base of shaft

27 1/2 gauge needle

start at dorsum, just lateral to dorsal vein either side, aiming laterally. watching for circumferential spread.

inject at approx 3 o’clock and 9 o’clock for remaining ventral half.

inject into ‘watershed’ areas as needed to complete the ring

2. Dorsal n. of penis

blue needle

identify pubic symphysis

two entry points, just lateral to midline on each side, just below PS

advance needle perpendicularly until bone is hit

Inject – resistance will be felt

Continuous pressure trying to inject while withdrawing – there will be sudden LOR as LA spreads within the correct plane/under Buck’s fascia. 0.5-2ml per side.

– EdM @ LRI

Clonidine

pre-synaptic alpha-2 adrenoreceptor agonist

Uses:

  • prolonging duration of LA for nerve blocks/ epidural
  • sedation and analgesia in ICU
  • opiate and alcohol withdrawal
  • chronic pain, regional pain syndromes
  • hypertension
  • diagnosis of phaeochromocytoma

Caution:

  • Bradycardia
  • Hypotension
  • Sensitivity
  • Porphyria
  • May cause initial hypertension

Dose

  • IV: 1-5mcg/kg bolus (adult), 1-2mcg/kg bolus (paeds)
  • Epidural: 1mcg/kg (up to 150mcg)

Single-breath vital capacity inhalation induction with high concentration Sevoflurane (SBVC – HC)

Single-breath vital capacity inhalation induction with high concentration sevoflurane (SBVC – HC)

 

Does exactly what it says on the tin.

 

Prime the circuit with 8% Sevo with >= 6 L /min O2 (+/- N2O).

Hold face mask against surface to build up Sevo.

Practice vital capacity breathing with patient.

Following forced expiration apply face mask and instruct to take vital capacity breath.

 

Induction complete in 50-60 sec.

 

http://bja.oxfordjournals.org/content/early/2012/09/16/bja.aes319.full.pdf

 

– PB @ LRI

 

Paeds infusions for sedation

Midazolom

Bolus: 0.1mg/kg = 100mcg/kg
Infusion: 1-4 mcg/kg/min

Syringe: 3 x BW (in mg) in 50ml
1ml/hr = 1mcg/kg/min
1ml = 0.06mg/kg = 60mcg/kg

Run at 1-4ml/hr

Morphine

Bolus: 0.1mg/kg = 100mcg/kg
Infusion: 10-40mcg/kg/hr

Syringe: BW (in mg) in 50ml
1ml/hr = 20mcg/kg/hr
1ml = 20mcg/kg

Run at 0.5-2ml/hr

Fentanyl

Bolus: 1-2 mcg/kg
Infusion: 2-8 mcg/kg/hr