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    Afkir Al-Husaine
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    - Bradycardia in pediatric patients is the first sign of hypoxia. Hypoxia is a common cause of respiratory arrest in the perioperative period. Unpredicted congenital anomalies can also occur. - Physiological and anatomical differences in pediatric patients include a large head to body ratio, prominent occiput, thin mandible, large tongue, higher larynx, and immature organ systems. These differences make pediatric patients more susceptible to issues like laryngospasm, gastric aspiration, apnea, and atelectasis. - Special considerations for pediatric anesthesia include maintaining normothermia, using appropriate sized equipment, focusing on airway management techniques, and accounting for the immature physiology of organ systems like

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    4th Lec pediatric anesthesia

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    - Bradycardia in pediatric patients is the first sign of hypoxia. Hypoxia is a common cause of respiratory arrest in the perioperative period. Unpredicted congenital anomalies can also occur. - Physiological and anatomical differences in pediatric patients include a large head to body ratio, prominent occiput, thin mandible, large tongue, higher larynx, and immature organ systems. These differences make pediatric patients more susceptible to issues like laryngospasm, gastric aspiration, apnea, and atelectasis. - Special considerations for pediatric anesthesia include maintaining normothermia, using appropriate sized equipment, focusing on airway management techniques, and accounting for the immature physiology of organ systems like

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    16 views20 pages

    4th Lec Pediatric Anesthesia

    Uploaded by

    Afkir Al-Husaine
    - Bradycardia in pediatric patients is the first sign of hypoxia. Hypoxia is a common cause of respiratory arrest in the perioperative period. Unpredicted congenital anomalies can also occur. - Physiological and anatomical differences in pediatric patients include a large head to body ratio, prominent occiput, thin mandible, large tongue, higher larynx, and immature organ systems. These differences make pediatric patients more susceptible to issues like laryngospasm, gastric aspiration, apnea, and atelectasis. - Special considerations for pediatric anesthesia include maintaining normothermia, using appropriate sized equipment, focusing on airway management techniques, and accounting for the immature physiology of organ systems like

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    of 20

    Physiological & anatomical

    diffrents in pediatric
    Anesthetic tricks
    By dr.Amassi Yakdhan
    2023 - 2022
    Important tricks
    • Bradycardia in pediatric is 1rst sign • Common problems :
    of hypoxia.
    • Laryngospasm partial or complete
    • Hypoxia is common cause of .
    respiratory arrest in peri operative
    • Gastric aspiration .
    period.
    • Apnea post operative.
    • Un predectide congenital
    anomalies • Atelactasis.
    Definitions
    • Newborn or neonate: From birth
    to 2 month
    • Infant : from birth to 1 year
    • Toddler : 2_ 3 years
    • baby : from birth to 4 years
    • Child : from birth to 14 years
    Anatomical differants
    • Large head , short neck , prominent • Mucosa softer
    occiput
    • Mucociliary action less⬇️
    • Thin under develped mandible.
    • Secretory glands more
    • Small nasal airway
    • Alveolar no less
    • Large toungue
    • Epiglottis : large , flobby end
    • Larynx : higher , funnel shape ,
    narrowest point C3 C 4
    Anatomical changes
    Larynx veiw
    Physiological changes
    Respiratory system
    • ⬆️BMR⬆️, O2 consumption • Cv closing volume = volume of
    lung at which small airway closed.
    • ⬆️RR , ⬆️work of breathing on
    respiratory muscle ➡️easy to get • CC closing capacity = Cv + Rv
    fatigue ➡️easy to get apnia after maximum expiration
    • ⬆️LC • Atelactasis is common
    • ⬇️FRC
    • CC < FRC
    Physiological changes
    C.V.S
    • HR⬆️
    • C.O.P⬆️
    • C.O.P depend on HR
    • ⬇️* HR = ⬇️C.O.P
    • Cardiac muscle complieance⬇️
    • ⬆️SVR
    • ➕️para sympathetic is domenant
    ➡️brady cardia common .
    Other systems changes
    • Renal system : • C.N.S : immature BBB ➡️
    permeability of anesthetic drugs
    • ⬇️ GFR ➡️ kidney cant tolerate
    over depletion or hydration of
    Prolong the effect➡️ delay
    fluids recovery

    • Immature liver enzyme ➡️ prolong • Immature thermoregulation center .


    anesthetic drugs effect ➡️ delayed
    recovery
    • Hypoglycemia is common
    Temperature in pediatric
    • Why temperature easy to loss in • What are the effect of loss of
    pediatric ? temperature ?
    • Immature thermoregulation center • Delay recovery .➡️prolong the effect of
    ➡️mechanism of heat control is anesthetic drugs
    immature➡️less shivering , less
    vasoconstriction , less sweating . • ⬇️ C.O.P
    • Large surface area / body wt. • Respiratory depression
    • Thin subcutaneous tissue . • Acidosis
    • Platelet aggregation
    • Risk of infection
    Plan of GA
    • Fasting : • Premedication :
    • Solid food = 6 hrs • Codeine syrup
    • Milk formula = 6_ 4 hrs • Fentanyl lollipop
    • Breast milk = 4_ 3 hrs • Ketamine spray
    • Clear fluids = 2 hrs • Parcetamol syrup
    • ELMA cream
    • Atropine
    • Pre O2
    Plan of GA
    • ELMA cream , small cannula
    • Full types ,fit size airways , laryngoscopies
    ( Miler type )
    • Fit size & anatomical masks .
    • Latex free gloves
    • Sensitive plaster
    • T- piece breathing circuit ( less dead space
    ) ➡️ sleep & recovery easy
    • Reservoir bag of 1_ 0.5 letre
    Air way management
    Neutral position : to make airway • Sniffing position : Neck flexion +
    of infant in alien , patency & prevent upper cervical extension .
    obstruction : keep pillow or 2 under • It’s the position for ETT
    back to make occiput 1- 2 cm lower
    than than shoulder & back . • Never forget soft tissue gentle
    touch of the baby .
    Air way management
    Air way management
    Masking technique 1 hand
    Masking technique 2 hands
    GA plan
    • Warm room • Replacement is : loss ,maintenance&
    3rd space loss .
    • Warm blanket
    • Warm fluids & drugs
    • Don’t forget blood replacement if
    need.
    • Infusion pump • pain managment by paracetamol intra
    • Dextrose hydration operatively
    • caudal or ilioinguinal block.
    • Post operative analgesic syrup or
    suppostorties
    Anesthetic plan ( drugs )
    • NMJ are immature so in newborn try to • Ketamine is safe
    be away from muscle relaxant unless you
    secure airway . • Propofol according to dose with slow
    induction .
    • Atracuruim is muscle relaxant of choice
    • Try to be away from pentothal because of
    • Atropine + O2 is the main step its prolongation effect + bronchospasm
    effect .
    • Sevoflurane is the induction volatile of
    choice . • Sevo is rapid induction ,rapid recovery
    pleasant test & smell ,less C.V.S effect.
    • Never induct with isoflurane unless the
    patient is deep sleep . • Iso cause hanging of breath , ⬆️ secretion
    , airway obstruction during induction .
    Thank you

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