An Overview of Paediatric Anaesthesia Dr Anna Englin Paediatric Anaesthetist, MMC

Overview Equipment/room set up Equipment/room set up Crises we see in kids Crises we see in kids

Equipment A irway A irway B reathing B reathing C irculation C irculation D rugs D rugs E nvironment/ exposure E nvironment/ exposure

Anaesthesia checklist A irway A irway B reathing B reathing C irculation C irculation D rugs D rugs E nvironment/ exposure E nvironment/ exposure

Airway Infants and neonates have anatomical differences cf adults Infants and neonates have anatomical differences cf adults Different sized equipment Different sized equipment

Face masks

Airways Lift tongue and epiglottis away from upper airway Lift tongue and epiglottis away from upper airway Different sizes: measure from centre of incisors to angle of jaw Different sizes: measure from centre of incisors to angle of jaw Nasopharyngeal airways Nasopharyngeal airways

LMA’s Don’t forget in a difficult intubation! Don’t forget in a difficult intubation! Less reliable than in adults Less reliable than in adults

Intubation laryngoscopes laryngoscopes

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

Equipment A irway A irway B reathing B reathing C irculation C irculation D rugs D rugs E nvironment/ exposure E nvironment/ exposure

Breathing T piece vs closed circuit T piece vs closed circuit Paediatric breathing circuit Paediatric breathing circuit

Equipment A irway A irway B reathing B reathing C irculation C irculation D rugs D rugs E nvironment/ exposure E nvironment/ exposure

Circulation ECG sometimes not used, mainly useful to detect bradycardia ECG sometimes not used, mainly useful to detect bradycardia Blood pressure lower Blood pressure lower Arterial line setup is different Arterial line setup is different

Equipment A irway A irway B reathing B reathing C irculation C irculation D rugs D rugs E nvironment/ exposure E nvironment/ exposure

Exposure Neonates especially prone to hypothermia Neonates especially prone to hypothermia Prevention of hypothermia Prevention of hypothermia –Operating theatre –Patient covering esp head –Warming blankets/ overhead heaters –Fluid warmers –Monitoring

Paediatric crises

Laryngospasm Common and can be scary! Risk factors Active or recent URTI Reactive airways Airway surgery Stimulation during light anaesthesia

Features

Treatment of laryngospasm CPAP with 100%O2 CPAP with 100%O2 Propofol Propofol Lignocaine: topical or IV 2mg/kg Lignocaine: topical or IV 2mg/kg Sux: 2mg/kg IV or 4mg/kg IM Sux: 2mg/kg IV or 4mg/kg IM

Bradycardia Risk factors Risk factors –Cardiac disease –Hypoxia –Drugs esp sux –CVP insertion –Reflex eg oculo-cardiac reflex Treatment Treatment –Treat cause –Atropine: 20mcg/kg IV or IM Chest compressions if persistent Chest compressions if persistent

The end NB: no children were harmed in the making of this talk