ABA Pediatric Anesthesiology flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Pediatric fasting interval

Clear liquids are permitted until 2 hours, breast milk 4 hours, and infant formula or a light meal 6 hours before elective anesthesia.

Estimated blood volume by age

Neonates have about 85-90 mL/kg, infants 75-80 mL/kg, and children 70-75 mL/kg; these values guide allowable blood loss calculations.

Allowable blood loss formula

Allowable blood loss equals estimated blood volume multiplied by the difference between initial and target hematocrit, divided by the initial hematocrit.

4-2-1 maintenance fluid rule

Give 4 mL/kg/h for the first 10 kg, 2 mL/kg/h for the next 10 kg, and 1 mL/kg/h for each kilogram above 20.

Leading cause of pediatric morbidity

Respiratory adverse events, including laryngospasm and airway obstruction, are the most common cause of perioperative morbidity and cardiac arrest in children.

Sevoflurane MAC in infants

Sevoflurane MAC is highest in infants at roughly 3.0-3.3% and lower in neonates, reflecting age-related changes in central nervous system sensitivity.

Neonatal body water content

Total body water is about 75-80% of body weight in neonates, increasing the volume of distribution and mg/kg loading dose of water-soluble drugs.

Neonatal glomerular filtration rate

GFR at birth is about 30-40% of adult values and matures by 6-12 months, prolonging elimination of renally cleared drugs in neonates.

Fetal hemoglobin P50

Fetal hemoglobin shifts the oxyhemoglobin dissociation curve left; neonatal P50 is about 19-20 mmHg compared with 26-27 mmHg in adults.

Succinylcholine in pediatric myopathy

Succinylcholine is avoided in children with suspected myopathy because of the risk of life-threatening hyperkalemia and cardiac arrest.

Infant oxygen consumption

Infants consume about 6-8 mL/kg/min of oxygen and have a small functional residual capacity, causing rapid desaturation during apnea.

Tetralogy of Fallot shunt control

In unrepaired tetralogy of Fallot, increases in pulmonary vascular resistance or decreases in systemic vascular resistance worsen the right-to-left shunt.

Left-to-right shunt management

With VSD or PDA, agents that disproportionately lower systemic vascular resistance increase shunt fraction; systemic vascular resistance should be maintained.

URI and elective surgery timing

Elective surgery is generally deferred for 2-4 weeks after an upper respiratory infection because of increased laryngospasm and bronchospasm risk.

Sickle cell perioperative precautions

Maintain hydration, oxygenation, and normothermia, and avoid tourniquets and hypothermia, which promote sickling and vaso-occlusive crisis.

Duchenne muscular dystrophy anesthesia

Succinylcholine and volatile agents are avoided in Duchenne dystrophy because of rhabdomyolysis and hyperkalemia; total intravenous anesthesia is preferred.

Pyloric stenosis preoperative correction

Hypochloremic, hypokalemic metabolic alkalosis and dehydration must be corrected before induction; the stomach should be decompressed to reduce aspiration risk.

Uncuffed ETT size formula

Uncuffed endotracheal tube internal diameter in millimeters equals age in years divided by 4, plus 4.

ETT depth at lip

In children older than 2 years, endotracheal tube depth at the lip in centimeters equals 3 times the internal diameter in millimeters.

Pediatric laryngospasm treatment

Give 100% oxygen with CPAP and deepen anesthesia; if persistent, use succinylcholine 0.5-2 mg/kg IV or 4 mg/kg IM.

Pediatric airway narrowest point

In younger children the narrowest portion of the airway is the cricoid ring, whereas in older children and adults it is the glottic opening.

Pediatric respiratory rates

Normal rates fall with age: neonate 40-60, infant 30-40, toddler 24-30, school age 18-24, and adolescent 12-18 breaths per minute.

Caudal block volume dosing

Caudal local anesthetic volume is 1.25 mL/kg for sacral spread, 1 mL/kg for lumbar spread, and 0.5 mL/kg for thoracic spread.

Maximum bupivacaine dose in children

The maximum bupivacaine dose is 2-2.5 mg/kg, equivalent to 0.5 mL/kg of 0.25% solution, to avoid local anesthetic systemic toxicity.

Ilioinguinal block landmark

The ilioinguinal and iliohypogastric nerves are blocked medial to the anterior superior iliac spine to cover inguinal hernia repair and orchiopexy.

Codeine avoidance in children

Codeine and tramadol are avoided in children under 12 years because ultrarapid CYP2D6 metabolism can cause opioid toxicity and respiratory depression.

Pediatric acetaminophen dosing

Acetaminophen is dosed at 10-15 mg/kg every 6 hours, with a maximum of 75 mg/kg per day, as part of multimodal analgesia.

Pediatric CPR compression ratio

The compression-to-ventilation ratio is 30:2 for a single rescuer and 15:2 for two rescuers, with compression depth of one-third chest AP diameter.

Pediatric arrest epinephrine dose

Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) is given IV or IO and repeated every 3-5 minutes during pediatric cardiac arrest.

Pediatric defibrillation energy

The first shock is 2 J/kg, the second is 4 J/kg, and subsequent shocks are 4-10 J/kg, not exceeding adult maximum energy.

Pediatric septic shock fluid bolus

An isotonic crystalloid bolus of 10-20 mL/kg is given, with reassessment after each bolus; larger volumes are used cautiously in cardiac disease.

Pediatric anaphylaxis epinephrine

Epinephrine 0.01 mg/kg IM (maximum 0.5 mg) of 1:1000 is injected into the anterolateral thigh and repeated every 5-15 minutes as needed.