Issues in Paediatric Anaesthesia - Anesthesia - Lecture Slides, Slides of Biomedical Engineering

Download Issues in Paediatric Anaesthesia - Anesthesia - Lecture Slides and more Slides Biomedical Engineering in PDF only on Docsity! Issues in Paediatric Anaesthesia 2004 Docsity.com Topics to be covered • Fasting Guidelines • Parental Presence at Induction • The Child with a Cold • Day Stay Tonsillectomy • Inguinal Hernia Repair in Ex-Prems Docsity.com Fasting for Infants • Breast milk is probably absorbed faster than formula ( Low Casein / Whey ratio ) • Most babies feed 3-4 hourly • Getting Anaesthetists to agree on fasting times for breast milk was difficult. Docsity.com ROYAL CHILDREN’S HOSPITAL DEPARTMENT OF ANAESTHESIA AND PAIN MANAGEMENT FASTING GUIDELINES ELECTIVE SURGERY AND ANAESTHESIA No milk, food, lollies or chewing gum for at least 6 HOURS Clear fluids are allowed up to 2 HOURS before surgery For children less than 6 months of age: Breast feeding is allowed up to 3 HOURS before surgery Formula or Cow’s milk feeding is allowed up to 4 HOURS before surgery Any variation to these guidelines will be by instruction of the anaesthetist of the day. Docsity.com ROYAL CHILDREN’S HOSPITAL DEPARTMENT OF ANAESTHESIA AND PAIN MANAGEMENT FASTING GUIDELINES EMERGENCY SURGERY AND ANAESTHESIA Patients should be fasted from first contact until further instructions from the duty anaesthetist Docsity.com Parental Presence at Induction • Parents are encouraged • Good substitute for Pre-Med • It is also OK to NOT be present • Anaesthetist must be willing • Unnecessary under 6 months of age • Who are we treating? ( The Parent ? ) Docsity.com The Child with a “cold” • The average 3 year old child gets a cold every 3 weeks • Cancel Day Surgery if : – Systemically Unwell – Temperature > 38.5 C – Signs on Examination ( Chest, Ears etc.) – Parents want to Cancel Docsity.com Day Stay Tonsillectomy •Done on the Kitchen Table in early 1900’s •Common Outpatient procedure in 1920’s •No deaths reported before overnight admission became popular in 1940’s to reduce infection Docsity.com Parental acceptance of day stay tonsillectomy - CHW • 80% preferred day stay arrangement • 20% would have preferred overnight stay: pain management (1) concern re oral intake (1) lack of confidence with sick child at home (4) Stewart, Baines, Dalton. A& I C 2002; 30:641-46 Docsity.com What are the risks of bleeding? • Hard to know - reported from 2-10% • Primary bleeding rate of approx 0.5-1% • Secondary bleeding rate of approx 0.5- 1% (but up to 7% in adults - Ranjit et al) • Can be predicted by intraop blood loss • Tends to occur within 2 hours of operation - (Nicklaus et al 1995 Arch of Otolaryngology) Docsity.com “Care by Parent Unit” RCH • 229 patients • 2 rooms available • After surgery and recovery (3 hours) • Review by surgeon before transfer to CBPU Docsity.com Inguinal Hernia Repair in Infants Docsity.com 3 month old infant. Now 5 kg Ex 35/40. Breast feeding How would you manage this baby? Docsity.com Risk of Apnoea • Ex prem ( small ) 20-40% Sick <1.5 Kg, currently having apnoeas • Ex prem ( big, no co-morbidity) 10-20 % • Term Baby 0-2 % Docsity.com Duration of Stay? • Must be APNOEA FREE for 12 hours Docsity.com Technique • General Anaesthesia ( fit, term baby ) • Regional Anaesthesia with volatile agent at beginning ( mod. risk ex prem ) • Spinal Anaesthesia ( high risk ex prem ) Docsity.com Airway Management GA • Laryngeal Mask – 1.5 • Endotracheal Tube – Spontaneous Ventilation – Relaxant Docsity.com