【Study Notes】Beijing Children's Hospital Xiaoma Continuing Education Note

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Pediatric anesthesia study notes

The note synthesizes what you see and hear + your own thinking + self-study knowledge, the clinical situation is ever-changing, the following is for reference only

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When: August 2022

Conventional preparation: propofol (20ml/only stock solution), sulfen (5ug/ml, 10ml), fentanyl (10ug/ml, 10ml), reventtanil (10ug/ml, 20ml), atropine (0.

In most cases, the order and dose of the induced drug administration: fentanyl (1 * kg) (ug) / sufentanil (0.

Pure venous initial pumping speed: propofol kg (ml/h), refen (40ug/ml) 0.

Supplies preparation: different types of masks (newborn model, small, medium; Small size is generally suitable for children under five or six years old), different types of breathing filters (newborn model, small size, medium; Match the mask), breathing circuit (one model), disposable cuffs of different widths (arm circumference 8-15cm, within one year of age; 14-20cm, under 6 or 7 years old; 18-26cm, under 13 or 4 years old; 25-35cm, adult cuff; 34-43cm, oversized

Endotracheal intubation model: age/4+4, depth age/2+12cm, nasal insertion depth plus 2-3cm

Throat cover: 1# <5kg, 1.

Special Viewing Points: History of Upper Sense; Avoid elective periods within 2 weeks after the general vaccine; Fasting for water time; The replacement period is usually 6-12 years old

Analgesic pump: unified as 100ml of 2ml/h constant speed pump [self-study: 78 years old or older can be added PCA as appropriate].

Invasive arteries: artery puncture within 1 year of age can be used 24#, and deep or obese children can use 22#

Fixation method:

Deep vein depth: within 1 meter, height / 10-1; > 1 meter, height / 10-2

Other:

√ Upper extremities are preferred for peripheral, arterial and oxime monitoring for ease of management

√ Body temperature protection

√ anesthesia machine after self-test before use again manually check whether there is air leakage, children are not tolerant of hypoxia, the induction process must always pay attention to whether the chest is undulating
.

Buckle masks prevent compression of the bridge of the nose from causing airway obstruction
.

Keep a simple respirator, laryngoscope, intubation, throat hood, and suction device at hand until full recovery
after extubation.

√ Routine infusion of sugar-containing solution
in children within 3 months.

If intraoperative blood gas indicates high blood sugar, first stop using the sugary solution
.

Recommended reading: "Anesthesia Guide for Newborns and Low-Weight Children", "Pediatric Perioperative Fluid and Blood Transfusion Management Guide (2017 Edition)", "Selection of Typical Cases of Pediatric Surgical Anesthesia"

Surgery seen and approximate duration:

Urology: hypospadias (2h), hydrocele (0.
5h), cryptorchidism (0.
5h)

Routine anesthesia management: laryngeal hood, all the way peripheral, pure vein maintenance, noninvasive monitoring

General surgery: hernia (0.
5 h), modified radical resection of Hirschsprosomylox (laparoscopic 3-4 h), intestinal obstruction intestinal resection anastomosis (1.
5 h), laparoscopic pyloric ring muscle incision (0.
5 h), laparoscopic splenectomy, Michel diverticulum (1,5 h)

Laparoscopic pressure that interferes with cardiopulmonary function refers to a decrease in
oxygen.

Case 1: 3-year-old boy, 14.
5 kg, laparoscopic modified radical resection of Hirschsprosom.


22# invasive artery, 22#, 24# two peripheral circuits, monitoring bis, body temperature, and use an analgesic pump
after surgery.

Inducing drugs Sufen 10ug, propofol 30 mg, refen 15 ug, cis-A 1.
5 mg, 4.
5 reinforced tubes
.

Pure intravenous maintenance, the initial velocity propofol 15 ml / h, refen 300 ug / h, no additional analgesia and muscle relaxant are added during the operation
.

Intraoperative surgery complains of poor muscle relaxant, because the addition of muscle relaxants may affect postoperative wakefulness, the choice of additional suction ether to enhance muscle relaxation effect, the concentration is maintained at 1%, while moderately reducing the amount of intravenous maintenance drugs, propofol 12 ml / h
.

After the completion of the operation, extubation is performed and returned to the ward
.

Case 2: Laparoscopic splenectomy with hereditary erythrocytosis at age 8 years, anemia
.

Three peripheral circuits, two connected infusions, invasive arterial manometry, with analgesic pumps
.

Static suction complex maintenance, sevoflurane 1.
5%.


Interoperative extubation
.

Case 3: 1 year of age Michael diverticulum, generally available, without significant intestinal obstruction
.

4#, routine monitoring, body temperature, bis, all the way infusion, analgesic pump
.

Orthopedics: supracondylar humerus fracture (0.
5h), pelvic fracture external fixator, scoliosis orthopedics (2h)

Orthopedic surgery: two peripheral (one for infusion, one for blood transfusion) + invasive artery monitoring
.

Children's chest is not supported enough, the heart can be compressed after the child's prone position, the blood pressure and heart rate decrease, and even the heart arrest occurs, and sometimes the child can be recovered
by lifting the child to turn over.

Appropriate volume replenishment before turning over, and the asana pad avoids compression of the heart
.

Intraoperative procedures are vigilant for compression of the heart and bleeding
.

Humeral fractures: general anesthesia compound ultrasound-guided axillary plexus block, 0.
375% ropivacaine 15 ml, muscle skin 5 ml, brachial plexus 10 ml, total amount can not exceed 3*kg (mg)

Thoracic surgery: funnel chest / chicken breast (0.
5-1h), in-brein chest nuss postoperative internal fixation removal (0.
5h)

Nuss intraoperative lung expansion, APL valve 40

Ophthalmology: chalazia/strabismus (bilateral 0.
5 h)

ENT: adenoidal tonsillectomy (0.
5 h), neck mass resection (0.
5-1 h)

Department of Respiratory Medicine: Fibroscopy (0.
5 h)

Using a non-reinforced throat shield, the tube body is hard and easy to operate
.

The operation process should pay attention to oxygenation, if necessary, pure oxygen can be sucked in, and the moisture volume can
be increased.

Some diseases have a large secretion, so prepare an attractor
.

Oncology: retroperitoneal neuroblastoma

Stomatology: General anesthesia oral root treatment (3h)

Nasal intubation
.

The model size is half a size smaller than the mouth cannula
.

When entering the nostril, the tip of the catheter should be flushed to the outside to avoid bleeding
caused by a beveled cut of the turbinate.

Before the sound advance, avoid excessive recoil of the head, otherwise it will make it difficult
to place the front end of the catheter to the anterior wall of the trachea.

Treatment of minor nosebleeds: epinephrine (1 ml 1 mg) is diluted 100-fold and a small amount is punched into the nostrils

Gastroenterology: general anesthesia gastrointestinal endoscopy (0.
5-1 h)

Cardiology: Interventional atrial deficiency closure/patent ductus arteriosus (0.
5 hours)

Neurosurgery: ventricular shunts, duringocele repair (1 h), skull fracture reduction + dural repair (3 h)

Plastic surgery: facial mass removal, facial laser, scalp expander insertion/removal

Notes/Garden

Typesetting/Meat