Add Glucose to IV for all children <12 months when surgery lasts >30'
Technique: add 5cc D50 to 95cc Normosol-R to make Dextrose 2.5% / Norm-R
Ref: Welborn LG, Anesthesiology 1987
We occasionally get calls from the NICU to anesthetize neonates that need cryotherapy for ROP. One of the pediatric subspecialists will go to the NICU to anesthetize these babies that are not already being mechanically ventilated. They are somewhat complex to schedule because they are urgent cases and should be done within the next 24-48 hours depending on the severity of their disease, they cannot be kept NPO for hours, and we need to arrange for the baby, equipment, pedi anesthesiologist, and surgeon (Peter Hedstrom) to be available all at the same time.
If you get called re one of these babies please take down the basic information and tell the NICU we will get back to them with a time. Please see the baby, and let the FW know first thing in the morning, the pedi subspecialist and FW will arrange a time and set NPO schedule.
Please let me know if you are having problems with this system.
K. Pope 11/2002
-in PACU Procedure Room
-pulmonologists Anne Marie Cairns & Tom Mellow
-patients seen in PAU (esp. CF) or same-day ASU
Anes technique to consider:
LMA with propofol infusion, spontaneous ventilation desirable to allow assessment of airway dynamics. Their flexible bronch is 3.5mm (and they may be getting a 2.8), small enough to pass easily through the LMA bars and not interfere with spont ventilation.
The pts should have EMLA applied on arrival (I've asked the pulmonologists to add this to their admission orders), as a number of these kids may not be candidates for inhalation induction.
Guidelines for O.R. Management: Dan Kovarik, October 2008
1) After the diagnosis of pyloric stenosis is established and before coming to the OR infants will have an IV placed and electrolytes drawn. The infant will come to the operating suite when clinically hydrated (wetting diapers, moist mucous membranes, etc.), the bicarb is less than 30 and the chloride is within normal limits.
2) Upon arrival in the OR the anesthesia team will lavage the infants stomach with a red rubber OroGastric tube and warm saline. The infant should be considered at risk for residual stomach contents and a rapid sequence or modified rapid sequence induction with a muscle relaxant to facilitate intubation is encouraged.
3) Avoid opioids, consider Tylenol 30-40mg/kg PR, local anesthetic at the incision site, and ketoralac if there are no contraindications.
3) These are elective cases that should not be started after 10PM, but it is hard on these babies and their families to spend extended times in the hospital waiting for surgery if they are adequately prepared.
4) NG tubes may prolong the alkalosis by removing gastric secretions and cannot be relied upon to completely empty the stomach of curdled formula. Therefore they will not be placed routinely preoperatively.
...in children < 3 years of age: Overnight Admission
- Ketamine + Midazolam
- Bolus: K 0.25-0.5 mg/kg M 0.1-0.2 mg/kg
- Infusion: K 1 mg/kg/hr M 0.1 mg/kg/hr
- Propofol: p.o. sedation with midazolam
- Bolus: 0.5 mg/kg every 60 sec until 2 mg/kg
- Infusion: 100 - 150 mcg/kg/min
- No Decadron without checking first with Oncologist caring for patient
- Just a reminder to everyone because this is easy to forget. Decadron is a chemotherapeutic agent and as such when we use it for anti-nausea prophylaxis or treatment we are administering a drug that will treat leukemia or lymphoma.
- This is not benign in a patient with known cancer (and what really keeps me up at night is the child with undiagnosed lymphoma that I give Decadron thus delaying their diagnosis and making them more resistant to treatment). Don't give it to our Children's Oncology patients even if they are having vomiting without discussing it with their oncologist.