Craig Sims - A Guide to Pediatric Anesthesia

1. Emergence Delirium

   Young children sometimes wake from anesthesia crying and unhappy. There are many reasons for this, although sevoflurane dysphoria is commonly blamed. See Chap..

2. The Uncooperative Child

   Many children become anxious during induction of anesthesia, and their anxiety may cause them to become uncooperative. There are many ways to reduce childrens anxiety. See Chap..

3. Videolaryngoscopes

   Many types of videolaryngoscopes are now available in sizes suitable for children. Their use is being informed by new studies, including the PediRegistry study of difficult airway management in children. See Chap..

4. Reducing Perioperative Respiratory Complications

   Respiratory complications are the leading cause of morbidity in pediatric anesthesia, and there has been a surge in studies looking at the risk factors for them and how to modify the risk. See Chap..

5. Shorter Fasting Times for Clear Fluids

   It is now realized clear fluids leave the stomach quickly, and allowing them up to 1 h or less before anesthesia has become common. See Chap..

6. Neurotoxicity of Anesthetic Agents

   There is laboratory evidence that many anesthetic agents, including volatiles, affect the developing brain of neonates. See Chap..

7. The Airway

   Many anesthetists do not like caring for children because of difficulties managing the pediatric airway. See Chap. for many practical tips.

8. RSI and Cricoid Pressure

   The adult technique of rapid sequence induction is dangerous if directly applied to young children. There are calls to abandon the technique and cricoid pressure altogether. See Chap..

9. Reducing Pain and Distress During Procedures

   Holding a child down to perform a procedure is becoming less and less acceptable. Many techniques and drugs are now used to make procedures more comfortable and less distressing for the child, parents, and staff. See Chap..

10. Hypotonic IV Fluids for Children

    Hypotonic, dextrose-containing solutions have been traditionally used for IV fluids in children. The risk of hyponatremia from these fluids is so high that salt-rich fluids are recommended nowadays. See Chap..

Body weight for infants = (age in months/2) + 4 kg (APLS)

Body weight for children 110 years = (age + 4) 2 kg (UK Resuscitation Council)

Body weight for children older than 10 years = age 3.3 kg (large variation in normal adolescent weight however) (APLS)

Expected systolic blood pressure for children older than 1 year = 80 + (age in years 2) mmHg.

Maintenance fluid rate in mL/h: (4:2:1 rule)

4 mL/kg first 10 kg weight + 2 mL/kg next 10 kg weight + 1 mL/kg for rest of weight (e.g., for a 19 kg child: (10 4) + (9 2) = 58 mL/h).

Minimum 10% dextrose infusion for neonate day one (4 mg/kg/min) in mL/h = 2.5 weight in kg (e.g., 3 kg neonate needs at least 7.5 mL/h 10% dextrose)

Uncuffed ETT size for a child over 2 years: Age/4 + 4 = ETT size (inside diameter, mm) (modified Cole formula)

Cuffed ETT size for a child over 2 years: Age/4 + 3.5 = ETT size (ID, mm) (Motoyama formula)

Position at vocal cords = ID size of ETT (e.g., 4.5 ETT should be 4.5 cm at vocal cords)

Oral ETT length (at lips in cm) = age/2 + 12

Nasal ETT length (at nostril in cm) = age/2 + 15 (and diameter of correct-size nasal ETT same as oral ETT for children)

Neonates: Oral ETT length (at lips in cm) = weight(kg) + 6

Neonates: Nasal ETT length (at lips in cm) = (weight(kg) 1.5) + 7

Size of suction catheter for ETT (in French Gauge) = 2 size of ETT (ID)

Urinary catheter size (FG) = 2 size of ETT (ID)

Depth for central line placement in right IJV = 10% of height (e.g., 8 cm in an 80 cm long child)