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ANAESTHESIA
Paediatric population is not
homogenous
Infant
Neonate
Pre-schooler
Anatomy
Physiology
Pharmacology
Psychology
Normal vital signs
Age Group HR (beats/min) RR (/min) Systolic BP mmHg
Preterm 120-170 40-60 40-55
MAP=GA
Effects of GA Un-physiological
Airway
Infant & young child:
Large head (prominent occiput)
Short neck
Large tongue
Prominent adenoids and tonsils
Implications:
Upper airway obstruction occurs easily under GA
Airway
Head position for intubation
Implications:
No need for pillow under head in young child to align the
oropharyngeal and laryngeal axis.
Neonatal intubation with straight blade **
Potential for endobronchial intubation
Breathing
Inefficient respiratory mechanics
Weak intercostal and diaphragmatic muscles
Very compliant chest wall
Horizontal ribs
Chest relatively small to abdomen
Protuberant abdomen with weak abdominal
muscles
Breathing
• O2 consumption 2x adult
• Ventilation/unit lung volume is more
• Decreased lung compliance
• Small airways : airways edema result in increased resistance
Implications
• Treat bradycardia
• Hypoxia is often the cause of bradycardia
Circulation
Normal Blood Volumes Normal Haemoglobin
Blood volume
NB 85-90 ml/kg
Smaller absolute volume (70-80 ml/kg) With trauma actual blood loss is significant relative to weight
compared to adults compared to adults
First sign of shock = Tachycardia
180/min in child less than 5 yr
160/min in child more than 5 yr
ABC & DE of Paediatric Anaesthesia
Pharmacokinetics of drugs
Age Premie Term One Adult Protein binding is less
neonate Neonate year old (male)
Reduced total serum
Total 85 80 60 60 proteins/specific proteins
Body
Reduced biding capacity
water %
Little fat/muscle
ICF water 25 35 35 40 Immature renal & hepatic
%
systems
ECF 60 45 25 20
water %
Neonates
Higher metabolism
Lower glycogen stores Intraoperative
Impaired gluconeogenesis ↓O2 consumption & metabolism, glucose
requirements
Surgery, pain, nausea and vomiting are potent causes of ADH release
Ongoing losses from NG or drains – isotonic fluids
Measure losses and check electrolyte levels
Thermoregulation
Loss of heat
High body surface : body weight ratio
Thin skin, low fat content
Immature thermoregulatory mechanism
Temperature monitoring
Passive heating devices : plastic wrap, caps, raising ambient OT
temperatures
Active heating devices : “hot air” blankets, radiation warmers, heating &
humidification gases
Psychological preparation
Family affair
“Fear of the unknown”
“Fear of separation”
Psychological differences
Adolescents
Might appear cool.
Fears of loss of autonomy & pain
May have morbid thoughts
Psychological Preparation
Young chlid Simple explanation
suffices
Explanation probably the
day before, not too early
Self centered and need
for re-assurance
Sense of mastery and
participation
Be careful of the “silent
child and listening child”
Psychological Preparation
Emotion > physical needs