Professional Documents
Culture Documents
Physiology
Postoperative apnea in former premature infants Implications
Immature CNS and BBB Regional alone decreases risk
Pharmacology
General and Implications
Distribution
CSF Volume Total Body Water Protein Binding
Clearance
Liver Renal
ml/kg
minutes
150 100 50 0
Infants
Adults
Duration of action
e.g. Spinal Tetracaine with epinephrine
ICF ECF
% of bodyweight
Full Term
4-6 months
Adult
Clin Pharm, 14:189, 1988
Clearance
Liver: Phase I & Phase II decreased Renal: GFR 30% of adult Adult levels by 3-5 months of age
Local Anesthetics
BE CAREFUL with repeated dosing and infusions Neurologic symptoms > cardiac symptoms
May not be able to illicit early neurologic symptoms in small children First sign may be a grand mal seizure
Opioids
Morphine's t1/2 in neonates twice of adults
Approaches adult by 2-4 months
Anatomy
Indications
Malignant Hyperthermia Avoid need for opioids
Sedation or respiratory depression DSU patients
Spinal anesthesia
Caudal Anesthesia
Caudal Anesthesia
Caudal Anesthesia
Needle or Angiocath
Caudal in a
http://www.cvm.okstate.edu/~users/aerrane/mandsagr/www/vms5422/lect22.htm
Single Dose:
Single Dose:
Single Dose:
Caudal Morphine
30 40 mcg/kg
Provides analgesia for 12-24 hours No respiratory depression in over 500 children Nausea incidence similar to general anesthesia
Less labor intensive Does not require special pain service Side Effects
Nausea Itching Propofol therapy single dose
Continuous Infusion
Technique and Dose
Caudal
16g angiocath with 19g epidural catheter Thread up to thoracic level Guard with clear steridrape
Epidural-lumbar
Use LOR to saline and continuous pressure method If thread up to thoracic level, need epidurogram
Types
<1 yoa: 0.1% bupivacaine >1 yoa: 0.1% bupivacaine + 3 mcg/ml fentanyl
Naloxone 10 mcg/kg *If infusion has fentanyl, then turn down infusion & may use naloxone
Cote, A Practice of Anesthesia for Infants and Children
Spinal Anesthesia
RARELY done Technique
IV access 1.5" 22g beveled needle
Dose
Tetracaine 1 mg/kg and "whiff" (0.02 ml) epinephrine
MILLIMETERS
3 yr
5 yr
10 yr
18 yr
Spinal Anesthesia
Positioning
Spinal Anesthesia
CSF Returns
Spinal Anesthesia
Injection
Spinal Anesthesia
Complications
No hypotension seen in children under 6 years of age If blood encountered, difficult to identify CSF
Limitations
Procedure Duration 45 minutes Surgeon
Pearls
Sugar Nipple Do not flex head Bovie Pad
Spinal Anesthesia