Pediatric
Anesthesia Basics
2012
Laura Downey, MD
Yun-Sheen Liu, MD
Julie Williamson, DO
NPO guidelines
Solids/formula = 6h
Breast milk = 4h
Clears = 2h
Older kids should be NPO after
midnight
Chewing gum and candy are
considered clear liquids
Premedication
IV Premed
0.5mg/kg Versed for toddlers, up to 2 mg of
IV Versed for children >5 years
Oral Medication order 20-30min before
case to be given by pre-op holding RNs
<6mo = usually no premed needed
6mo to 12y = oral premed (0.5 mg/kg up to
20 mg)
Over 12y = IV in pre-op area
Set Up: T-MSMAID
Table
Machine
Suction
Monitors
Airway
IV
Drugs
Table
Bair Hugger
Shoulder Roll
3 lead EKG
Pulse Ox
Appropriate
sized BP cuf
Special cable
for neonatal
cufs
Machine
Standard Machine check
Monitor set to Neonate or Pediatric
Mode
Reset alarms for age appropriate
vitals
Suction
Red rubber Rob Nell for little kids
Yankauers may be in anesthesia
machine or on surgical shelves.
Have available before induction.
Turn on suction
Monitors
BP cuf of appropriate size
Pulse ox
3 lead EKG
White lead on right
Green lead is V5 and equivalent to red
lead in adults
Airway
ETT (3)
Two laryngoscope blades
Oral airways
Flavored face mask
Cloth white tape to secure ETT
One half size bigger and
one half size smaller
Appropriate size stylet
Two Y-strips
Red rubber for suction
Eye tape:
Paper tape > 1year
Mepitec for <1 year
or fragile skin
Mepitec
Cloth
Tape
ETT
Size based on
the childs pinky
or (age/4) + 4
Subtract 0.5 size
for cufed tube
Have one halfsize smaller and
larger available
Laryngoscope blades
for babies up to 3 months: Miller 0
for babies aged 3 months to 18 months: Miller
1
for 18 month- 3 years: Miller 1.5, Mac 1, Wisc
1.5
for 3-5 years: Miller 1.5, Mac 2, Wisc 1.5
for >5 years: Miller 2, Mac 2-3
Note: Mac 4 is not standard in room. You will
need to request one from tech
Airway
AGE For
mul
a
32
wee
ks
Ter
m
3
mo
6mo 12
mo
18
mo
2 yr
3 yr
5 yr
10
yr
Kg
2.0
3.5
5.0
6.0
11
13
15
20
40
5.5
ETT
size
(age/
4) +4
2.5
3.0
3.5
3.5
4.0
4.5
4.5
4.5
5.0
ETT
dept
h
ETT
size*
3
7.5
9.0
10.5
10.5
12.0
13.5
13.5
13.5
15.0
Mil 0
Mil 0
Mil 0
Mil 1
Mil 1
Mil 1
Wis
1.5
Mac
1
Mil
1.5
Mac
1
Mil
1.5
Mac
2
Mil 2
Mac
2-3
1.5
1.5
2.5-3
Bla
de
LM
A
IV
IV supplies in kidney basin
mini tourniquet cut to
half width for small babies
Alcohol pads
20, 22, 24g PIV catheters
Opsites
2x2 gauze
Paper tape for additional
reinforcement
Scissors
Arm board
Syringe with T-piece
IV continued
Debubble all buretrols and
IV sets. Green clip should
be left in open position
A bubble is a bullet to
the brain Boltz
Draw back on syringes
to de-air before injecting
Children <6m should have
dextrose infusion
Buretrol IV set for <2yo
Microdripper for <12 yo
of
t
ou ents
y
tl ati VF
n
e
rr for p for I
u
e c ags mp
r
a
b
s
pu
l
c
o
c
e
etr 250 ring
r
Bu ck. r sy
sto yo o
<5
.
for ants
Drugs
Pyxis machine in OR
Contains:
Access: 6 digit dictation number + password or
fingerprint
LPCH Pharmacy (near OR 7):
Emergency drugs, opioids, induction agents
Note that ketamine comes in 100mg/ml (for IM injection) and
10mg/ml
Albumin, Crystalloid, Dextrose
Call to have drips made for big cases 721-2731. Can
be ordered in advance under Anesthesia OR drips
in Cerner.
10mcg/ml pre-made Epinephrine sticks available
Stanford Main OR Pharmacy:
Sign out a green box for patients going for procedures
in Stanford Hospital (AMC, interventional radiology)
Drugs
Emergency Drugs
Sux 4-6 mg/kg on IM needle
Atropine 0.02 mg/kg on IM
needle
Ephedrine 10cc of 5mg/cc
Phenylephrine
1 syringe of 100ug/cc
1 syringe of 10ug/cc
Epinephrine 10 mcg/cc
Two syringes of saline flush
aila
v
a
le s
d
e
n e s e.
d
n
s a RY ca
e
g
n
VE
yri
E
s
l
r
l
ma
p fo
s
u
e
Hav ot draw
n
Do
Other emergency drugs
Calcium Chloride
10cc of 100mg/cc
10cc of 10mg/cc
Sodium bicarbonate
8.4% 1 mEq/cc for patients >1 year
Note dilute solution for infants
Syringes of 5% albumin
Induction Drugs
Ketamine 0.5-5 mg/kg IV, 3-5
mg/kg IM
Propofol 2-3 mg/kg IV
Time and date all syringes. Discard
after 6 hours.
Rocuronium 0.6-1.2 mg/kg, dilute to
1 mg/cc for children <1 years
Pain medications
PR acetaminophen 30-40 mg/kg (single
dose)
IV acetaminophen dose is age dependent:
10mg/kg <2 years. 15 mg/kg >2 years. Redose Q 6 hours. Slow push/infusion over 15
minutes.
Toradol 0.5 mg/kg IV or IM
Fentanyl single dose 0.5 to 1 mcg/kg,
dilute to 1 mcg/cc for babies, 10 mcg/cc for
children<10 years
Morphine single dose 0.1 mg/kg IV
Hydromorphone single dose 10 mcg/kg IV
Flow of the OR
Pre-op: Ground floor of LPCH outside OR
Holding: 8 bed area in OR suite
Inpatients are brought to holding when <30 min until case
start
Patients too big to carry out of pre-op are brought to holding
for premed
Need GO sticker before you can leave holding
OR
Patient admitted to Pre-op where NPs see patients and often
start care form
7 main ORs
MRI/CT suites on ground floor
APU outpatient procedures on 1st floor LPCH
PACU: next to holding area
ICUs are all on 2nd floor LPCH
May I have a GO?.....
GO stickers:
H and P from surgeon (with 24 hour update)
Preoperative note from anesthesia signed by
attending
Patient marked
GO
Room is ready
First time out is done in pre-op at
patients bedside. Check MRN, birth date,
allergies.
Maneuvering the
Paperwork
Cerner Powerchart is LPCH EMR
User name and Password are the same as for OB
EMR access from home is on LPCH intranet:
[Link]
Or access from [Link]
Intranet password is diferent password than
Cerner
Choose LINKS from menu and Powerchart
Sign into Cerner
How do I find my
schedule?
In Cerner:
Choose compass icon (Explorer
Menu)
Open Main Menu Folder
Open Perioperative Services
Folder
Choose Perioperative
Schedule
In Gray Box:
Surgery All Areas Bookshelf:
Choose LPCH Perioperative
All Areas Bookshelf
View Master View
Execute
This generates the daily
schedule with Anesthesia
Attending, Resident, Patient
name and number and site
Finding information
Old Anesthesia Records:
Clinical Documents Tab:
(after 9/2009)
OR and Procedure Notes
Scanned Documents Tab:
(before 9/2009)
Anesthesia Records,
Anesthesia Pre-Op
OR and Procedure Notes
Under ClinDocs, Care
Forms, Pre Anesthesia NP
note
ECHOS/EKG
Clin Docs Tab
Ancillary Documents
