Table 82-1 -- Common Neonatal Problems Associated with Weight and Gestational Age

Gestational Age Body Size Neonatal Problems Occurring with Increased Frequency
Preterm Small Respiratory distress syndrome
Apnea
Hypoglycemia
Hypomagnesemia
Hypocalcemia
Fetal alcohol syndrome
Viral infection
Thrombocytopenia
Congenital anomalies
Maternal drug addiction
Neonatal asphyxia
Aspiration pneumonia
Term Small Congenital anomalies
Viral infection
Thrombocytopenia
Maternal drug addiction
Neonatal asphyxia
Hypoglycemia
Fetal alcohol syndrome
Postmature Small Congenital anomalies
Viral infection
Thrombocytopenia
Maternal drug addiction
Neonatal asphyxia
Aspiration pneumonia
Hypoglycemia
Fetal alcohol syndrome
Any gestational age Large Birth trauma
Hyperbilirubinemia
Gestational Age Body Size Neonatal Problems Occurring with Increased Frequency
Hypoglycemia: infant of diabetic mother
Transposition of great arteries
From Cot CJ, Lerman J, Todres ID (eds): A Practice of Anesthesia for Infants and Children, 4th ed.
Philadelphia, Saunders, 2008
Table 82-3 -- Summary Statistics for 17 Studies That Compared the Characteristics of
Sevoflurane and Halothane
Problem
Sevoflurane Halothane
Chi Square
Yes No Percent Yes No Percent
Laryngospasm 22 773 2.8 22 601 3.5 .503
Breath-holding 33 635 4.9 34 439 7.2 .143
Coughing 42 662 6.0 52 454 10.3 .008
Excitement during induction 92 556 14.2 58 423 12.0 .338
Bronchospasm 2 604 0.33 2 436 0.46 .856
Excitement during emergence 169 645 20.8 102 573 15.1 .006

Table 82-4 -- Commonly Used Muscle Relaxants and Reversal Agents in Pediatrics
Drug Average Intubation Dose (mg/kg) Category
Approximate
Duration
Muscle Relaxants *
Pancuronium 0.1 Long acting 45-60 min
Cisatracurium 0.1
Intermediate
acting
30 min
Vecuronium 0.1
Intermediate
acting
30 min
Rocuronium Dose related:
0.3 Short acting 15-20 min
0.6
Intermediate
acting
30-45 min
1.2 Long acting 45-75 min
Reversal Agents
[]

Edrophonium
0.3-1.0 mg/kg + atropine,
0.02 mg/kg

Neostigmine 0.02-0.06 mg/kg + atropine,
Drug Average Intubation Dose (mg/kg) Category
Approximate
Duration
0.02 mg/kg
*

The response of preterm and term neonates (who may be more sensitive to the drugs) to muscle relaxants varies greatly from patient
to patient. Therefore, all doses should be titrated to response. The recommended intubation doses may be reduced 30% to 50% in the
presence of a potent inhaled agent.

The dose of reversal agent given to antagonize nondepolarizing neuromuscular blockade should be determined by the degree of
residual neuromuscular blockade (i.e., the dose should be titrated to clinical effect).

Table 82-5 -- Fasting Guidelines for Pediatric Patients
Fasting Time (hr) *
Age Milk and Solids Clear Liquids
<6 months 4 2
6-36 months 6 3
>36 months 8 3
*

Note that the American Society of Anesthesiologists guideline allows a light breakfast (tea and plain toast) 6 hours before
anesthesia; however, it is difficult to determine what a light breakfast is for a child.

Table 82-6 -- Recommended Sizes and Distance of Insertion of Endotracheal Tubes and
Laryngoscope Blades for Use in Pediatric Patients
Age of
Patient
Internal Diameter of
Endotracheal Tube (mm)
Recommended Size of
Laryngoscope Straight Blade
Distance of
Insertion * (cm)
Preterm
(<1250 g)
2.5 uncuffed 0 6-7
Full term 3.0 uncuffed 0-1 8-10
1 yr 3.5-4.0 cuffed 1 11
2 yr 4.5-5.0 cuffed 1-1.5 12
6 yr 5.0-5.5 cuffed 1.5-2 15
10 yr 6.0-6.5 cuffed 2-3 17
18 yr 7-8 cuffed 3 19
*

Inserting the endotracheal tube this distance from the alveolar ridge of the mandible or maxilla places the distal end of the tube in the
midtrachea.




Table 82-8 -- Laryngeal Mask Size versus Patient Weight *
Laryngeal Mask Size Patient Weight
1 5 kg
1.5 5-10 kg
2 10-20 kg
2.5 20-30 kg
3 30-50 kg
4 50-70 kg
5 70-100 kg
6 >100 kg
*

Manufacturer's recommendations (LMA North America).

Table 82-9 -- Calculation of Maintenance Fluid Requirements for Pediatric Patients
Weight (kg) Hourly Fluid Requirements (mL)
<10 4 mL/kg
11-20 40 mL + 2 mL/kg for each kilogram above 10
>20 60 mL + 1 mL/kg for each kilogram above 20