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ANESTHESIA FOR

INFANTS &
CHILDREN

FUNDAMENTAL
DIFFERENCES

Anatomical differences
Respiratory system
Cardiovascular system
Blood
Renal function & fluid balance
Maintenance of body temperature
Psychological differences

Respiratory System
Respiratory rate
Lung capacities
Control of respiration

Respiratory rate (RR)

Oxygen consumption: 7 ml/kg per


minute (twice the adult value)
Resting minute ventilation: 200 ml/kg
per minute (twice the puberty value)
Tidal volume: 7 ml/kg (remains
constant at throughout life)
RR:
At birth : 30 breaths/min
At 1 year
: 24 breaths/min
Adult
: 12 breaths/min

Causes of bradycardia
Causes of reflex bradycardia &
hypotension during anesthesia:
Laryngoscopy
Tracheal intubation
Tracheal suctioning
Traction on eye muscles & viscera
Variety of anesthetic drugs:
suxamethonium
(succinylcholin), halothane & neostigmine

Prevent or treat: atropine 20 ug/kg


i.v.

Blood volume

Average: range from 80-90 ml/kg


at birth
By 1 month of age: 70-80 ml/kg
(as in the adult)

Pediatric anesthetic
pharmacology

Pharmacokinetics
Liver
Kidney
Pharmacodynamics

Intravenous
anesthetics

Thiopenthone
Methohexitone
Profopol
Opioids

Methohexitone

For i.v. induction when rapid recovery


is required (day case procedures)
Usual
dose:
2.5
mg/kg
(unpremedicated children)
Recovery: 5-10 minutes
Pain on injection can be reduced: 50
mg lidocaine to 50 ml of 1%
methohe-xitone solution

Thiopentone

Standard i.v. induction agent for


children
Intravenous injection is painless &
produces smooth induction of
anesthesia
Neonates
: 4-5 mg/kg
The
dose varies
with
age:
Infants
: 7-8
mg/kg
Children

: 5-6 mg/kg

Profopol

Newer i.v induction agent with


recovery similar to methohexitone
Induction is smoother than with
methohexitone, but not as smooth
as with thiopentone
Usual dose for children: 3 mg/kg

Morphine
Standard

opioid analgesic for

children
Supplementing balanced
anesthesia in children:
Loading dose
: 100 ug/kg
Maintenance
: 25
Few
problem dose
with
respiratory
ug/kg
depression
and producing excellent
postoperative analgesia (aged over
6 months)

Tube size

Cuffed tracheal tube not usually


required in infants and children
Excessive
large
tube:
postintubation croup
The correct size of tube: passes
easily through cricoid ring &
allows a slight leak when 20-25
cmH2O pressure is applied

Formula for tube size


(children aged 2 years and
over)
Tube size
(mm i.d.)

Age (years)
=-------------- + 4.5
4

Formula for estimate


orotracheal tube
length
Age
(years)
(children aged over
2 years)

Orotracheal tube =-------------- + 13


length (cm)
2

Average weights of
children
(aged from 1 to 12 year)

[ Age (years) + 3 ] x

5
Weight
(kg)

=--------------------------2