Pediatric Anesthesia Lecture Notes

Introduction

• Pediatric anesthesia involves specialized equipment and considerations.
• Equipment includes small endotracheal tubes and IV catheters.
• Unique challenges in emergency situations, especially after respiratory infections.
• Presented by Max Feinstein at Mount Sinai Hospital.

Differences in Anesthetic Delivery

• Pre-Operative Medication:
  • Adults: Midazolam administered intravenously (IV).
  • Children: Midazolam often given orally due to intolerance to IV placement.
• Induction of Anesthesia:
  • Adults: Generally through IV.
  • Children: Through inhalation via a mask to avoid trauma from IV placement.

IV Placement in Pediatric Patients

• Pediatric IVs are smaller (e.g., 24-gauge compared to 20-gauge for adults).
• Air bubbles in IVs are more dangerous in children due to potential heart defects allowing air to reach the brain.

Medication Dosing

• Adults: Standard dosing, independent of weight, e.g., 2 mg of IV midazolam.
• Children: Weight-based dosing, e.g., 0.5 mg/kg of midazolam.
• Pediatric anesthesiologists memorize weight-based doses.

Emergency Situations in Pediatrics

• Pediatric patients have less functional reserve compared to adults.
• Oxygen Desaturation:
  • Adults: Can maintain saturation longer with 100% oxygen.
  • Children: Desaturation occurs much quicker (10-20 seconds in newborns).
• Emergency medications are prepared in advance:
  • Atropine: Increases heart rate.
  • Succinylcholine: Fast-acting paralytic for airway management.

Risk Factors and Emergency Conditions

• Recent respiratory infections increase risk of laryngospasm.
• Laryngospasm can lead to apnea, decreased heart rate, and potential cardiac arrest.
• Surgeries postponed if recent respiratory illness, unless urgent.

Malignant Hyperthermia

• Rare but severe reaction to certain anesthetics like succinylcholine.
• Can lead to severe injury or death if untreated.

Equipment Differences

• Pediatric equipment is smaller but similar in function to adult equipment.
• Examples include smaller laryngoscope blades and endotracheal tubes.

Miscellaneous

• Pediatric anesthesiologists often wear fun scrub caps to comfort children.
• There is extensive training and textbooks dedicated to pediatric anesthesia.

Additional Resources

• Max Feinstein is undergoing training to become a pediatric anesthesiologist.
• More detailed videos available on his channel.

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These notes cover the key points from the lecture on pediatric anesthesia by Max Feinstein. The information includes unique procedures, equipment, and emergency management specific to pediatric patients as compared to adults.