KEEP THE AIRWAY OPEN
The first, simplest move when a sleeping child's airway seems blocked or they start snoring loudly.
What is a chin lift / jaw thrust (reposition the head)?
The finger or toe clip that shows the child's oxygen level.
What is the pulse oximeter?
Big "kissing" tonsils that nearly touch in the middle of the throat make this part of the body harder to keep open during anesthesia.
What is the airway? (Moderate-to-severe tonsillar hypertrophy is a red flag for extra airway risk.)
The two things checked at the front desk before every case:
What are NPO (fasting) status and health status (recent illness)?
A child's cords snap shut (laryngospasm) and oxygen is dropping. Before any drug is given, name the FIRST step.
What is positive-pressure ventilation with 100% oxygen by a tight mask seal, plus a jaw thrust and removing the trigger (suction blood/secretions)?
The vocal cords suddenly snap shut, often from saliva, blood, or water in the throat. The child may make a high-pitched sound, then go silent.
What is laryngospasm?
The monitor that shows a breathing waveform and alerts the team first when a child stops breathing.
What is capnography (end-tidal CO₂)?
Loud snoring, gasping, or pauses in breathing during sleep point to this condition, which raises the chance of airway obstruction and low oxygen under anesthesia.
What is obstructive sleep apnea (OSA)?
Loud snoring or pauses in breathing during sleep can mean this condition, which raises airway risk.
What is obstructive sleep apnea?
The jaw thrust and positive pressure aren't breaking the spasm and the oxygen keeps falling. Name the SECOND step (what the doctor does next, before a paralytic).
What is call for help and deepen anesthesia — give IV propofol (about 0.5–1 mg/kg)?
The assistant's job that helps prevent laryngospasm during dental work: keeping water, blood, and debris out of the throat.
What is good suctioning (and using a throat pack/isolation)?
During general anesthesia, vital signs should be recorded at least this often.
What is every 5 minutes?
A child with this common breathing condition — or a cough, wheeze, or runny nose from a recent cold — has twitchy airways that can trigger spasm; the cold-related risk can last a few weeks.
What is asthma (and recent upper respiratory infection)?
A child with a new cough, runny nose, or fever on the morning of the case should be reported to this person before starting.
Who is the doctor / anesthesia provider (the case may need to be rescheduled)?
Propofol didn't work, oxygen is still dropping, and the heart rate is starting to fall. Name the next drug — and the second drug given with it in kids to protect the heart rate.
What is succinylcholine (IV ~1–2 mg/kg, or IM ~4 mg/kg if no IV), given with atropine to prevent bradycardia?
The device squeezed over the child's face to breathe for them if they stop breathing.
What is a bag-valve-mask (Ambu bag)?
True or false: if the oxygen number looks fine, the child must be breathing well.
What is false? Extra oxygen can keep the number normal even when breathing has slowed, so watch the chest and the capnography too.
Name two other things that can make a child higher-risk and may mean "do this in a hospital, not the office."
What are very young age (under about 3, especially under 6 months), obesity, Down syndrome, prematurity, or a serious medical condition (ASA III/IV)? (Any one qualifies.)
Before going home, the child must be back to about this level of alertness.
What is how awake they were before the procedure (meeting discharge criteria)?
A child suddenly has hives, wheezing, and a dropping blood pressure — anaphylaxis. Name the first-line drug, the route, and where it's injected.
What is intramuscular epinephrine in the mid-outer thigh (0.15 mg for ~15–30 kg, 0.3 mg for ≥30 kg)? Antihistamines and steroids do NOT replace it.
Most serious problems during children's sedation and anesthesia involve this part of the body, so it's what the whole team should practice most.
What is the airway / breathing?
A child stops breathing (apnea) but the cords are open. Walk through the first two moves.
What is open/reposition the airway with a jaw thrust, then bag-valve-mask ventilation with 100% oxygen (and call for help / consider naloxone if an opioid was given)?