Delirium
What type of anesthesia is more effective in preventing emergence delirium?
Total Intravenous Anesthesia (TIVA) - gas has increased risk
What is the most common arrest in PACU?
Respiratory, often treated quickly and recognized so promptly that no arrest record recquired
A tool created for children to help them communicate their pain.
What is Wong-Baker pain scale
A life threatening pharmacogenetic reaction that occurs on administration of general anesthesia, characterized by hypermetabolism. This results in dangerously high body temp, muscle rigidity/spasms and rapid heart rate.
What is malignant hyperthermia.
Pediatric patients are generally not considered febrile until they reach a temperature of 100.4F or higher. True or false.
True
In what age does pediatric emergence delirium occur most frequently?
What is 2 to 5 years.
The narrowest part of the upper airway in a pre-pubertal child.
What is the cricoid cartilage?
These are some examples: Distractions, popsicles, tylenol, opioids.
What are examples of pain interventions for peds.
The forceful closure of vocal cords preventing respiration that can occur in stage 2 of anesthesia, when the airway is unprotected.
What is laryngospasm
Bradycardia in children is most often the result of this.
What is hypoxia.
Child appears confused, he's crying & screaming & kicking. He doesn't respond to verbal cues nor opens his eyes......
What are the signs and symptoms of emergence delirium.
Child shows signs of fatigue, weak cry, cricoid tug, grunting.
What are the signs and symptoms of respiratory distress.
This can be used to evaluate emergence delirium.
Pediatric Anesthesia Emergence Delirium (PAED) scale - eye contact/purposeful/aware/restless/inconsolable
A noxious stimulus that can result in increased ICP, pain, emesis, hypoxemia, hypertension, and cardiac dysrhythmias.
What is direct laryngoscopy.
Restlessness is one of the first signs of this.
What is hyoxia/hypoxemia.
What medications can help prevent pediatric emergence delirium?
Clonidine, Precedex, Ketamine, Opiods
What are the signs and symptoms of upper airway obstruction in peds.
There are multiple interventions that can be utilized pre- and post-op for children who are anxious. List 3
Distraction, weighted blanket, parent/guardian presence, medication.
Angioedema, stridor, wheezing, and shock develop within minutes to hours.
What is anaphylaxis.
This is the initial nursing action for a laryngospasm event.
What is positive pressure ventilation while calling for help, anticipate need for succinylcholine.
Which pediatric patients are at highest risk for emergence delirium following anesthesia?
Preschool age (2–6 years), Use of volatile agents (especially Sevoflurane), Rapid emergence, and Preoperative anxiety
These are two anatomical airway differences in pediatric patients vs adult patients.
What are shorter neck & trachea; smaller mandible, nares, airway diameter; floppier airway, cricoid ring is narrowest part
There are 4 stages of anesthesia: Stage 1 - analgesia; Stage 2 - delirium; Stage 3 - surgical anesthesia; Stage 4 - respiratory arrest. The stage that includes loss of consciousness, irregular respirations and increase potential for laryngospasm is this stage.
What is stage 2.
A previously healthy 5 year old presents with a heart rate of 55 in the PACU. Your immediate action should be what?
Assess patient for adequate oxygenation and ventilation.
This inhaled medication is commonly used for stridor or airway edema in pediatric patients.
What is racemic epinephrine.
Adults: 0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer every 3-4 hours as needed
Children 4 years and older: 0.5 mL of 2.25% solution via jet nebulizer (diluted to 3 mL with NS) over 15 minutes every 3-4 hours as needed
Children under 4 years old: 0.05 mL/kg via jet nebulizer (diluted to 3 mL with NS) over 15 minutes; no more than every 12 hours; not to exceed 0.5 mL/dose
Use the low end of dosing range for younger infants
Should observe rapid response, can be repeated every 2 hours in older children but monitor heart rate with repeated dosing