Download Tips and Tricks the Pediatric Patient

Tips and Tricks
The Pediatric Patient
Mark Rainosek MDA
Holly Chapman MDA
There are many differences and it is impossible to write every situation. Learn the basics and apply those
principles to each situation. Here are some tips and tricks.
It all starts in Pre-Op, oral sedation, distraction techniques, warm room and bair hugger, mask induction, IV after
induction before intubation or IMA. The type of case dictates the airway management. If the nurse is not good
at starting pediatric IV, the nurse may manage the airway while the anesthesia provider starts the IV.
Pre-Op
 Some providers will order oral sedation since IV is rarely started in peds patients under 10 years
 Oral midazolam (versed) can take 10+ minutes to begin working. Ask when appropriate to bring patient
to OR
 Distraction techniques are often used to help relax the child, and every provider has their own style so
be flexible in assisting
 Transport to the OR (the room must be warmed ahead of time and in addition to room warming there
should be a pediatric under-body warmer for small children).
 Sometimes small children are carried to the room, brought in a wagon, or stretcher depending on many
variables. If unsure what method of transport is appropriate it is best to ask.
OR
Induction by mask: points to remember
 Mask induction is slower than with IV
 It is important to talk softly, having the environment fairly quiet, when the patient falls off to sleep
 Make sure any pressure points are padded or removed from the IV line and leave the distal injection
port exposed.
 Pediatric IV starts are very different than adults. If not experienced ask for direction. If you are not
comfortable, ask another nurse or anesthesia provider to help start the IV. If extra help is not available,
the anesthesiologist may ask the nurse to help with mask ventilation so he/she can start the IV.
 Many pediatric airways are secured using nasal tubes (i.e. dental cases). If unfamiliar with nasal tubes
ask how you may help.
 If appropriate the anesthesia provider may do pain control procedures once the IV and airway are
secure.
 Always ask how to help with positioning.
 Children loose heat very quickly so do not cool room until patient is draped and rewarm room before
removing drapes.
 Every Anesthesiologist has different styles. Your will learn their style and how to best assist them.
For example:
Dr. Rainosek likes a deep extubation followed by turning the patient on their side on the
stretcher with the head partially elevated when appropriate. This decreases the chance of the
secretions dripping onto the vocal cords and causing airway problems. Many others will wait
until the child is awake for extubation.
PACU/Transport from the OR
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Most providers will transport children to PACU with O2 blow by.
Remember Anesthesiologist all have different styles to safety take care of the patient
For instance: Dr. Rainosek likes a deep extubation followed by turning the patient on the side on the
stretcher with the head partially elevated when appropriate. This decreases the chance of secretions
dripping onto vocal cords and causing airway problems. Many others wait until the child is awake for
extubation.
Be patient when arriving to the PACU, as the first responsibility of staff will be to make sure the patient
is doing well, attaching monitors ( if applicable) and making the patient comfortable.
Other Considerations:
 In children with autism, CNS issues, or severe behavioral problems, the oral premedication may not
sufficient and IM sedation may have to be given in preop to be able to get them in the OR.
These patients can be aggressive, so it is important to have additional help so that neither the staff nor
patient is injured.
 Induction and emergence are critical times. Securing the airway is the most important thing. What get
kids into trouble are respiratory issues not cardiac. Kids can do well for a long time but once they
decompensate, they can spiral down more quickly than adults.
 In pediatric cases the parents also have to be considered. Procedures need to be explained and they
need to be reassured. Their anxiety can transfer to the child. We do not allow parents in the OR unless
there are extremely special circumstances. They just need to be told that is the policy. Sometimes the
parents who want to accompany their child are not good candidates to be in the stressful environment
of the OR. Assure them that they will be allowed in the PACU to be with their child once they awaken.