Pediatric

Anesthesia Basics
2012
Laura Downey, MD
Yun-Sheen Liu, MD
Julie Williamson, DO

NPO guidelines

Solids/formula = 6h
Breast milk = 4h
Clears = 2h
Older kids should be NPO after
midnight
Chewing gum and candy are
considered clear liquids

Premedication

IV Premed

0.5mg/kg Versed for toddlers, up to 2 mg of

IV Versed for children >5 years

Oral Medication order 20-30min before

case to be given by pre-op holding RNs
<6mo = usually no premed needed
6mo to 12y = oral premed (0.5 mg/kg up to
20 mg)
Over 12y = IV in pre-op area

Set Up: T-MSMAID

Table
Machine
Suction
Monitors
Airway
IV
Drugs

Table

Bair Hugger
Shoulder Roll
3 lead EKG
Pulse Ox
Appropriate
sized BP cuf

Special cable
for neonatal
cufs

Machine

Standard Machine check

Monitor set to Neonate or Pediatric
Mode
Reset alarms for age appropriate
vitals

Suction

Red rubber Rob Nell for little kids

Yankauers may be in anesthesia

machine or on surgical shelves.
Have available before induction.

Turn on suction

Monitors

BP cuf of appropriate size

Pulse ox
3 lead EKG
White lead on right
Green lead is V5 and equivalent to red
lead in adults

Airway

ETT (3)

Two laryngoscope blades

Oral airways
Flavored face mask
Cloth white tape to secure ETT

One half size bigger and

one half size smaller
Appropriate size stylet

Two Y-strips

Red rubber for suction

Eye tape:
Paper tape > 1year
Mepitec for <1 year
or fragile skin

Mepitec

Cloth
Tape

ETT

Size based on
the childs pinky
or (age/4) + 4

Subtract 0.5 size

for cufed tube
Have one halfsize smaller and
larger available

Laryngoscope blades

for babies up to 3 months: Miller 0

for babies aged 3 months to 18 months: Miller
1
for 18 month- 3 years: Miller 1.5, Mac 1, Wisc
1.5
for 3-5 years: Miller 1.5, Mac 2, Wisc 1.5
for >5 years: Miller 2, Mac 2-3
Note: Mac 4 is not standard in room. You will
need to request one from tech

Airway
AGE For
mul
a

32
wee
ks

Ter
m

3
mo

6mo 12
mo

18
mo

2 yr

3 yr

5 yr

10
yr

Kg

2.0

3.5

5.0

6.0

11

13

15

20

40

5.5

ETT
size

(age/
4) +4

2.5

3.0

3.5

3.5

4.0

4.5

4.5

4.5

5.0

ETT
dept
h

ETT
size*
3

7.5

9.0

10.5

10.5

12.0

13.5

13.5

13.5

15.0

Mil 0

Mil 0

Mil 0

Mil 1

Mil 1

Mil 1

Wis
1.5
Mac
1

Mil
1.5
Mac
1

Mil
1.5
Mac
2

Mil 2
Mac
2-3

1.5

1.5

2.5-3

Bla
de
LM
A

IV

IV supplies in kidney basin

mini tourniquet cut to
half width for small babies
Alcohol pads
20, 22, 24g PIV catheters
Opsites
2x2 gauze
Paper tape for additional
reinforcement
Scissors
Arm board
Syringe with T-piece

IV continued

Debubble all buretrols and

IV sets. Green clip should
be left in open position
A bubble is a bullet to
the brain Boltz
Draw back on syringes
to de-air before injecting
Children <6m should have
dextrose infusion
Buretrol IV set for <2yo
Microdripper for <12 yo

of
t
ou ents
y
tl ati VF
n
e
rr for p for I
u
e c ags mp
r
a
b
s
pu
l
c
o
c
e
etr 250 ring
r
Bu ck. r sy
sto yo o
<5
.
for ants

Drugs

Pyxis machine in OR

Contains:

Access: 6 digit dictation number + password or

fingerprint

LPCH Pharmacy (near OR 7):

Emergency drugs, opioids, induction agents

Note that ketamine comes in 100mg/ml (for IM injection) and
10mg/ml
Albumin, Crystalloid, Dextrose

Call to have drips made for big cases 721-2731. Can

be ordered in advance under Anesthesia OR drips
in Cerner.
10mcg/ml pre-made Epinephrine sticks available

Stanford Main OR Pharmacy:

Sign out a green box for patients going for procedures

in Stanford Hospital (AMC, interventional radiology)

Drugs

Emergency Drugs
Sux 4-6 mg/kg on IM needle
Atropine 0.02 mg/kg on IM
needle
Ephedrine 10cc of 5mg/cc
Phenylephrine
1 syringe of 100ug/cc
1 syringe of 10ug/cc

Epinephrine 10 mcg/cc
Two syringes of saline flush

aila
v
a
le s
d
e
n e s e.
d
n
s a RY ca
e
g
n
VE
yri
E
s
l
r
l
ma
p fo
s
u
e
Hav ot draw
n
Do

Other emergency drugs

Calcium Chloride
10cc of 100mg/cc
10cc of 10mg/cc

Sodium bicarbonate
8.4% 1 mEq/cc for patients >1 year
Note dilute solution for infants

Syringes of 5% albumin

Induction Drugs

Ketamine 0.5-5 mg/kg IV, 3-5

mg/kg IM
Propofol 2-3 mg/kg IV

Time and date all syringes. Discard

after 6 hours.

Rocuronium 0.6-1.2 mg/kg, dilute to

1 mg/cc for children <1 years

Pain medications

PR acetaminophen 30-40 mg/kg (single

dose)
IV acetaminophen dose is age dependent:
10mg/kg <2 years. 15 mg/kg >2 years. Redose Q 6 hours. Slow push/infusion over 15
minutes.
Toradol 0.5 mg/kg IV or IM
Fentanyl single dose 0.5 to 1 mcg/kg,
dilute to 1 mcg/cc for babies, 10 mcg/cc for
children<10 years
Morphine single dose 0.1 mg/kg IV
Hydromorphone single dose 10 mcg/kg IV

Flow of the OR

Pre-op: Ground floor of LPCH outside OR

Holding: 8 bed area in OR suite

Inpatients are brought to holding when <30 min until case

start
Patients too big to carry out of pre-op are brought to holding
for premed

Need GO sticker before you can leave holding

OR

Patient admitted to Pre-op where NPs see patients and often

start care form

7 main ORs
MRI/CT suites on ground floor
APU outpatient procedures on 1st floor LPCH

PACU: next to holding area

ICUs are all on 2nd floor LPCH

May I have a GO?.....

GO stickers:
H and P from surgeon (with 24 hour update)
Preoperative note from anesthesia signed by
attending
Patient marked
GO
Room is ready

First time out is done in pre-op at

patients bedside. Check MRN, birth date,
allergies.

Maneuvering the
Paperwork

Cerner Powerchart is LPCH EMR

User name and Password are the same as for OB

EMR access from home is on LPCH intranet:

https://intranet.lpch.org
Or access from ether.stanford.edu
Intranet password is diferent password than
Cerner
Choose LINKS from menu and Powerchart
Sign into Cerner

How do I find my
schedule?

In Cerner:
Choose compass icon (Explorer
Menu)
Open Main Menu Folder
Open Perioperative Services
Folder
Choose Perioperative
Schedule
In Gray Box:
Surgery All Areas Bookshelf:
Choose LPCH Perioperative
All Areas Bookshelf
View Master View
Execute
This generates the daily
schedule with Anesthesia
Attending, Resident, Patient
name and number and site

Finding information

Old Anesthesia Records:

Clinical Documents Tab:

(after 9/2009)

OR and Procedure Notes

Scanned Documents Tab:

(before 9/2009)

Anesthesia Records,
Anesthesia Pre-Op

OR and Procedure Notes

Under ClinDocs, Care

Forms, Pre Anesthesia NP
note

ECHOS/EKG

Clin Docs Tab

Ancillary Documents