PACU Pediatric Anesthesia Supply Cart

Pediatric Anesthesia Supply Cart

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To unlock the cart click 2 and 4 simutaneously, then press 3. Finally, turn the knob clockwise.

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Remember, if a child is not having any airway difficulty post anesthesia, it is best to not stimulate the child. If airway concerns arise, reposition the child. If optimal positioning is not opening the airway, a jaw thrust maneuver can be utilized. A jaw thrust is achieved by placing two or three fingers under the angle of the mandible bilaterally and lifting the jaw upwards. During a laryngospasm you may apply pressure to the larygospasm notch. To do this simutaniously pull the jaw forward and firmly push the soft tissue just behind both earlobes. You want to push at a point as superior as you can go in this notch. Consider utilizing an OPA to assist. Please see OPA window for additional positioning and OPA insertion tips!

Give me the Little Sucker!

Suctioning post tonsillectomy is very important to prevent secretions from entering a child's reactive airway, but should be completed with extreme caution. Yankauer suction devices can be traumatic to the surgical area due to their large size and suction power. Soft suction catheters can be difficult to control. Little Sucker Suction devices have soft, flexible tips and can also be controlled easily within the oral cavity. Continue to exercise caution to avoid the fresh surgical site when suctioning.

Laryngeal Mask Airway

LMA devices help maintain an open airway by sealing around the larynx. These are inserted by the anesthesia provider. Scan this QR Code to watch a video on pediatric LMA insertion.

Pediatric Ambu Bags

Pediatric Ambu bags and a separate PEEP device are available should a patient require additional airway support. Attach the valve to the end of the Ambu Bag. A PEEP valve applies positive pressure at the end of expiration to help maintain oxygenation by engaging alveoli, and helps break and prevent further airway collapse during a laryngospasm. Turn the blue knob to change the PEEP setting. It is safe to turn the PEEP to 5 during a pediatric airway crisis unless otherwise directed by the anesthesia provider. Do not shut the pop-off valve without direction from the anesthesia provider.

Tip: For initial airway resuscitation use the standard pediatric ambu-bag. Anesthesia is to apply this. When using this device, you may hear air blowing off to maintain the requested PEEP. You may also notice the bag collapses and the PEEP falls below the set number when ventilating. Wait for the bag to reinflate and the requested PEEP to return before ventilating or you can increase O2 flow. Scan this code for a video!

Jackson Rees

The anesthesia provider may request a different ambu bag with an integrated pressure manometer. This can be used to maintain an airway requiring positive end expiratory pressure (PEEP) and/or requiring intermittent positive inspiratory pressure (PIP). The PEEP can be set by the wheel on the side. PEEP and PIP can be visualized on the monometer. To prepare, hook up to 10-15L/min of oxygen then attach to appropriate sized mask. Do not close the pop-off valve unless instructed to do so.

Pediatric Mask

A child's masking should extend from the bridge of the nose to the cleft of the chin, enveloping the nose and mouth but avoiding compression of the eyes. Ensure there is an airtight seal. You may need to add air or take away air through the port to assist.

You must be vigilant in assessing the rate, depth, and quality of respirations in pre-op, in the OR, and in PACU. Children exhibiting bradycardia or tachycardia, grunting, wheezing, stridor, accessory muscle usage, excessive secretions, or changes in SPO2 require immediate intervention. Notify anesthesia immediately. If necessary, suction secretions, reposition the airway, perform head-tilt and jaw thrust maneuver, and consider additional gentle positive pressure ventilation until help arrives.

Boogie wipes main ingredient to disolve mucus and snot is saline. There are no harsh chemicals or perfumes allowing easy clean up of those sweet little faces without rubbing or irritation.

Boogie Wipes

Did you know???

Fluid Management

In infancy, the total body fluid is 80% of body weight, decreasing to 65% by 3 years of age and reaching adult proportions of 60% by age 15. Due to the higher proportion of body water, infants and younger children are more at risk for dehydration and fluid overload. Practice careful consideration of fluid volumes during and post procedure. Fluid replacement should be completed using an isotonic crystalloid solution (such as 0.9% Normal Saline) with mini drip tubing.

Miller and Mac Blades

These are all-in-one handle and blade for intubation. Miller blades have a straight blade. Macintosh (Mac) blades are curved. If you are assisting with intubation, the anesthesia provider will tell you which blade to hand off. Pull up on the blade to lock it into place and ensure light comes on.

An armboard may be utilized to protect IV access. Pad the armboard and secure utilzing gauze and tape.

Postanesthesia Agitation (PAA)

PAA is also known as emergence delirium, emergence agitation, and postanesthetic excitement and can be common in children post anesthesia. Behaviors associated with PAA include disorientation, nonpurposeful movements, lack of focused eye contact, disorientation, inconsolability, restlessness, and agitation. If this occurs, ensure adequate oxygenation and ventilation, wrap IV access, protect drains and incisions, prevent and monitor for potential injury to the patient and staff. Since an agitated child is not capable of self-reporting pain, assess the need for analgesia. Calm fears and anxiety by reassurance and utilize family when appropriate. Reassure family members this can occur after anesthesia and may last up to 45 minutes.

Optimal Airway Positioning

When in the supine position, the relatively large head in babies and children causes natural flexion, causing compression on the soft upper airway passages. Optimal position for the airway is referred to as the sniffing position. Notice how the chin plane is horizontal to the ceiling with the neck wide open. The external meatus is horizontal with the suprasternal notch. Avoid over-extension. Positioning can be achieved by rolling a towel/blanket under the head or behind the shoulders. Side lying in the sniffing position with their mask supporting the chin is also a common, effective post-operative position.

GlideScope

We are able to use a video laryngoscrope for more safe and faster intubations. The GlideScope is located between each two sets of OR's in the substerile areas. They come with miller and mac options and have a quick connect magnetic top.

More information regarding dosages coming soon!

Nasal Atomization Device

The anesthesia provider may ask for intranasal medications to be administered in Pre-op, OR, or PACU. To administer, draw up the ordered medication, remove needle and attach the atomization device via the leur lock mechanism. Suction the nasal passage if necessary. With the patient at a 45 degree angle, use your free hand to hold the crown of the patient's head stable, place the tip of the atomiser against the nostril snugly while aiming slightly up and outward. For dosages greater than 1ml, volume should be split between both nostrils. Briskly depress the plunger and encourage the child to sniff if able.

Oralpharangeal Airways

Oralpharageal airways can be used in an unconscious child to maintain an open airway and prevent mandibular tissue from obstructing the posterior pharynx. Measure from the maxillary incisors (Four front teeth) to the angle of the mandible (Figure 1). Place the child in the optimal sniffing position without hyperextending the neck, use a tongue depresser to depress the tongue, then insert the OPA sideways and rotate with the arch of the tongue. Assess lung sounds for air exchange to ensure optimal position of OPA (Figure 2).

Rapid Sequence Intubation Kit

Oral Endotracheal Tubes

The Rapid Sequence Intubation Kit (RSI Kit) is located in the Pyxis. Remove quickly by removing under Employee Access instead of patient name. Scan this QR Code to see a video of pediatric intubation.