2. Dr. Mrs. Minnu M Panditrao
Consultant
Department of Anaesthesiology &
Intensive Care
Public Hospital Authority’s
Rand memorial hospital,
Freeport, Bahamas
4. NEONATES & INFANTS
• Do they really need anaesthesia?
• Yes, they do
• Precision & accuracy very important
for safety
5. What is new?
CURRENT PRACTICES
• Pre anaesthetic preparation & medication
• Anaesthesia Induction agents
Inhalation agents
IV Induction agents
• Neuromuscular blocking drugs
• Reversal agents
• Analgesics - Opioids/Non Opioids
• Local anaesthetics
• Miscellaneous drugs
6. PRE OPERATIVE
PREPARATION
• Pre operative checkup / visit
• Counseling of patients / parents
• General explanation of place,
equipment & procedure
7. PREMEDICATION
• Injectables are not preferred
• Other routes
– Oral :- Triclofos, Promethazine,
Midazolam, Ketamine
– Sublingual/Trans Mucosal :- Fentanyl
– Intra nasal :- Midazolam, Ketamine,
Sufentanil
– Rectal :- Midazolam, Methohexital,
Diazepam, Ketamine
– IM :- Ketamine (2 mg/kg)
8. INDUCTION AGENTS
• Inhalational – for routine surgeries,
uncooperative patients, incremental induction/
starting with high concentrations.
• Intravenous – for rapid sequence induction in
emergency surgeries, patients with i.v. lines in
situ, cooperative patients.
9. SEVOFLURANE
• Polyflurinated methyl isopropyl ether
• Inhalational agent of choice for
induction
• Rapid induction & recovery - low blood
gas solubility
• Techniques of induction
• MAC
• Metabolism
• Disadvantages
10. HALOTHANE
• Still used ‘coz of cost restraints
• Advantages
• Techniques of induction
• Disadvantages
14. KETAMINE
• Water soluble, non irritant
• Good analgesic, CVS stability
• Routes of administration
I.V. / I.M. (for induction)
Oral, Intra nasal
IV infusion
Additive in neuraxial, regional
blocks
• Disadvantages
15. THIOPENTONE
• Still has a place where other IV
agents are contraindicated i.e.
• Neuroanaesthesia in neonates
• Convulsive disorders etc.
16. NEURO MUSCULAR
BLOCKING DRUGS
• Paediatric patients are
Resistant to depolarizing NMBDs
Sensitive to non-depolarizing NMBDs
• Metabolism in the liver delayed
19. REVERSAL AGENTS
• Neostigmine / Edrophonium +
Atropine / Glycopyrrolate
• Sugmadex – Modified γcyclodextrin
sodium salt, specific for reversal of
rocuronium. No need to combine with
Atropine. Reports of use in adults.
Dose: 12-15 mgKg
23. LOCAL ANAESTHETICS
Neonates and infants - prone to L.A. toxicity
Local Anaesthetic Doses
Drugs Single Continues Max. dose
shot infusion 4 hr period
technique MgKghr MgKg
MgKg
Lignocaine 3-5
Bupivacaine 2-2.5 0.2-0.5 2
Levobupivacaine 2 0.125-0.4 2
Ropivacaine 3 0.2-0.4 1.6
24. MISCELLANEOUS
DRUGS
Clonidine
• α2 adrenergic agonist
• Co-analgesic
Routes of administration
Oral (1-2 µg Kg 8 hrly)
IV ( 0.1- 0.5 µg Kg hr)
Spinal/epidural (2 µg Kg)
Regional nerve blocks
25. Dexmedetomidine
A newer α2 adrenergic agonist
Has hypnotic & analgesic properties
Reported use – as a sedative for
Radiological investigative procedures
Cardio-catheterisation
Awake craniotomies
Burn dressings
Sevoflurane emergence agitation
Also co-administered in paediatric cardiac
anaesthesia
26. Dexmedetomidine
• Given as an I.V infusion
• Dose:
• Loading dose 1-4 µg Kg
• Infusion rate 0.5-1 µg Kg hr
• Onset of action 10-20 min
• Recovery time 20-60 min
• Side effects
↓ HR (15 %)
↓ MAP (15%)
27. Gabapentin
• Has an analgesic and opioid sparing
effect
• Dose 10-20 mgKg orally
• Side effects
Gastritis
Nausea, Vomiting
Dizziness
28. Melatonin -for sedation
Satisfactory effect in elderly patients.
Unsatisfactory in children
Dose- 5-10 mg
Caffeine- for apoenic spells
Dose- 10 mgKg24 hrs
Side effects: Tachycardia, Sympathetic
stimulation