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Pediatric OR Setup
THIS PAGE HAS BEEN REVISED AND REFRESHED. PLEASE GO TO OUR NEW SECTION ON PEDIATRIC OR SETUP
Your First Pediatric Case!
Cheers! so here you are assigned to do your first pediatric case. Don't be afraid! Pediatric anesthesia is a lot of fun. There are certainly pertinent differences from adults, and definite rationale and logic to what we do. We fully understand, that it can be overwhelming and daunting for you in the beginning. Please remember, that we are here to teach and help you get the most out of your training. NEVER hesitate to ask! COMMUNICATION is vital for safe anesthesia care!
Section Contents
- Preparing the Operating Room
- Preparing the OR Bed
- Monitors
- Breathing System and Circuits
- Airway Desktop
- Medication Desktop
- Standard Drug Dilutions in the General Pediatric OR
- IV Tray
- IV Setup
- Accessory Equipment
Preparing the Operating Room
Adequately warm the OR and ensure that all equipment is in working condition. You would need a Pediatric Anesthesia Cart for patients 12 years of age and under. Ensure, that a stool is available for the child's parent to sit during induction. The OR environment can be very overwhelming and stressful for parents and children alike. Ensuring a quiet, calm OR environment, free of unnecessary loud chatter, allows for a smoother experience. Please refer to the Pediatric Normal Parameters and Equipment Page for additional practical information which will help you with your case setup
Preparing the OR Bed
A "shoulder roll" with our without a combination "head rest" is recommended to properly position neonates and infants for induction and intubation.
Older children will generally only need a head rest to bring them in good sniffing position.
For neonates, infants, and children, a Baer Hugger Forced Air Warming Underbody Blanket should be placed securely on the OR bed. These come in two sizes - Pedi and Large Pedi. For older children and young adults, a regular upper and lower body Baer Hugger blanket should be considered
Older children will generally only need a head rest to bring them in good sniffing position.
For neonates, infants, and children, a Baer Hugger Forced Air Warming Underbody Blanket should be placed securely on the OR bed. These come in two sizes - Pedi and Large Pedi. For older children and young adults, a regular upper and lower body Baer Hugger blanket should be considered
Monitors
Change the PROFILE on the Philips Monitor to PEDIATRIC OR NEO as appropriate.
Pediatric Pulse Oximeters come in two types
Conventional Pediatric Pulse Oximeters
Masimo Pulse Oximeters
Masimo Pulse Oximeters are particularly useful in neonates and infants as they are more tolerant to motion and low perfusion artifacts.
The Masimo Neonatal Adhesive Sensor requires a separate cable which is available with the anesthesia techs in the work-room
Neonatal (white) NIBP cuffs come in 4 sizes (1-4). A separate compatible cable is required and available from our techs in the Anes Work-Room
Pediatric EKG leads come in a separate 3-lead stick on package. The leads are color coded (white, black and green). The green lead is in fact the red (Left Leg) electrode and should therefore get plugged appropriately.
Pediatric Pulse Oximeters come in two types
Conventional Pediatric Pulse Oximeters
Masimo Pulse Oximeters
Masimo Pulse Oximeters are particularly useful in neonates and infants as they are more tolerant to motion and low perfusion artifacts.
The Masimo Neonatal Adhesive Sensor requires a separate cable which is available with the anesthesia techs in the work-room
Neonatal (white) NIBP cuffs come in 4 sizes (1-4). A separate compatible cable is required and available from our techs in the Anes Work-Room
Pediatric EKG leads come in a separate 3-lead stick on package. The leads are color coded (white, black and green). The green lead is in fact the red (Left Leg) electrode and should therefore get plugged appropriately.
Breathing Systems and Circuits
The Pediatric Breathing Circuit is extendable up to 60 inches, and comes with a 1L (default) latex free reservoir bag.
The Neonatal Breathing Circuit is a fixed length circuit which commands very low compliance loss volume. The neonatal circuit comes with a 0.5L (default) reservoir bag. The Y connector is designed to minimize anatomical dead space.
The Neonatal Breathing Circuit is a fixed length circuit which commands very low compliance loss volume. The neonatal circuit comes with a 0.5L (default) reservoir bag. The Y connector is designed to minimize anatomical dead space.
Airway Desktop
2 Pedi Laryngoscope handles
2 Pedi Blades of the appropriate size
Guedel Oral Airways (have at least 2 sizes available)
Anesthesia masks (have at least 2 sizes available)
Microcuff ETTs with 3cc syringes for cuff inflation
10F Repogle NGT for rapid gastric decompression
6, 8. & 10F ETT suction catheters
Esophageal Temp Probe
Pink and White tape
Mastisol adhesive
Tegaderm
Pediatric Bite Block
Anesthesia Reservoir Bags come in 3 sizes.
1L Bag: Comes standard in the kit. Good for use in older infants, toddlers, and young children
0.5L Bag is used for neonates < 3 Kg
2L Bag is used for older children (over 7 years old)
2 Pedi Blades of the appropriate size
Guedel Oral Airways (have at least 2 sizes available)
Anesthesia masks (have at least 2 sizes available)
Microcuff ETTs with 3cc syringes for cuff inflation
10F Repogle NGT for rapid gastric decompression
6, 8. & 10F ETT suction catheters
Esophageal Temp Probe
Pink and White tape
Mastisol adhesive
Tegaderm
Pediatric Bite Block
Anesthesia Reservoir Bags come in 3 sizes.
1L Bag: Comes standard in the kit. Good for use in older infants, toddlers, and young children
0.5L Bag is used for neonates < 3 Kg
2L Bag is used for older children (over 7 years old)
Medication Desktop
Induction Agent (propofol)
Opioid (fentanyl)
Muscle Relaxant (atracurium / rocuronium)
NS Flush and NS Flush on Leash
Antibiotics / Antiemetics / Steroids as needed
Pedi Anes Emergency Syringe Pack Should always be available on 22G 1-inch Blue Sharp Needles to facilitate rapid IM injection
Atropine
Epinephrine
Succinylcholine
Setup an IV Leash to deliver small amounts of medication and fluids accurately in neonates, infants, and toddlers.
Opioid (fentanyl)
Muscle Relaxant (atracurium / rocuronium)
NS Flush and NS Flush on Leash
Antibiotics / Antiemetics / Steroids as needed
Pedi Anes Emergency Syringe Pack Should always be available on 22G 1-inch Blue Sharp Needles to facilitate rapid IM injection
Atropine
Epinephrine
Succinylcholine
Setup an IV Leash to deliver small amounts of medication and fluids accurately in neonates, infants, and toddlers.
Recommended Standard Drug Dilutions in the General Pediatric OR
IV Tray
IV Catheters 24 and 22G
Tourniquet: Blue Latex Free
Alcohol swabs
4x4 Gauze
Tegaderm
Mastisol Adhesive
White tape / Pink Tape
Tourniquet: Blue Latex Free
Alcohol swabs
4x4 Gauze
Tegaderm
Mastisol Adhesive
White tape / Pink Tape
IV Setup
For infants and toddlers under 24 months of age, a 150 ml burette set is recommended to help prevent accidental excessive fluid administration. For very small infants and neonates, it is advisable to administer fluids through a smart infusion pump to enhance safety and accuracy.
For older children, prepare a micro drip IV set (60 drops - 1cc) on a 250cc / 500cc bag with a 3-way stop-cock and luer lock T - connector at the end.
It is vital to get ALL AIR BUBBLES OUT of the IV tubing system. This is particularly important, when setting up for preemies, neonates and infants.
For older children, prepare a micro drip IV set (60 drops - 1cc) on a 250cc / 500cc bag with a 3-way stop-cock and luer lock T - connector at the end.
It is vital to get ALL AIR BUBBLES OUT of the IV tubing system. This is particularly important, when setting up for preemies, neonates and infants.
Accessory Equipment
Stryker Forced Air Warming System
Nerve Stimulator
Rapid Fluid Warming System
Smart Pumps
Syringe Pumps
Pediatric Enflow Fluid Warming System
Mapleson Resuscitator for Backup Ventilation and Transport
Nerve Stimulator
Rapid Fluid Warming System
Smart Pumps
Syringe Pumps
Pediatric Enflow Fluid Warming System
Mapleson Resuscitator for Backup Ventilation and Transport
Putting It All Together
