Pediatric Equipment
The Dedicated Pediatric Equipment Cart
The anesthesiologist caring for a pediatric patient must be prepared
for the unexpected, particularly an undiagnosed congenital malformation or a difficult
endotracheal intubation. Having designated pediatric carts containing pediatric
equipment is a convenient way of providing optimal care in a variety of locations
in and outside the operating room. These carts contain intravenous catheters of
various sizes, butterfly needles (scalp vein needles), electrocardiographic pads,
blood pressure cuffs, precordial stethoscopes, esophageal stethoscopes in both adult
and pediatric sizes, armboards, intravenous fluids in pediatric-size containers,
pediatric laryngoscope blades and handles, oral airways, endotracheal tubes, stylets,
masks of various sizes, LMAs, tape, drugs for resuscitation as well as commonly administered
medications, and syringes, especially tuberculin syringes, for more precise administration
of drugs. Intraosseous needles can be a lifesaving means for establishing emergency
venous access for drug or crystalloid administration and should be present in the
pediatric cart.[310]
[311]
[312]
Anesthesia Circuits
Much has been written about the advantages and disadvantages of
various anesthesia circuits for use in pediatric patients (also see Chapter
9
).[313]
[314]
[315]
Most of the attention has been directed to
the neonate and ways of reducing the work of breathing while preventing rebreathing.
Nonrebreathing circuits provide the advantage of minimal work of breathing because
they have no valves to be opened by the patient's respiratory efforts.[314]
The rate of induction of anesthesia may be more rapid because the volume of the
nonrebreathing circuit is smaller, no equilibration with the carbon dioxide canister
is required, and anesthetic gases are delivered immediately at the airway. Additionally,
because the volume of the nonrebreathing circuit is small in comparison to the circle
system, the compression and compliance volume will be significantly less.[315]
[316]
This improves the ability to observe respiratory
efforts, as reflected by movement of the anesthesia bag, as well as the ability to
estimate pulmonary compliance. Thus, the actual delivered ventilation, when used
in conjunction with a ventilator, may be greater with a Mapleson D system than with
a circle system if no compensatory adjustment is made in tidal volume ( Fig.
60-15
). The Mapleson D circuit will be more sensitive to changes in fresh
gas flow (i.e., an increase or decrease in minute ventilation) or to the addition
of a humidifier (decreased minute ventilation because of added compression volume)
during mechanical ventilation. The most recent generation of ventilators is less
susceptible to these types of issues because they automatically compensate for changes
in fresh gas flow.[317]
A pediatric circle system can also be safely used for neonates
as long as one understands the clinical implications: large compression volume losses,
longer time to equilibrate, and perhaps a decreased ability to determine changes
in compliance.[315]
[318]
I have used pediatric circle systems exclusively for the past 10 years, and as long
as pressure-limited ventilation with the same peak inflation pressure is used, the
same tidal volume is delivered as with the nonrebreathing system.[317]
[319]
[320]
