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9 Cards in this Set
- Front
- Back
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what are the indications for a spinal in paediatric patients? Why? |
main indication is neonatal hernia repair. significantly reduces post op apnoea ONLY IF NO OTHER SEDATION GIVEN. good for premie babies. Give sucrose, wrap them up and they will sleep.. |
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what are the major issues with paediatric spinals? |
Failure: higher failure rate c/w adults - 10x > Age: if to old will be unable to cope. mainly up to 3 months. can be up to 1 year if pushing it. Spread: No lumber lordosis/thoracic curve till walking so different spread - can be high. Duration: shorter...quote 40 min but more likely 80min. |
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what is the dose for spinal? what agent/strength? |
frawley rule of 1's 1mg/kg of either bupiv, levobupic or ropiv. for 0.5% = 0.2ml/kg. or double for 0.25% bupiv is stronger but at these high doses their dose ends up the same. |
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how does this c/w adult dose? why is it different? |
adults use about 3mls for 70kg = 0.04ml/kg of 0.5%...so neonatal is 5x the dose for a shorter duration. > CS volume, > CSF turnover (related to CO) |
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Caudels: draw the anatomy of the posterior sacrum? |
Spinus tubercles=3-4 ridges down the middle Sacral foramina=holes for nerve roots Sacral Cornu=2 ridges beside sarcal hiatus. Sacral hiatus=space needle goes through. |
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Draw the lateral anatomy of the spinal cord and landmarks from top of lumber spine down. Where do structures finish? |
Conus medullaris=end of spinal cord at L1/2. Cauda equine goes from there to sacral hiatus. Dural sac/arachnoid space finishes at S2 Filum terminale attaches to the coccyx to anchor cord |
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What Structure are you injecting a caudal into? What ligament do you go through? what is in the space? |
Caudal needle into sacral canal through the sacral hiatus. sacral canal is continuation of spinal canal. Ligament needle goes through is sacrococcageal ligament (continuation of ligamentum flavum) sacral canal contains: sacral/coccygenal spinal nerve roots, fillum terminale, veins, fat. |
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How do you perform a caudal? |
landmarks: 2 post superior illiac spine (PSIS) and sacral cornu form equilateral triangle angle needle 30deg to skin, advance till LOR, then flatten and advance. inject under direct vision of skin, slowly, looking at ECG. |
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What dose of what LA do you put in a caudal? What is the max age and dose you can use? |
Rule of 1's. 1ml/kg of 0.25% bupiv/levobupiv. can use less/more for lower/higher block. Max dose=15-20mls as this is all space can hold. Age: no exact age. factors: parents carrying kid, distressed if can't walk, inpatient. |
