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Pediatric Anesthesia - ASC Guide

This is meant as a guide only.

Anesthesiologists should use their own discretion based on individual patient assessments.

Discuss any specific preferences with surgeon and nursing staff.



NPO guidelines:

NPO (all solids and cow's milk): 8 hours

NPO (clears): 2 hours

Patient encouraged to drink clear liquids up to 2 hours prior to surgery time to prevent dehydration.


Anesthesia Preop Pediatrics order set

+/- Midazolam PO: 0.5 mg/kg

*Dr. Shapiro’s patients at UCLA did not routinely receive midazolam. Her cases are usually very short.
*If using midazolam, consider earlier administration to prevent delayed emergence and to facilitate efficient recovery and discharge.

+/- Acetaminophen PO: 15 mg/kg

Parents are not permitted in OR




Change to pediatrics

Main Set-Up-> Profile -> Pediatric Centigrade


Pediatric cart will be brought to OR.

Check supplies and pediatric circuit/suction prior to case.

Prepare IV bag and IV set up

Buretrol vs. 100-500mL (instead of 1L bag) fluid bag based on patient's weight


Inhalation vs IV induction


+/- paralytic

Oral RAE for Dr. Shapiro’s T&A cases


Inhalational vs TIVA

Dr. Shapiro preferes Sevo down or off soon after induction to enhance emergence
FiO2 25-30% for T&A cases

Dexamethasone IV: 0.1 mg/kg (Dr. Shapiro  prefers 0.25 mg/kg for her T+As)
Fentanyl IV 1 mcg/kg vs morphine IV <0.05 mg/kg

*Patients undergoing T+A with OSA may be more sensitive to opioids


Ondansetron IV: 0.1 mg /kg

Paralytic reversal as needed
Suction stomach as needed
Place oral airway with Tri-Flo suction inside at end of case for Dr. Shapiro’s cases 

Extubate. Bring to PACU when awake and in Phase 2 recovery (ie. ALDRETE score >=8)



Anesthesia Recovery Pediatrics order set Please discuss discharge planning with surgeon

Tonsillectomies to remain in PACU at least 60 min for observation before discharge

Adenoidectomies may be discharged sooner

**Anesthesiologist will remain on site until pediatric patient awake and stable. Then can sign out to remaining anesthesiologist on site and be available by phone until patient discharged.

Pediatric Emergencies


Suction airway

Give positive pressure 100% O2

Neck extension, jaw thrust

Oral airway if needed

Consider deeper anesthesia if incomplete laryngospasm (ie. propofol, sevoflurane)

Consider paralytic and intubation if complete laryngospasm


IV: 0.25-0.5 mg/kg

IM: 2-4 mg/kg

Note: Younger children may be at risk for bradycardia. Consider pre-treating with atropine 0.02 mg/kg IV or IM for bradycardia.



Fluid resuscitation

Intubate (RSI) if indicated, possible difficult airway due to swelling/bleeding

Call surgeon
Transfer to higher level care as needed



For non-emergencies requiring medical observation or treatment:

Transfer to Children’s Hospital of LA
ASC RN Manager to call CHLA Transfer Center: 1-888-631-2452

Physician to give direct report to receiving physician
Provide following info:

Patient name

Date of birth

Purpose of the transport

Chief diagnosis
Patient condition

Patient location

If unable to transport to outside hospital, go to St. John’s Emergency Room. From there, patient can be transferred to appropriate hospital. Anesthesiologists

Created by Annie Lee, MD on 3/27/23 revised 4/25/23

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