Nina Shapiro, MD
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 (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
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.
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.
Intubate (RSI) if indicated, possible difficult airway due to swelling/bleeding
Transfer to higher level care as needed
For EMERGENCIES: Call 911
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:
Date of birth
Purpose of the transport
If unable to transport to outside hospital, go to St. John’s Emergency Room. From there, patient can be transferred to appropriate hospital.
1 https://pubs.asahq.org/anesthesiology/article/138/2/132/137508/2023-American-Society-of- Anesthesiologists
Created by Annie Lee, MD on 3/27/23 revised 4/25/23