Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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104 Surgery and Healing in the Developing World
1. If possible, have local staff who speaks the child’s language/dialect accompany
the patient for the induction. Instruct this assistant about soothing
techniques prior to separating the child from the parents.
2. Perform a thorough machine check, including the presence of working suction,
prior to induction.
3. Succinylcholine and atropine should be drawn up and epinephrine and
lidocaine immediately available at the bedside.
4. Two anesthesia team members must be present for each induction with a
child.
5. Ensure that the halothane administration is performed by the second anesthesia
provider for all children.
6. The use of muscle relaxants versus deep intubation should be dictated by
the skill, experience and comfort of the anesthetist with the chosen technique.
7. Auscultate both sides of the chest and the epigastrium to ensure proper
depth of tube placement after intubation. RAE endotracheal tubes, because
of a set length, are more prone to endobroncheal placement.
8. Tape the endotrachael tube (ETT) securely midline under the lower lip.
Preinduction Adult
Frequently because of difficulty with language and the danger of administering
the wrong drug or the incidence of the incorrect dose being too high, premedication
is frequently omitted. However, the use of premedication should be dictated by the
skill, expertise, and comfort of the anesthesia provider with the chosen technique.
Induction and Intubation
1. Place any monitoring equipment, blood pressure cuff, ECG, pulse oximeter,
temperature strip.
2. Place intravenous line prior to induction.
3. Succinylcholine and atropine should be drawn up and lidocaine immediately
available.
4. Intravenous or mask induction with halothane.
5. Auscultate both sides of the chest and epigastrium to ensure proper depth
of tube placement after intubation.
6. Protect eyes with lubricant and tape.
7. Place temperature strip.
C. Maintenance
1. Maintain the patient at the appropriate surgical depth while allowing the
patient to spontaneously ventilate, if appropriate.
2. Do not leave the room of an anesthetized patient under your care unless
appropriate coverage has been arranged.
3. Monitor all patients by
• Precordial stethoscope
• Continuous pulse oximetry when available
• Vital signs recorded every 5 minutes (every 3 minutes in children < 2
y/o). Vital signs include: heart rate, respiratory rate, SpO2 and blood
pressure (electrocardiography (ECG) and end tidal carbon dioxide
(ETCO2) when available)