Minor Facial Laceration Repair

• 2-5 year old

• History + Consent with parents
• Clarify recent chest infections, coughs, colds
• Obtain patient weight
• Ametoptopical, 30-45 mins prior
• EMLAtopical, 1 hour prior
• Parental guidance and support re: induction

Preparation of drugs and equipment

• ETT uncuffed + size above/below, note down tube length
• LMA size + size above/below
• Ayres T-piece
• propofol2.5-5mg/kg
• fentanyl2mcg/kg
• ondansetron0.15mg/kg
• dexamethasone0.15mg/kg
• paracetamol15mg/kg
• atropine20mcg/kg
• suxamethonium4mg/kg IM - Attach blue needle, 2mg/kg for IV dose

• Good pre-oxygenation
• Parental support

If patient suitable for IV access:

• Ask patient / parent to remove LA cream
• Ethyl chloride spray if appropriate (may distress some children)

If IV access not appropriate / unavailable:

• Facemask tightly over face
• nitrous oxideOptional
• sevofluraneHigh flow
• High concentrations of volatile agents in young children can precipitate breath-holding
• IV access once patient is asleep
• Prior to airway insertion: PropofolSmall 1-2mg/kg bolus
• AirwayLMAFlexi-LMA

If IV access available:

• Fentanyl1-2mcg/kg

Maintenance

• SevofluraneMAC 1.2

Analgesia

• Paracetamol15mg/kg

Anti-emetics

• Ondansetron0.15mg/kg
• Dexamethasone0.15mg/kg

Other

• Antibiotics as required

• Transfer to recovery deep + LMA + Ayres T-piece (if appropriate)
• Paracetamol15mg/kg
• Ibuprofen10mg/kg
• Ondansetron0.15mg/kg