Minor Facial Laceration Repair

• 2-5 year old

• History + Consent with parents
• Clarify recent chest infections, coughs, colds
• Obtain patient weight
• Ametop ( topical, 30-45 mins prior )
• EMLA ( topical, 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
• propofol ( 2.5-5mg/kg )
• fentanyl ( 2mcg/kg )
• ondansetron ( 0.15mg/kg )
• dexamethasone ( 0.15mg/kg )
• paracetamol ( 15mg/kg )
• atropine ( 20mcg/kg )
• suxamethonium ( 4mg/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 oxide ( Optional )
• sevoflurane ( High flow )
• High concentrations of volatile agents in young children can precipitate breath-holding
• IV access once patient is asleep
• Prior to airway insertion: Propofol ( Small 1-2mg/kg bolus )
• Airway
  LMA - Flexi-LMA

If IV access available:

• Fentanyl ( 1-2mcg/kg )
• Propofol ( 2.5-3mg/kg )
• Airway
  LMA - Flexi-LMA

Maintenance

• Sevoflurane ( MAC 1.2 )

Analgesia

• Paracetamol ( 15mg/kg )

Anti-emetics

• Ondansetron ( 0.15mg/kg )
• Dexamethasone ( 0.15mg/kg )

Other

• Antibiotics as required

• Transfer to recovery deep + LMA + Ayres T-piece (if appropriate)
• Paracetamol ( 15mg/kg )
• Ibuprofen ( 10mg/kg )
• Ondansetron ( 0.15mg/kg )