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 )