Author: James L. Rothschiller, MD – Please submit your comments.
The intraoperative pediatric opioid dose is determined by the degree of obstruction during anesthetic induction and ideal body weight (IBW).
Opioid Dose in Children
Weight Status Category BMI Percentile Range
- Underweight Less than the 5th percentile
- Healthy Weight 5th percentile to less than the 85th percentile
- Overweight 85th to less than the 95th percentile
- Obesity 95th percentile or greater
Obesity in Children
All sizes of children develop
75% of obese children will become obese adults. Metabolic Syndrome (MetS) occurs in obese individuals, that is the clustering of dyslipidemia, hypertension, and impaired glucose tolerance/insulin resistance which further increases the risk of atherosclerotic heart disease. Metabolic syndrome prevalence increased significantly among those aged 20 to 39 years.
Even at ages 8 to 11, as many as 9.5% of obese children already have metabolic syndrome. That means they have at least three of these risk factors: abnormally large waist size, high blood-sugar levels, low levels of HDL “good” cholesterol, high blood fat levels, and high blood pressure.
Obstructive Sleep Apnea (OSA) in Children
Obstructive sleep apnea (OSA), occurs in up to 60% of obese children. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation.
An obese child is not more difficult to intubate. Optimize your intubating conditions.
Medications in obese children are based on ideal body weight. Antibiotics are based on real weight to a maximum adult dose.
Grade R1 – R4
R1: None -No obstruction on mask induction
R2: Obstruction relieved with CPAP – Positive obstruction on mask induction relieved with CPAP
R3: Obstruction relieved with OAW – Positive obstruction on mask induction requiring an oral airway (OAW) to adequately move air
R4: Obstruction relieved with ETT – Positive obstruction on mask induction with little to no improvement using CPAP or an OAW – requiring intubation
R1: No opioid sensitivity
R2: Low opioid sensitivity -Rarely have ever seen opioid sensitivity
R3: Medium opioid sensitivity – Higher risk of some level of opioid sensitivity
R4: High opioid sensitivity – Very high risk of opioid sensitivity
- 0 Tonsils 0% gap between anterior tonsillar pillars – are entirely within the tonsillar fossa.
- 1+ Tonsils – >75% gap = Tonsils < 25% (12.5% – 75% space – 12.5%)
- 2+ Tonsils – 50% gap = Tonsils 25-50% (25% – 50% space – 25%)
- 3+ Tonsils – 25% gap = Tonsils 50-75% (37.5% – 25% space – 37.5%)
- 4+ Tonsils – <25% gap = Tonsils >75% – touching