"Detroit girl, 9, dies after routine tonsillectomy"

[Ronin2258]

The peds group was separate. Not sure if they still are

I think they now combined. DMC was picked up by Northstar. Was told to kind of shy away from that group when looking by a friend in the area.

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[WholeLottaGame7]

Another factor in determining who stays should be the parents degree of education and the home environment we are discharging the child to.

So I was actually going to bring this point up earlier? Does anybody take education level or home environment into dispo decisions? I feel like I do, but usually in the opposite direction (parents of a chronically ill child talk me into letting them go home because they're comfortable with taking care of their kid).

Occasionally I'll hold someone in PACU a little longer to wake up some more if they have a long car ride, but I don't know that I've ever looked at parents and been like "I don't trust you to take care of your child at home." I mean, I have, but that applies to perfectly normal, non-anesthetized children, also.

 

[sigrhoillusion]

off topic but i dont give glyco to kids because ive always been under the impression it's too late by the time the kid is induced and iv started; i feel like a t&a would be half or nearly over by the time the antisialagogue effect kicks in. am i wrong?

Not sure about T+As in ASCs but I
m at an academic hospital so they usually take 20-45 minutes depending on patient/surgeon. So yea the glyco is more for the secretions overall. Onset probably kicks in towards the middle/end of the procedure, but I think it helps (or at least doesn't hurt) especially with the ketamine.

Where I did my peds training it seemed like half the attendings gave glyco/stropine to EVERY kid for EVERY surgery, while some rarely gave it. This is the few times I give it, unless there is a legit reason for it. People use it to "pre-treat" but I think most evidence has debunked that. The problem with giving anticholinergic for bradycardia with kids is that the bradycardia is usually due to hypoxia and not cardiac related, so while you might fix the HR for a little while the bigger issue is getting air into the kids lungs.

Also, depending on where you work, glyco can be expensive so why use it if you don't have it. Not sure if the glyco is doing much for these kids, but I figure after giving them ketamine (which itself is a bronchodilator) it is probably helping prvent them from having a ton of upper airway secretions in the PACU.