Rigid Bronch
Option 1: Propofol and Alfentanil
Prep
- Order “Alfentanyl/Propofol” infustion from pharmacy (500mcg Alfentanil + 190mg Propofol)
- Will run at 200mcg/kg/min (175-225 range)
- 1 mL Alfentanil dilute in 9mL (Results in 50mcg/mL dilution)
Intraop
- Sevo mask induction
- PIV in saph for access
- Start infusion once PIV inserted
- After Sevo induction, give neb lido (while sevo high and before infusion at steady state. Will prevent laryngospasm.)
- If pt moves, give 5mcg/kg alfentanil. (Eg if 10kg child moves, give 1mL alfentanil)
Epic Documentation
- Alfentanil rate = Propofol rate/380
| Propofol Rate |
Alfentanyl Equivalent Rate |
| 250 mcg/kg/min |
0.65 |
| 225 mcg/kg/min |
0.60 |
| 200 mcg/kg/min |
0.53 |
| 175 mcg/kg/min |
0.45 |
Option 2: Ketamine and Precedex
Preop:
Intraop:
- Fentanyl 1mcg/kg
- Decadron 0.5mg/kg
- Precedex 1mcg/kg over 10 min
- Ketamine 1mg/kg bolus
- Ketamine 2mg/kg in 100cc buretrol
- Zofran (Do not use glycopyrrolate!)
- Propofol in syringe (in case)
Equipment
- Curved blade
- Lidocaine LTA (wait 3 minutes)
- Flex connector
- Straight connector
- Magills
At End
- Propofol induction
- Sevo
- Intubate
- Suction stomach