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Pediatrics > Chapter 6 - Medical Conditions Influencing Anesthetic Management > Flashcards

Chapter 6 - Medical Conditions Influencing Anesthetic Management Flashcards

1
Q

T/F

Children with an UNcomplicated upper respiratory tract infection who are Otherwise Healthy have a Greater incidence of intraop desaturation, brochospasm, and laryngospasm

A

T

The following with a concommitant URTI may have MORE SERIOUS airway problems during and after anesthesia:

  • Infants < 1 year
  • Infants who were premature
  • Children exposed to second hand smoke
  • Children with reactive airway disease

Postop desaturation is MORE COMMON in children with a history of URTI

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2
Q

Airway irritabilty after a URTI may last for how many weeks?

A

6 to 8 weeks

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3
Q

T/F

Anticholinergics affect the incidence of perioperative airway complications in a negative way, in children with URTI

A

F

Do NOT Affect

help

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4
Q

T/F

Preoperative bronchodilators and a vital capacity cough may resolve bronchospasm and airways plugged with mucus

A

T

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5
Q

What can be done intraop to deliver most of the content of each puff of albuterol to the tip of the ETT?

A

A long narrow guague (19g) catheter may be inserted to the distal third of the ETT

  • This allows the majority of the aresol to reach the tracheal mucosa
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6
Q

Children who present for elective surgery with which 4 signs and symptoms should be rescheduled after 4 weeks?

A
  1. Pyrexia > 38.5 C
  2. Change in behavior, diet, or activity
  3. Prulent secretions
  4. Signs of lower respiratory tract involvement (wheezing) that do not clear with forced cough
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7
Q

Child comes in for an elective hernia repair and has a URTI and a history of asthma. The surgeon insist that the case would be less than 1 hour, should you delay the case? If so, for how long?

A

Delay procedure 4 weeks

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8
Q

T/F

In an emergency surgery, when suitable, the LMA should be used as an alteratenative to tracheal intubation, it may result in fewer airway complications

A

T

Postop, the child should be carefully observed

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9
Q

In a child with asthma, if oral steroids are prescribed, it suggest what?

A

A recent exacerbation

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10
Q

During which time frame is a child’s airway reactivity increased and residual mucosal edema and secretions impair pulmonary function?

A

1 month (4 weeks) after the last acute attack

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11
Q

If the child with asthma is taking theophylline, and is presenting for elective surgery, what should be done preoperatively?

A

The blood level of theophylline should be measured

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12
Q

In the preoperative anesthesia managment, a stress dose of steroids should be administered at induction of anesthesia to who?

What is the drug and dose used for the stress dose?

A

IV hydrocortisone 1 to 1.5 mg/kg

Stress dose given to:

  1. >5 mg perdnisone per day
  2. Oral steroids within 3 months
  3. High-dose inhaled steroids
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13
Q

T/F

Atropine is contraindicated in children who present with asthma due to its bronchoconstrictive effects.

A

F

Decreases secretion and bronchodilates

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14
Q

What is the preferred IV induction agent for children with asthma?

A

Propofol

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15
Q

Which IV induction agent may cause bronchoconstriction in an asthmatic child due to the release of histamine?

A

Thiopental

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16
Q

Can ketamine be used for IV induction for a child with asthma?

A

Yes.

Use atropine to limit secretions

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17
Q

Which inhaled anesthetic may precipitate arrhythmias in children also receiving theophylline?

A

Halothane

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18
Q

Which inhaled anesthetic increases airway resistance in asthmatic children?

A

Desflurane

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19
Q

Intraoperative wheezing should be treated by…?

A
  1. Deepening anesthesia
  2. Give bronchodilaor via ETT
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20
Q

What are some nonasthmatic causes of wheezing intraoperatively?

A
  1. Partially obstructed ETT
  2. Endobronchial intubation
  3. Pneumothorax
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21
Q

T/F

At the end of surgery, in a child with asthma, muscle relaxants can be reversed using atropin and neostigmine.

A

T

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22
Q

Extubation in a child with asthma is prefferby performed with the child deeply anesthetized and breathing spontaneously. However, if awak extubation is planned, what may be given to reduce laryngeal reflexes?

A

IV lidocaine

or

IV Propofol

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23
Q

Cystic fibrosis is an inherited disorder that results from a genetic defect on which chromosome?

A

Defect on chromosome 9

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24
Q

What causes the incrased viscosity of secretions and increased electrolyte content in a patient with cystic fibrosis?

A

Abnorml Chloride and Sodium transport

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25
Q

What can occur in a child with cystic fibrosis in the second decade of life concerning malabsorption and pulmonary issues?

A

Malabsorption is superseded by increasing pulmonary problems because of abnormally viscious secretions

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26
Q

In an individual with cystic fibrosis, when does respiratory failure usually develop?

Respiratory failure is secondary to what?

A

Respiratory failure usually develpos by second or third decade of life, secondary to reatined secreions and chronic infection.

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27
Q

T/F

When considering anesthesi problems in a patent with cystic fibrosis, because of the V/Q disturbance, Hypoxia may quickly develop and induction with inhalational agents is prolonged

A

T

  • Prolong induction with inhaled agent exacerbated with less soluble anesthics such as sevoflurane
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28
Q

What can ou say about the lung compliance in a patient with cystic fibrosis?

A

Lung compliance is reduced

  • Cuffed ETT used
  • High peak pressures required to adequately ventilate the lungs and prevent hypoxemia
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29
Q

What time of the day is pulmonary function in a patient with cystic fibrosis usually at its worst?

A

Usually at its worst early in the morning

  • If possible, schedule surgery that allows for chest physiotherapy and clearing of secretions preoperatively
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30
Q

The child with cystic fibrosis should be offered clear fluids until how many hours preoperatively?

A

Cystic fibrosis - clear fluids up to 2 hours before surgery

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31
Q

In a child with cysic fibrosis, and requires general anesthesia, how long should they my preoxygenated for?

A

100% O2 for 5 min. with pulmonary involvement

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32
Q

T/F

Postoperative treatment for anagesia can be provided with the use of regional anesthesia and NSAIDs whenever possible

A

T

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33
Q

What is the Hb concentration at birth?

Hb by 3 months?

Hb by 6 years?

A

At birth: Hb is 18 to 20 g/dl

3 months: 10 to 11 g/dl

6 years: 12 to 14 g/dl

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34
Q

What are the three reasons that in the preterm infant, the Hb often decreases to lower concentrations?

A
  1. Reduced RBC mass at birth
  2. Brief survial time of the fetal RBC
  3. Poor erythropoietin
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35
Q

In children with anemia, the major compensating mechanism to transport the oxygen to the tissues is?

A

Increased cardiac output

  • Hb-02 curve (caused by increase 2,3 DPG) contributes very little
  • Hb (<8 g / dl) the cardiac output must increase to compensate
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36
Q

At what Hb level is the myocardium compromised to meet its own needs?

A

<5 g/dl

  • Results in subendocardial ischemia
  • High-output congestive cardiac failure may occur
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37
Q

In children with significant cardiac or respiratory disease, what Hb level is considered the acceptable minimum?

A

14 g/dl

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38
Q

How long does it take for Hb levels to increase for iron-deficiency anemic children after oral iron therapy?

A

3 to 4 weeks

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39
Q

Infarction of the lungs is also known as?

A

Acute chest syndrome

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40
Q

Why does performing the Sickledex test in the first 6 months have a chance of NOT detecting the presence of HbS?

A

HbS replaces fetal Hb (HbF) after 6 months of age

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41
Q

Tell me about Sickle cell trait

A
  • Mild form
    • HB AS heterozygous
  • < 50% HbS
  • Sickling unlikely without VERY SEVERE hypoxemia
  • Sickling under anesthesia possible during cardiopulmonary bypass
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42
Q

Telll me about Sickle cell disease

A
  • Severe form
    • HbSS homozygous
  • >75% HbS
  • Serious complications
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43
Q

What is the second most common abnormal Hb diseae?

A

HbC

44
Q

T/F

Infants with Sickle cell trait should recieve pneumococcal vaccine and PCN prophylaxis up to 6 years of age

A

F

Sickle cell disease (Hb SS)

45
Q

T/F

The difference between Sickledex and Sickleprep, is that Sickledex can differentiate sickle disease from sickle trait

A

F

Neither DO NOT differentiate between disease and trait

46
Q

In infants < 6 months, what provides an acurate diagnosis to Sickle cell?

A

Hb electrophoresis

47
Q

T/F

Children with HbC may have a NORMAL Hb concentration but are still at risk of sickiling

A

T

48
Q

In the child with sickle cell disease, tell me about the traditional approach to preoperative transfusions.

A

Traditional approach

  • Packed RBC infused over several days
  • Supresses erythropoiesis
  • HbS reduces to <40% which is considered safe for MOST surgeries
49
Q

In the child with sickle cell disease, tell me about the conservative approach to preoperative transfusions.

A

Conservative approach

  • blood transfusion as necessary to increase Hb to _>_10 g/dl
  • As effective as traditional approach
50
Q

Children with Sickle cell disease who require cardiopulmonary bypass and hypothermia should have packed cell infusions or exchange transfusion to reduce the HbS levels to less than ___%

A

Hb S < 5%

51
Q

The diagnosis of Factor VIII deficiency can be performed by what test?

A

Factor VIII assay

52
Q

In a child with classic hemophilia Type A, an emergency surgery is necessay, but facilities of a hematology department are not available, what should be administered?

A

Fresh-Frozen Plasma (20 ml/kg)

53
Q
  1. In a child with classic hemophilia type A, one hour before surgery an infusion of Factor VIII concentrate of what dose should be given?
  2. Followed by what test?
A
  1. 25 U/kg to 50 U/kg
  2. Assay for plasma factor VIII activity
54
Q

1 U/kg factor VIII increases plasma level by what %?

A

1 U/kg increases factor VIII plasma level by 2%

55
Q

What is the half-life of factor VIII concentrate?

A

Half-life is 12 hours

56
Q

After a patient has been given factor VIII concentrate, what level of factor VIII activity is recommended before proceeding with surgery?

A

> 50%

57
Q

For major surgery, an infusion of factor VIII at what rate is advisable?

A

Factor VIII 3 to 4 u/kg/hr

58
Q

What is the most common congenital bleeding disorder?

A

Vo Willebrand disease

59
Q

Von Willebrand’s disease may occur secondary to what two other diseases?

A

Congenital heart disease

&

Wilms tumor

60
Q

What is the basic defect in Von Willebrand’s disease?

A

Lack of plasma cofactor that is a carrier protein for Factor VIII

61
Q

How many types of the Von Willebrand’s disease are there?

A

3 types

62
Q

Tell me about Von Willebrand’s disease Type 1.

A

Type 1

  • Common (90%)
  • Mild
  • Bleeding time prolonged
  • PT & PTT are often normal

*DDAVP is effective

63
Q

Tell me about Von Willebrand’s disease Type 2a

A

Type 2a

  • Common (90%)
  • Mild
  • Bleeding time prolonged
  • PT & PTT are often normal

PLUS

  • Normal platelet count

*DDAVP is effective

64
Q

Tell me about Von Willebrand’s disease Type 2b

A

Type 2b

  • Common (90%)
  • Mild
  • Bleeding time prolonged
  • PT & PTT are often normal
  • Normal platelet count

PLUS

  • Thrombocytopenia

*DDAVP may exacerbate Type 2b

*MUST be treated with crypprecipitate or FFP

65
Q

Tell me about Von Willebrand’s disease Type 3

A

Type 3

  • Most severe form
  • von Willebrand factor and factor VIII undetectable

*DDAVP is ineffective

*MUST be treated with crypprecipitate or FFP

66
Q

T/F

Abnormal cholinesterase may result in prolonged apnea after administration of muscle relaxants?

A

T

67
Q

What are the 5 aleles of pseudocholinesterase found on chromosome 3 that comprise the majority of the phenotypes?

A
  1. Normal
  2. Silent gene
  3. Atypical
  4. Fluopride rsistant
  5. E Cynthiana (Neitlich or C5 variant)
68
Q

Homozygous Atypical can delay recovery of muscle strength for how long?

A

5 to 6 hours

69
Q

Heterozygous Atypical can delay recovery of muscle strength for how long?

A

5 to 25 min.

May be unrecognizable

70
Q

What are the normal ranges for the following?:

  • Cholinesterase activity?
  • Dibucaine number?
  • Fluoride number?
A

Normal levels:

  • Cholinesterase activity
    • 60 to 200 units
  • Dibucaine number
    • 75 to 85
  • Fluoride number
    • 55 to 65
71
Q

What is the presenting sign for Factor VIII Deficiency in neonates?

What about in infants?

A

Neonates: Bleeding from umbilical cord

Infants: Bleeding after circumcision

72
Q

What is the most common endocrine disorder of childhood?

A

DM

73
Q

Symptomatic hyperglycemia (ketoacidosis) may have an abrupt onset and mimic what condition?

A

Appendicitis

  • Abdominal pain
  • Leukocytosis
74
Q

T/F

Hyperglycemia is associated with increased wound infection.

A

T

75
Q

In a child with DM, and coming in for a brief procedure, when should the surgery be scheduled?

A

As early as possible in the morning

76
Q

Before surgery, in a pt with DM, how much insulin should be administered?

A

1/2 to 2/3 the usual dose of insulin.

Intermediate only.

NOT Short-Acting

77
Q

For brief procedures (<1 hour), in a DM patient, start an infusion of 5% glucose containing solution and infuse at (3 to 4 ml/kg/hr) a maintenance rate unless the blood glucose is less then?

A

Less than 5 mmol/L (90 mg/dl)

  • In which case, the rate should be increased
78
Q

Prolonged procedures (> 1 hour) in a patient with DM, what is the preferred technique for maintence fluids?

A

Infusion of insulin

PLUS

Infusion of dextrose

79
Q

How would you mix a bag for insulin infusion?

How much would you infuse per hour?

A

Add 50 u of reg insulin to 500 ml saline

(0.1 unit/ml)

  • Saturate insulin binding sites in IV tubing with 50 to 100 mL

Infuse 1 ml/kg/hr

(Delivers 0.1/kg/hr)

80
Q

When infusing a 5% glucose solution in a procedure lasting > 1 hour, the rate would be adjusted to maintain glucose level at…?

A

5 to 10 mmol/L (90 to 180 mg/dl)

81
Q

In a pt with ketoacidosis and emergency surgery, which lines should be placed to assist in correcting hypovolemia and hyperglycemia?

A

CVP

A-line

82
Q

In a patient with ketoacidosis, the goal is to reduce the gluce level how much per hour?

A

100 mg/dl each hour

83
Q

T/F

In correcting ketoacidosis, hypokalemia is expected

A
84
Q

In a patient with Ketoacidosis, sodium bicarb can be used when…?

A

Severe acidosis occurs

(pH < 7.0)

85
Q

Subclinical brain swelling occurs during the treatment of ketoacidosis and total fluid administration be limited to…?

A

4 L/m2/24 hr

86
Q

In a child with malignancy, What can occur if dexamethasone is administered?

A

Tumor lysis syndrome

  • Metabolic disorder

Characterized by:

  • hyperkalemia
  • hypocalcemia
  • acute renal failure
87
Q

T/F

Respiratory infections, chronic sinus infections, and ear infections are common in Down syndrome.

A

T

88
Q

T/F

With trisomy 21, Thyroid hypfunction and subglottic stenosis is common.

A
89
Q

With Trisomy 21, what abnormalities are common with the radial arteries?

A

Single median artery is common

90
Q

What is presently the “gold standard” for diagnostic test for MH?

A

Caffeine-Halothane test

91
Q

T/F

An increase in temperature of more than 1 C, is an early sign of MH

A

F

It is a late sign

  • Prognosis is much more favorable MH is recognized early and dantrolene is administered before significant increase in temp occurs
92
Q

MH treatment?

A
  1. Discontinue all inhalationals, send for help!
  2. 100% O2
  3. Dantrolene
    • 2.5 mg/kg IV
    • 1mg/kg Q5 min. as needed
  4. If DANTROLENE not available, or if arrythmias persist, give:
    • Procainamide
    • 1mg/kg/min up to 15 mg/kg
  5. Sodium Bicarb (7.5%) 4ml/kg IV
  6. Mannitol 0.5 g/kg
  7. Active coolong
  8. Insert A-line, CVP, foley
93
Q

How to treat hyperkalemia in MH?

A

Give

0.15 u/kg of reg insulin

with

0.5 g/kg of glucos

94
Q

During MH, why should you maintain urine output at 1 ml/kg/hr?

A

to prevent

rhabdomyolysis - induced renal failure

95
Q

T/F

Calcium channel blocker agents are considered during MH

A

F

They interact with dantrolene and produce prfound myocardial depression

and

No therapeutic role

95
Q
A
96
Q

What is a disorder charcterized by:

  • Fever
  • Muscle rigidity
  • Tachycardia
  • Autonomic instability

in patients taking antipsychotic medication

A

Neuroleptic Malignant Syndrome

97
Q

T/F

40% of children with spinal bifida have latex allergy

A

T

due to number of surgerie and exposure to latex

98
Q

The signs of latex allergy, usually develop in how many minutes after the induction of anesthesia?

A

30 to 200 min.

99
Q

T/F

Allergy to chestnuts, bananas, avocado, and kiwi places you at risk for latex allergy?

A
100
Q

T/F

In patients with crebral palsy, GERD is common

A

T

101
Q

T/F

Latex allergy is common in children with cerebral palsy

A

T

102
Q

T/F

When providing anesthesia to a child with CP, careful administration of succinylcholine should be taken in order to prevent hyperkalemia

A

F

Succ does not induce hyperkalemia in children with CP

103
Q

What happens to the MAC of inhaled anesthetic agents in a child with CP?

A

20% decrease

104
Q

Are children with CP prone to hypothermia?

A

Yes

105
Q

T/F

In a patient with a transplanted heart,

coronary artherosclerosis is accelerated and ischemia may occur without pain

A

T

Pediatrics (4 decks)

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