Chapter 6 - Medical Conditions Influencing Anesthetic Management Flashcards
T/F
Children with an UNcomplicated upper respiratory tract infection who are Otherwise Healthy have a Greater incidence of intraop desaturation, brochospasm, and laryngospasm
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
Airway irritabilty after a URTI may last for how many weeks?
6 to 8 weeks
T/F
Anticholinergics affect the incidence of perioperative airway complications in a negative way, in children with URTI
F
Do NOT Affect
help
T/F
Preoperative bronchodilators and a vital capacity cough may resolve bronchospasm and airways plugged with mucus
T
What can be done intraop to deliver most of the content of each puff of albuterol to the tip of the ETT?
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
Children who present for elective surgery with which 4 signs and symptoms should be rescheduled after 4 weeks?
- Pyrexia > 38.5 C
- Change in behavior, diet, or activity
- Prulent secretions
- Signs of lower respiratory tract involvement (wheezing) that do not clear with forced cough
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?
Delay procedure 4 weeks
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
T
Postop, the child should be carefully observed
In a child with asthma, if oral steroids are prescribed, it suggest what?
A recent exacerbation
During which time frame is a child’s airway reactivity increased and residual mucosal edema and secretions impair pulmonary function?
1 month (4 weeks) after the last acute attack
If the child with asthma is taking theophylline, and is presenting for elective surgery, what should be done preoperatively?
The blood level of theophylline should be measured
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?
IV hydrocortisone 1 to 1.5 mg/kg
Stress dose given to:
- >5 mg perdnisone per day
- Oral steroids within 3 months
- High-dose inhaled steroids
T/F
Atropine is contraindicated in children who present with asthma due to its bronchoconstrictive effects.
F
Decreases secretion and bronchodilates
What is the preferred IV induction agent for children with asthma?
Propofol
Which IV induction agent may cause bronchoconstriction in an asthmatic child due to the release of histamine?
Thiopental
Can ketamine be used for IV induction for a child with asthma?
Yes.
Use atropine to limit secretions
Which inhaled anesthetic may precipitate arrhythmias in children also receiving theophylline?
Halothane
Which inhaled anesthetic increases airway resistance in asthmatic children?
Desflurane
Intraoperative wheezing should be treated by…?
- Deepening anesthesia
- Give bronchodilaor via ETT
What are some nonasthmatic causes of wheezing intraoperatively?
- Partially obstructed ETT
- Endobronchial intubation
- Pneumothorax
T/F
At the end of surgery, in a child with asthma, muscle relaxants can be reversed using atropin and neostigmine.
T
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?
IV lidocaine
or
IV Propofol
Cystic fibrosis is an inherited disorder that results from a genetic defect on which chromosome?
Defect on chromosome 9
What causes the incrased viscosity of secretions and increased electrolyte content in a patient with cystic fibrosis?
Abnorml Chloride and Sodium transport