Common ped surgeries lecture

Question 1

gastroschisis vs omphacele

Answer 1

gastro- gastric contents out
omphacele- central defect in a sac

Question 2

gastroschisis vs omphacele associated ocnditions

Answer 2

gastro- none
omphacele- 50-70% (survival rate drops with ocngenitl heart defect, prematurity)

Question 3

beckwith weidman syndrom

Answer 3

overgrowth syndrome
macroglossia, microsmia

Question 4

potential complicaitons of surgery for admoninal

Answer 4

can impede venous return/hotn
can impair diaphragm- inadequate ventilation
aortocaval compressions- bowel ischemia, decreased co, renal and hepatic functino

Question 5

When is surgical management unsafe

Answer 5

intragastric pressure >20
change in cvp >4
etco2 >50
pip >35

Question 6

maintenance and replacement fluid for abdominal surg

Answer 6

maintenance d5 or d10 .2NS
replacement- isotonic 2-4x maintenance (usually 8-15ml/kg)

Question 7

when do u need 2 pulse ox

Answer 7

abdominal surgery
pre ductal RA
post ductal LF

Question 8

abdominal anesthetic management

Answer 8

AVOID n2o distends bowel

Question 9

CDH

Answer 9

allows herniation of abdominals into the thoracic cavoty

Question 10

CDH classification

Answer 10

posterolateral 80-90%
anteromedial 2%
para esophageal 20%

Question 11

CDH complications

Answer 11

bilat lung hypoplasia
pulmonary htn
lv dysfunction

Question 12

classic presentation of CDH

Answer 12

dyspnea, cyanosis, dextrocardia (heart sounds on wrong side)
bulging chest, decreased breathe sounds, bowel sounds in chest

Question 13

key to survival for cdh

Answer 13

prenatal diagnosis- birth can occur in high level center w experienced surgeons

Question 14

goals of cdh management

Answer 14

maximize arterial oxygenation (mech vent, low pressures >30)
correct acidosis
prevent hypothermia
prevent pain

Question 15

when can surgery occur for cdh

Answer 15

bp normal for 24 hours
preductal sat >85 on fio2 50
lactate <3
uo 1-2ml/kg/hr

Question 16

after the honeymoon phase of cdh, what might be required ?

Answer 16

ecmo, no

Question 17

ecmo criteria

Answer 17

wieght >2kg
gestation >35 weeks

Question 18

what meds to avoid with cdh

Answer 18

hypothermia
n2o

Question 19

when does pyloric stenosis present

Answer 19

2-8 weeks of life

Question 20

pyloric stenosis symptoms

Answer 20

hyponatremic, hypokalemic, hypochloremic metabolic alkalosis
vomit out all the salt, chloride, potassium

Question 22

primary concern of pyloric stenosis management

Answer 22

aspiration of gastric fluid

Question 23

TEF classic presentation

Answer 23

inability to manage oral secretions
gastric distention
choking on first feed

Question 24

goal TEF ETT

Answer 24

below fistula above carina
advance into R mainstem, withdraw until ett breathe sounds are confirmed in L axilla

Question 25

hallmark sign condgenital dislocation of the hip

Answer 25

ortalani clock as femoral head moves in and out of acetabulum

Question 26

greatest concern for ocngenital hip dislocation

Answer 26

loss of airway
pt must be kept in stage 3 to prevent laryngospasm

Question 27

when will clubfoot be fixed

Answer 27

3-6 months

Question 28

what is osteogenesis imperfecta

Answer 28

fibroblasts dont work well- they normally heal wounds and form collagen

Question 29

most severe type of OI

Answer 29

2- 90% pass by 1 week

Question 30

OI clinical presentation

Answer 30

bowing of long bones
deafness
bleeding is rare
HYPERMETABOLIC- NOT MH
airway is usally normal, but be careful w c spine when intubating

Question 31

when would fracture need urgent repair

Answer 31

vascular compromise
hotn
large hematoma

Question 32

myelodysplasia

Answer 32

Congenital failure in the middle or end of nueral tube
spina bifida- safe, meningocele- bulge in spinal fluid, myelomeningocele- bulge with CSF and nerves- most severe

Question 33

symptoms with scoliosis

Answer 33

decreased lung volumes
decreased chest wall compliance
vq MM, chronic hypoxemia
increased PVR, pulmonary htn causing RV failure
get echo if curvature >35, if over 65, restrictive lung disease

Question 34

when to use MEPs

Answer 34

scoliosis surgery
propofol, remifent, versed, ketamine

Question 35

PPAP

Answer 35

periop precision analgesia platform- improve analgesia and reduce serious immediate long term adverse outcomes

Question 36

scoliosis aneshtetic management

Answer 36

low bp map 70
txa 10mg/kg load, then 10mg/kg/hr
aggresive temp management

Question 37

scoliosis problems

Answer 37

siadh, hypvolemia, pain