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NUNA 692 Principles III > Exam IV: Common Post Anesthesia Complications in Children > Flashcards

Exam IV: Common Post Anesthesia Complications in Children Flashcards

1
Q

Laryngospasm

Any _____ patient
Any _____
Induction or emergence
_____ or _____ extubation
May have no precipitating cause

A

pediatric
technique
Deep or awake

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2
Q

Laryngospasm

Most common culprit: ___________________

A

Secretions and/or stimulation during Stage 2

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3
Q

What can we do to prevent laryngospasms during intubation? (2)

A
  • Do not rush, especially with no muscle relaxant (MR).
  • Before repeated laryngoscopy with no MR, re-dose propofol or mask ventilate with high-percent sevo.
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4
Q

What can we do to prevent laryngospasms during extubation? (5)

A
  • Suction oropharynx before extubation.
  • Extubate end-inspiration or with positive pressure.
  • Extubating awake? Make sure they are AWAKE.
  • Extubating deep? Keep them DEEP.
  • Immediately upon extubation, apply PEEP until air movement is confirmed.
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5
Q

Laryngospasm Treatment:

100% O2 with ____ _____

A

+ pressure

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6
Q

Laryngospasm Treatment:

______ 0.5-1mg/kg

A

Lidocaine

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7
Q

Laryngospasm Treatment:

Succinylcholine (__-__ ___) with _____ (0.1mg) in young children

A

0.5-1 mg/kg
atropine

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8
Q

Laryngospasm Treatment:

I_____

A

Intubate

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9
Q

Laryngospasm Treatment:

BEWARE of post-obstructive _____ _____ ______ edema

A

negative pressure pulmonary edema (especially in muscular, adolescent males)

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10
Q

“If the laryngeal nerve becomes _____ enough, a laryngospasm will break.”

A

hypoxic

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11
Q

But until then… What about hypoxia in infants?
Hypoxia causes bradycardia which causes ______ and eventually _____
Must treat decreasing heart rate quickly!

A

dysrhythmias
arrest

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12
Q

Succinylcholine leads to _______
Many advocate _____ with sux, but that practice is being questioned.

A

bradycardia
atropine

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13
Q

Consider quick, aggressive treatment for those at high risk of _____ _____ _____ edema.

A

negative pressure pulmonary

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14
Q

Bronchospasm

Increased risk with hx of ____ _____ disease

A

reactive airway

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15
Q

Bronchospasm

Usually during _____, before extubation

A

emergence

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16
Q

Bronchospasm

May require extremely ___ ___ (uncuffed ETT?)

A

high PIP

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17
Q

Bronchospasm

Treatment: ____ ____

A

β2 agonist (albuterol) aerosol

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18
Q

Bronchospasm

If severe: ______ (____/___ ___)

A

Epinephrine (10 mcg/kg IV)

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19
Q

Bronchospasm

If severe and extubated: _____

A

Reintubate

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20
Q

About Epinephrine…

Your patient weighs 10 kg
You want to give 10 mcg/kg
10 mcg x 10 kg = 100 mcg
How many mcg/mL in this Epi jet?

A

Answer: 100 mcg/mL

SO – For every 10 kg, give 1 mL of 1:10,000 Epi

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21
Q

Airway Obstruction

  • Sedation due to _____, _____, _____ anesthesia
  • ______ neuromuscular blockade
  • Positioning
  • Sleep apnea
  • Laryngospasm
  • Laryngeal ____
  • Secretions
  • Wound hematoma
  • Vocal cord _____
A

opioids, midazolam, general anesthesia
Residual
edema
paralysis

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22
Q

A/W obstruction symptoms

A
  • Desaturation
  • Stridor
  • Paradoxical breathing
  • Inspiratory retractions
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23
Q

A/W obstruction interventions

A

Stimulation
Chin lift, jaw thrust*
Oral or nasal airway
Repositioning
Suctioning
CPAP, PEEP
Antagonists
Intubation

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24
Q

PONV - determine _____ if possible

A

cause
(Opioids, ileus, gastric distension, pain, blood in stomach, vagal stimulation, motion, increased ICP)

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25
Q

PONV - continue _____

A

IVF

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26
Q

PONV - most effective prophylaxis

A

Hydration + 5-HT3 antagonist + dexamethasone

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27
Q

PONV - most effective rescue

A

5-HT3 antagonist, Phenergan, Non-opioid analgesics

28
Q

Aspiration Prevention:

Suction after _____ and before extubation

A

induction

29
Q

Aspiration Prevention:

Minimal ____ with LMAs and masks

A

PIPs

30
Q

Aspiration Prevention:

Extubate with ____ ____ intact

A

airway reflexes

31
Q

Aspiration Prevention:

_____ position postoperatively

A

Recovery

32
Q

Aspiration Prevention:

Medical _____

A

prophylaxis

33
Q

If aspiration suspected…

Baseline CXR and ABG
CXR re-evaluation at 4 hours
No change = _____ _____ _____

A

Probably no aspiration

34
Q

Mild aspiration: _____ and _____ _____

A

O2 and chest PT

35
Q

Major aspiration: _____, _____ ventilation, ____ may be required

A

Intubation, mechanical ventilation, ICU may be required.

36
Q

Pulm edema causes: (2)

A
  • Fluid overload (especially with poor CV reserve)
  • Post-obstructive negative pressure incident
37
Q

Pulm edema treatment: (4)
Health pt should _____ within a few hours

A
  • O2
  • Diuretics
  • Admit until resolved
  • Reintubate if severe

resolve

38
Q

Hemodynamic Instability

______: Uncommon in peds except with congenital heart disease or hypovolemia

A

Hypotension

39
Q

Hemodynamic Instability Treatment:

A
  • IV fluid boluses (crystalloid or colloid) if Hct stable
  • PRBCs may be indicated.
  • Recombinant Factor VII (Novo 7®)
    Return to OR?
40
Q

Hemodynamic Instability

Hypertension usually due to ____

A

pain.

41
Q

____ overload can cause HTN.

A

Fluid

42
Q

Hemodynamic Stability

Bradycardia (significant?)
Tachycardia (significant?)
Other dysrhythmias are _____.

A

rare

43
Q

Hypothermia

Defined:

A

Defined: Core temp < 36˚C (96.8˚F)

44
Q

Hypothermia Risks

Delayed ____ _____ and awakening
Wound infection and delayed healing
_____ crisis

A

drug metabolism
Sickling

45
Q

Hypothermia

Temp ≥ ____: CMS quality indicator for pay for performance incentives

A

36

46
Q

Hypothermia warming methods

A
  • FORCED WARM AIR
  • HMEs
  • Fluid warmers
  • Wrapping (especially the head)
  • Make the surgeon sweat
47
Q

Emergence Delirium

Delirium vs. ____ vs. Hungry vs. Wanting Mama…

A

Pain

48
Q

Emergence Delirium

Studies after MRI show its a ____ _____

A

true phenomenon

49
Q

Emergence Delirium

_____, _____, _____

A

disoriented, inconsolable, irrational

50
Q

Emergence Delirium

Worse with ____flurane and ____flurane than with ____flurane

A

sevo
des
iso

51
Q

Emergence Delirium

Usually < ____ years old

A

6

52
Q

Emergence Delirium

Usually __-__ minutes

A

5-15

53
Q

Emergence Delirium - strategies

A
  • Regional
  • Opioids
  • Dexmedetomidine
  • Propofol
  • Ketamine
  • Flumazenil
54
Q

Stridor (Croup) Laryngeal edema due to:

A
  • Traumatic or repeated laryngoscopy
  • Poorly fitted ETT (cuffed or uncuffed)
  • ETT cuff pressure
  • Prolonged intubation
  • Head and neck procedures
  • Intraoperative positioning
  • Upper respiratory infection
  • Coughing
55
Q

Stridor treatment

A
  • Humidified O2
  • IV dexamethasone
  • Racemic epinephrine aerosol
56
Q

Severe stridor, they need _____

A

reintubation

57
Q

If stridor unresolved, _____ for _____ and obs

A

admit for treatment

58
Q

Laryngeal Edema leads to _____ _____

A

Subglottic Stenosis

59
Q

Pressure at the cricoid ring causes reduced blood flow and edema which leads to ulcerated mucosa developing _____ and leaving _____ ____

A

collagen
fibrous scar

60
Q

Scar contracts causing permanent subglottic stenosis and significant ____ _____

A

airway narrowing

61
Q

Laryngeal tracheal reconstruction (LTR) with cartilage grafting is the _____ _____

A

definitive treatment.

62
Q

Post-op Evaluation

Time of evaluation varies according to ____ _____.

A

hospital policy

63
Q

Post-op Evaluation

CMS states all post-op notes must be documented before discharge by an (3)

A

anesthesiologist, CRNA or anesthesia resident.

64
Q

Post-op Evaluation

_____ VS, O2 requirements, level of consciousness, pain, nausea/vomiting, sore throat, intake.

A

Evaluate

65
Q

Post-op Evaluation

Report and/or treat possible _____ and follow-up.

A

complications

NUNA 692 Principles III (20 decks)

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