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NUNA 692 Principles III > Exam IV: Peds GU and Ortho > Flashcards

Exam IV: Peds GU and Ortho Flashcards

1
Q

Common Peds GU Procedures

C_______

A

Circumcision

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2
Q

Common Peds GU Procedures

Hypospadius/Chordee p. 679
Urethra opens on the ______ of the penis
MAGPI (_____ ______ and ______)

A

underside
meatal advancement and glanulopasty

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3
Q

Common Peds GU Procedures

__________ p. 680
Undescended testes “pulled down” into scrotum
May require fixation

A

Orchiopexy

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4
Q

Common Peds GU Procedures

Inguinal Hernia p. 680
Bowel loop protruding out of ______ _____
Becomes emergent if bowel loop ______

A

inguinal ring
incarcerates

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5
Q

Common Peds GU Procedures

All of these done with _____ +/- _____ ______ or caudals

A

GA
regional blocks

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6
Q

Common Peds GU Procedures

_________ risk during foreskin, hernia and testes retraction

A

Laryngospasm

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7
Q

GU Reflux

Ureteral reimplantation
For reflux at the _____/_____ junction
Procedure lasts several hours, heavy ______ use
GA + ______ anesthesia works well

A

ureter/bladder
retractor
caudal

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8
Q

GU Reflux

P_______
Ureter/kidney pelvis junction
Usually _____ with kidney flexion; sometimes prone
_____ do not cover well
Other regionals gaining popularity

A

Pyeloplasty
lateral
Caudals

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9
Q

GU Reflux

________ technique gaining popularity for both

A

Laparoscopic

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10
Q

GU Reflux

Ureteral _______ may be bilateral

A

reimplantation

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11
Q

GU Reflux

Pyeloplasty unilateral (why?)

A

you dont want to put them into renal failure, have at least one working kidney at all times

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12
Q

Nephrectomy p. 683
For non-functioning, dysplastic kidney, stones, cancer
Chronic disease leads to _____, _____
Lateral with _____ _____ or prone
Partial nephrectomy will increase risk of ____ ____ ____

A

anemia, HTN
kidney flexion
high blood loss

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13
Q

Bladder and Cloacal Exstrophy

Failure of abdominal wall to close over ____ _____ wall

A

anterior bladder

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14
Q

Bladder and Cloacal Exstrophy

Cloacal exstrophy often accompanies _______, ______ defects, _____ anus

A

omphaloceles
spinal
imperforate

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15
Q

Bladder and Cloacal Exstrophy

Highly associated with ____ defects

A

CV

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16
Q

Bladder and Cloacal Exstrophy

High intraoperative ____ ____ loss
______ repair (closure of bladder, urethra, abdominal wall) requires MANY procedures, sometimes over _____.

A

third space
Staged
years

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17
Q

Scoliosis Repair

Classified as _____ (unknown etiology), _____ (spina bifida), ______ (Duchenne MD), _____ (arthrogryposis)

A

idiopathic
congenital
neuromuscular
mesenchymal

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18
Q

Scoliosis Repair

Evolves during ____ _____

A

growth spurts

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19
Q

Scoliosis Repair

Pulmonary compromise correlates with _____ of ______

A

degree of curve

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20
Q

Scoliosis Repair

Vital capacity begins to decrease at ____, becomes severe at _____.

A

60°
100°

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21
Q

Scoliosis Repair

Neuromusculars (NM) : Deteriorating _____ function + mechanical _____

Prolonged PTT & ↓ factor VII activity leads to higher ____ ____
5 x higher risk than idiopathics
_____ routine for NMs in many centers

A

muscle
distortion
blood loss
TXA

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22
Q

Scoliosis Repair

Non-______ + _____ curve = high risk

A

ambulatory
60˚

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23
Q

Anesthetic Implications

Posterior Spinal Fusions are _____, _____, AND _____ RISK

A

LONG, BLOODY, AND HIGH

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24
Q

Anesthetic Implications

Pre-op
- Thorough history, CBC, lytes, coags
- Other diagnostics if indicated (based on ____ ____)
- _____ MUST be available – confirm with Blood Bank
- Detailed ____ ____ discussion
- Describe post-op scenario (ICU, edema, pain mgt, etc.)

A

patient history
PRBCs
informed consent

25
Q

Anesthetic Implications

Before “flipping”
- 2 large IVs (at least 1 _____), blood set-up, arterial line, foley, esophageal temp probe, ____ ____ block*, eyes lubed/taped securely, ____ ____ electrodes in place
- Just before “flip”, ______ EVERYTHING.

A

warmed
soft bite
evoked potential
disconnect

26
Q

Positioning

Prone (may be difficult with _____)

A

deformities

27
Q

Positioning

____ _____ may minimize cardiac effects

A

Jackson table

28
Q

Positioning

Major positioning risk: POVL usually d/t _____ _____ _____ and unrelated to globe pressure

A

ischemic optic neuropathy

29
Q

Positioning

Biggest risk factors: > ___ _____ and high ____ loss

A

6 hours
blood

30
Q

Positioning

Document ____ ____ (mirror?)

A

eye checks

31
Q

Hypothermia
_____ drop in core temp causes a 3x ↑ risk of _____ _____

A

2° C
wound infection

32
Q

Monitoring
All standards + ____ ____, SSEP/MEPs, foley

A

arterial line

33
Q

Instruments: _____ screws, vertical expandable prosthetic titanium rib rod (_____), _____ rods

A

Pedicle
VEPTR
Harrington

34
Q

HUGE 3rd space loss, high blood loss, ___-___ hour procedure
_____ Post-op

A

5 – 10
ICU

35
Q

Managing Blood Loss

Controlled hypotension (controversial): MAP of ____ - _____mm Hg
MUST have ____ ____
Opioids, dexmedetomidine, clonidine, Ca2+ channel blockers

A

50 – 65
arterial line

36
Q

Managing Blood Loss

______ with colloid or crystalloid

A

Hemodilution

37
Q

Managing Blood Loss

Autologous and/or _____ donation

A

directed

38
Q

Managing Blood Loss

Anti______
- Aminocaproic acid (Amicar®), tranexamic acid (TXA)
- Studies showing most significant results with _____ _____

A

fibrinolytics
neuromuscular disorders

39
Q

Managing Blood Loss

Intraoperative salvage (____ ____)

A

cell saver

40
Q

Managing Blood Loss

_____ for dilutional thrombocytopenia

A

Platelets

41
Q

Managing Blood Loss

_____ to replace factors

A

FFP

42
Q

Managing Blood Loss

Recombinant factor VIIa (Novo7®) for _____ _____

A

refractory bleeding

43
Q

Evoked Potentials

_____ pathways are most vulnerable to ischemia during hardware ______

A

Motor
insertion

44
Q

Evoked Potentials

Motor pathways perfused by ____ ____ _____ artery

A

single anterior spinal

45
Q

Evoked Potentials

Somatosensory (SSEP) and Motor (MEP) have replaced the “_____ _____”

A

wake-up test

46
Q

Evoked Potentials

Anesthetic agents depress _____ and increase _____

A

amplitude
latency

47
Q

Evoked Potentials

_______ (surgeon, CRNA, EP tech) is key to successful monitoring

A

Communication

48
Q

Evoked Potentials

____ or ______ volatile agent to preserve EPs

A

No or subanesthetic

49
Q

Evoked Potentials

No N2O (causes significant ____ _____)

A

EP depression

50
Q

Evoked Potentials

Propofol, opioids, ketamine, etomidate, dexmedetomidine and clonidine ____ ____

A

preserve EPs

51
Q

Evoked Potentials

No muscle relaxants (MRs have little effect on _____ but block transmission of _____)

A

SSEPs
MEPs

52
Q

Evoked Potentials

Common techniques: _____ infusion + _____ infusion (remifentanil or sufentanil) ≤0.5 MAC volatile? Ketamine? Dexmedetomidine?

A

Propofol
opioid

53
Q

Wake-up Testing

To ensure ____ & _____ pathways remain intact throughout procedure.

A

sensory and motor

54
Q

Wake-up Testing

Good pre-op ____ ____ is a MUST.

A

patient education

55
Q

Wake-up Testing

Anesthetic lightened after _____ _____.

A

hardware insertion

56
Q

Wake-up Testing

Patient told to ____ ____. After bilateral ____ movement confirmed, patient “re-induced”.

A

move feet
foot

57
Q

Wake-up Testing

Problems:

A

HTN, tachycardia, blood loss, risk of recall during period of light anesthesia

58
Q

Wake-up Testing

Now, most centers using SSEPs+MEPs or _____ alone.

A

MEPs

59
Q
A

NUNA 692 Principles III (20 decks)

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