Exam IV: Peds GU and Ortho Flashcards
Common Peds GU Procedures
C_______
Circumcision
Common Peds GU Procedures
Hypospadius/Chordee p. 679
Urethra opens on the ______ of the penis
MAGPI (_____ ______ and ______)
underside
meatal advancement and glanulopasty
Common Peds GU Procedures
__________ p. 680
Undescended testes “pulled down” into scrotum
May require fixation
Orchiopexy
Common Peds GU Procedures
Inguinal Hernia p. 680
Bowel loop protruding out of ______ _____
Becomes emergent if bowel loop ______
inguinal ring
incarcerates
Common Peds GU Procedures
All of these done with _____ +/- _____ ______ or caudals
GA
regional blocks
Common Peds GU Procedures
_________ risk during foreskin, hernia and testes retraction
Laryngospasm
GU Reflux
Ureteral reimplantation
For reflux at the _____/_____ junction
Procedure lasts several hours, heavy ______ use
GA + ______ anesthesia works well
ureter/bladder
retractor
caudal
GU Reflux
P_______
Ureter/kidney pelvis junction
Usually _____ with kidney flexion; sometimes prone
_____ do not cover well
Other regionals gaining popularity
Pyeloplasty
lateral
Caudals
GU Reflux
________ technique gaining popularity for both
Laparoscopic
GU Reflux
Ureteral _______ may be bilateral
reimplantation
GU Reflux
Pyeloplasty unilateral (why?)
you dont want to put them into renal failure, have at least one working kidney at all times
Nephrectomy p. 683
For non-functioning, dysplastic kidney, stones, cancer
Chronic disease leads to _____, _____
Lateral with _____ _____ or prone
Partial nephrectomy will increase risk of ____ ____ ____
anemia, HTN
kidney flexion
high blood loss
Bladder and Cloacal Exstrophy
Failure of abdominal wall to close over ____ _____ wall
anterior bladder
Bladder and Cloacal Exstrophy
Cloacal exstrophy often accompanies _______, ______ defects, _____ anus
omphaloceles
spinal
imperforate
Bladder and Cloacal Exstrophy
Highly associated with ____ defects
CV
Bladder and Cloacal Exstrophy
High intraoperative ____ ____ loss
______ repair (closure of bladder, urethra, abdominal wall) requires MANY procedures, sometimes over _____.
third space
Staged
years
Scoliosis Repair
Classified as _____ (unknown etiology), _____ (spina bifida), ______ (Duchenne MD), _____ (arthrogryposis)
idiopathic
congenital
neuromuscular
mesenchymal
Scoliosis Repair
Evolves during ____ _____
growth spurts
Scoliosis Repair
Pulmonary compromise correlates with _____ of ______
degree of curve
Scoliosis Repair
Vital capacity begins to decrease at ____, becomes severe at _____.
60°
100°
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
muscle
distortion
blood loss
TXA
Scoliosis Repair
Non-______ + _____ curve = high risk
ambulatory
60˚
Anesthetic Implications
Posterior Spinal Fusions are _____, _____, AND _____ RISK
LONG, BLOODY, AND HIGH
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.)
patient history
PRBCs
informed consent
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.
warmed
soft bite
evoked potential
disconnect
Positioning
Prone (may be difficult with _____)
deformities
Positioning
____ _____ may minimize cardiac effects
Jackson table
Positioning
Major positioning risk: POVL usually d/t _____ _____ _____ and unrelated to globe pressure
ischemic optic neuropathy
Positioning
Biggest risk factors: > ___ _____ and high ____ loss
6 hours
blood
Positioning
Document ____ ____ (mirror?)
eye checks
Hypothermia
_____ drop in core temp causes a 3x ↑ risk of _____ _____
2° C
wound infection
Monitoring
All standards + ____ ____, SSEP/MEPs, foley
arterial line
Instruments: _____ screws, vertical expandable prosthetic titanium rib rod (_____), _____ rods
Pedicle
VEPTR
Harrington
HUGE 3rd space loss, high blood loss, ___-___ hour procedure
_____ Post-op
5 – 10
ICU
Managing Blood Loss
Controlled hypotension (controversial): MAP of ____ - _____mm Hg
MUST have ____ ____
Opioids, dexmedetomidine, clonidine, Ca2+ channel blockers
50 – 65
arterial line
Managing Blood Loss
______ with colloid or crystalloid
Hemodilution
Managing Blood Loss
Autologous and/or _____ donation
directed
Managing Blood Loss
Anti______
- Aminocaproic acid (Amicar®), tranexamic acid (TXA)
- Studies showing most significant results with _____ _____
fibrinolytics
neuromuscular disorders
Managing Blood Loss
Intraoperative salvage (____ ____)
cell saver
Managing Blood Loss
_____ for dilutional thrombocytopenia
Platelets
Managing Blood Loss
_____ to replace factors
FFP
Managing Blood Loss
Recombinant factor VIIa (Novo7®) for _____ _____
refractory bleeding
Evoked Potentials
_____ pathways are most vulnerable to ischemia during hardware ______
Motor
insertion
Evoked Potentials
Motor pathways perfused by ____ ____ _____ artery
single anterior spinal
Evoked Potentials
Somatosensory (SSEP) and Motor (MEP) have replaced the “_____ _____”
wake-up test
Evoked Potentials
Anesthetic agents depress _____ and increase _____
amplitude
latency
Evoked Potentials
_______ (surgeon, CRNA, EP tech) is key to successful monitoring
Communication
Evoked Potentials
____ or ______ volatile agent to preserve EPs
No or subanesthetic
Evoked Potentials
No N2O (causes significant ____ _____)
EP depression
Evoked Potentials
Propofol, opioids, ketamine, etomidate, dexmedetomidine and clonidine ____ ____
preserve EPs
Evoked Potentials
No muscle relaxants (MRs have little effect on _____ but block transmission of _____)
SSEPs
MEPs
Evoked Potentials
Common techniques: _____ infusion + _____ infusion (remifentanil or sufentanil) ≤0.5 MAC volatile? Ketamine? Dexmedetomidine?
Propofol
opioid
Wake-up Testing
To ensure ____ & _____ pathways remain intact throughout procedure.
sensory and motor
Wake-up Testing
Good pre-op ____ ____ is a MUST.
patient education
Wake-up Testing
Anesthetic lightened after _____ _____.
hardware insertion
Wake-up Testing
Patient told to ____ ____. After bilateral ____ movement confirmed, patient “re-induced”.
move feet
foot
Wake-up Testing
Problems:
HTN, tachycardia, blood loss, risk of recall during period of light anesthesia
Wake-up Testing
Now, most centers using SSEPs+MEPs or _____ alone.
MEPs
