Exam IV: Peds GU and Ortho Flashcards by Linsley Lloyd

Common Peds GU Procedures

C_______

Circumcision

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Common Peds GU Procedures

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

underside
meatal advancement and glanulopasty

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Common Peds GU Procedures

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

Orchiopexy

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Common Peds GU Procedures

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

inguinal ring
incarcerates

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Common Peds GU Procedures

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

GA
regional blocks

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Common Peds GU Procedures

_________ risk during foreskin, hernia and testes retraction

Laryngospasm

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GU Reflux

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

ureter/bladder
retractor
caudal

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GU Reflux

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

Pyeloplasty
lateral
Caudals

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GU Reflux

________ technique gaining popularity for both

Laparoscopic

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GU Reflux

Ureteral _______ may be bilateral

reimplantation

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GU Reflux

Pyeloplasty unilateral (why?)

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

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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

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Bladder and Cloacal Exstrophy

Failure of abdominal wall to close over ____ _____ wall

anterior bladder

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Bladder and Cloacal Exstrophy

Cloacal exstrophy often accompanies _______, ______ defects, _____ anus

omphaloceles
spinal
imperforate

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Bladder and Cloacal Exstrophy

Highly associated with ____ defects

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Bladder and Cloacal Exstrophy

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

third space
Staged
years

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Scoliosis Repair

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

idiopathic
congenital
neuromuscular
mesenchymal

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Scoliosis Repair

Evolves during ____ _____

growth spurts

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Scoliosis Repair

Pulmonary compromise correlates with _____ of ______

degree of curve

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Scoliosis Repair

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

60°
100°

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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

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Scoliosis Repair

Non-______ + _____ curve = high risk

ambulatory
60˚

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Anesthetic Implications

Posterior Spinal Fusions are _____, _____, AND _____ RISK

LONG, BLOODY, AND HIGH

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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