FINAL 3 Flashcards
Acute bacterial infection involving lingular surface of epiglottis, aryepiglottic folds, and aretynoids.
Epiglottitis
Another name for Epiglottitis is
Acute Supraglottis
Is Epiglottis life threatening?
Yup
4 Ds of Epiglottis
Dysphagia
Dysphonia
Dyspnea
Drooling
Epiglottitis starts as
sore throat and dysphagia with thick, muffled voice
Classic presentation of epiglottis
child sitting, dyspneic, mouth open, drooling, forward chin thrust, tripod position
Induce Epiglottitis with ____ and _____
Sevo and oxygen
Dose for atropine
0.02mg/kg
Fluid bolus epiglottis pts with
20-30ml/kg
Epiglottitis…ETT should be ________ than usual
1-2x smaller
______ confirms epiglottitis diagnosis
cherry red edpiglottis
Do you want to use muscle relaxants with epiglottitis?
nope- contraindicated, relaxation of pharyngeal muscle could block laryngeal airway
Epiglottitis- maintain _______pressure ( ____ cmH20) to minimize collapse of airways.
positive pressure (10-15cm H2O)
Epiglottitis. After stabilized, child may be sedated for _____hours to prevent extubation.
24hours
Epiglottitis. Have emergency _____ kit available during intubation and and ____ doc around.
trach
ENT
Abnormality of the POSTERIOR fossa causing cephalad displacement of the cerebellum through the formamen magnum
Chiara malformations
What type of chiari malformation?
Caudal herniation of vermis, brainstem, and 4th ventricle. Associated with myelomeningocele and other anomilies. “ARNOLD CHIARI MALFORMATION”
Type 2
What type of chiari?
Tonsillar herniation >5mm below the plane of the foramen magnum. No associated brainstem herniation or supratentorial anomalies. Low frequency of hydrocephalus.
Type 1
What type of chiari?
Most severe.
Occipital encaphalocele containing dysmorphic cerebellar and brainstem tissue
Type 3
What type of chiari?
Hypoplasia or aplasia of the cerebellum
“absent cerebellum”
Type 4
What is the most common pediatric neurosurgical condition?
Hydrocephalus
What happens with hydrocephalus?
Mismatch of CSF production and absorption, leading to increased intracranial CSF volume.
Most hydrocephalus is due to (2 things). With the exception of _____
Obstruction
Inability to absorb CSF
Exeption: Choroid Plexus Papillomas
Hydrocephalus is caused by (5 things)
Congenital Cause (like aqueductal stenosis) Hemorrhage Trauma Infection Tumors
Classification of Hydrocephalus is based on______ ______________
2 classifications
the ability of CSF to flow around spinal cord 1 Nonobstructive (communicating) 2 Obstructive (Noncommunicating)
Treatment of hydrocephalus (2)
- Treat cause (etiology)
2. Surgical placement of ventricular drain or V-P shunt
Most shunts carry CSF from ______ to _______
lateral ventricles to peritoneal cavity
Anesthetic plan with Hydrocephalus
Control ____ and relieve _______
Increased ICP increases risk for ______and ______
Avoid _______ (induction drug)
Avoid _________(ventilation)
Risk of ____ during placement of distal end of VP shunt
Control ICP and relieve obstruction
Increased ICP increases risk for vomiting and aspiration
Avoid Ketamine
Avoid Hyperventilation
Risk of VAE during placement of distal end of VP shunt
Mannitol is used to treat i_______
increased ICP
PO dose of midazolam and onset time
0.5-1mg/kg 10-20mins
IV dose of midazolam
0.05mg/kg
Art line- transduce at level of the
head
Contraindications to nasal intubations
choanal stenosis
possible basilar skull fracture
transsphenoidal procedures
sinusitis
Ensure free _____ movement during prone positioning
abdominal
VP shunts, temporal & parietal craniotomies will use what position
modified lateral
Posterior fossa & spinal cord surgery will use what position?
Prone
What position may be used in morbidly obese
Sitting
2x MAC of isoflurane can cause
isoelectric EEG
Volitile agents and vasodilators ___ CBF and ICP
increase
Fentanyl dosage- loading and maintenance.
5-10 mcg/kg with 2-5mcg/kg/hr for maintenance
Most blood loss begins at the ____ of neurosurgery
beginining
VAE risk is greatest in the ____ position
sitting
VAE Sx is sudden decrease in
ETCO2
What is the most specific method to detect VAE
Echo
VAE- use precordial dopper to monitor ___ sounds
RH
VAE- The larger the press gradient between ______ site and ______ the greater the risk for air embolism
The larger the press gradient between operative site heart, the greater the risk for air embolism
Put these in order from most sensitive to least sensitive for detection of air embolisms. ECG Systemic Blood Pressure ECHO ETCO2 ET-Nitrogen Respiratory Pattern Esophageal Stethoscope Right Atrial Pressure Precordial Doppler
Precordial Doppler Echo ET-Nitrogen ETCO2 RAP SBP Esophageal Stethoscope Respiratory Pattern ECG
ETCO2 will _____ after VAE
Decrease
Treatment for VAE- To prevent entrainment of air
Flood Field with Saline Bone Wax to exposed bone edges D/C N20 T-Burg Occude IJV, but don't occude carotid PEEP to Increase CVP Aspiration of air from CVP line- rarely works
Emergence from neurosurgical anesthesia- avoid ___ to avoid _____ ICP.
Also give Lidocaine ______mg/kg to help suppress____
vomiting
increased
1.0-1.5mg/kg
coughing
Dose for Labetelol in adolescents
____ with the use of esmolol in infants d/t _____
0.1-0.4mg/kg IV q 5-10 mins
Caution- HR dependent from CO
Do you want to deep extubate neurosurgery patients?
Nope- Adequate spontaneous ventilation, oxygenation and wakefulness required before extubation
