Lecture 3 (Part 2)-Peds Ortho Surgeries Flashcards
Congenital dislocation of the hip—cause = prolonged displacement of the fetal ___ head from the acetabulum, resulting in posterior dislocation during hip flexion
Fetal femoral head
Severity of congenital dislocation of the hip ranges from joint ___ to ___ displacement
Joint laxity to irreducible displacement
Treatment of congenital dislocation of hip = ___ harness; fluoroscopy guided closed reduction and ___ casting
Pavlick harness; spica casting
Congenital dislocation of hip is common in ___ deliveries
Breech
Congenital dislocation of hip could lead to degenerative hip ___ if missed
Arthritis
Sign of congenital dislocation of hip = ___ click as the femoral head moves in and out of the acetabulum
Ortolani click
Pavlick harness prevents ___ and ___ of hip joint while allowing some slight movement in the “safe zone”
Prevents extension and adduction of hip joint
Anesthetic management for congenital hip dislocation—greatest concern = loss of ___ because patient will be lifted from the OR table to the spica casting frame and then back to the OR table
Airway
Anesthetic management for congenital hip dislocation—___ anesthetic maintained via mask, LMA, ETT; patient must be kept ___ (stage ___) so that manipulation does not produce ___
Inhalation anesthetic; patient must be kept deep (stage III) so that manipulation does not produce laryngospasm
Congenital hip dislocation—make sure airway device is ___ so that it does not become dislodged during position changes; disconnect ___ during position changes; d/c ___ prior to circuit disconnect
Make sure airway device is secured so that it does not become dislodged during position changes; disconnect circuit during position changes; d/c nitrous prior to circuit disconnect
What condition is this describing?—structural deformity—shortened medial tendons of the lower leg, shortened Achilles’ tendon; foot pointed downward, rotated inward
Congenital clubfoot
Congenital clubfoot = foot pointed ___, rotated ___
Foot pointed downward, rotated inward
Treatment of congenital clubfoot = manipulation and casting done at ___-___ months of age
Manipulation and casting done at 3-6 months of age
Anesthetic management for congenital clubfoot = general + regional—___ anesthetic and then one shot caudal with ___—provides analgesia for ___-___ hours, ___ (increases/decreases) inhaled anesthetic requirement
General + regional—inhaled anesthetic and then one shot caudal with bupivicaine 0.25% 1 ml/kg—provides analgesia for 4-6 hours, decreases inhaled anesthetic requirement
Congenital clubfoot—can use ___ instead of caudal
IV opioids
Fentanyl 2-5 mcg/kg
Mag sulfate 0.1 mg/kg
Patients with congenital clubfoot have immense post-op pain—consider consulting pain team for epidural catheter—T/F?
True
Anesthetic management for congenital clubfoot—___ are utilized; stabilization of ___, continuous monitoring of breath sounds; positioning and padding of ___ extremities (position can sometimes be prone); intraoperative ___ monitoring and use of ___ containing solution (procedure can take 4 hours if bilateral); temperature ___
Tourniquets are utilized; stabilization of ETT, continuous monitoring of breath sounds; positioning and padding of upper extremities; intraoperative glucose monitoring and use of glucose containing solution; temperature conservation
Congenital clubfoot surgery is usually done at ___-___ months
3-6 months
What condition is this describing?—defect of collagen production, resulting in abnormal bones, ligaments, teeth, and sclera; patients suffer fractures after innocuous [unharmful] contact or trauma
Osteogenesis imperfecta
In osteogenesis imperfecta, ___ in the bone don’t work well
Fibroblasts
OI clinical presentation—___ of long bones and kypho___; oto___ and deafness; ___metabolic (not MH); ___ abnormalities and decreased Factor ___ levels in 30%
Bowing of long bones and kyphoscoliosis; otosclerosis and deafness; Hypermetabolic (not MH); platelet abnormalities and decreased factor VIII levels in 30%
OI—the normal excessive prevention of hypothermia should be tempered because these patients have a Hypermetabolic state and their temps may rise easily (can be mistaken for MH but is just a Hypermetabolic state)—T/F?
True
Bleeding d/t platelet/factor VIII abnormalities is rare in those with osteogenesis imperfecta—T/F?
True even though 30% of patients with OI have these abnormalities
OI anesthetic management—gentle manipulation of the C-spine and airway is vital—patients will have atlantooccipital ___; cervical and mandibular fractures occur ___; airway cartilages and teeth are easily ___
Patients will have atlantooccipital instability; cervical and mandibular fractures occur easily; airway cartilages and teeth are easily damaged
OI anesthetic management—normal airway = routine ___ or ___ induction and intubation
Routine inhalation or IV induction and intubation
OI anesthetic management—difficult airway = ___ intubation
Awake fiber optic
OI anesthetic management—give muscle relaxants only after adequate ___ is established
Adequate mask ventilation
Analgesia for OI =
IV opioids
Fentanyl 2-5 mcg/kg
Mag sulfate 0.1 mg/kg
OI—applying a tourniquet cannot cause a fracture—T/F?
False—tourniquet application can cause fractures in patients with OI
OI—consider using a ___ laryngoscope to decrease the need for excessive extension of neck
Video laryngoscope
OI—consider ___ for pain management
Peripheral nerve blocks
OI anesthetic management—pay meticulous attention to ___ and ___ of the extremities; avoid aggressive ___ measures and anti-___ (because these patients are Hypermetabolic); ___ are utilized; ___-induced fasciculations can cause fractures
Pay meticulous attention to positioning and padding of the extremities; avoid aggressive heat conservation measures and anti-muscarinics; tourniquets are utilized; succinylcholine-induced fasciculations can cause fractures
What disorder is this describing?—static encephalopathy, or any non progressive central motor deficit related to hypoxic or anoxic cerebral damage in the perinatal period; etiology = prematurity, birth trauma, hypoglycemia, intrauterine and neonatal infections, congenital vascular malformations
Cerebral palsy
CP clinical presentation—associated with mental ___; ___ disorders; abnormalities of vision, speech, hearing, behavior, and cognition
Associated with mental retardation; seizure disorders; abnormalities of vision, speech, hearing, behavior, and cognition
CP clinical presentation—skeletal muscle ___ and ___tures; impairment of ___ and ___ reflexes, leading to ___ and ___; poor dental ___
Skeletal muscle spasticity and contracture; impairment of laryngeal and pharyngeal reflexes, leading to GERD, and aspiration; poor dental hygiene
CP—all anesthetic techniques and agents have been used safely in patients with CP—T/F?
True
Moderate to severe CP airway management should involve intubation r/t predisposition to ___
Predisposition to aspiration
