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Pediatric Anesthesia > Orthopedic Surgery > Flashcards

Orthopedic Surgery Flashcards

1
Q

Anesthesia Mngt issues associated with orthopedic procedures?

A 
Airway
Positioning 
Blood/Fluid Loss 
Temperature Conservation 
*Post-op pain
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2
Q

How is Congenital dislocation of the hip caused?

A

Prolonged displacement of the fetal femoral head in from the acetabulum resulting in posterior dislocation during hip flexion

-Severity ranges fro joint laxity to irreducible displacement

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3
Q

What is the treatment for congenital dislocation of the hip ? (CHD)

A
  • Pavlick Harness

- Fluoroscopy guided closed reduction and spica casting

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4
Q

T/F: the procedure for CHD is long and painful?

A

FALSE

Short and not painful

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5
Q

What is the greatest concern during CHD repair?

A

LOSS OF AIRWAY

  • IH via mask, LMA, ETT
  • Pt lifted from OR table to the spica casting frae then back to OR table
  • Disconnect circuit during position changes, ( remember to DC N2) prior to circuit disconnect )
  • Monitor breath sounds continuously
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6
Q

What is another big concern during CHD surgery?

A

Laryngospasm

A lot of movement, pt must be in STAGE III to prevent this, strict attention to securing the device so it does not becomes dislodged during position changes

  • Easiest is to use ETT
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7
Q

Congenital Clubfoot, a structural deformity- shortened medial tendons of the lower leg, Achilles tendon- what was does the foot point?

A

Downward and inward

Plantar and inversion

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8
Q

What is the treatment for Congenital club foot?

A
  • Manipulation and casting

- Surgical Correction and casting at 3-6 months

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9
Q

What are our options for anes. mngt during congenital clubfoot?

A

General and Regional

  • IH and then caudual injection with bupivacaine 0.25% 1ml/kg
  • Analgesia for 4-6 hours, decreases IHA requirement
  • IV opioids instead of caudal
  • -Fentanyl 2-5 mcg/kg
  • -MSO4 0.1 mg/kg
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10
Q

Do we want to use an ETT or maintain SV during congenital club foot repair?

A

ETT- cnt monitor breath sounds

  • Tourniquets are utilized
  • Position and padding up upper extremities
  • Intraop glucose monitoring and USE of glucose containing solution
  • Temperature conservation

*Usually have sx 3-6 months of age

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11
Q

What is osteogenesis Imperfects?

A

Defect of collagen production resulting in abnormal bones, ligaments, teeth, sclera

**Pts suffer fractures after innocuous contact or trauma

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12
Q

What are clinical presentations of Osteogenesis Imperfecta?

A
  • Bowing of long bones and kyphoscoliosis
  • Ostosclerosis and deafness ( bones in inner ear don’t vibrate )
  • Hypermetabolic-NOT MH
  • Platelet abnormalities and decreased Factor VIII levels in 30%
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13
Q

Anesthetic Management of OI?

A
  • *VITAL gentle manipulation of the C-spine and airway
  • -Atlantooccipital instability
  • -Cervical and mandibular fxs occur easily
  • -Airway cartilages and teeth are easily damaged
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14
Q

How do you management a normal vs difficult airway in its with OI?

A

Normal-routine IH or IV induction and intubation

Difficult: Awake fiberoptic

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15
Q

When do you give muscle relaxants in pts with OI?

A

Only AFTER adequate mask ventilation is established

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16
Q

What medications can we give for analgesia in OI?

A

Fentanyl 2-5 mcg/kg

MSO4 0.1 mg/kg

17
Q

Special considerations on anes. mango with pts who have OI?

A
  • Meticulous attention to positioning and padding of extremities
  • Avoid aggressive heat conservation measures and anti-muscarinics - signs like MH
  • Tourniquets are utilized
  • Succinylcholine induced fasciculations can cause fractures
18
Q

T/F: Cerebral Palsy ( CP) is evolving encephalopathy or any progressive central motor deficit r/t hypoxic or anoxic cerebral damage in the perinatal period?

A

FALSE

STATIC encephalopathy
NONprogressive

19
Q

What is the etiology of CP?

A 
Prematurity 
Birth Trauma
Hypoglycemia 
Intrauterine and neonatal infections 
Congenital vascular malformations
20
Q

What other diseases is CP associated with?

A

Mental Retardation
Seizures Disorders
Abnormalities of Vision, Speech, hearing, behavior and cognition

21
Q

What is the clinical presentation on CP?

A

Skeletal muscle spasticity and contractures

  • Impairment of laryngeal and pharyngeal reflexes- GERD, aspiration
  • Poor dental hygiene
22
Q

How do we management CP patients peri-operatively ?

A
  • Mod-sev airway ETT r/t predisposition to aspiration
  • Pre - medicate individualized
  • -Intra Nassal Midazolam 0.2-0.3 mg/kg
  • -Intra muscular ketamine 5-10 mg/kg
  • -SCh does NOT produce exaggerated K release
  • Response to NDNMB normal
  • Opioids are okay but caution with impaired alertness or airway reflexes
  • Caudal decrease IHA requirement and provides post op analgesia
23
Q

What are disorders and drug interactions we need to be aware of with patients and CP?

A

Seizure Disorder:

  • Phenobarbital, phenytoin, carbamazepine - TAKE day of procedure
  • Phenobarbital- hepatic enzyme INDUCER

Spasticity:

  • Dantrolene
  • Baclofen
24
Q

Why are fractures common in this population?

A

Trauma

-Evaluate for injury to c-spine and other organ systems

25
Q

What are our considerations in surgical repairs of fxs?

A

Urgent/Emergent: vascular compromise, large hematoma, hypotension

Delayed stabilize and admit

26
Q

Anes. mngt for fxs?

A
  • RSI and ETT for ED/Urgent/Elective repair
  • Analgesia - IV opioids/caudal
  • Have blood product available
  • Temperature Conservation
27
Q

What is Myelodysplasia?

A

Congenital failure of the middle or caudal end of the neural tube to close

28
Q

What does Myelodysplasia result in?

A

Spina Bifida
Meningocele
Myelomeningocele

Review Slide 25

29
Q

What is the clinical presentation in meningocele ?

A
  • Neural function intact
  • Spinal cord is tethered by sacral nerve roots
  • In not repaired, results in orthopedic and or urologic symptoms
30
Q

What are myelomeningocele signs and symptoms?

A
  • Varying degrees of sensory and motor deficits
  • Dilation of upper urinary tract
  • Spasticity
  • Scoliosis
31
Q

When do we repair myelodisplasia?

A

Surgical repair on first day of life

-Lack of skin covering defect, prone to infection and sepsis

32
Q

How to we manage myelodysplasia peri operatively ?

A
  • Routine induction/standard agents
  • ETT with LATERAL decubitus position or SUPINE supported on towels or a donut to avoid putting pressure on the sac
  • Use of neurometric monitoring ( avoid NDNMBs initially)
  • Careful pre-op assessment of intravascular volume- potential for hypovolemia due to seepage of fluid from sac
  • Blood loss is not extensive
  • Temperature conservation measures
33
Q

Scolliosis

A

An entire brainscape on one of the other ones we have :)

Pediatric Anesthesia (3 decks)

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