Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FRCA Final > Paediatric anaesthesia > Flashcards

Paediatric anaesthesia Flashcards

1
Q

Preterm

A

< 37 weeks post conceptual age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Low birth weight

A

Less than 2.5kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Very low birth weight

A

Less than 1.5kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Extremely low birth weight

A

Less than 1Kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infant

A

1 month - 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which studies are the neonatal survival rates derived from?

A

EPICure and EPICure 2 Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the morbidity and mortality for < 23 weeks

A

Negligible survival. Appropriate to not attempt resuscitation as standard.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the morbidity and mortality for 23 - 23+6?

A

80% mortality 54% survivors have moderate to severe disability Reasonable to not attempt resuscitation but decision made with family

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the morbidity and mortality for 24 - 24+6?

A

66% Mortality Half remaining have moderate to severe disability Resuscitation is generally considered appropriate unless there are other antenatally diagnosed conditions that would further impair survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the morbidity and mortality for > 25 weeks?

A

33% Mortality Resuscitate as standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When does surfactant secretion begin?

A

24-26th week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does alveolar development begin?

A

From 32nd week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the cut off ages for 24 hour postoperative apnoea monitoring in neonates?

A

Up to 60th PC week if born preterm Up to 44th PC week if born term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How commonly is a patent ductus arteriosus seen in preterm neonates?

A

Up to 50% of extreme preterms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the physiological complications of a PDA

A

Excessive pulmonary blood flow Low systemic pressures Myocardial failure Inability to wean from mechanical ventilation Sequela of low DBP e.g. NEC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List cardiorespiratory complications of ex-premature neonates

A

Bronchopulmonary dysplasia Tracheomalacia (from long term ETT placement) Subpglottic stenosis Persistent pulmonary hypertension of the newborn (PPHN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Neonate

A

Less than 1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Paediatric defibrillation energy

A

4 J/Kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Paediatric cardiac arrest adrenaline dose

A

10 mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Infant estimated weight

A

(0.5 X Months) + 4 in Kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Child weight estimate

A

weight in kg = 2 x (age in years + 4)

e.g. a 5 y/o = 18 Kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Uncuffed tube size

A

(Age / 4) + 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Cuffed tube size

A

(Age / 4) + 3.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Oral ETT length

A

(Age / 2) + 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Nasal ETT length

A

(Age / 2) + 15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

LMA size for less than 5 Kg

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

LMA size for 5 - 10 Kg

A

1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

LMA size for 10 - 20 Kg

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

LMA size for 20 - 30 Kg

A

2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

LMA size for 30 - 50 Kg

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Normal obs for infant

A

RR 30 - 40 HR 110 - 160 SBP 70 - 90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Normal obs for child 1 - 3

A
  • RR 25 - 35
  • HR 100 - 150
  • SBP 80 - 95
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Normal obs for child 3 - 6

A
  • RR 25 - 30
  • HR 95 - 140
  • SBP 80 - 100
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Normal obs for child 6 - 13

A
  • RR 20 - 25
  • HR 80 - 120
  • SBP 90 - 110
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Normal obs for child 13 - 17

A
  • RR 15 - 20
  • HR 60 - 100
  • SBP 100 - 120
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Propofol dose

A

1 - 4 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Thiopentone dose

A

4 - 6 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Ketamine dose

A

2 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Fentanyl dose

A

1 - 2 mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Morphine dose

A

0.1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Alfentanyl dose

A

30 - 50 mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Paracetamol dose

A

15 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Ibuprofen dose

A

5 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Codeine dose

A

1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Atracurium dose

A

0.5 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Rocuronium dose

A

1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Suzamethonium dose

A

2 mg/kg

48
Q

Ondansetron dose

A

0.1 mg/kg

49
Q

Dexamethasone dose

A

0.1 mg/kg

50
Q

Neostigmine / Glycopyrrolate dose

A

1 amp per 50 kg

51
Q

Sugammadex dose

A

16 mg / kg immediate reversal

52
Q

Atropine dose

A

20 mcg/kg

53
Q

Adrenaline dose

A

10 mcg/kg

54
Q

Phenylephrine dose

A

1 mcg/kg

55
Q

Amiodarone dose

A

5 mg/kg

56
Q

Naloxone dose

A

100 mcg/kg (2mg in older than 5)

57
Q

Tranexaminc acid dose

A

15 mg/kg (max 1 g)

58
Q

Co-amoxiclav dose

A

30 mg/kg

59
Q

Cefuroxime dose

A

20 mg/kg

60
Q

Metronidazole dose

A

7.5 mg/kg

61
Q

Flucloxacillin dose

A

25 mg/kg

62
Q

Gentamicin dose

A

1 - 2 mg/kg

63
Q

Diclofenac dose

A

1 mg/kg

64
Q

Midazolam dose

A

0.1 mcg/kg

65
Q

Oromorph dose

A

200 - 400 mcg/kg

66
Q

Adenosine dose

A

100 mcg/kg then double (max 12g)

67
Q

Noradrenaline infusion

A

0.01 - 0.5 mcg/kg/min (start at 0.1)

68
Q

Adrenaline infusion

A

0.01 - 0/5 mcg/kg/min (start at 0.1)

69
Q

Morphine infusion

A

10 - 40 mcg/kg/hour (start at 20)

70
Q

Midazolam infusion

A

0.1 mg/kg/min

71
Q

Calculate SBP based on age

A

80 + (Age X 2)

72
Q

Define status epilepticus

A

Seizures lasting >30 mins or 2 or more seizures without recovery

73
Q

First line seizure management

A

Lorazepam 0.1 mg/kg IV Diazepam 0.5 mg/kg PR

74
Q

Second line seizure management

A

Phenytoin 15-20 mg/kg over 20 mins Phenobarbital 20 mg/kg if on phenytoin already

75
Q

Third line seizure management

A

GA Thio 4-5 mg/kg Midaz 0.1 mg/kg

76
Q

Common pitfalls in paediatric sedation

A

Inexperience Too much sedation (verbal endpoints different) Too little sedation Poor timing Non-fasting Dose errors Hyperactive delirium (e.g. katamine)

77
Q

Cause of cleft palate

A

Defective palatal growth and fusion in 1st trimester

78
Q

Incidence of pyloric stenosis

A

1:3-400 live births

79
Q

Pyloric stenosis male:female

A

85% Male

80
Q

Metabolic resuscitation goals for pyloric stenosis prior to theatre

A

Cl greater than 90 HCO3 = 24 Na = 135

81
Q

O2 consumption differences (Adult and Paed)

A

Paediatric: 6-8 ml/kg/min Adult: 4ml/kg/min

82
Q

Closing volume of lung

A

Within tidal breathing

83
Q

Level of the larynx

A

C4

84
Q

Narrowest part of paediatric airway

A

Cricoid ring

85
Q

Define laryngospasm

A

A variable upper airway obstruction secondary to partial or complete ADduction of the vocal cords. Due to a primitive reflex to protect the airway from aspiration. Large -ve pressures can cause pulmonary oedema

86
Q

Patient risk factors for laryngospasm

A
  • Increased secretions
  • Anxiety (i.e. increased sympathetic stimulation)
  • Younger age
  • URTI
  • GORD
  • Asthma
  • Smoking
  • Obseity / OSA
87
Q

Anaesthetic risk factors for laryngospasm

A
  • LMA use
  • Light planes of anaesthesia
  • Desflurane / Isoflurane
  • Airway manipulation
  • Inexperience of anaesthetist
88
Q

Surgical risk factors for laryngospasm

A
  • ENT surgery
  • Blood in airway
  • Poor surgical timing - pain at light plane
  • Hypospadias repair
89
Q

Treatment of laryngospasm

A
  • Remove trigger
  • Ensuring a clear larynx
  • Open airway
  • CPAP with 100% oxygen
  • Consider propfol 0.5mg/kg bolus
  • Consider suxamethonium 0.1-2 mg/kg
90
Q

Methods to prevent laryngospasm

A
  • Clear communication on surgery start
  • Avoid moving in light planes
  • Meticulus suctioning
  • Pharmacological
    • Mg 15 mg/kg
    • Lidocaine 1.5 mg/kg IV
    • Lidocaine 4% spray to cords
    • Atropine premed - presumably to dry secretions
91
Q

What is “viral croup?”

A
  • Laryngotracheobronchitis
  • Responsible for 80% of acute stridor in children
  • Usually 2° to parainfluenza, influenza A or B, respiratory syncytial virus or rhinovirus.
92
Q

Assessment priorites when returning to theatre with a bleeding tonsil

A
  • Evaluate blood loss (usually underestimated)
  • Ensure IV access
    • Send blood for x-match
    • Resuscitate
  • Review anaesthetic chart
    • Airway
    • Dentition / Loose teeth
  • Review pt haemodynamics: Cap refil, UO, HR, RR, differential temperature
  • Recent food
  • Stridor or breathing difficulty
  • Recent opiod analgesia
93
Q

Perioperative priorities when returning to theatre with a bleeding tonsil

A
  • Equipment
    • Selection of laryngoscope blades
    • Smaller than expected tracheal tubes
    • 2 suction catheters
  • Induced once the child is haemodynamically stable
  • PreO2 and RSI with slight head-down positioning
  • Consider left lateral if bleeding is excessive
  • Fluid resuscitation and transfusion continue intraoperatively as necessary
  • Following haemostasis, a large-bore OG to emply stomach
  • Extubate the child fully awake in the recovery position
  • After operation, monitor closely for any recurrence of bleeding.
94
Q

Methods to decrease PONV in bleeding tonsils

A
  • OG/NG and thorough suctioning
  • Suctioning of blood from pharynx
  • Dual antiemetics
    • 0.15 mg/kg IV Dex
    • 0.1 mg/kg IV ondansetron
  • Reduce BMV (stomach insuflation)
  • Recude opiate analgesia (LA by surgeons)
95
Q

What are the clinical features of viral croup?

A
  • Barking cough
  • Low-grade fever
  • Inspiratory stridor
  • Increased respiratory effort:
    • Fatigue
    • Hypoxia
    • Hypercarbia
96
Q

Give an example Croup Scoring system and appropraite actions.

A
  • Breath sounds: Normal, Harsh, Delayed
  • Stridor: None, Inspiratory, Biphasic
  • Cough: None, Horse, Bark
  • Recession/Flaring: None, Flaring, Subcostal
  • Cyanosis: None, in air, in 40% O2

​Score 0, 1, 2 in each category

  • 0-3 Mild
  • 4-6 Moderate - transfer to HDU
  • > 7 Severe - consider intubation
97
Q

Treatment options for Viral Croup

A
  • Humifified oxygen
  • Steroids
    • Dexamethasone 0.6 mg/kg IV/PO or
    • Beclomethasone 2 mg NEB
  • Nebulised Adrenaline
    • 0.5ml of 1/1000 (500mcg) diluted to 5 ml
    • Repeated 30-60 minutes as needed
  • Heliox
98
Q

Describe the proceedure for intubation for a child with Viral Croup

A
  • Escort child to theatres
  • Minimal monitoring so as to not upset child
  • Inhalational induction with sevoflurane in 100% O2
  • Maintain SV, apply CPAP via mapleson-F
  • Establish IV acces ASAP following induction
  • Intubate once pupils are small and central
  • Oral intubation preferred (quicker)
  • Be prepared with a number of smaller uncuffed tubes
  • Consider exchange for nasal ETT once stable
  • Maintain sedation
  • Secure lines (consider arm splint)
  • Extubate once a leak is demonstrated
99
Q

What is epiglotitis?

A

a life-threatening emergency caused by bacterial infection of the epiglottis, aryepiglottis, and arytenoids. Typically caused by Haemophilus influenzae type b (Hib), beta-haemolytic streptococci, staphylococci, or pneumococci. Vaccination against Hib has greatly reduced its incidence. Regardless, 10% of those with Hib epiglotitis had the vaccine.

100
Q

How can you clinically distinguish epiglotitis and croup?

A

Epiglottitis Differentiating Characteristics​

  • More Toxic appearance
  • Slightly older children (2–6 yrs)
  • Abrupt onset:
    • high fever
    • sore throat
    • dysphagia
    • stridor
    • drooling
  • Speech muffled/lost
  • Absence of cough
  • Classically forward sitting, open mouth with drooling
  • Unlikely to be relieved by adrenaline nebs
101
Q

Describe the proceedure for intubation for a child with Epiglotitis

A
  • Escort child to theatres
  • Minimal monitoring so as to not upset child
  • Inhalational induction with sevoflurane in 100% O2
  • Maintain SV, apply CPAP via mapleson-F
  • Have ENT standing by for immediate surgical airway
  • Establish IV acces ASAP following induction
  • Intubate once pupils are small and central
  • Oral intubation preferred (quicker)
  • Be prepared with a number of smaller uncuffed tubes
  • Consider exchange for nasal ETT once stable
  • Maintain sedation
  • Secure lines (consider arm splint)
  • Extubate once a leak is demonstrated
102
Q

What technique can you employ if you cannot visualise the airway during epiglotitis intubation?

A
  • Compress the chest slightly but suddenly
  • Bubbles appear at the laryngeal inlet
  • Intubate at the bubbles
103
Q

What is an appropriate dose of antibiotics for epiglotitis?

A
  • extended spectrum cephalosporin
  • e.g. ceftriaxone 80 mg/kg/day max 4 g/day
104
Q

What is bacterial tracheitis?

A

An uncommon bacterial infection of the trachea. Most commonly 2° to: Staphylococcus aureus, Haemophilus influenzae, streptococci or Neisseria spp. Since the Hib vaccine, this has taken over as the leading cause of infective upper airway obstruction in children.

105
Q

What are the clinical features of bacterial tracheitis?

A
  • Midway between viral croup and bacterial epiglotitis
  • URTI 48 hours preceeding
  • Sudden deterioration in condition (8-10 hrs)
  • High fever
  • Respiratory distress
  • Copious purulent secretions
  • No dysphasia or drooling
  • Child can usually lie flat
106
Q

You are about to intubate a case of bacterial tracheitis. Any extra proceedures necessary?

A
  • Inhalation induction and set up as for epiglotitis
  • Bronchoscope ready to remove pus/debris from airway proior to intubation
  • In extremis, intubation must go first, but immediate bronchoscopy and a tube change is very likely
107
Q

Antibiotic treatment in bacterial tracheitis?

A
  • Ceftriaxone
  • Consider vancomycin if MRSA suspected
108
Q

Describe the proceedure for administering caudal anaesthesia.

A
  • SLIMRAG
  • Left lateral position, knees drawn up to the chest
  • Landmarks:
    • Equilateral triangle formed between two posterior superior iliac spines and the cornua
    • Hiatus palbable between cornua
  • Needle introduced slightly cranial through the hiatus
  • A click is felt as the needle pierces the sacrococcygeal membrane
  • Aspirate to confirm the absence of blood/cerebrospinal fluid
  • Inject local anaesthetic while feeling for inadvertent subcutaneous injection
109
Q

What is the armitage dosing guide for caudal anaesthesia?

A
  • 0.5 ml/kg, 0.25% bupivacaine (sacro-lumbar block)
  • 1 ml/kg, 0.25% bupivacaine (upper abdominal block)
  • 1.2 ml/kg, 0.25% bupivacaine (mid-thoracic block)
110
Q

A rough rule to work out a childs SBP

A

systolic blood pressure = (age in years x 2) + 80.

111
Q

Calculate a childs blood volume

A
  • 80 ml/kg up to 2 years
  • 70 ml/kg thereafter
112
Q

Adrenaline in anaphylaxis dose

A
  • >12 years - 500 mcg IM
  • 6-12 years - 300 mcg IM
  • <6 years - 150 mcg IM
  • Can use IV at doses of 1mcg/kg, but IM is the resus council recommended route
113
Q

Cause, incidence, gender distribution and presentation of cleft palate?

A
  • Environmental/genetic factors
  • early failure of fusion of embryoinic palate
    • Typically 1st trimester
  • 1 in 1000 LB
  • Male preponderance
  • Left preponderance
114
Q

Cleft lip/palate disease assocations

A
  • Pierre Roban
  • Treacher Collins
  • Downs
  • EtoH fetal syndrome
115
Q

What is the incidence of MH in children?

A

1 in 15,000

116
Q

Why are neonates prone to respiratory fatigue?

A

disproportionately fewer Type 1 (oxidative) slow muscle fibres in the diaphragm

FRCA Final (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions