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FRCA & FICM > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is the usual abnormality in Down’s syndrome and how would you test for it?

A

Trisomy 21

Antenatal - amniocentesis & chorionic villous sampling
Postnatal - genetic testing

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2
Q

What are some features of Down’s syndrome?

A 
Small mouth
Big tongue
Flat occiput
Epicanthic folds
Upward slanting palpebral fissures
Small ears
Single palmar crease
Obesity
Short stature
Short neck
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3
Q

What congenital abnormalities are associated with Down’s syndrome?

A 
Congenital heart disease - Tetralogy of Fallot, ASD, VSD, AVSD, PDA
Subglottic stenosis
Duodenal atresia
Hirschprung’s disease
Pyloric stenosis
Meckel’s diverticula
Imperforate anus
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4
Q

What haematological malignancy has a higher incidence in Down’s syndrome?

A

AML

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5
Q

What are 2 common spinal abnormalities in Down’s?

A

Atlanto-axial instability

Cervical spondylosis

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6
Q

What features of Down’s syndrome are relevant to the anaesthetist?

A 
Craniofacial abnormalities
OSA
Small mouth
Macroglossia
Micrognathia
Short neck
Adenotonsillar hypertrophy
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7
Q

How do you treat a cyanotic spell from ToF?

A

Administer O2
Console child in knee-chest position
Correct hypoglycaemia/hypothermia/arrhythmia

Anything that increases SVR and corrects hypoxia/acidaemia
Opioids/ketamine/midazolam - decrease stress/hypercapnoea; may cause decreased SVR

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8
Q

What is the physiology behind a cyanotic spell in ToF?

A

Decreased SVR or increased PVR
R to L shunt through VSD
Decreased PaO2/increased PaCO2/decreased pH
Tachypnoea
Increased negative intrathoracic pressure
Increased venous return
Increased R to L shunt

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9
Q

What is the circulating volume of a neonate?

A

85-90ml/kg

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10
Q

What is the total body water percentage of a neonate?

A

75-80% water (with proportionally more ECF than adults)
GFR is relatively low - caution with renally excreted drugs

Adults = 60-65% water

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11
Q

What is the acronym for paediatric critical care transfers?

A 
ACCEPT:
A - Assessment
C - Control
C - Communication
E - Evaluation
P - Preparation & Packaging
T - Transportation
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12
Q

What are the RESPIRATORY differences between a neonate and an adult?

A

Diaphragmatic ventilation
Diaphragm easily splinted by organs
Lower FRC
Rate dependent minute ventilation, unable to increase Vt
Respiratory muscles easily fatigued - Type I fibres
Lower number of alveoli
Closing volume > FRC so greater risk of airway collapse

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13
Q

What are the CARDIOVASCULAR differences between a neonate and an adult?

A 
CO is rate dependent
Fixed SV
Less compliant myocardium
Dominant parasympathetic tone
Higher blood volume per kg
Transitional circulation
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14
Q

Outline the pathophysiology of laryngospasm

A
  • Stimulus of vocal cords during inadequate anaesthesia
  • Afferent limb: sensory fibres from INTERNAL branch of SUPERIOR laryngeal nerve to vagus
  • Efferent limb: motor response from RECURRENT laryngeal nerve from vagus nerve
  • 3 intrinsic muscles - lateral cricoarytenoids, thyroarytenoids and cricoarytenoids stimulated
  • Adduction of cords
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15
Q

What are the causes of seizures in children?

A 
Epilepsy
Hypoglycaemia
Intracranial pathology - tumour, meningitis, haemorrhage
Non-accidental injury
Poisoning
Fever (in 6 months-6years old)
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16
Q

What are the features of an innocent murmur in a child?

A

Soft
Early systolic
Varies with position
No abnormal signs/symptoms/normal milestones achieved

17
Q

What are the anaesthetic considerations for pyloric stenosis surgery/patients?

A
  • Medical emergency (not surgical)
  • Correction of volume deficit, electrolyte and acid-base abnormalities with chloride containing fluid (e.g. 20ml/kg 0.9% NaCl followed by 5% Dextrose with 20mmol KCl at 1-1.5 x maintenance)
  • Require adequate UO and normal Cl-/HCO3/K+ prior to surgery
  • Require ETT (aspiration risk)
  • Orogastric tube and aspiration prior to induction of anaesthesia
  • Avoid opioid (risk of apnoea, CSF takes time to catch up to plasma levels)
  • Extubate awake in lateral position
18
Q

What is the presenting feature of pyloric stenosis?

A

Hypokalaemic, hypochloraemic metabolic alkalosis

Key to reversing this is chloride and volume
Only when chloride is given can the kidney excrete enough bicarbonate to correct the alkalosis

19
Q

What determines fetal oxygenation in utero?

A

—Delivery of O2 to the placenta - uteroplacental blood flow and maternal O2 content

—Fetal O2 carrying capacity (high Hb at birth ~180)

—Transfer of O2 across placenta:

  • O2 gradient
  • Higher O2 binding capacity of HbF
  • Double Bohr effect (CO2 shifting OHDC to the right in mother and left in fetus)
20
Q

What block could you perform for circumcision?

A

Caudal

Dorsal penile nerve block

21
Q

Describe a dorsal penile nerve block

A

Dorsal Nerve of Penis is from Pudendal nerve (S2-4)
Used for circumcision, hypospadias etc
Performed between pubic symphisis and corpora cavernosa

Dose = 1ml 0.5% levobupivacaine each side plus 0.1ml/kg up to 10ml

22
Q

Describe the anatomy and technique to perform a caudal epidural block for postoperative pain relief in a 3 year old. What volume and conc of agents will be required?

A 
Sacral hiatus identified using the post.inf.iliac spines
Pop through sacrococcygeal membrane
Flatten off needle
Armitage formula:
—0.5ml/kg for sacral block
—1ml/kg for T10 block
—1.25ml/kg for mid thoracic block
23
Q

Where does the spinal cord end in children?

A

Dural sac ends at S3/4 in neonate

Spinal cord ends at L3 in neonates/infants

24
Q

How do you calculate fluid replacement in the dehydrated child?

A

Fluid replacement = weight x % dehydration x 10

25
Q

What are your obligations when suspecting child abuse or non-accidental injury/NAI?

A

Act in the child’s best interests
Be aware of the child’s right to protection
Respect confidentiality
Contact paediatrician
Be aware of local child protection mechanisms
Be aware of parent’s rights

FRCA & FICM (9 decks)

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