Paeds Flashcards
Syndromes:
Apert
AD
cardiac / renal
“C’s”
premature closure of cranial sutures
midface hypoplasia
choanal atresia
cleft palate
C5/6 fusion
syndactyly
II due to megalocephaly/hypoplasia of white matter/corpsum collosum agenesis
Key
1. OSA 50% –> UAW –> routine maneouver
craig sims
craniosynostosis - usual surgery
Syndomes:
Beckwith-Wiedemann
Macroglossia
Visceromegaly - big heart etc
* Hypoglycaemia
Omphalocoele
Key
1. Glucose when fasting
Beckwith-Wiedemann syndrome (BWS) presents unique perioperative challenges due to its hallmark features. Here’s a mnemonic to simplify key considerations, focusing on airway management, tumor risks, and pharmacological adjustments:
B.E.C.K.W.I.T.H
Big tongue (macroglossia): Anticipate difficult airway; use video laryngoscopy or fiberoptic intubation[1][5].
Euglycemia: Monitor glucose pre-/intraoperatively due to neonatal hypoglycemia risk[1][3].
Cancer surveillance: Check for Wilms tumor (abdominal ultrasound) and hepatoblastoma (AFP levels)[3][9].
Kidney function: Avoid renally excreted neuromuscular blockers (e.g., pancuronium); use cisatracurium (Hoffman degradation)[3][6].
Watch hepatic metabolism: Prefer sevoflurane over hepatotoxic volatiles (e.g., halothane) due to hepatoblastoma risk[3][9].
Inspect for organomegaly: Gentle handling during abdominal procedures to avoid injury[1][5].
Think asymmetry (hemihyperplasia): Adjust positioning and IV access sites[1][5].
Hemodynamic stability: Assess for cardiomyopathy preoperatively; avoid myocardial depressants[9].
This mnemonic emphasizes proactive management of airway challenges, tumor-related precautions, and tailored pharmacologic choices to mitigate risks associated with BWS.
Citations:
[1] https://medlineplus.gov/genetics/condition/beckwith-wiedemann-syndrome/
[2] https://en.wikipedia.org/wiki/Beckwith%E2%80%93Wiedemann_syndrome
[3] https://www.eviq.org.au/cancer-genetics/paediatric/risk-management/3700-beckwith-wiedemann-syndrome-risk-management
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC2987155/
[5] https://www.chop.edu/conditions-diseases/beckwith-wiedemann-syndrome
[6] https://www.ncbi.nlm.nih.gov/books/NBK1394/
[7] https://www.childrenshospital.org/conditions/beckwith-wiedemann-syndrome
[8] https://rarediseases.org/rare-diseases/beckwith-wiedemann-syndrome/
[9] https://my.clevelandclinic.org/health/diseases/21993-beckwith-wiedemann-syndrome
Answer from Perplexity: pplx.ai/share
Syndromes:
CHARGE
Colobama of eye
Heart defects
choAnal atresia
R - develop delay
G - GU abnor
E - ear abnor
Key
1. Cardiac defect
2. Poor resp reserve
Syndrome:
DiGeorge
1:4000 microdeletion 22q11.2 chromosome deletion
~ cardiac disease
Key
1. Micrognathia
2. Cleft palate
3.
Syndrome
Cri-du-Chat
C - C
Cat cry / cardiac defect
Severe II
Hypotonia
Key
1. Micrognathia
2. Abn larynx
3. Cardiac defect
Syndrome
Prader-Willi
Chr 15
PWC OOHH - cardiac/obesity/OSA/hypot/hypog
Hypotonia
Hypogonad
II
erratic
short
MO***
Key
1. OSA
2. Cardiac
3. Difficult PIVC
4. Difficult to fast
Syndrome
Treacher Collins Syndrome
1st 2nd branchial arches
AB C - b arches collins
Key
1. Very diff airway
2. Abnom funnel shape larynx
3. LMA effective
4. AW more diff with age - mandible does not grow
- ## require trache
Conditions associated with airway problems
Pierre Robin
Treacher Collins
Goldenhar
Micrognathia
Retrognathia
goldenhar - Congenital heart disease - asymmetry treacher collins
PRS - cleft palate, tongue immobile due to small mandible
AW mx - nasopharyngeal (suture - tricky if cleft palate), jaw thrust, LMA, prone/lateral (displace tongue)
Syndrome
Down’s
Commonest - 1.6/1000
3/3/3/3
CNS
Impaired development
Atlantoaxial instability
Epilepsy
CVS
Congential cardiac defects - AVSD/TOF
Eisenmenger’s syndrome
*Bradycardia (autonomic dys)
Resp
Recurrent RTI –> O2 + PT
hypoventilation
Endo
Obesity
Hypothyroidism
GORD
Ex:
Large tongue
crowding mid facial feactures
narrow palate
micrognathia
short/broad neck
CVS/resp EX + IX
Hypotonia
Key:
1. Difficult BMV
2. Bradycardia —> consider pre-induction atropine + early attach ECG + 6% sevo/dial back sooner
3. Difficult PIVC
4. Avoid a2 agonist maybe - bradycardia (2microg/kg) - but faster
5. If intubate - CMAC
Pyloric stenosis
PAEDIATRICS – GI/Gen - Pyloromyotomy
[16A08] A six-week-old term baby weighing 4.0 kg requires pyloromyotomy for pyloric stenosis.
How would you assess the baby’s hydration status? (50%)
Detail and justify your resuscitation regimen. (50%)
1:350
80% male
4-6 weeks of age
hypochloraemic
alkalosis
dehydrate
never urgent –> resus
PERIOP:
- risk of asp due to GOO
- NGT
- RSI+cric if NG loss >2mL/kg/h
rectus sheath block if laparoscopic
remove NGT end of surg
Extubate awake
Risk of apnoea (worsened by alkalosis)
Resus and replace NG loss with NS 0.9%
a) Hydration status
5/10/15% body weight loss
5% - skin turg/CRT
10% (shock) - fontanelle/cool skin/oliguria
15% - ALOC/sbp down
b) Resus
- replace/resus - 10mL/kg
- maintain - 4/2/1
- ongoing loss - add K+
- K+ = 3mmol/kg/24h OR add 20mmol to 1L (20mmol/L KCl)
c) ongoing loss PRN
Think
1. NGT
2. Add K
3. Cl > 95, HCO3 <300, K>3.5
4. UO 1-2ml/kg/hr
Shock - give resus fluid stat
Dehydr - loss given over 24-48h
SSU + SAQ
Emergency drug doses
- Sux (IV/IM)
- Atropine
- Adrenaline (anaphylaxis/arrest)
- Adenosine
- Amiodarone
Shock
Cardioversion
Fasting
sux IM 4mg/kg
sux IV 1.5-2mg/kg
atropine 20microg/kg
adrenaline
1. anaphylaxis 10microg/kg
2. arrest 10/kg
3.*reduce to 1microg/kg in LAST
+ IM
150microg = <6yo
300 microg = 6-12yo
500 microg = 12yo+
q5min PRN lateral thigh
adenosine
100–>200–>300microg/kg
amiodarone
5mg/kg
Shock
arrest 4J/kg
other 1–>2–> 4Jg
1hr = CF
4hr = BM
6hr = Everything else - FM
https://www.anzca.edu.au/safety-advocacy/standards-of-practice/perioperative-anaphylaxis-management-guidel
Pros and cons of T piece
Pros:
1. Low resistance
2. valveless
3. lightweight
4. expiratory limb > Vt - prevent emtrainment of room air during SV
5. assess Vt
6. PEEP/CPAP by occluding bag
7. potential of assisted/controlled ventilation
8. Lung compliance
9.
Cons:
1. Up to 20kg, inefficient beyond
2. Scavenging is limited
3. FGF min 3L for most
4. FGF dependent of RR - high RR = high FGF
CMT
prejx
muscle atrophy - spinal/limb —> kypho
Key
1. RLD
2. Neuropathic pain
3. Avoid sux
4. inc sens to NDMB
cvs/resp/drugs/triggers
Charcot-Marie-Tooth (CMT) disease presents specific perioperative considerations, particularly regarding neuromuscular blockers and volatile agents. Here’s a mnemonic to remember key points: C.M.T. PAUSE
C - Check Respiratory Function
- Assess for respiratory muscle weakness, especially in advanced cases[4][7].
- Monitor for scoliosis-related restrictive lung disease[2][6].
M - Muscle Relaxant Caution
- Avoid succinylcholine due to risk of hyperkalemia from muscle denervation[7].
- Use reduced doses of non-depolarizing agents (e.g., rocuronium) as patients may be sensitive[7].
T - Temperature & Positioning
- Maintain normothermia (cold extremities common due to muscle atrophy)[2].
- Pad pressure points to prevent ulcers (sensory loss in feet/hands)[2][8].
P - Pain Management
- Avoid excessive opioids (neuropathic pain may require adjuncts like gabapentin)[4][8].
- Consider regional anesthesia cautiously (weigh risks of nerve injury)[8].
A - Anesthetic Choice
- Prefer TIVA (total intravenous anesthesia) over volatile agents to avoid theoretical exacerbation of neuropathy[7].
- If using volatiles, monitor for prolonged sedation (muscle weakness)[7].
U - Unusual Anatomy
- Anticipate foot/hand deformities (e.g., pes cavus, hammer toes) for IV access and positioning[1][4].
- Use soft padding and neutral positioning to prevent joint injury[2][6].
S - Sensory Precautions
- Inspect extremities post-op for unnoticed injuries (reduced pain/temperature sensation)[2][5].
E - Evaluate Post-Op Weakness
- Monitor for delayed respiratory depression or prolonged neuromuscular blockade[7].
This mnemonic highlights critical perioperative steps to mitigate risks in CMT patients, emphasizing neuromuscular blocker sensitivity, respiratory vigilance, and tailored anesthesia plans.
Citations:
[1] https://www.mayoclinic.org/diseases-conditions/charcot-marie-tooth-disease/symptoms-causes/syc-20350517
[2] https://www.mda.org/disease/charcot-marie-tooth/signs-and-symptoms
[3] https://www.sydney.edu.au/news-opinion/news/2017/07/17/first-effective-treatment-of-children-with-charcot-marie-tooth-d.html
[4] https://www.hopkinsmedicine.org/health/conditions-and-diseases/charcotmarietooth-disease
[5] https://medlineplus.gov/genetics/condition/charcot-marie-tooth-disease/
[6] https://www.mda.org/disease/charcot-marie-tooth
[7] https://www.ninds.nih.gov/health-information/disorders/charcot-marie-tooth-disease
[8] https://www.healthdirect.gov.au/charcot-marie-tooth-disease
[9] https://www.nhs.uk/conditions/charcot-marie-tooth-disease/symptoms/
[10] https://www.mayoclinic.org/diseases-conditions/charcot-marie-tooth-disease/diagnosis-treatment/drc-20350522
[11] https://www.cmtausa.org/understanding-cmt/what-is-cmt/
[12] https://www.nhs.uk/conditions/charcot-marie-tooth-disease/treatment/
[13] https://www.rch.org.au/neurology/patient_information/Charcot-Marie-Tooth_disease/
[14] https://www.mda.org/disease/charcot-marie-tooth/medical-management
[15] https://www.cmtausa.org/living-with-cmt/managing-cmt/medications/
[16] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/charcot-marie-tooth-disease-cmt
[17] https://www.ncbi.nlm.nih.gov/books/NBK562163/
[18] https://my.clevelandclinic.org/health/diseases/6009-charcot-marie-tooth-disease-cmt
[19] https://www.nhs.uk/conditions/charcot-marie-tooth-disease/
Answer from Perplexity: pplx.ai/share
Friedreich’s
AR
Skeletal muscle weakness
Key
1. Risk of RF
2. cardiac involvement
3. avoid sux - debility —> hyperK
4. inc sens to NMDB
Duchenne
Beckers
X-linked recessive
- lack of dystrophin (duchenne)
- partial lack (beckers)
Prox muscle wasting
CVS/RESP failure
Can be normal at birth, weakness before 8, WC by adolescence
Key:
1. DCM - negative inotropes…
2. RLD
3. risk of AIR (anaes induced rhabdo) - HALOGENATED
- absent
Myotonic dystrophy
Type 1: DMPK gene - birth
Type 2: CNBP - mild
CNS: bulbar —> aspiration
Key:
- Aspiration —>
Lung protective strategies
F: fluid mx
I: Intubate
P: pain
P: PT - pre/post
V: ventilation strategy
- avoid sux - generalised contractures from fasciculations
-
Myotonia congenita
AD chr 17
muscle hypertrophy
- resp - asspiration
Hyperkalamic periodic paralysis
Hypokalaemic periodic paralysis
Metabolic myopathies
Mitochondrial myopathies
loss of ATP product
Hurler’s
Muccopolysacchrides
Deposits - airway, muscle, skin, cardiac
Difficult intubate
LMA effective
Consider PICU if intubated
Syndrome
Williams
Sudden death
Supravalvular AS - tertiary only if elective
Marfans
DCM
Arrhythmmias AOurtic root dialtion
VATERYL
VACTERL
Tracheosohageal fistula
Renal - drug
Turners
Coartation aorta
Small jaw
renal
Noonan
PS
HOCM
Diff intub
Achondroplasia
OSA
Difficult PIVC
Premed
Osteogenesis
Gentle
Stickler’s
Boney
SUFE
Issue | Volatile Agents | Neuromuscular Blockers |
|———————|—————————|———————————–|
| Risk | ↑ IOP → retinal detachment[1][3] | Residual weakness → joint instability[2][3]Enhanced succinylcholine effect[5]PONV exacerbation[3] |
| Management | Use TIVA (propofol)[1][3] | 1. Avoid succinylcholine (risk of prolonged blockade)[5]2. Prefer short-acting non-depolarizers (e.g., rocuronium)[3]3. Mandatory nerve stimulator monitoring[3][7]4. Full reversal with sugammadex[2][3] |
Stickler syndrome presents unique perioperative challenges due to collagen defects affecting multiple systems. Here’s a mnemonic focusing on key considerations, particularly regarding volatile agents and neuromuscular blockers:
S.T.I.C.K.L.E.R. Mnemonic
S - Secure airway first
- Anticipate difficult intubation due to micrognathia, cleft palate, or Pierre Robin sequence[1][2][4]. Use fiberoptic intubation if needed.
T - TIVA over volatiles
- Avoid volatile agents (e.g., sevoflurane) to prevent intraocular pressure (IOP) spikes[6][10]. Opt for total intravenous anesthesia (TIVA) to protect against retinal detachment[6][10].
I - Intraocular pressure vigilance
- Monitor for glaucoma/retinal risks. Avoid supine positioning that increases venous pressure near the eyes[6][10].
C - Collagen fragility
- Handle tissues gently during intubation (risk of airway trauma)[2][4]. Use smaller endotracheal tubes.
K - Keep joints stabilized
- Hypermobility and arthritis require careful positioning to prevent dislocations[1][3][5]. Pad pressure points.
L - Limit neuromuscular blocker doses
- Use minimal neuromuscular blockade and ensure full reversal (e.g., sugammadex) to avoid post-op weakness exacerbating joint instability[3][5].
E - Evaluate for emergencies
- Pre-op retinal exam to rule of detachment[6][8]. Post-op, monitor for visual changes (sudden floaters/flashes = retinal emergency)[6].
R - Respiratory caution
- Post-op airway edema risk due to micrognathia[2][4]. Extubate fully awake.
Here’s the completed table section for neuromuscular blockers in Stickler syndrome, incorporating evidence from recent ophthalmic anesthesia research and connective tissue disorder guidelines:
Key additions based on evidence:
- Succinylcholine contraindication due to collagen defects potentially prolonging paralysis[5]
- Non-depolarizers preferred but require cautious dosing (1.2x ED95 for intubation)[3]
- PONV risk increases with incomplete reversal - sugammadex shown to reduce post-op emesis by 40% vs neostigmine[3]
- Airway considerations: avoid NMBAs if difficult ventilation anticipated (cleft palate variants)[7]
This update reflects current strabismus anesthesia protocols and connective tissue disorder precautions[3][5][7].
Citations:
[1] https://academic.oup.com/bjaed/article/8/1/5/277663
[2] https://www.orphananesthesia.eu/en/rare-diseases/published-guidelines/stickler-syndrome/298-stickler-syndrome/file.html
[3] https://journals.sagepub.com/doi/10.1177/0310057X20937710
[4] https://www.ncbi.nlm.nih.gov/books/NBK576442/
[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC6778961/
[6] https://mhmedical.com/content.aspx?aid=58082380
[7] https://academic.oup.com/bjaed/article/5/3/76/278691
Answer from Perplexity: pplx.ai/share
Septic child
Recognition:
1. Proven infection +
2 of
a) <36.5 or >38.5
b) tachy
c) altered ms
d) prolonged cap refill (>2s)
e) immunocompromise
f) hypotension
Warm shock:
vasodilation
bounding peripheral pulse
wide pp
Immediate:
1) ABC
2) fluid bolus
3) DEFG - 2mL/kg 10% gluc
4) adren 0.1-0.5 microg/kg/min
5) abx: cefotaxime 50 microg/kg/min
Inhaled FB
Bronch
Acute AW obstruction
CXR - hyperinflation
Induction:
- 100% O2 with sevo
- topical to VC
- drying agent
– glyco 5microg/kg IV
– atro 10microg/kg IV
FM or LMA
Upper AW - maintain SV
lower AW - ippv + relaxant
Post op:
- DEX if traumatic
PRN:
1. physio
2. bronchodilator
3. abx
Gestation
Term: 37+
Preterm: 32-37, 28-32
Ex-prem: 22-28
Caudal block
Achieve:
Surgical anaesthesia for BELOW the umbilicus
sacral epidural space
sacral canal
1. terminal dural sac
2. cauda equina
3. filum terminale
4. venous plexus
5. epidural fat
Caudal space:
Define: position/palp/punc
Pos: left lat
Palp: triange - PSISx2 and sacral cornu - sacral hiatus between 2 cornu
Location: S4 - sacral hiatus
Access:
PAEDIATRICS – CVS – Praecordial murmur
[16B15] A 2yo boy scheduled for hypospadias repair is found to have a praecordial murmur. Justify decision to proceed. (also 11A09, 08A11)
(74.3%) The borderline candidate should demonstrate they can differentiate b/w a benign and pathological murmur and comment on
potential cardiac sequelae. Inappropriate cardiology review or investigations without consideration of a benign murmur may be marked down.
Benign vs pathological
70% infant has murmur - most are innocent
Innocent murmur
- Still’s
- pulm flow
- venous hum (flow in systemic great veins)
continuous, disappear when supine
HX (likely pathological)
1. Age - ** < 12mo **
2. chromosome abn
3. Cardiac -
4. Resp - cough, wheeze,
5. FTT
6. Recurrent infection
EX (pathological)
1. Loud/harsh murmur
2. Timing - pansystolic/diastolic vs early/ejection systolic
IX
*ECG
Referral when
1. <1yo
2. Features of path murmur
7s of innocent murmur
Short
sweet small soft systolic small single
Univentricular circulation
Aims
Preserve HPV
Pathophys: Inc PVR —> inc PAP —> blood shunt via PDA to aorta
- Forward flow - SVR maintain/minimuse
- Min PVR
- Max CO
- inotropy
- ensure left side goes to right side
- run dilute adrenaline - Fluids +++ (resuscitate) —> more fluid
- Spont vent - less PVR, short I time
- Positioning - foot > RA (lower limb ~ 20-30% circulation)
Obtain IV access + IAL +/- CVL (avoid neck and upper arm —> FEMORAL)
10-20mL/kg fluid prior induction
PAEDIATRICS - Autism
[21B11] A 14yo with severe autism is rescheduled for dental surgery. The operation was previously abandoned due to their poor cooperation with the team.
Justify your perioperative management plan.
Key
1. Recent exp
2. Anticipating
3. Priorities
4. Plan pre/intra/post
Anticipate CCPP
1. Comm
2. Coop
3. Postop del
4. Pain mx
Priorities
- ID from last exp
- Calm
- Low stim
- safe d/c
Pre
Min waiting time
Intra
- streamline
- premed
- OT
Postop
- post op distress ?cause
- FLACC score
- Hyration
PAEDIATRICS – CNS/Neuro – Craniotomy/MH
[20A01] You are asked to anaesthetise a two-year-old child for an eight-hour craniotomy. The child is susceptible to developing malignant hyperthermia.
a. Outline your strategies for obtaining intravenous access in this child.(50%)
b. Discuss the issues of using a total intravenous anaesthetic technique in this situation.(50%)
a) PIVC strategy in VA CI pt
1. Environ
- parent present
- calm and quiet room
- distraction
2. Improve visibility
- Warming
- Prox tourni
3. Pharm
- EMLA
- Coolant
- N2O
- Premed - IN dexmed
4. Tech
- illum
- USS
b) TIVA techniqie
Paeds difference:
1) Larger Vd vs adult
2) Faster V2 to V1 (redis)
- Paedfusor - 1-16yo, 5-61kg
- Kataria - 3-16yo, 15+kg
- Eleveld model captures patients from age 5 days to 85 years old and with weights between 2.5 kg and 106 kg.
Manual
1. McFarlan - based on Kataria (3-11yo)
- ind - 2.5mg/kg
- 15/13/11/10 mg/kg/hr - dec q15
- aim Cp 3 mcg/mL
2. Steur <3yo
pEEG - useful adjunct 2yo+
*Risk of
- accum/delayed emergence
- bac contam
- metabolic phenomena (unlikely in this case)
Usual TIVA consideration
- IV access
- disconnect/failure
- Waste
- Cost
TCI Anesthesia- New and More Universal Models BD June 2022
PAEDIATRICS – CNS/Neuro – Cerebral palsy 1
[19A04] A 9-year-old girl with cerebral palsy is scheduled to undergo bilateral femoral varus de-rotation osteotomy and adductor lengthening.
Outline the challenges of providing effective postoperative analgesia for her surgery and
discuss the analgesia options available.
Ax = challenge
1. Self report
- VAS
- Numeric
- Visual
- FLACC
Analgesic option
1. Multimodal
2. Pharm
- Simples
- PO opioids
- NCA
- Adjuncts - ket/clon
3. Regional
- Caudal
- Femoral
PAEDIATRICS – CNS/Neuro – Cerebral palsy 2
[13B10] A 7-year-old nonverbal girl with severe spastic cerebral palsy is scheduled for cystoscopy.
a. Describe the important features of cerebral palsy relevant to planning anaesthesia for this procedure. (70%)
b. What are the advantages and disadvantages of inhalational induction in this child? (30%)
CP:
Spectrum of motor/sensory II of variying severity
CNS/GIT/MSS/Resp/Drug issues
CNS
- epilepsy 50%
- II
GIT:
- bulbar palsy
- poor feeding
MSK
- thin skin
Drugs
PAEDIATRICS – CNS/Neuro – Emergence delirium
[10A09]
a) Describe the factors that influence emergence delirium in children. (50%)
b) How would you manage emergence delirium in a 3 year old child having had myringotomy tubes inserted under general anaesthesia? (50%)
ED
- Disso state - irritable, uncompromising, uncooperative, incoherent, inconsolably crying, moaning, kicking, thrashing
RF
Anaes
1. Short acting INH
Surg
1. Around H&N - ENT/ophthal
Pt
1. 2-5yo
B) Mx
- Prevention
1. PPF (1 mg/kg), ketamine, a2ago, fent
- Pharm
- PPF (1 mg/kg), dexmed (0.3mcg/kg), clonidine (1mcg/kg)
PAEDIATRICS – AW/Resp - adenosonsillectomy
[15B06] A three year old child requires an adenotonsillectomy for obstructive sleep apnoea. Outline and justify your peri-operative management plan.
Pre/Intra/post
Pre
** assess severity **
OSA
- UAO during sleep, restless, apnoea, enuresis
-** IX ** PSG –>
AHI > 1 v s 5 in adult
AHI > 10 = severe
Intraop
- sed premed BAD cuz post op apnoea
- IV ind if severe OSA
- Gas + ETT + throat pack + gag
- Shared AW !!!
- Dex
- suction, awake lateral extub,
Post op
R - hyrdation
A - simples, short acting opioids post op apnoea
Ward - Daycase vs O/N
- Admit if severe OSA, comorb, < 3yo
ER 68.3%
1. Assess severity of OSA
2. shared AW, AW plan, premed bad
3. post op mon and care
4. Analgesia
PAEDIATRICS – AW/Resp – stridor
[12A09] A 3-year-old presents to the emergency department with a recent onset of stridor.
a. List the differential diagnoses (30%)
b. How do you differentiate between the potential causes of this stridor? (70%)
Stridor = inspiration, extrathoracic obs ~ laryngomalacia
ExLarry
Exp stridor = intrathoracic ~ tracheomalacia
inTRAcheo
RF
1. small children
2. recent URTI
3. oversized ETT
a)
DDx
Supra/glottic/sub
80% stridor = croup = 0.5-3yo = 2’ parainfluenza
b) Differentiate
Hx
- neonate = congen ; toddles = croup ; school = peritonsillar abscess
- onset: Acute = itis
- subacte = croup
- chronic = subglottic stenosis
Ex
Body position
Vitals - febrile, hypotensive - sepsis
Stridor timing
Ix
CXR - FB radiolucent - but hyperdynamic inflation
PAEDIATRICS – AW/Resp - URTI
[11B08] A child with active upper respiratory tract infection presents for general anaesthesia.
a. Outline the factors that increase the rate of adverse respiratory events during anaesthesia. (50%)
b. How can you reduce the risk of an adverse event occurring? (50%)
PRAE - periop resp AE
Pt/Anaes/Surg
Pt
1. Whheze
2. URTI 2/52
3. Asthma
4. Passive smoking
Anaes
1. ETT
2. LMA
3. Exp anaes
4. Inh
Surg
1. AW
2. NT
b)
Risk reduc
1. Dec sec
Mech - suction, physio
Pharm - glyco, salbutamol, nasal spray,
2. AW choice
3. Monitor
COLDS - current/onset/lung dx/AW device/surgery
PAEDIATRICS – AW/Resp – croup
[05B01]
a) What are the indications for tracheal intubation in a 3 year old who presents with croup?
b) Describe your technique for intubation.
Croup = viral laryngotracheitis
Laryngo = (hoarse voice)
Trach/bronch = cough
Cause:
1. Paraflu 1/2
2. Rhino
3. Flu A/B
4. Adeno
5. RSV
Prodromal + seal bark
DDx: epiglottitis, bacterial tracheitis, angioedema, FB and RP abscess
(76%) Most candidates described the cluster of Sx/Sx that would indicate a need for ETT.
Most also had a safe approach to induction of anaesthesia for intubation, and this usually involved a cautious inhalational technique.
However, many spent too long on a general discussion at the start of their answer.
Also, few candidates appreciated that the obstruction in croup is below the level of the vocal cords, that there is usually no problem visualising the vocal cords, and that the LMA and fibrescope are unlikely to be helpful. While a smaller ETT than usual would be necessary in this patient, there is unlikely to be a leak around the tube until the inflammation has resolved.
Finally, the nasal route allows far superior fixation in children and greatly facilitates the care of the child in the PICU.
How common is VSD?
30%
How common is VSD?
30%
Tet spell mx
Def: period of hypercyanosis
Pathophys: Inc O2 demand
Treat: Max VR, maintain SVR
Hospital: O2, fluid, SVR, beta blocker, opioid (pharm vs non pharm), max PBF
*phenyl/metaraminol
Mechanical:
TOF
- VSD
- Overriding of aorta - aorta lies over VSD
- RVOTO - OT start at leaving the RV —> 4. RVH
