Pediatric Anes. Pt. 2 (Exam 4 Final)

Question 1

What is the primary goal when performing a preoperative evaluation for a pediatric patient?
A. Focus only on previous anesthesia experiences
B. Minimize family involvement
C. Establish trust and open communication with the child and caregivers
D. Avoid asking about medications unless the child is hospitalized

Answer 1

C. Establish trust and open communication with the child and caregivers

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Question 2

True or False

Routine labs, ECG, and CXR are recommended for healthy children

Answer 2

False
Routine labs, ECG, and CXR are not recommended for healthy children

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Question 3

Which of the following is not typically assessed during pediatric preoperative evaluation?
A. Vaccination status
B. Family history
C. Favorite toys
D. Medication allergies

Answer 3

C. Favorite toys

Also ask about current medications and previous anesthesia experiences

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Question 4

What strategies help reduce anxiety and build cooperation during pediatric preoperative evaluation? (Select 3)
A. Using playful interaction and games
B. Speaking only to the parent, not the child
C. Establishing open communication
D. Engaging toddlers with eye contact
E. Skipping questions to speed up the interview

Answer 4

A. Using playful interaction and games
C. Establishing open communication
D. Engaging toddlers with eye contact

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Question 5

Which age group is most prone to preoperative separation anxiety?
A. < 6 months
B. 9–12 months
C. 1–3 years
D. 6–10 years

Answer 5

C. 1–3 years

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Question 6

Children less than _____ months of age are less prone to separation anxiety.

A. 9 months
B. 12 months
C. 18 months
D. 1 year

Answer 6

A. 9 months

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Question 7

Which of the following are common contributors to pediatric preoperative anxiety? (Select 3)
A. Parental separation
B. Familiar environments
C. Previous anesthesia experiences
D. Painful procedure

Answer 7

A. Parental separation
C. Previous anesthesia experiences -OR is a scary place
D. Painful procedure

Unfamiliar environment

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Question 8

Which of the following interventions is commonly used to reduce preoperative anxiety in pediatric patients?
A. Restraining the child to prevent distress
B. Administering sedatives upon admission
C. Showing videos with child life specialists
D. Avoiding discussion of the surgery

Answer 8

C. Showing videos with child life specialists

“I will say most pediatric hospitals have a good child life department now that helps do some of this before we even meet the patient. They show patients videos or pictures of the operating room. They talk about the mask. They help them sticker or flavor the mask.”

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Question 9

What are some purposes of a pre-anesthesia visit for pediatric patients and their families?
(Select 3)
A. Set expectations for the day of surgery
B. Evaluate the child’s nutritional status
C. Decrease anesthesia-related anxiety
D. Reduce procedure-related anxiety
E. Begin postoperative rehabilitation

Answer 9

A. Set expectations for the day of surgery
C. Decrease anesthesia-related anxiety
D. Reduce procedure-related anxiety

Child AND parental preparation

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Question 10

Match the age group with the appropriate developmental response:
Age Groups:

1–3 years
3–6 years
7–12 years

Developmental Responses:

A. Require more explanation and want to actively participate
B. Distraction techniques are most effective
C. Preoperative play is beneficial

Answer 10

1–3 years → B. Distraction techniques are most effective

3–6 years → C. Preoperative play is beneficial

7–12 years → A. Require more explanation and want to actively participate

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Question 11

What is the key concern with parental presence during induction?

A. Increases anesthesia complications
B. Creates a more sterile environment
C. May cause distress if parents are unprepared
D. Causes delays in surgery

Answer 11

C. May cause distress if parents are unprepared

“The big thing with parental presence in the OR and with induction is making sure we are teaching the parents what is happening”

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Question 12

Which of the following statements are true about perioperative anxiety in infants aged 0–6 months?
Select 2:

A. Infants at this age experience minimal stress
B. Cognitive development makes them more aware of procedures
C. Infants exhibit significant behavioral regression
D. Fear of separation is maximal
E. Parental stress is often higher than the infant’s

Answer 12

A. Infants at this age experience minimal stress
E. Parental stress is often higher than the infant’s

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Question 13

What perioperative behaviors are commonly observed in children aged 6 months to 4 years?
Select 3:

A. Maximum fear of separation
B. Magical thinking begins
C. Concern about body image
D. Inability to understand explanations
E. Fear of the unkown

Answer 13

A. Maximum fear of separation
B. Magical thinking begins 🦄
D. Inability to understand explanations

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Question 14

Which interventions are most appropriate for children aged 6 months to 4 years?
Select 3:

A. Detailed surgical explanations
B. Behavioral regression
C. Cognitive development and increased tantrums
D. Offer choices to support autonomy
E. Expect significant postoperative upset

Answer 14

B. Behavioral regression
C. Cognitive and increased tantrums
E. Expect significant postoperative upset

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Question 15

What are common sources of anxiety in children aged 4 to 8 years?
Select 3:

A. Fear of separation persists
B. Increasing concern about body integrity
C. Cognitive understanding begins to fade
D. Misinterpretation of language
E. Begins to understand surgical explanations

Answer 15

A. Fear of separation persists
B. Increasing concern about body integrity
E. Begins to understand surgical explanations

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Question 16

Children aged 8 years through adolescence typically:
Select 3:

A. Experience minimal anxiety
B. May interpret everything literally
C. Fear loss of control or waking up during surgery
D. Are unlikely to understand the procedure
E. Tolerate separation better

Answer 16

B. May interpret everything literally
C. Fear loss of control or waking up during surgery
E. Tolerate separation better

*Understands process and explanations

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Question 17

Which of the following concerns are most common in adolescent patients during the perioperative period?
Select 3:

A. Fear of losing control or dignity
B. Separation from parents
C. Issues with self-esteem and body image
D. Concern about waking up during surgery
E. Fear of the unknown

Answer 17

A. Fear of losing control or dignity
C. Issues with self-esteem and body image -developing sexual characteristics
E. Fear of the unknown

*Independent

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Question 18

Which of the following questions is most specific to a younger pediatric preoperative evaluation compared to an adult?

A. Do you take any medications regularly?
B. Have you had any surgeries before?
C. Were you full-term at birth?
D. Do you have a history of hypertension?

Answer 18

C. Were you full-term at birth?

“We want to know where they are full-term baby. Did they have to stay in the NICU for any extended time? And why?”

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Question 19

When asking about seizures in pediatric patients, it is important to determine:
Select 2
A. Whether the child was faking the seizures
B. If they were febrile seizures
C. If they have ever stuck their finger in a electrical socket
D. If they are allergic to antihistamines
E. They are on current seizure medications

Answer 19

B. If they were febrile seizures
E. They are on current seizure medications

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Question 20

A child with a repaired congenital heart defect is scheduled for elective surgery. What is the best next step?

A. Proceed with surgery with standard monitoring
B. Cancel surgery until cleared by a neurologist
C. Confirm follow-up with cardiology for clearance
D. Delay surgery for 6 months regardless of condition

Answer 20

C. Confirm follow-up with cardiology for clearance

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Question 21

Which pulmonary question is best tailored to parents who may not recognize “asthma”?

A. Does your child take any inhalers?
B. Has your child been diagnosed with asthma?
C. Does your child cough at night?
D. Does your child ever wheeze?

Answer 21

D. Does your child ever wheeze?

Any recent URI or use of an inhaler?

“A big thing for pediatric patients is asthma or any breathing problems, not all parents know that their kids have asthma. They might just have some wheezing.”

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Question 22

Secondhand smoke exposure in pediatric patients is especially important to assess because it increases the risk of:

A. C. Laryngospasm
B. Respiratory depression
C. Emergence delirium
D. Hypoglycemia

Answer 22

A. Laryngospasm or bronchospasm

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Question 23

A pediatric patient is found to be wearing a continuous glucose monitor. Which of the following is a key pre-op consideration?

A. Removing it immediately
B. Verifying the battery life
C. Ensuring it can be kept on
D. Replacing it with a standard fingerstick device

Answer 23

C. Ensuring it can be kept on or nearby during surgery

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Question 24

In pediatric patients, lab work is often drawn after the child is asleep in the OR to prevent _______________.

A. fasting violations
B. disruptions in the surgical schedule
C. trauma or distress from needle sticks
D. parental consent issues

Answer 24

C. trauma or distress from needle sticks

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Question 25

When should a pregnancy test (UPT) typically be considered before pediatric surgery? Select 2 A. All girls under age 10 B. Girls over 10 years regardless of menstruation C. Girls aged 12 and older D. Only when requested by the parent E. Those who have started menstruating

Answer 25

C. Girls aged 12 and older E. Those who have started menstruating "...pregnancy tests really depend on facility guidelines. Most say once they're 12 years or older, or have had their first menstruation, then we would do a pregnancy test. Some facilities allow the parents to refuse the pregnancy test. Others do not. We have to have a written consent" ## Footnote slide 10

Question 26

Which of the following is the best follow-up question to end a pediatric pre-op interview with parents? A. “What is your child's favorite snack?” B. “Can you repeat your child’s medical history?” C. “Is there anything important I forgot to ask?” D. “Are you sure your child doesn’t need labs?”

Answer 26

C. “Is there anything important I forgot to ask?” ## Footnote Slide 10

Question 27

You should look at facial features, the size and shape of their ____________, their __________, their maxilla, this might you a hint that this could be a difficult airway. A. Tongue, cheeks B. Head, mandible C. Nose, eyes D. Larynx, esophagus

Answer 27

B. Head, mandible ## Footnote slide 11

Question 28

Which of the following is a primary goal during a pediatric airway exam? Select 2 A. Mallampati B. Determine BMI percentile C. Assess visual acuity D. Loose teeth E. Measure oxygen saturation during exertion

Answer 28

A. Mallampati D. Loose teeth ## Footnote slide 12

Question 29

Why is it important to assess for loose teeth in pediatric patients prior to anesthesia? Select 2 A. To improve nutritional assessment B. To identify risk for dental caries C. To prevent dislodgement D. To document dental maturity E. To document location of loose tooth

Answer 29

C. To prevent dislodgement or *aspiration during airway manipulation* E. To document location of loose tooth "...it's important to document where the loose tooth is. And I always try to get an idea of how loose it is. If it's really loose, **we may pull it even before intubation** just to avoid having that tooth become dislodged during intubation or during the surgery." ## Footnote slide 12

Question 30

Which patient characteristics would make you more cautious during intubation due to airway concerns? (Select 3) A. History of cardiac surgery B. Age < 1 year C. Athletic build D. Obesity E. Normal facial symmetry

Answer 30

A. History of cardiac surgery B. Age < 1 year D. Obesity * Maxillofacial surgery * Mallampati classification "So be aware of that, obesity, and any history of maxillofacial or even cardiac surgery, because a lot of those kids have anomalies that are associated with difficult airway ## Footnote slide 12

Question 31

Which of the following are predictors of a difficult pediatric airway? (Select 3) A. Mallampati class I B. Mandibular protrusion C. Limited neck mobility D. Increased tongue thickness E. ASA I status

Answer 31

B. Mandibular protrusion C. Limited neck mobility - *Movement of the atlantooccipital joint* D. Increased tongue thickness * ASA II-IV * Reduced mandibular space "some predictors of difficult airway in children, looking at their mandible, their overall chin, jaw look, if they're able to move their head around well." ## Footnote slide 12

Question 32

# Syndromes associated with difficult airway Which of the following syndromes is most commonly associated with **macroglossia (large tongue)** and atlantooccipital abnormalities, increasing the risk of difficult airway? A. Treacher Collins syndrome B. Pierre-Robin sequence C. Down syndrome D. Edwards syndrome

Answer 32

C. Down syndrome (Trisomy 21) "sometimes kids will have an x-ray of their neck to show that they've had clearance or if they have a problem." | (I've only mentioned the ones she pointed out from her lecture) ## Footnote Slide 13

Question 33

Which of the following syndromes is characterized by **micrognathia (small chin)**, glossoptosis, cleft palate, and cervical dysfunction? A. Freeman-Sheldon syndrome B. Pierre-Robin sequence C. Hunter syndrome D. Klippel-Feil syndrome

Answer 33

B. Pierre-Robin sequence ## Footnote Slide 13

Question 34

Which of the following are common airway features associated with Treacher Collins syndrome? Select 3 A. Micrognathia B. Large tongue C. Small oral opening D. Zygomatic hypoplasia E. Cervical fusion

Answer 34

A. Micrognathia C. Small oral opening D. Zygomatic hypoplasia ## Footnote Slide 13

Question 35

What airway device or technique is recommended when intubating a pediatric patient with syndromes such as Pierre-Robin sequence or Treacher Collins syndrome? A. Standard direct laryngoscopy with a Miller blade B. Nasal intubation without visualization C. Video laryngoscopy or fiberoptic intubation D. Supraglottic airway as the primary plan

Answer 35

C. Video laryngoscopy or fiberoptic intubation ## Footnote slide 13

Question 36

Which of the following are key components of a preoperative physical exam in children? Select 3 A. Respiratory system evaluation B. Assessment of hydration status C. Thyroid palpation D. Cardiovascular exam E. Deep tendon reflexes

Answer 36

A. Respiratory system evaluation B. Assessment of hydration status D. Cardiovascular exam Nervous System ## Footnote slide 14

Question 37

Which of the following statements about pediatric upper respiratory infections (URIs) is most accurate? A. URIs are more commonly caused by viral infections B. Viral URIs typically require antibiotic therapy to reduce airway reactivity C. URIs in children are most commonly caused by bacterial pathogens D. Bacterial URIs do not increase the risk of perioperative respiratory complications

Answer 37

A. URIs are more commonly caused by viral infections *and may lead to increased airway reactivity during anesthesia* **Virus causes inflammation, airway edema, and increased secretions** ## Footnote Slide 15

Question 38

Which of the following are considered perioperative respiratory adverse events (PRAEs) commonly associated with pediatric upper respiratory infections (URIs)? Select 4 A. Bacterial pneumonia B. Breath holding C. Bradycardia D. Postintubation croup E. Venous oxygen desaturation F. Deep vein thrombosis G. Bacterial pneumonia

Answer 38

A. Bacterial pneumonia B. Breath holding D. Postintubation croup G. Bacterial pneumonia * Bronchospasm * Laryngospasm ## Footnote slide 15

Question 39

Which of the following are common complications seen in children with URIs undergoing anesthesia? Select 3 A. Atelectasis B. Decreased renal function C. Urticaria D. Planned hospital admission E. Arterial oxygen desaturation F. Unplanned hospital admission G. Hypertension

Answer 39

A. Atelectasis E. Arterial oxygen desaturation F. Unplanned hospital admission ## Footnote Slide 15

Question 40

Which airway management technique is associated with a higher incidence of perioperative respiratory adverse events in children with a URI? A. Nasal cannula B. Laryngeal mask airway (LMA) C. Non-invasive ventilation D. Endotracheal tube (ETT)

Answer 40

D. Endotracheal tube (ETT) ## Footnote slide 15

Question 41

Which induction technique is associated with a lower incidence of perioperative respiratory adverse events in pediatric patients with a URI? A. Inhalational induction B. Ketamine-only induction C. Intravenous induction D. Rapid sequence induction

Answer 41

C. Intravenous induction ## Footnote Silde 15

Question 42

According to current recommendations, how long should elective surgery be postponed after resolution of URI symptoms? A. 1 week B. 2 weeks C. 4 days D. 6 weeks

Answer 42

B. 2 weeks "If it's a healthy patient, an ASA-1 patient with a clear runny nose and no fever, then typically we'll continue with the anesthetic." "If the patient is febrile, if they have really purulent drainage coming out, **if they have a lot of comorbidities, then typically we will cancel the case and reschedule 2 weeks, sometimes 4 weeks out"** ## Footnote slide 16

Question 43

Bronchial hyperreactivity can persist for up to ______________+ weeks after a URI. A. 1 B. 2 C. 4 D. 6

Answer 43

D. 6+ ## Footnote slide 16

Question 44

# Matching Instructions: Match each clinical sign or patient characteristic with the appropriate action regarding proceeding with anesthesia. 1. Runny nose 2. Purulent nasal drainage 3. Clear lungs 4. Wheezing 5. Older child 6. Child < 1 year or previous preemie 7. No changes in behavior 8. Fever Options: A. Proceed with Caution B. Cancel the Case

Answer 44

1. A 2. B 3. A 4. B 5. A 6. B 7. A 8. B ## Footnote slide 16

Question 45

Which of the following features would classify a child's illness as a severe cold in the preoperative setting? A. Runny nose and dry cough B. Wheezing and fever C. Dry cough and watery congestion D. Moist cough and clear lungs

Answer 45

B. Wheezing and fever ## Footnote slide 17

Question 46

Children with a ______________ cold and no high-risk features may proceed with surgery after pretreatment with salbutamol. A. Severe B. Moderate C. Mild D. Persistent

Answer 46

C. Mild * Runny nose * Dry cough * Watery congestion ## Footnote slide 17

Question 47

Which of the following is a recommended anesthetic strategy in a child with URI symptoms who requires surgery? A. Always intubate the child early B. Avoid using an LMA C. Use desflurane for rapid emergence D. Avoid endotracheal intubation if possible

Answer 47

D. Avoid endotracheal intubation if possible * Avoid Desflurane * Use LMA * Use propofol * Use lidocaine ## Footnote slide 17

Question 48

Which of the following are considered risk factors that may delay surgery in a child with a moderate cold? (Select 3) A. Age under 1 year B. Active smoking exposure C. ENT or eye surgery D. No change in behavior E. Need for endotracheal intubation

Answer 48

A. Age under 1 year C. ENT or eye surgery E. Need for endotracheal intubation * Passive smoking * Pulmonal comorbidity ## Footnote slide 17

Question 49

According to the decision algorithm, when should surgery be postponed for ≥2 weeks? A. The child has clear lungs and a dry cough B. The child has purulent congestion and moist cough C. The child has a mild cold with watery congestion D. The child has wheezing, purulent congestion, and fever

Answer 49

D. The child has wheezing, purulent congestion, and fever **Severe Cold** * Malaise * Moist Cough ## Footnote Slide 17

Question 50

Which of the following are considered benefit factors that may support proceeding with surgery in a child with a moderate cold? (Select 3) A. ENT surgery is strongly indicated B. Pulmonary comorbidity is well-controlled C. The anesthesia team has expertise managing children with colds D. Parent expresses strong desire to avoid rescheduling E. Parental compliance is high F. Fever resolved within 24 hours

Answer 50

A. ENT surgery is strongly indicated *(e.g., adenoids/tonsils are the infectious focus)* C. The anesthesia team has expertise managing children with colds E. Parental compliance is high ## Footnote Slide 17

Question 51

# Matching

Answer 51

Clear liquids → B. 2 hours Breast milk → D. 4 hours Infant formula, nonhuman milk, or light meal → A. 6 hours Regular meal, including fatty foods → C. 8 hours ## Footnote Slide 18

Question 52

Which of the following statements best reflects appropriate NPO practices for pediatric patients? A. Clear liquids are encouraged up to 2 hours before surgery to prevent dehydration. B. Breast milk is treated the same as infant formula in preoperative fasting guidelines. C. Pediatric patients should remain completely NPO for 6–8 hours regardless of intake type. D. Pediatric patients should not receive any oral intake once scheduled for surgery.

Answer 52

A. Clear liquids are encouraged up to 2 hours before surgery to prevent dehydration. "The big thing with our pediatric patients is looking at formula versus breast milk versus clear liquids. We do actually like our pediatric patients, especially our infants, to have some hydration and not go six or eight hours completely NPO" ## Footnote slide 18

Question 53

Informed consent requires discussion of all _________ and _________ of both the procedure and the anesthetic. A. Risks; benefits B. Feelings; reactions C. Advantages; medications D. Symptoms; treatment options

Answer 53

A. Risks; benefits * What the family can anticipate * Our role is to protect the child * Reassure the safety of the child ## Footnote Slide 19

Question 54

Which of the following is the most appropriate way to explain anesthesia risk to a child and their family during informed consent? A. "There’s no risk—anesthesia is completely safe." B. "You are more likely to crash your car than have any issues with anesthesia." C. "There are always risks with anesthesia, ranging from small to serious." D. "Let’s just sign the form so we can get started."

Answer 54

C. "There are always risks with anesthesia, ranging from small to serious" ## Footnote Slide 19

Question 55

Which action helps make the preoperative conversation more engaging for the pediatric patient? A. Ignoring the child unless they ask a question B. Asking the child directly about allergies or medical history C. Only addressing the parents D. Focusing solely on technical terms and physiology

Answer 55

B. Asking the child directly about allergies or medical history ## Footnote Slide 19

Question 56

# True of False During preoperative evaluation its important to discuss specific monitoring devices

Answer 56

True "Let them know we are going to be monitoring all these vital signs...monitoring heart rate, blood pressure, oxygen levels" ## Footnote Slide 19

Question 57

Which of the following best reflects best practices when preparing pediatric airway equipment for a case? A. Only one size of each airway device should be set out in advance to conserve space. B. All equipment must be pre-connected and ready for immediate use. C. Only suction and an ETT are needed in most pediatric cases. D. Airway equipment should be available in multiple sizes

Answer 57

D. Airway equipment should be available in multiple sizes, *even if not all are set out.* ## Footnote Slide 22

Question 58

Which of the following airway devices are commonly found in a pediatric anesthesia cart? (Select 4) A. Endotracheal tubes B. Oral airways C. Cricothyrotomy kits D. Supraglottic airway devices E. Chest tubes F. Nasal airways

Answer 58

A. Endotracheal tubes in multiple sizes B. Oral airways D. Supraglottic airway devices F. Nasal airways ## Footnote Slide 22

Question 59

Which of the following equipment items are important to have available when preparing for a pediatric anesthetic? (Select 3) A. Bronchoscope B. Suction C. Adult defibrillator pads D. Masks E. Anesthesia machine with desflurane F. Laryngoscope

Answer 59

B. Suction D. Masks F. Laryngoscope ## Footnote Slide 22

Question 60

What is the most important consideration when selecting the correct mask size for a pediatric patient? A. The mask should be large enough to cover the entire face, including the eyes. B. The mask should only cover the mouth for easier ventilation. C. The mask should cover the nose and mouth without extending into the eyes. D. The mask should be loose to avoid pressure on the face.

Answer 60

C. The mask should snugly cover the nose and mouth without extending into the eyes. "You want it to cover the nose and mouth without occluding either of those. You don't want it to protrude too far up in the eyes so you're not getting a good seal. So you see how this mask fits all around the patient's face without occluding any of the airway" ## Footnote slide 24

Question 61

How do you determine the appropriate size for an oral airway in a pediatric patient? A. Measure from the corner of the mouth to the earlobe B. Measure from the nostril to the chin C. Measure from the tip of the mouth to the angle of the mandible D. Match to the size of the child’s thumb

Answer 61

C. Measure from the tip of the mouth to the angle of the mandible "...make sure you're using an oral airway more in an *unconscious patient*. Awake patients do not like you putting this hard piece of plastic in their mouth." ## Footnote Slide 25

Question 62

If the oral airway used is too small for the pediatric patient it may press on the ___________ and cause occlusion of the ___________ vein, making the tongue swell. A. epiglottis; jugular B. tongue; lingual C. tonsil; facial D. soft palate; carotid

Answer 62

B. tongue; lingual ## Footnote slide 25

Question 63

If the oral airway used is too large for the pediatric patient, it may protrude from the mouth and press on the ___________, potentially worsening the airway obstruction. A. epiglottis B. vocal cords C. soft palate D. larynx

Answer 63

A. epiglottis | Picture B ## Footnote slide 25

Question 64

A nasal airway can be sized using either the distance from the ______________ to the mandible, or by comparing to the child's ______________ finger. A. tip of the chin; index B. nostril; ring C. tip of the nose; pinky D. nasal bridge; thumb

Answer 64

C. tip of the nose; pinky **Not commonly used** ## Footnote Slide 25

Question 65

A nasal airway that is too large may cause ______________ around the nostril, indicating excessive pressure and poor fit. A. bruising B. blanching C. swelling D. bleeding

Answer 65

B. blanching ## Footnote Slide 25

Question 66

What type of endotracheal tube is most commonly used in pediatric anesthesia today? A. Cuffed ETT B. Unuffed ETT C. Nasopharyngeal airway D. Tracheostomy tube

Answer 66

A. Cuffed ETT "A few of the older anesthesiologists that still sit cases will use uncuffed ET tubes, but overall most people use a cuffed ET tube." ## Footnote Slide 28

Question 67

n which type of surgical procedure is an **oral RAE** tube most commonly used? A. Orthopedic surgery B. Abdominal surgery C. ENT procedures D. Neurosurgery

Answer 67

C. ENT procedures *(tonsils and adenoids)* "...oral ray for all ENT procedures, so it just bends straight down and is a little bit out of the way." ## Footnote Slide 28

Question 68

A nasal RAE tube is typically used during which type of surgery? A. Craniotomy B. Dental surgery C. Spinal fusion D. Umbilical hernia repair

Answer 68

B. Dental surgery "We use nasal ray tubes for dental procedures. If you do get a nasal tube, you want some McGill forceps." | McGill forceps ## Footnote Slide 28

Question 69

The ____________ blade is a straight laryngoscope blade commonly used in **neonates and toddlers.** Select 2 A. Wis-Hipple B. MAC C. Miller D. D-blade E. Seldinger

Answer 69

A. Wis-Hipple C. Miller ## Footnote Slide 28

Question 70

What is the recommended internal diameter (ID) of the **uncuffed** endotracheal tube for neonates > 3 kg and infants under 1 year of age? A. 3.0 mm B. 3.5 mm C. 4.0 mm D. 4.5 mm

Answer 70

A. 3.0 mm ## Footnote Slide 29

Question 71

What is the recommended formula to estimate the internal diameter (ID) of an uncuffed ETT for a **child older than 2 years?** A. (Age in years + 10) / 2 B. (16 + age in years) / 4 C. Age in years × 3 D. Age in months / 2

Answer 71

B. (16 + age in years) / 4 OR (age in years/4) + 4 ## Footnote Slide 29

Question 72

To determine the appropriate size for a **cuffed** endotracheal tube, what should you do **after** calculating the uncuffed size? A. Add 0.5 mm B. Subtract 1 mm C. Subtract 0.5 mm D. Double the size

Answer 72

C. Subtract 0.5 mm ## Footnote slide 29

Question 73

For a child aged 4 years, what is the estimated uncuffed ETT size using the (age/4 + 4) formula? A. 3.5 mm B. 4.0 mm C. 4.5 mm D. 5.0 mm

Answer 73

D. 5.0 mm ## Footnote slide 29

Question 74

Which of the following formulas can be used to estimate ETT depth (lip placement) based on age? A. Age × 2 + 10 B. Age / 2 + 12 C. Age × 3 + 1 D. Age + 5

Answer 74

B. Age / 2 + 12 ## Footnote Slidef 29

Question 75

Another way to estimate ETT length is by multiplying the internal diameter (ID) of the tube by what factor? A. 2 B. 2.5 C. 3 D. 4

Answer 75

C. 3 OR Height (cm)/10 + 5 Weight (kg)/5 + 12 ## Footnote Slide 29

Question 76

# Matching

Answer 76

## Footnote Slide 30

Question 77

Column A: Patient Weight (kg) < 5 5-10 10-20 20-30 30-50 50-70 70-100 Column B: LMA Size and Suggested Inflation Volume A. Size 3, up to 20 mL B. Size 5, up to 40 mL C. Size 1, up to 4 mL D. Size 2.5, up to 14 mL E. Size 2, up to 10 mL F. Size 1.5, up to 7 mL G. Size 4, up to 30 mL

Answer 77

size 1 rarely used if less than 5kg then just going to tube them ## Footnote slide 31

Question 78

What size bag typically come on a pediatric circuit? A. 1.5 liter B. 2liter C. 3liter D. 1liter

Answer 78

D. 1 liter

Question 79

When considering which bag to use on a circuit you want to make sure that... A. you can giver proper volumes w/o over ventilating B. tidal volumes can reach at least 500 C. you can give bigger volumes so you and ventilate less often D. you can give big volumes and over ventilate

Answer 79

A. you can giver proper volumes w/o over ventilating ## Footnote slide 32

Question 80

During airway set up, you also want to make sure you have different sizes of A. hard suction B. soft suction C. EKG leads D. blood pressure cuffs

Answer 80

B. soft suction ## Footnote slide 32

Question 81

When do you start the IV on a patient under the age of 12? A. pre op B. post op C. after induction D. during emergence

Answer 81

C. after induction "were going to do a mask induction and then start the IV" ## Footnote slide 33

Question 82

What sixe fluid bag is approriate for a IV set up? A. 100mL B. 1000mL C. 250mL D. 500mL

Answer 82

D. 500mL ## Footnote slide 33

Question 83

We will use a _____ drip tubing for the smaller patients vs a _______ drip like adult patient A. micro; macro B. macro;micro

Answer 83

A. micro; macro ## Footnote slide 33

Question 84

What will be set the buretrol to? A. 15-30ml/kg B. 5-10ml/kg C. 10-20ml/kg D. 20-30ml/kg

Answer 84

C. 10-20ml/kg *so if you have a 5kg patient then it'll be 50ml" ## Footnote slide 33

Question 85

What are the commonly used drugs that we will draw up for our patient? (select 2) A. phenylephrine B. propofol C. fentanyl D. norepinephrine

Answer 85

B. propofol (5-10mL syringes) C. fentanyl plus or minus a paralytic (roc) ## Footnote slide 34

Question 86

According to lecture what is a common drug that we diliute for the pediatric patient? A. fentanyl B. propofol C. Rocuronium D. dexamethasone

Answer 86

A. fentanyl diluted in 10mL syringe so 10mcg/ml Make sure it is LABELED and passed to whoever is pushing drugs or taking over your case Also would advise you to go by what is normally done at your facility ## Footnote slide 34

Question 87

What are some additional medications commonly given in pediatric cases? (select 4) A. robaxin B. ofirmev C. dexamethazone D. ondansetron E. dexmedetomidine

Answer 87

B. ofirmev C. dexamethazone D. ondansetron E. dexmedetomidine and antibiotics if needed ## Footnote slide 34

Question 88

What drug could you draw up for a LTA (laryngotracheal airway)? A. 0.75% ropivacaine B. 4% lidocaine C. 2% bupivacaine D. 3% chloroprocaine

Answer 88

B. 4% lidocaine ## Footnote slide 34

Question 89

True or false: You should always have emergency meds readily available with syringes and IM needles next to them

Answer 89

True ## Footnote slide 35

Question 90

What is the dose of epinephrine for pediatric patients? A. 0.01mg/kg B. 0.1mg/kg C. 1mg D. 0.02mg/kg

Answer 90

A. 0.01mg/kg ## Footnote slide 35

Question 91

What is the emergency dose of succinylcholine IV and IM (select 2) A. 1.5mg/kg IV B. 2mg/kg IV C. 3mg/kg IM D. 4mg/kg IM

Answer 91

B. 2mg/kg IV D. 4mg/kg IM ## Footnote slide 35

Question 92

What is the pediatric emergency dose for atropine A. 0.2mg/kg B. 0.03mg/kg C. 0.02mg/kg D. 0.01mg/kg

Answer 92

C. 0.02mg/kg ## Footnote slide 35

Question 93

What is the emergency dose for glycopyrrolate for pediatrics A. 0.04mg/kg B. 0.1mg/kg C. 0.02mg/kg D. 0.01mg/kg

Answer 93

D. 0.01mg/kg ## Footnote slide 35

Question 94

What are things you can do to prepare the OR? (select 2) A. make sure OR is warm B. bair hugger is one bed C. one size blood pressure cuff D. one size EKG monitors

Answer 94

A. make sure OR is warm B. bair hugger is one bed different sizes of BP and EKG ## Footnote slide 36

Question 95

How many sat probes do we typically put on our neonates A.1 B. 2 C. none

Answer 95

B. 2 Its good to have 2 because it is hard to get to them after they are draped ## Footnote slide 37

Question 96

What type of ekg do we use for our pediatric patients A. 3 lead B. 5 lead C. 12 lead D. pulse ox is fine

Answer 96

A. 3 lead ## Footnote slide 37

Question 97

What is an additional standard monitor we have on our pediatric patients A. BIS monitor B. temperature probe C. nerve stimulator D. laryngeal nerve monitor

Answer 97

B. temperature probe BIS monitor is questionable and not frequently used in pediatric patient ## Footnote slide 37

Question 98

Why is a pre-cordial stethoscope a great tool to have for pediatric cases (select 2) A. post op monitoring B. listening to heart sounds before induction C. can't get to your patient D. hard time hearing breath sounds

Answer 98

C. can't get to your patient D. hard time hearing breath sounds ## Footnote slide 37

Question 99

# True or false It is important to have what you need set up because the faster you can get them settles and off to sleep the better for patient and family

Answer 99

true ## Footnote slide 38

Question 100

Midazolam (the most admistered benzodiazepine) has a PO dose of ________ and an onset of _______ for the pediatric patient A. 1-1.25mg/kg; 5min B. 0.25-1mg/kg; 20 min C. 0.25-1mg/kg; 5 min D. 1-1.25mg/kg; 20 min

Answer 100

B. 0.25-1mg/kg; 20 min most people give 0.5mg/kg intranasally works between 15-20 min ## Footnote slide 40

Question 101

Dexmedetomidine is an Alpha 2 adrenergic agonist and has a dose of ______ intranasal for the pediatric patient A. 1-2mcg/kg B. 2-4mcg/kg C. 0.25-1mcg/kg D. 0.5-1mcg/kg

Answer 101

A. 1-2mcg/kg ## Footnote slide 40

Question 102

Ketamine for the pediatric patient preop has a dose of______ A. 1-2mg/kg B. 0.5-4mg/kg C. 3-7mg/kg D. 5-10mg/kg

Answer 102

D. 5-10mg/kg ## Footnote slide 40

Question 103

A key concept for parental presence disscussed in lecture is A. IV access before the OR B. letting parent be interactive and hold the mask C. education D. vital signs

Answer 103

C. education ## Footnote 41

Question 104

Most pediatric patients get inhaled induction if they are what age? A. 12 and under B. 13 and under C. 15 and under D. 18 and under

Answer 104

A. 12 and under ## Footnote slide 42

Question 105

Why do we tend to do inhalation induction over IV induction A. better relaxation B. more traumatizing for the patient C. more pulmonary safe D. not to traumatize them with IV insertion

Answer 105

D. not to traumatize them with IV insertion | most kids wont hold still ## Footnote slide 42

Question 106

What is the main reason we would choose an IV induction vs inhaled on a pediatric patient (<12y/o) A. difficult airway B. planned surgery C. RSI/ full stomach D. ear tubes

Answer 106

C. RSI/ full stomach difficult airway is a valid reason but "for smaller pediatric patients even if its a difficult airway we will still do inhalation because difficult intubation doesnt mean difficult ventilation" ## Footnote slide 42

Question 107

What is considered the most popular technique on anesthesia for the pediatric patient? A. IV B. neuraxial C. regional D. inhalation

Answer 107

D. inhalation ## Footnote slide 43

Question 108

What is a good starting dose of nitrous when doing a mask induction (select 2) A. 50% B. 30% C. 70% D. 80%

Answer 108

A. 50%- use on teenagers B. 30%- what she normally uses ## Footnote slide 43

Question 109

Which patient population would be best to NOT use 30% nitrous when starting Mask induction A. 15 B. 10 C. 5 D. 12

Answer 109

A. 15 "teenagers do not do well with 30 nitrous they dont really do well with less than 50% they get so disinhibited that they become a little more anxious and uncooperative" ## Footnote slide 43

Question 110

When should you discontinue to nitrous? A. after LOC B. prior to LOC C. after intubation D. 5 min before case end

Answer 110

B. Prior to LOC and intubation and administer sevofluarne in 100%oxygen ## Footnote slide 43

Question 111

When is the IV placed? A. preop B. after intubation C. during stage 2 D. during stage 3

Answer 111

D. during stage 3 IV placed after patient is through stage 2, prior to airway placement ## Footnote slide 43

Question 112

What should occur after IV is in place? A. intubation B. continue with the case C. 100% oxygen 3. turn nitrous back on

Answer 112

C. 100% oxygen then intubation ## Footnote slide 43

Question 113

If the need for an IV in preop arrises what are 2 things we can do to help the pediatric patient (select 2) A. a parent to hold them down B. PO midazolam C. a lollipop D. EMLA cream

Answer 113

B. PO midazolam D. EMLA cream ## Footnote slide 47

Question 114

What situations should the IV be placed in Preop A. patient ate some Mcdonalds before coming B. they have a history of GERD C. the patient drank water 4 hours ago D. the patient has breast milk 4 hours ago

Answer 114

A. patient ate some Mcdonalds before coming (full stomach) B. they have a history of GERD ## Footnote slide 47

Question 115

What is the NMBD of choice for the pediatric pateint requiring RSI A. Pancuronium B. Vecuronium C. Rocuronium D. succinylcholine

Answer 115

D. succinylcholine "even though it comes with that box warning about hyperkalemia and cardiac arrest still it's our drug of choice for RSI" dont forget the cricoid pressure ## Footnote slide 48

Question 116

List the steps in order for Mask induction Airway Sevo +/- N2O Medications +/- PO midazolam Place monitors IV placement

Answer 116

+/- PO premed (midazolam) Place monitors (at least pulse ox the other 2 can wait) Sevo +/- N2O (nitrous off then go 100% FiO2) IV placement (once they are through stage 2) Medications Airway ## Footnote slide 49

Question 117

List in order of IV induction place monitors +/- IV premedication medications Preoxygenation airway

Answer 117

+/- IV Premed Place monitors Preoxygenation Medications Airway ## Footnote slide 49

Question 118

Due to upper airway anatomy like, big tongue, big tonsils and adnoids, occiput, superior larynx, what is common in pediatric patients A. collapse B. increase diameter C. easier ventilation D. easy intubation

Answer 118

A. collapse (obstruction) large occiput makes them flex forward ## Footnote slide 50

Question 119

During assisted ventilation with a mask, it is important to A. ensure asynchronus movement of chest and abdomen B. visualize chest wall and abdomen movement C. deliver big tidal volumes D. make sure they are using their abdominals for effort

Answer 119

B. visualize chest wall and abdomen movement make sure you assess to make sure there is no obstruction evidenced by them using their abdominal muscles, or asynchronus abdominal and chest movement ## Footnote slide 50

Question 120

All of the following are ways to help relieve obstruction EXCEPT A. chin lift B. jaw thrust C. closed mouth D. CPAP E. lateral decubatis position F. oral/nasopharyngeal airways G. deepen anesthetic

Answer 120

C. closed mouth MOUTH OPENING ## Footnote slide 50

Question 121

What is one thing the anesthesia provider can listen for to recognize an obstruction A. inspiratoy and expiratory stridor B. murmur C. burping D. crying

Answer 121

A. inspiratoy and expiratory stridor ## Footnote slide 50

Question 122

# True or false Sniffing position in pediatrics can be difficult due to their occiput so we need to be creative on how to align their axis

Answer 122

true ## Footnote slide 51

Question 123

What is a way to open an airway and align the axis A. trendelenburg B. prone C. flat on back D. shoulder roll

Answer 123

D. shoulder roll ## Footnote slide 52

Question 124

During masking, our pointer finger and thumb make a ___ and ____ A. E; hold the jaw up B. E; rest on the mandible C.C; assist in keeping the airway open D. C; hold the mask

Answer 124

D. C; hold the mask ## Footnote side 55

Question 125

During masking, our three fingers besides the pointer finger and thumb make a ___ and ____ A. E; hold the jaw up B. E; rest on the mandible C.E; rest on the soft tissue D. C; hold the mask

Answer 125

B. E; rest on the mandible **not press on soft tissue** or it will cause obstruction hold the mask like a "tea cup" so when you need to jaw thrust you just reach the pinky behind there ## Footnote slide 55

Question 126

Visualizing the airway is ______ difficult than an adult A. more B. less C. same

Answer 126

A. more ## Footnote slide 56

Question 127

During intubation you want to move _______ and ________ due to the blades being bigger than what the patient needs A.slow and aggressive B. fast and furious C. slow and gentle D. fast and gentle

Answer 127

C. slow and gentle but don't take a lot of time ## Footnote slide 56

Question 128

When placing the ETT you want to make sure the balloon is____ A. 2-3 cm past the vocal cords B. just past the vocal cords C. half way past the vocal cords D. above the vocal cords

Answer 128

B. just past the vocal cords make sure the stylet is not too deep in the tube or it could hurt the lungs make sure the whole balloon is just pass the vocal cords ## Footnote slide 56

Question 129

Another extremely important concept for intubating a pediatric patient is A. its okay to let go of tube to turn on ventilator B. a slight movement in head before taping is okay C. theres more space in the trachea so the odds on right mainsteming is very low D. NEVER let go of the tube before taping

Answer 129

D. NEVER let go of the tube before taping "you want to make sure you're still holding on to the ET tube with the pediatric patients before you're doing all this and make sure someone listens before you tape one of the big things i recommend after you get the tube in and you're holding it is to make sure you hold the ET tube against the corner of the mouth really tightly and that way you know it's secure right there in the corner of the mouth and when you tape you tape very close to the corner of the mouth" ## Footnote slide 56

Question 130

Which of the following are goals of perioperative fluid management? (Select 3) A. Meet maintenance fluid requirements B. Control intraoperative bleeding C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses E. Maintain normoglycemia F. Reduce postoperative nausea and vomiting

Answer 130

A. Meet maintenance fluid requirements C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses ## Footnote Slide 59

Question 131

For a 25 kg patient, how much total maintenance fluid should be given per hour? A. 55 mL/hr B. 65 mL/hr C. 75 mL/hr D. 85 mL/hr

Answer 131

**B. 65 mL/hr** Explanation 4-2-1 rule First 10 kg: 10 × 4 = 40 mL Next 10 kg: 10 × 2 = 20 mL Remaining 5 kg: 5 × 1 = 5 mL Total = 40 + 20 + 5 = 65 mL/hr ## Footnote Slide 59/60

Question 132

What is a known limitation of the 4-2-1 rule in pediatric fluid management? A. It underestimates fluid needs in healthy adults B. It overestimates maintenance needs in sick children C. It requires invasive hemodynamic monitoring D. It does not consider weight-based calculations

Answer 132

B. It overestimates maintenance needs in sick children ## Footnote Slide 61

Question 133

Which of the following contribute to increased perioperative fluid losses? (Select 3) A. Environmental temperature B. Cold, dry anesthetic gases C. Use of regional anesthesia alone D. Neuroendocrine regulation affected by anesthetic agents E. Warm, humidified oxygen

Answer 133

A. Environmental temperature B. Cold, dry anesthetic gases D. Neuroendocrine regulation affected by anesthetic agents ## Footnote Slide 61

Question 134

IVF is used to replace intraoperative blood loss and fluid loss resulting from __ and __. A. Fever and dehydration B. Sweating and urination C. Evaporation and third spacing D. Bleeding and vomiting

Answer 134

C. Evaporation and third spacing ## Footnote Slide 61

Question 135

What is essential to monitor during perioperative fluid management to guide ongoing therapy? A. Anesthetic depth B. Oxygen tank pressure C. Physiological parameters D. Patient allergies

Answer 135

C. Physiological parameters *Dr. M: loss as long as the patient's tolerating it well and we want to continually assess and monitor the patient for any physiological changes looking at their heart rate and blood pressure to see if we're maintaining our fluid step as well* ## Footnote Slide 61

Question 136

How is the preoperative fluid deficit calculated in a pediatric patient? A. Maintenance fluid rate × weight in kg B. Maintenance fluid rate × NPO hours C. Bolus dose based on BMI D. Fixed 10 mL/kg/hr replacement

Answer 136

B. Maintenance fluid rate × NPO hours *or off IV fluids if they're inpatient* ## Footnote Slide 62

Question 137

Match the hour with the correct proportion of fluid deficit to be replaced:

Answer 137

1st hour → B. 1/2 2nd hour → A. 1/4 3rd hour → C. 1/4 ## Footnote Slide 62

Question 138

Which of the following are appropriate for replacing fluid deficits in pediatric patients? (Select 2) A. Normal Saline B. Lactated Ringer’s C. D5W D. Hypertonic saline E. LR + dextrose

Answer 138

A. Normal Saline B. Lactated Ringer’s ## Footnote Slide 63

Question 139

Which type of fluid should generally be avoided when giving boluses to neonates and older children according to lecture? A. Normal Saline B. Lactated Ringer’s C. Dextrose-containing fluids D. Balanced electrolyte solutions

Answer 139

C. Dextrose-containing fluids ## Footnote Slide 63

Question 140

Which of the following are goals of perioperative fluid management? (Select 3) A. Meet maintenance fluid requirements B. Control intraoperative bleeding C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses E. Maintain normoglycemia F. Reduce postoperative nausea and vomiting

Answer 140

A. Meet maintenance fluid requirements C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses ## Footnote Slide 59

Question 141

In which pediatric population is routine dextrose administration not advised during anesthesia? A. Critically ill infants B. Healthy children C. Diabetic children D. Premature infants

Answer 141

B. Healthy children ## Footnote Slide 65

Question 142

____ and those ____ may develop hypoglycemia due to prolonged periods of fasting. A. Healthy toddlers; >15 kg B. Critically ill infants; < 10 kg C. Neonates ; with diabetes D. Premature infants; > 5 kg

Answer 142

B. Critically ill infants; < 10 kg **Critically ill infants** and those weighing **< 10 kg** may develop hypoglycemia with prolonged periods of fasting

Question 143

Match the clinical scenario with the appropriate dextrose treatment:

Answer 143

A → 3 Routine intraoperative use in infants = 2.5% dextrose-containing isotonic solutions intraop B → 2 Symptomatic hypoglycemia: IV 10% dextrose 2 ml/kg C → 1 If seizures are present, give 10% dextrose 4 ml/kg ## Footnote Slide 65

Question 144

n which of the following cases should glucose-containing fluids be considered? (Select 4) A. Healthy toddlers under 20 kg B. Premature infants C. Infants of diabetic mothers D. Children receiving pre-op insulin E. Children on parenteral nutrition

Answer 144

B. Premature infants C. Infants of diabetic mothers D. Children receiving pre-op insulin E. Children on parenteral nutrition ## Footnote Slide 65

Question 145

Match each age group with its estimated blood volume (EBV) range:

Answer 145

A → 5 B → 3 C → 4 D → 2 E → 1 ## Footnote Slide 66

Question 146

The incidence of apnea is higher in neonates and premature infants with hematocrit values less than __. A. 20% B. 25% C. 30% D. 35%

Answer 146

C. 30% ## Footnote Slide 67

Question 147

# True or False Healthy children with normal cardiovascular function may tolerate lower hematocrit levels.

Answer 147

True *Compensate with increased CO if a **higher inspired [O2]** is provided to improve O2 delivery* ## Footnote Slide 67

Question 148

Which of the following is the correct formula to calculate Maximum Allowable Blood Loss (MABL)? A. MABL = EBV × (Target Hct / Starting Hct) B. MABL = (EBV – Blood loss) / Hematocrit C. MABL = EBV × (Starting Hct – Target Hct) / Starting Hct D. MABL = EBV × Target Hct

Answer 148

C. MABL = EBV × (Starting Hct – Target Hct) / Starting Hct ## Footnote Slide 67

Question 149

Which of the following statements are true regarding intraoperative blood loss replacement? (Select all that apply) A. Blood loss can be replaced with 3 mL of crystalloid per 1 mL of blood loss B. Colloids are the first-line fluid for all pediatric surgeries C. Packed red blood cells should be given in a 1:1 ratio for blood loss replacement D. Dextrose-containing solutions are ideal for fluid boluses E. Crystalloid replacement is less efficient than PRBCs in restoring oxygen-carrying capacity

Answer 149

A. Blood loss can be replaced with 3 mL of crystalloid per 1 mL of blood loss C. Packed red blood cells should be given in a 1:1 ratio for blood loss replacement ## Footnote Slide 67

Question 150

3-year-old child weighs 15 kg, starting hct 38%, desired hct = 25%, what is the MABL?

Answer 150

MABL = [(15 x 70) x (38-25)] / 38 = ? MABL = 360 mL ## Footnote Slide 68

Question 151

Which of the following are goals of perioperative fluid management? (Select 3) A. Meet maintenance fluid requirements B. Control intraoperative bleeding C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses E. Maintain normoglycemia F. Reduce postoperative nausea and vomiting

Answer 151

A. Meet maintenance fluid requirements C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses ## Footnote Slide 59

Question 152

What is the approximate hematocrit of packed red blood cells (PRBCs)? A. 30% B. 45% C. 60% D. 70%

Answer 152

C. 60% ## Footnote Slide 69

Question 153

__ mL/kg of PRBCs will raise the hemoglobin level by 1 g/dL. A. 2 B. 3 C. 4 D. 5

Answer 153

C. 4 mL/kg ## Footnote Slide 69

Question 154

Which of the following are appropriate methods for warming small volumes of blood in pediatric patients? (Select 2) A. Draw into a syringe and warm by hand B. Place under a forced-air warming blanket C. Warm using standard adult blood warmers D. Use a microwave for rapid warming E. Allow the unit to reach room temperature over time

Answer 154

A. Draw into a syringe and warm by hand B. Place under a forced-air warming blanket ## Footnote Slide 69

Question 155

Which of the following is a contraindication to outpatient anesthesia in infants? A. Full-term infants over 2 months old B. Infants born at 36 weeks gestation and now 61 weeks post-conceptual age C. Infants born before 35 weeks gestation or under 60 weeks post-conceptual age D. Infants with resolved GERD and no respiratory symptoms

Answer 155

C. Infants born before 35 weeks gestation or under 60 weeks post-conceptual age * At risk for postoperative apnea * Must stay overnight in hospital ## Footnote Slide 70

Question 156

Postoperative discharge goals include ensuring that the patient is ventilating well, tolerating __ intake, and not experiencing significant __. A. IV; fever B. oral (PO); nausea or vomiting C. tube feeding; apnea D. glucose; hypotension

Answer 156

B. oral (PO); nausea or vomiting *The patient needs to be able to **take PO meds without n/v prior to d/c*** | Postoperative goals are the same as for all surgeries ## Footnote Slide 70

Question 157

Which of the following statements about postoperative apnea in premature infants are true? (Select 2) A. Infants born at 28 weeks have the highest risk of apnea B. Anemia increases the risk of apnea, regardless of age C. The risk of apnea disappears entirely by 40 weeks D. Risk decreases as post-conceptual age approaches 60 weeks E. Infants born at 36 weeks have no risk of apnea

Answer 157

A. Infants born at 28 weeks have the highest risk of apnea D. Risk decreases as post-conceptual age approaches 60 weeks *Dr. M: that's why we want patients to stay overnight until they reach that 60 week post-conceptual age* ## Footnote Slide 71

Question 158

Which of the following is NOT typically performed under outpatient anesthesia? A. ENT procedures B. Ophthalmology procedures ( C. Urology procedures = D. Craniotomy E. Radiology procedures (e.g., CT or MRI under sedation) F. Dental procedures

Answer 158

D. Craniotomy ## Footnote Slide 70

Question 159

Which of the following is NOT a contributing cause of perioperative hypothermia? A. Cold operating room B. Anesthetic-induced vasodilation C. Infusion of room-temperature IV fluids D. Use of warming blankets E. Evaporative heat loss F. Cool irrigating solutions G. Inspiration of cool/dry anesthetic gases

Answer 159

D. Use of warming blankets ## Footnote Slide 72

Question 160

Which of the following are strategies to prevent hypothermia in neonates during surgery? (Select 3) A. Use of radiant heat lamps B. Applying cold IV fluids quickly C. Over-body Bair-hugger warmer D. Keeping the head warm E. Using cool anesthetic gases

Answer 160

A. Use of radiant heat lamps C. Over-body Bair-hugger warmer D. Keeping the head warm ## Footnote Slide 72

Question 161

Causes of Perioperative Cardiac Arrest in Children Cause 1. Cardiac-related 2. Respiratory-related Category A. Hypovolemia B. Myocardial ischemia C. Hyperkalemia D. Sudden arrhythmias E. Laryngospasm F. Inadequate oxygenation G. Difficult intubation

Answer 161

A. Hypovolemia → 1 B. Myocardial ischemia → 1 C. Hyperkalemia → 1 D. Sudden arrhythmias → 1 E. Laryngospasm → 2 F. Inadequate oxygenation → 2 G. Difficult intubation→ 2 *Dr. M: most prevalent in kids with congenital heart disease often during non-cardiac surgery* ## Footnote Slide 73

Question 162

Which of the following are goals of perioperative fluid management? (Select 3) A. Meet maintenance fluid requirements B. Control intraoperative bleeding C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses E. Maintain normoglycemia F. Reduce postoperative nausea and vomiting

Answer 162

A. Meet maintenance fluid requirements C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses ## Footnote Slide 59

Question 163

# True or False The incidence of respiratory complications is not influenced by the experience level of the anesthesia provider.

Answer 163

FALSE Incidence of respiratory complications has been repeatedly reported to be **dependent on the experience level of the anesthesia provider** ## Footnote Slide 73

Question 164

Match each patient type to the preferred extubation approach: Patient Scenario: A. Full stomach / RSI B. Difficult airway C. Reactive airway disease D. Risk of needing emergent re-intubation Extubation Type: 1. Deep extubation 2. Awake extubation

Answer 164

A. Full stomach / RSI → 2 Awake extubation B. Difficult airway → 2 Awake extubation C. Reactive airway disease → 1Deep extubation D. Risk of needing emergent re-intubation → 2 Awake extubation ## Footnote Slide 74

Question 165

Which of the following influence the decision to perform an awake extubation? (Select a2) A. Preference and comfort of the provider B. Comfort and competency of the recovery room staff C. Patient’s insurance status D. Operating room noise level

Answer 165

A. Preference and comfort of the provider B. Comfort and competency of the recovery room staff ## Footnote Slide 74

Question 166

During which stage of anesthesia is extubation considered most risky due to heightened airway reflexes and potential for laryngospasm? A. Stage 1 B. Stage 2 C. Stage 3 D. Recovery phase

Answer 166

B. Stage 2 ## Footnote Slide 74

Question 167

What is a helpful post-extubation positioning strategy for pediatics according to lecture? A. Supine with neck extended B. Prone with head elevated C. Lateral (side-lying) position D. Trendelenburg position

Answer 167

C. Lateral (side-lying) position ## Footnote Slide 74

Question 168

Which of the following circuits is recommended for transporting a patient to PACU? A. Bain circuit B. Jackson-Reese circuit C. Circle system D. Venturi circuit

Answer 168

B. Jackson-Reese circuit ## Footnote Slide 75

Question 169

Which of the following are essential monitoring tools during patient transport to the PACU? (Select 2) A. Precordial stethoscope B. Pulse oximeter C. Tourniquet D. Blood glucose meter E. ECG leads

Answer 169

A. Precordial stethoscope B. Pulse oximeter ## Footnote Slide 75

Question 170

Which of the following are essential emergency medications to have available during transport to the PACU? (Select 4) A. Propofol B. Succinylcholine (Succs) C. Atropine D. Epinephrine E. Midazolam

Answer 170

A. Propofol B. Succinylcholine (Succs) C. Atropine D. Epinephrine ## Footnote Slide 75

Question 171

Which of the following best explains the increased risk of postoperative apnea in premature infants? A. Enhanced sensitivity to hyperoxia B. Impaired ventilatory response to hypoxia and hypercarbia C. Increased airway resistance due to narrow trachea D. Overdevelopment of respiratory centers

Answer 171

**B. Impaired ventilatory response to hypoxia and hypercarbia** *Dr. M: when the baby has respiratory distress they can fatigue a lot faster leading to apnea apnea can lead to bradycardia and hypoxemia very easily.* ## Footnote Slide 76

Question 172

Which of the following is used to stabilize respiratory rhythm in premature infants at risk for apnea? (Select 2) A. Morphine B. Dexamethasone C. Caffeine D. CPAP E. Midazolam

Answer 172

**C. Caffeine** *Caffeine 20 mg/kg & maintenance therapy is ~ 5 mg/kg/day* **D. CPAP** ## Footnote Slide 77

Question 173

Which of the following are goals of perioperative fluid management? (Select 3) A. Meet maintenance fluid requirements B. Control intraoperative bleeding C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses E. Maintain normoglycemia F. Reduce postoperative nausea and vomiting

Answer 173

A. Meet maintenance fluid requirements C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses ## Footnote Slide 59

Question 174

# True or False Postoperative apnea in premature infants typically resolves with maturation.

Answer 174

True ## Footnote Slide 77

Question 175

Which of the following is the primary tool used to detect postoperative apnea in premature infants? A. Arterial blood gas B. Pulse oximetry C. Chest X-ray D. ECG monitoring

Answer 175

B. Pulse oximetry *< 60 weeks post-conceptual age should be admitted for 24-hour observation* ## Footnote Slide 77

Question 176

Which of the following anesthetic strategies are recommended to reduce the risk of apnea in premature infants? (Select 3) A. Use of spinal or caudal anesthesia if appropriate B. High-dose opioids for prolonged analgesia C. Non-opioid medications for pain control D. TAP blocks (with caution regarding local anesthetic dosing) E. Routine use of general anesthesia with inhaled agents

Answer 176

A. Use of spinal or caudal anesthesia if appropriate C. Non-opioid medications for pain control D. TAP blocks (with caution regarding local anesthetic dosing) *Dr. M: premature infants that are having episodes of apnea often called episodes of As and Bs apnea and bradycardia we want to do things to limit our opioid medicine so consider opioid sparing techniques* ## Footnote Slide 77

Question 177

What is the estimated incidence of emergence agitation in the pediatric population? A. 1–10% B. 10–80% C. 50–90% D. <5%

Answer 177

B. 10–80% *No single cause* ## Footnote Slide 78

Question 178

Which of the following is NOT considered an altered behavior in the PACU associated with emergence agitation or delirium? A. Restlessness B. Crying C. Moaning D. Bradycardia E. Incoherence F. Disorientation

Answer 178

D. Bradycardia ***Agitation may be d/t: Pain, cold, full bladder, fear, anxiety, parental separation, etc*** ## Footnote Slide78

Question 179

Which of the following are characteristics of pediatric postoperative delirium? (Select 4) A. Inconsolable crying B. Disorientation C. Following commands D. Not responding to parents E. No eye contact

Answer 179

A. Inconsolable crying B. Disorientation D. Not responding to parents E. No eye contact ## Footnote Slide 78

Question 180

Which of the following age groups is most commonly associated with an increased risk of emergence delirium? A. Neonates B. Infants under 6 months C. Children 2–9 years old D. Adolescents 12–18 years old

Answer 180

C. Children 2–9 years old ## Footnote Slide 78

Question 181

Which of the following factors may contribute to an increased risk of emergence delirium in pediatric patients? (Select all that apply) A. Recent upper respiratory infection B. Length of surgery C. Type of surgery D. Anesthetic technique used E. Use of regional anesthesia alone

Answer 181

**C. Type of surgery** *Dr.M: a lot of ENT procedures* **D. Anesthetic technique used** *Dr.M: anesthetic gas is the highest risk factor where if you used tiva it would be a lower risk factor* ## Footnote Slide 79

Question 182

Which of the following are appropriate treatment options for emergence delirium in pediatric patients? (Select 4) A. Anticholinergics like glycopyrrolate B. Alpha-2 agonists C. Administration of propofol D. Effective pain management E. Inhaled corticosteroids F. Allowing time for resolution

Answer 182

B. **Alpha-2 agonists** C. Administration of **propofol** D. Effective **pain management** F. Allowing **time** for resolution ## Footnote Slide 79

Question 183

Strict attention to the dose of ________ and ________ is essential when performing regional anesthesia in children. A. Propofol; ketamine B. Local anesthetic; epinephrine C. Fentanyl; dexmedetomidine D. Midazolam; nitrous oxide

Answer 183

B. Local anesthetic; epinephrine ## Footnote Slide 80

Question 184

Which of the following are goals of perioperative fluid management? (Select 3) A. Meet maintenance fluid requirements B. Control intraoperative bleeding C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses E. Maintain normoglycemia F. Reduce postoperative nausea and vomiting

Answer 184

A. Meet maintenance fluid requirements C. Replace preoperative fluid deficits D. Compensate for ongoing perioperative losses ## Footnote Slide 59

Question 185

Which of the following statements is true regarding regional anesthesia in pediatric patients? A. Regional anesthesia is never performed under general anesthesia due to increased risk. B. Sensory level assessment of a block is easier under general anesthesia. C. The risk of injury may be reduced if the child is calm and not combative during placement. D. Accidental dural puncture is easily recognized and treated in anesthetized children.

Answer 185

C. The risk of injury may be reduced if the child is calm and not combative during placement. - Usually performed with the child under GA - Limited ability to properly assess the sensory level of the block under GA - Consequences of accidental dural puncture are more challenging to assess & treat ## Footnote Slide 80

Question 186

Levels: L1 S1 S3 L3 Match the following: *Adults:* Conus Medullaris Dural Sac Terminus *Infants* Conus Medullaris Dural Sac Terminus

Answer 186

*Adults:* Conus Medullaris - L1 Dural Sac Terminus - S1 *Infants* Conus Medullaris - S1 Dural Sac Terminus - S3 ## Footnote Slide 81

Question 187

What is the most commonly used regional anesthesia (RA) technique in pediatric anesthesia? A. Spinal B. Epidural C. Caudal D. Femoral

Answer 187

C. Caudal *Adjunct to GA or solely for postop analgesia* ## Footnote Slide 82

Question 188

The use of ____ is recommended to improve accuracy during caudal block placement. A. Fluoroscopy B. Nerve stimulator C. Ultrasound D. X-ray

Answer 188

C. Ultrasound ## Footnote Slide 82

Question 189

Caudal anesthesia is administered with the patient in the __________ position with knees __________. A. Supine; extended B. Prone; abducted C. Lateral; flexed D. Lithotomy; straight

Answer 189

C. Lateral; flexed ## Footnote Slide 82

Question 190

Which anatomical landmarks are used to identify the sacral hiatus for caudal anesthesia placement? A. Anterior superior iliac spine and L3 spinous process B. Tip of the coccyx and sacral cornua on either side of the sacral hiatus C. Greater trochanter and posterior superior iliac spine D. Tuffier’s line and sacral promontory

Answer 190

B. Tip of the coccyx and sacral cornua on either side of the sacral hiatus *Forms an equilateral triangle*

Question 191

Put the Following Steps in the Correct Order for Caudal Anesthesia Placement: A. Aspirate to check for blood or CSF B. Place 22-gauge needle bevel up at a 45° angle to the skin C. Inject local anesthetic D. Advance needle until loss of resistance (LOR) is felt through the sacrococcygeal membrane E. Reduce needle angle and advance cephalad F. Use saline for LOR confirmation

Answer 191

B → D → E → F → A → C 1. 22-gauge needle placed bevel up at 45° angle to the skin (B) 2. Once LOR felt when sacrococcygeal membrane is punctured (D) 3. Reduce the needle angle, and advance cephalad (E) 4. Use saline for LOR (F) 5. Aspirate (A) 6. Inject LA (C) ## Footnote Slide 84

Question 192

What volume of local anesthetic (LA) is typically used to achieve a T4–T6 dermatome level in pediatric caudal anesthesia? A. 0.5 mL/kg B. 1.0 mL/kg C. 1.2–1.5 mL/kg D. 2.5 mL/kg

Answer 192

C. 1.2–1.5 mL/kg ## Footnote Slide 85

Question 193

What is the recommended maximum concentration of local anesthetic for caudal anesthesia in children? A. 1.0 mg/kg B. 1.5 mg/kg C. 2.0 mg/kg D. 2.5 mg/kg

Answer 193

D. 2.5 mg/kg ## Footnote Slide 85

Question 194

Which factor most determines the choice of local anesthetic used in caudal blocks for children? A. Age of the child B. Hospital protocol C. Provider preference D. Cost of medication

Answer 194

C. Provider preference ## Footnote Slide 85

Question 195

Approximately what volume of LA is used for lower procedures (e.g., below T10) in pediatric caudal anesthesia? A. 2 mL/kg B. 1.5 mL/kg C. 1.0 mL/kg D. 0.5 mL/kg

Answer 195

C. 1.0 mL/kg ## Footnote Slide 85

Question 196

Which of the following are commonly used additives in pediatric caudal anesthesia? A. Epinephrine (1:200,000) B. Clonidine (1–2 mcg/kg) C. Fentanyl D. Midazolam E. Naloxone

Answer 196

A. Epinephrine (1:200,000) B. Clonidine (1–2 mcg/kg) C. Fentanyl ## Footnote Slide 85