Brainscape's Knowledge GenomeTM

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


See full index

AS - N934 Advanced Principles II > Pediatric Anesthesia > Flashcards

Pediatric Anesthesia Flashcards

1
Q

Otorhinolaryngology

A

Head & neck

OHN/ENT

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

Tonsillectomy & Adenoidectomy

A

T&A
Chronic lymphoid tissue inflammation & hypertrophy in the pharynx
Surgical intervention to relieve the obstruction & remove the infection focus
3rd most common surgical procedure

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

Common Tonsillitis Causes

A 
Streptococcus
Viral agents (adenovirus, influenza, Ebstein-Barr, parainfluenza, enteroviruses)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tonsillitis S/S

A

Inflammation & swelling → respiratory obstruction

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

What’s currently the most common indication for T&As in America?

A

OSA 80% → chronic airway obstruction, CO2 retention, cor pulmonale, FTT, & speech abnormalities
Infection 20%

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

Considerations to admit T&A postop:

A 
< 3yo
Abnormal bleeding tendencies
Significant OSA
Airway abnormalities
Other systemic diseases
Excessive distance from hospital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tonsillectomy Recommendations

A 
Dexamethasone 0.5mg/kg IV
NO periop Abx
Adequate pain management
- Avoid Codeine
- Ketorolac?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T&A Intraop Considerations

A

Standard induction
- Oral RAE cuffed ETT (consider reinforced)
- LMA
- Secure midline
Rotate HOB 45-90°
Mouth gag (requires stimulating jaw thrust)
- Adequate anesthesia
- Re-evaluate airway to ensure correct placement
- Throat pack in/out
Muscle relaxants okay
Relatively quick operation

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

T&A Analgesic Management + Dosages

A 
Fentanyl 1-2mcg/kg
Tylenol 10-15mg/kg IV
Dexamethasone 0.5-1mg/kg
Ondansetron 0.1mg/kg
Dexmedetomidine 0.1-0.5mcg/kg
Ketorolac or Ibuprofen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tonsillectomy Methods

Cold Steel

A

Stainless steel scissors & scalpels
Toothed forceps & herd’s dissector/retractor used to dissect the tonsil tissue from its capsule
↑pain & hemorrhage risk

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

Tonsillectomy Methods

Electro-Dissection

A

Mono-polar or bipolar whole tonsil dissection
Cautery up to 300-400°C to induce hemostasis
Lateral thermal damage ↑postop pain & discomfort
Kinetic energy heats the intracellular & extracellular fluids & ruptures localized tissue cells

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

Tonsillectomy Methods

Microdebrider

A

Soft tissue shaver
90-95% tonsillar tissue removed (risk to return)
Natural biological dressing left in place over the pharyngeal muscles, preventing injury, inflammation, & infection
↓blood loss & pain

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

Tonsillectomy Methods

Coblation

A

Cold ablation
Energy used in plasma field to break the molecular bonds to excise or dissolve soft tissue at 40-70°C
Maintains surrounding tissue integrity
Provides dissection, cautery, suction, & hemostasis
Quick, precise, & smooth procedure

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

Tonsillectomy Methods

Radio Frequency

A

Cost-effective, easy to use, & time-saving alternative to laser
Mono polar radio frequency transferred via inserting probe into the tonsil tissue in 3-4 settings
Produces tonsil tissue scarring → reduces size

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

Tonsillectomy Methods

Laser

A

CO2 & KTP lasers
↓bleeding, pain, & discomfort
↑postop pain & 2° hemorrhage (bleeding after the scab formed or > 24hrs postop)

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

T&A Emergence

A

Laryngospasm, aspiration, & airway reactivity risk
OG to empty the stomach
Awake (able to protect airway) vs. deep extubation
Soft suction & prevent coughing
Recovery position - lateral w/ head down (allows blood to brain away from vocal cords)

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

What S/S present in children w/ restless?

A

Airway compromise or hypoxia

Careful opioid administration

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

Post-Tonsillectomy Bleeding

A

S/S include abdominal pain (especially w/ PONV prophylaxis)
1° hemorrhage w/in 24hrs
2° hemorrhage > 24hrs (5-10 days)
Ensure adequate IV access x2
Vigorous resuscitation to treat hypovolemia
Hemodynamic instability on induction
Labs: Hgb/Hct, type & cross, coags
RSI Propofol or Ketamine + Succinylcholine 2mg/kg IV
OG to empty stomach (blood)

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

Bilateral Myringotomy & Tympanostomy

A

BMT
Chronic otitis media common in young children → hearing loss & cholesteatoma formation
Myringotomy - creates an opening in the tympanic membrane to allow fluid to drain
Tympanostomy - ventilation tube placement w/ lumen to alleviate pressure from the middle ear & serves as stent to allow continual drainage until the tube are naturally extruded in 6mos-1yr

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

BMT Anesthetic Considerations

A

Often patients present w/ URI (reason they’re getting the surgery)
Short operation
Consider rectal Tylenol > PO Midazolam (outlasts the procedure)
Mask-only case
Place IV only when another procedure being done
Discontinue Sevo when turn to 2nd side

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

Myelodysplasia

A

Most common CNS defect that occurs during the 1st month gestation
Spina bifida - failure the neural tube to close resulting in the spinal cord & meninges herniating through a defect
Meningocele - contains ONLY meninges
Myelomeningocele - contains meninges & neural elements
Hydrocephalus often present & paralysis below the lesion
URGENT repair required w/in 24-48hrs d/t infection risk or worsening cord function

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

Myelodysplasia Risk Factors

A

Folate deficiency

Chromosomal abnormalities

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

Where does myelodysplasia most commonly occur (the region)?

A

Lumbosacral region

24
Q

Myelodysplasia Repair

Anesthetic Considerations

A 
Preop
- Assess lesion level & deficit
- Systems review & r/o additional congenital anomalies
- Labs:  CBC & type + screen
Intraop
- Routine monitors
- Avoid muscle relaxation when MEPs
- Supine or lateral for induction
- Prone to perform surgery
- Inhalational or IV induction
- Blood loss dependent on defect size
- Prone to hypothermia
- Latex free OR
Postop
- Goal to extubate
- Apnea monitoring
25
Q

Hydrocephalus

A

Excess CSF builds-up w/in the fluid-containing ventricles

Hydro meaning water & cephalus meaning head

26
Q

Hydrocephalus Causes

A 
Congenital defect (Arnold-Chiari aqueduct stenosis)
Acquired disease - trauma, infection, or tumor
27
Q

Ventriculoscopy

A

Fiberoptic scope inserted via cranial burr holes to visualize lateral, 3rd, & occasional 4th ventricle
Shunts also able to be positioned under U/S guidance

28
Q

Ventriculo-Peritoneal Shunt

A

VP shunt
Lateral ventricle → peritoneum
*Most common
Allows room for growth

29
Q

Ventriculo-Atrial Shunt

A

VA shunt

Lateral ventricle → R atrium

30
Q

Endoscopic 3rd Ventriculostomy

A

ETV

Burr hole created in the 3rd ventricle floor allowing CSF to flow directly into the basal cisterns

31
Q

CSF Shunt Creation

Anesthetic Considerations

A 
Preop
- Assess baseline neuro status & ICP
- Avoid premeds when ↑ICP
- Assess vomiting history & dehydration
- Review previous anesthesia records (repeat shunt revisions)
- PIV x1-2
Induction
- Standard monitoring
- Fentanyl, Propofol, & Rocuronium
- Isoflurane or Sevoflurane
- GETA
- Protect & pad the eyes
- Cefazolin 30mg/kg IV
32
Q

VP Shunt

Anesthetic Considerations

A 
Maintenance
- Avoid hyperventilation
- Maintain paralysis or bolus Propofol when tunneling
- VA shunts caution air embolism or PPV when vein open
Emergence
- Reverse paralytic
- Antiemetics
- Extubate
- Neuro assessment
33
Q

Humerus Fracture

Types

A

Proximal - break in upper part near shoulder
Mid-shaft - break in the middle
Distal - break occurs near the elbow (usually more complex elbow injury involving loose bone fragments)

34
Q

Supracondyle Humerus Fractures

A

Most common elbow fracture in children
Result from falling w/ an outstretched hand & extended elbow
Complications include compartment syndrome, nerve palsies, & late deformities

35
Q

Humerus Fracture

Anesthetic Considerations

A 
Supine w/ HOB rotated 90°
GETA
Assess NPO status & RSI indications
Pinning 30-60min
Open reduction 30-90min
Emergence timing based on cast or splint placed after closing
36
Q

Scoliosis

A

Sideway spine curvature
Idiopathic - no definite cause, most common form (> 70%), 1° affects adolescent girls
Neuromuscular - caused by conditions w/ muscle weakness (CP, MD, SCI) or spasticity & associated w/ ↑blood loss

37
Q

Scoliosis

Cobb Angle

A

Degree lateral curvature → impairs respiratory function
> 45°
Restrictive lung disease
↓TLC & VC

38
Q

Posterior Spine Fusion

Instrumentation

A

Prevent curve progression & correct curvature
Metal implants attached to the spine then connected to 1-2 rods
Anterior (one-lung ventilation) vs. posterior approach
Prone positioning
6 hours
Significant blood loss risk - hypotensive technique, maintain BP w/in 20% baseline, admin TXA, cell save, autologous blood & hemodilution

39
Q

Posterior Spine Fusion

Preop

A

Labs: CBC, coags, BMP, HCG
Type & cross
PRBCs 2 units available & cell saver

40
Q

Posterior Spine Fusion

Intraop

A 
Prone position w/ superman arms
Bair hugger
Nerve monitoring
Bilateral soft bite blocks
A-line & PIV x2
Cell saver, fluid warmer, & blood tubing
Standard induction
BIS & cerebral oxygen
OG tube
Multiple fluids & syringe channels
41
Q

Posterior Spine Fusion

Evoked Potential Monitoring

A 
Avoid volatile inhalational agents & N2O
Dexmedetomidine & opioids are compatible
Ketamine enhances amplitude
Propofol ↑latency ↓EPs amplitude
Continue monitoring 15-20min after surgical closure started
42
Q

Posterior Spine Fusion

Postop

A 
Dependent facial edema
Plan to extubate when possible
CXR when patient supine on inpatient bed
Admit 3-6 days step-down or ICU
Neuromuscular scoliosis patients potentially more sensitive & require postop ventilation 2° muscle weakness
43
Q

Posterior Spine Fusion

Complications

A 
Spinal cord ischemia
Massive blood loss
Embolism
Accidental extubation
Corneal abrasion
Visual loss
Neurological sequel w/ SSEP or MEPs loss
44
Q

Hypertrophic Pyloric Stenosis

A

Pylorus thickening or swelling (muscle b/w the stomach & intestines) that causes severe & forceful vomiting in the first few months life
Pylorus enlargement → narrowing (stenosis) of the opening from the stomach to the intestines ჻ blocks stomach contents from moving into the intestine

45
Q

Hypertrophic Pyloric Stenosis

Clinical Presentation

A

Palpable obstruction lesion (olive-shaped)
Usually diagnosed b/w 2-12 weeks old
Post-prandial projectile emesis, palpable pylorus, visible peristaltic waves
Surgical correction = pyloromyotomy
Semi-elective surgery (urgent, but requires medical management 1st to correct dehydration & electrolyte imbalance)

46
Q

Pyloric Stenosis

A

Persistent vomiting depletes Na+, K+, Cl¯, & H+ ions causing hyperchloremic metabolic alkalosis
- Kidneys attempt to compensate via sodium bicarbonate excretion
- Hyponatremia/dehydration worsen & kidneys attempt to conserve Na+
Avoid LR (lactate metabolized to bicarbonate)

47
Q

Pyloric Stenosis

Anesthetic Considerations

A

IV to replace intravascular volume
Suction stomach w/ OG prior to induction
Twist/roll/tilt to remove all stomach contents
RSI w/ cricoid pressure
HIGH aspiration risk
Pre-oxygenate → Propofol & Succinylcholine or Rocuronium
Cuffed ETT
Quick procedure
Extubate awake - limit Fentanyl & Dexmedetomidine

48
Q

Nissen Fundoplication

A

General abdominal procedure for children w/ gastric reflux that fail medical management
Laparoscopic minimally invasive procedure to restore LES (valve b/w the esophagus & stomach) function
Surgeon wraps the stomach around the esophagus

49
Q

Nissen Fundoplication

Anesthetic Considerations

A

GETA
Laparoscopic - insufflation, VAE, vagal response
Minimal blood loss, fluid shifts, & pain
Esophageal bougie to ensure no leaks after anastomosis

50
Q

Circumcision

A

Foreskin removal
Most common procedure
Foreskin opened, adhesion removed, & foreskin separated from the glans
Cut foreskin then cauterize & suture the skin edges

51
Q

Circumcision

Anesthetic Considerations

A

Indications include phimosis, recurrent balanitis, or parental preference
Local, regional, or GA (adults)
≈ 1 hour
Most common complication = bleeding

52
Q

Hypospadius

A

Malposition of the urethra meatus
Urethral opening not located at the penis tip
Underneath the penis tip more common than near the penis base

53
Q

Hypospadius

Anesthetic Considerations

A

1-4+ hours
General LMA or ETT
Regional controversial

54
Q

Cleft Lip & Palate

A 
Repaired in stages
- Lip 10-12 weeks
- Palate 12-18mos
- Alveolar bone graft
- Pharyngoplasty 5-15yrs
Difficulty feeding → malnutrition 
Impaired speech development
Congenital heart defects
55
Q

Cleft Lip & Palate

Anesthetic Considerations

A

Standard induction
Potential difficult airway
Oral RAE w/ flexible connector
Mouth gag - reassess breath sounds once positioned
No air bubbles
Local anesthetic + Epi to reduce blood loss & provide analgesia
Protect eyes
Airway & tongue edema
Awake extubation once protective airway reflexes intact

AS - N934 Advanced Principles II (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions