Pediatric Anesthesia

Question 1

Pyloric stenosis: expected Chem for mild and severe disease

Answer 1

Mild: HypoCl, hypoK metabolic alkalosis
Severe: Same + lactic acidosis. So neutral pH.

Question 2

How do you TREAT emergence delirium?

Answer 2

Propofol, opioid agents, or Precedex.

Question 3

Workup for all children with TE Fistulas

Answer 3

VACTERL:
Vertebral
Anal atresia
Cardiac (VSDs)
TE-fistula
Renal
Limb

Question 4

Most common TEF type

Answer 4

C Type (blind esophageal pouch. Distal esophagus attached to trachea)

Question 5

What murmur characteristics are pathologic

Answer 5

Anything grade 3+/6
Diastolic murmurs (AI/PI = early, MS/TS = mid-late)

Question 6

Agitation on extubation. Causes.

Answer 6

• Big 3: Pain, hypoxia, hypotension
• Emergence delirium

Question 7

Spinals: dural sac of a newborn is at what level

Answer 7

S3

Question 8

Caudal block dose

Answer 8

1 mL/kg of 0.25% bupi or 0.2% ropi

Question 9

How long do you delay a case for a child with URI? PNA?

Answer 9

URI: if febrile or productive cough - 2-3 weeks
PNA: 4-6 weeks

Question 10

What are some pedi surgeries with higher incidence of PONV?

Answer 10

strabismus, orchiopexy, T&A

Question 11

Pediateic ETT size equation

Answer 11

(16 + Age)/4

if cuffed, subtract 0.5

Question 12

Mapleson circuits. Best for spontaneous breathing? Controlled?

Answer 12

Spontaneous: ADCB
Controlled: DBCA

Question 13

Evidence for parental presence in OR

Answer 13

Not supported by research. paper from late 80s (not controlled or random) showed it made parents happier but didn’t help the kid EXCEPT in cases where parent stayed calm (no guarantee) and kid was anxious.

Question 14

What is Larson’s maneuver

Answer 14

pressure point at anterior mastoid process that helps break laryngospasm

Question 15

Break a laryngospasm

Answer 15

Positive pressure, deepen anesthesia, succinylcholine, Larson’s maneuver

Question 16

Do you want to give dextrose to the child during a case?

Answer 16

Only if <2 months (no glycogen stores). If older, hold it. Risk hyperglycemia and risk bolusing on accident.

Question 17

Oral premed doses: midazolam

Answer 17

0.5 mg/kg

Question 18

premedication dose: Dexmedetomidine

Answer 18

3-4 mcg/kg intranasal

Question 19

Why is succinylcholine contraindicated in Duchenne’s/Becker’s?

Answer 19

You can get hyperK arrest (increased ACh receptors).
NOT MH!

Question 20

Child has “jaws of steel” masseter muscle spasm after induction. WDYD?

Answer 20

• 100% O2, nasal airway/attempt nasal intubation, prep surgical airway.
• admit for 12-24hr obs (50% chance MH, rhabdo), monitor etCO2, temp, CK and K+

Question 21

Why is PEEP bad in someone with a ASD?

Answer 21

Can reverse the normal L->R gradient if the ASD. Promote hypoxia and emboli