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Anesthesia Written Board Questions > Pediatric Anesthesia > Flashcards

Pediatric Anesthesia Flashcards

1
Q

What are the most common syndromes associate with Pierre Robin Sequence?

A

The most common syndromes associated with PRS are:

  • Stickler syndrome
  • Velocardiofacial syndrome
  • Treacher-Collins Syndrome
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2
Q

What physical characteristics define Pierre Robin Sequence (PRS)?

A

PRS is a collection of:

  • Micrognathia
  • Glossoptosis
  • Cleft palate
  • Laryngomalacia
  • Hearing loss
  • Airway obstruction
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3
Q

What is the advantage of using a circle breathing system vs. a non-rebreathing system in pediatrics?

A

Circle systems conserve heat and humidity better, which is an advantage in caring for small neonates prone to hypothermia.

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4
Q

What is the advantage of using a non-rebreathing system vs. a circle system in pediatrics?

A

Non-rebreathing circuits have no valves, which decrease the work of breathing as well as the partial-pressure of inhaled agents increase faster in non-rebreathing circuits since the total volume of the circuit is less compared to a circle system.

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5
Q

At what spinal level does the glottis lye in the pediatric population?

A

Full-term neonate: C4

Premature baby: C3

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6
Q

What happens to pulmonary vascular resistance (PVR) in a neonate at birth?

A

Lung expansion decreases the PVR, which results in physiologic closure of the ductus arteriosis.

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7
Q

What are the exclusion criteria for infants presenting for outpatient surgery?

A

< 56 weeks post conceptual age and < 32 weeks post gestation when born
or
< 54 weeks post conceptual age and < 35 weeks post gestation when born

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8
Q

Cause of epiglottitis and signs and symptoms?

A

It is caused by Haemophilus influenza type B

Signs and symptoms include: high fever, child leaning forward and drooling

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9
Q

What acid/base derangement will you expect to see in a patient with pyloric stenosis?

A

Hyponatremic, hypochloremic, hypokalemic metabolic alkalosis with alkalotic urine

possibly compensated by a respiratory acidosis

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10
Q

What are the common metabolic and physiological abnormalities seen in premature babies?

A

1) Hyperkalmia - due to immaturity/dysfunction of the kidneys, metabolic acidosis, and a low urine output due to a low systemic blood flow
2) Hypothermia - due to their higher surface area to volume ratio
3) Hypocalcemia
4) PT is usually 10% longer due to an immature liver (this normalizes within the first week of life

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11
Q

What is the most common congenital neural tube defect?

A

Meningomyelocele, which results when the neural tube fails to close in the fourth week of gestation

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12
Q

What is the P50 of an infant?

A

Leftward shift = 19 mmHg

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13
Q

What metabolic abnormalities is a premature infant prone to?

A

Hyperkalemia - due to immature or dysfunctional kidneys, metabolic acidosis and a low urine output due to low systemic blood flow.

Hypothermia - due to higher surface area to volume ratio

Hypocalcemia - can present as unexplained hypotension, irritability, and seizures

Prolonged PT - due to immature liver, PT is usually 10% longer

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14
Q

Which congenital anterior abdominal wall defect (gastroschisis vs. omphalocele) is NOT associated with other congenital anomalies?

A

Gastroschisis

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15
Q

What percentage of a preterm infant’s body is composed of water? vs. term infants? by 6 months old?

A

85% of their total body weight vs 75% water in a term infant

6 month olds’ bodies are composed of 60% water

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16
Q

How long may patients exhibit bronchial hyperactivity after a URI?

A

Up to 7 weeks after his/her symptoms have resolved

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17
Q

What are the blood volumes for a premature infant vs. a full term infant vs. 3-12 month old child vs. a child > 1 year old?

A

Premature infant = 100 mL/kg
Full term infant = 90 mL/kg
3-12 month old chid = 80 mL/kg
> 1 year old child = 70 mL/kg

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18
Q

How is the maximal allowable blood loss (MABL) volume calculated?

A

MABL = estimated blood volume (EBV) x [(starting Hct - target Hct) / starting Hct]

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19
Q

What are the characteristics of Fetal Hydantoin Syndrome?

A

It is characterized by growth deficiency, microcephaly, and mental retardation.

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20
Q

How does the chronic use of barbiturates by pregnant women effect the fetus?

A

Transient coagulation abnormalities which can be treated with vitamin K

21
Q

LMA sizes (according to weight)

A 
LMA #1 = < 5kg
LMA #1.5 = 5-10 kg
LMA #2 = 10-20 kg
LMA #2.5 = 20-30 kg
LMA #3 = 30-50 kg
22
Q

What age range of children benefit the most for having parental presence in the OR?

A

Ages 1 to 6 years of age

23
Q

At what age does separation anxiety become an issue?

A

Around 8 months of age

24
Q

What are patients with spina bifida at an increase risk of?

A 
Latex allergy
Club foot
Hip dislocation
Scoliosis
Leg weakness
Paralysis
Bladder and bowel incontinence
Frequent UTIs
Hydrocephalus
25
Q

What are the characteristics of a patient with pyloric stenosis?

A

It is a condition that typically affects MALE babies in the first 2-6 WEEKS of life.

NON-BILIOUS VOMITING and FAILURE TO THRIVE

26
Q

What patients are advised to receive antibiotic prophylaxis prior to dental procedures?

A
  • Children with prosthetic cardiac valves or prosthetic material used in the valve repair
  • Children with unrepaired TOF or other cyanotic lesions (are at the greatest risk for developing infective endocarditis)

[Patients with MVP are no longer recommended to receive antibiotic prophylaxis. Also, children who had their PDA ligated or ASD sutured do NOT require antibiotic prophylaxis.]

27
Q

Describe the Fontan Procedure and what is used for?

A

The Fontan procedure involves anastomosing the RA appendage to the PA, allowing better blood flow to the pulmonary circulation.

Tricuspid atresia

28
Q

What plateau pressures should be maintained in patients with ARDS?

A

Pressure should be maintained at or below 30 cm H2O

29
Q

In utero, when does coordinated swallowing begin?

A

Early in the 2nd trimester

30
Q

From what embryologic structure does the pharynx, esophagus, stomach, and first part of the duodenum derive?

A

The Foregut

31
Q

At what point does a fetus’ GI tract become functional and is able to excrete waste products?

A

From 9 weeks to 40 weeks post conception, the GI tract become rudimentarily functional and is able to excrete waste products.

32
Q

What artery supplies the midgut?

A

The omphalomenteric artery

33
Q

What electrolyte abnormality are preterm infants at high risk of?

A

HYPOcalcemia

Signs/symptoms:

  • twitching
  • irritability
  • seizures
34
Q

What is the equation to determine appropriate ETT size?

A

(Age in years/4) + 4 = size of uncuffed ETT

The appropriate size for a cuffed ETT is 0.5mm smaller than the calculated uncuffed size.

35
Q

Describe epigastric omphaloceles vs. hypogastric omphaloceles

A
  • Epigastric omphaloceles are highly associated with congenital heart diseases as well as thoracic defects
  • Hypogastric omphaloceles are associated with exstrophy of the bladder and genital malformations
36
Q

Describe the incidence and findings associated with congenital diaphragmatic hernia (CDH).

A

The incidence is 1 in 4000, making quite rare

~40-50% of these patients do NOT survive despite treatment

9 out of 10 times, it occurs on the left side

The ventilatory goals is to maintain the O2 sat >90% and permissive hypercapnia is helpful in maintaining respiratory drive with a goal PaCO2 of 60-65 mmHg

37
Q

Patients with cystic fibrosis need pre-op evaluation assessing what organ function?

A

Coagulation studies can help gauge the extent of liver pathology

38
Q

Following a Tonsillectomy, at what time period is a patient at greatest risk for postoperative bleeding?

A

Up to 6 hours

39
Q

What happens to hemoglobin levels at the age of 2-3 months?

A

A physiologic anemia takes place with a Hgb level of ~ 10-12 g/dL.

After the 3 month mark, the Hgb value consistently increases

40
Q

How can hydralazine used to treat preeclampsia, effect a neonate?

A

Hydralazine can cause thrombocytopenia and Lupus-like syndrome in neonates

41
Q

How can HOCM in the pediatric population be treated?

A

Occlusion of the 1st septal penetrating artery (a branch of the LAD)

42
Q

What is the dose of epinephrine required to identify intravascular injection for pediatric regional anesthesia during inhaled anesthesia?

A

0.5 and 0.75 mcg/kg of epinephrine in infants > 3 months

43
Q

By what age does an infant’s elimination half-life of morphine decrease to adult values?

A

2 - 3 months of age

44
Q

What is the typical pediatric dosing of methadone?

A

A bolus of 0.1 - 0.2 mg/kg followed by 0.05 mg/kg every 6-8 hours

45
Q

What is the most appropriate medication in treating cardiac lesions where systemic oxygen delivery is dependent on ductus flow?

A

e.g. interrupted aortic arch

Prostaglandin E1, which maintains ductal patency (connecting the PA to the proximal descending aorta)

46
Q

What are the side effects of prostaglandin E1?

A

Apnea
Hypotension
Fever

47
Q

What dermatomes are covered with a caudal block consisting of 1 mL/kg of local anesthetic in a neonate/infant?

A

It will provide a sensory block from S5 to T10

48
Q

What are the risk factors for PONV in the pediatric population?

A

Eberhart’s classification:

  • family history of PONV
  • duration of anesthesia
  • age > 3 yrs
  • strabismus surgery
49
Q

At what level is the dural sac located in a neonate?

A

The dural sac in the neonate can extend to S 3-4 (until age 1 year, where it is at the adult level of S2)

Anesthesia Written Board Questions (13 decks)

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