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Advanced Principles B (Summer '24) > Pediatric Anesthesia (Exam I) > Flashcards

Pediatric Anesthesia (Exam I) Flashcards

1
Q

Resistance is inversely related to airway radius to the ____ power.

A

4th

Poiseuille’s Law

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2
Q

Laryngospasm occurs during inspiratory or expiratory effort?

A

Inspiratory

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3
Q

The following EtCO₂ waveform in a pediatric patient would be suggestive of what?

A

Bronchospasm

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4
Q

A polyphonic wheeze with prolonged expiration and increased respiratory effort would be suggestive of what?

A

bronchospasm

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5
Q

What should be done to the I:E ratio in the instance of bronchospasm?

A

I:E ratio should increase in bronchospasming patients to minimize air trapping.

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6
Q

What is the pediatric dose of epinephrine for bronchospasm?

A

0.05 - 0.5 mcg/kg q1min as needed

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7
Q

The following symptoms are associated with what type of spasm?

A

Laryngospasm

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8
Q

The following symptoms are associated with what type of spasm?

A

Bronchospasm

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9
Q

Inflammation & edema related to compression of the tracheal mucosa is after extubation is known as?

A

Post-extubation Croup

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10
Q

What are the risk factors for post-extubation croup?

A
  • Larger ETT size
  • Changes in position during surgery
  • Repeated intubation attempts
  • Age 1-4
  • Longer (>1hr) surgeries
  • Previous hx of croup
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11
Q

What are the treatment options for croup?

A
  • Prevention: micro-cuff ETT (high volume/low pressure)
  • Racemic Epi
  • Dexamethasone
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12
Q

What is the pediatric dexamethasone dosage for croup?

A

0.5 mg/kg

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13
Q

What are the pulmonary consequences of CDH (Congenital Diaphragmatic Hernia) ?

A
  • ↑ PVR
  • Pulm HTN
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14
Q

_______ is caused by failure of the complete closure of the pleural and peritoneal canals.

A

CDH

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15
Q

The most common form of CDH occurs at the left posterolateral _____ ____ _______.

A

Foramen of Bochdalek

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16
Q

Foramen of Bochdalek CDH is the largest type and is associated with the greatest degree of pulmonary ________.

A

hypoplasia

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17
Q

80% of CDH are left-sided Bochdalek’s hernia. What other hernias can occur?

A
  • Morgagni (2%)
  • Paraesophageal (15 - 20%)
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18
Q

Which lung will be compressed in left posterolateral CDH?

A

Left lung (ipsilateral to the CDH)

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19
Q

What is the major cause of mortality in infants undergoing CDH repair without ECMO?

A

Pulmonary HTN

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20
Q

If an infant’s stomach is too small to hold herniated abdominal contents from a CDH, what can be used to hold viscera outside of the body and slowly introduce it into the abdomen over time?

A

Silo Pouch

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21
Q

Is single lung ventilation necessary for CDH repair?

A

Not necessarily.

Low flow, low pressure CO₂ insufflation on the ipsilateral lung can aid in returning abdominal viscera back where it needs to go.

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22
Q

Elevated _______ should be avoided in CDH surgeries.

A

PVR

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23
Q

What are some common causes of elevated PVR?

A
  • Hypoxemia
  • Acidosis
  • Hypothermia
  • Hypercarbia
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24
Q

What are some commonly used methods to avoid increased PVR in CDH patients?

A
  • Hyperventilation
  • Narcotics (SNS blunting)
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25
Q

What VAA should be avoided in CDH management?

A

N₂O

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26
Q

Which type of Transesophageal Fistula (TEF) is most common?

A

Type C

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27
Q

TEF is usually located where in relation to the carina?

A

1-2 rings above the carina

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28
Q

When does TEF occur gestationally?

A

Weeks 4-5

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29
Q

TEF is often associated with VACTERL. What does this acronym stand for?

A
  • Vertebral anomalies
  • Anus imperforate
  • Congenital heart disease
  • TracheoEsophageal fistula
  • Renal abnormalities
  • Limb abnormalities
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30
Q

How is TEF diagnosed prenatally?

A
  • Polyhydramnios
  • Absent/small gastric bubble
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31
Q

What signs/symptoms cause concern for TEF postnatally?

A

The 3 C’s

  • Choking
  • Coughing
  • Cyanosis
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32
Q

How is TEF confirmed post-birth?

A
  • Inability to pass NG tube into stomach more than 7cm.
  • Imaging (air in esophagus & distal stomach) or bronchoscopy
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33
Q

The following image is likely for what?

A

TEF

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34
Q

What anesthetic airway maneuvers should be avoided prior to surgery for TEF?

A
  • Mask ventilation
  • Tracheal intubation

Likely to exacerbate distention.

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35
Q

What positioning is common for TEF and why?

A

Left Lateral Decubitus

Right thoracotomy approach that helps avoid the aortic arch.

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36
Q

Where should the ETT tip be placed in TEF patients?

A

Inbetween the fistual and carina

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37
Q

Gentle mask ventilation with high peak pressures should be used on induced TEF patients. T/F?

A

False. Ensure peak pressures are low

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38
Q

What newborn condition is often diagnosed between 2 - 8 weeks of age with non-bilious projectile vomiting?

A

Pyloric stenosis

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39
Q

What is pyloric stenosis?

A

Hypertrophy/Hyperplasia of muscular layer of pylorus resulting in gastric outlet obstruction.

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40
Q

What acid-base imbalance is typical for pyloric stenosis?

A

Metabolic alkalosis with hypokalemia & hypochloremia

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41
Q

Why does metabolic alkalosis occur with pyloric stenosis?

A

Kidney excretion of HCO₃⁻ & K⁺ to maintain normal blood pH and retain Na⁺.

42
Q

Is pyloric stenosis a medical emergency typically?

A

No. 24-48 hours are typically taken to correct electrolyte imbalances

43
Q

The “donut” sign is typical for what condition?

A

Pyloric stenosis

44
Q

How should an infant with pyloric stenosis be induced?

A

RSI

Then suction right, center, then left.

45
Q

What narcotics are typically used for pyloric stenosis?

A

Trick question. No Narcotics!

46
Q

What is the pediatric dose of lidocaine for induction?

A

Lidocaine 1-2 mg/kg

47
Q

What is the pediatric dose of atropine for induction?

A

Atropine 0.2 mg/kg

48
Q

What is the pediatric dose of propofol for induction?

A

2-4 mg/kg

49
Q

What is the pediatric dose of succinylcholine for induction?

A

2mg/kg

50
Q

What is the pediatric dose for rectal tylenol?

A

30-40 mg/kg

51
Q

What type of fluids are used for hydrating infants post operative for pyloromyomectomy (until adequate oral intake occurs)?

A

Dextrose containing fluids (for calories & glucose).

52
Q

Pyloric stenosis repair necessitates an ______ extubation.

A

awake

53
Q

What condition is depicted below?

A

Gastroschisis

54
Q

What condition is depicted below?

A

Omphalocele

55
Q

Where are the herniated viscera typically located in gastroschisis patients?

A

Typically to the right of the umbilicus.

56
Q

Between gastroschisis and omphalocele, which typically has the more normal bowel function?

A

omphalocele

57
Q

The following are characteristics of…

A

Gastroschisis

58
Q

The following are characteristics of…

A

Omphalocele

59
Q

What are some non-genetic environmental factors that can cause neural tube defects?

A
  • Folate deficiency
  • Anti-epileptic drugs
  • Retinoids
  • Maternal diabetes
60
Q

____ _____ is characterized by abnormal or incomplete formation of midline structures over the back.

A

Spina Bifida

61
Q

What are characteristics of spina bifida occulta?

A
  • Overlying tissue appears normal
  • Possible hairy patch
  • Sacral dimple
  • Lipoma
62
Q

What are characteristics of spina bifida aperta?

A
  • Obvious lesion on back

Either meningocele or myelomeningocele.

63
Q

Differentiate a meningocele and a myelomeningocele.

A
64
Q

Flip for picture of Spina Bifida sub-types.

A
65
Q

Hydrocephalus is more common with which category of spina bifida?

A

Spina Bifida Aperta

66
Q

Do nerve roots below the level of the lesion function for myelomeningocele?

A

No

67
Q

What additional surgery is necessary for spina bifida w/ concomitant hydrocephalus.

A

VP shunt

68
Q

What disorder is characterized by cerebellar herniation through foramen magnum into the cervical space?

A

Chiari Malformations

69
Q

Chronic increasing of _____ is characteristic of chiari malformations.

A

ICP

  • Headache
  • Irritability
  • N/V
70
Q

What are the four types of chiari malformations?

A
71
Q

The following s/s are characteristic of what?

A

Arnold Chiari Malformation

72
Q

What are the varying types of craniosynostosis?

A
73
Q

“Cloverleaf” craniosynostosis, hypertelorism, proptosis, syndactaly, and hypoplasia of the midface are all symptoms characteristic of what?

A

Apert Syndrome

74
Q

What is hypertelorism?

A

Larger than normal distance between the eyes

75
Q

Crouzon syndrome is a syndrome similar to Apert except for what key differences?

A

Differing ophthalmic defects

especially optic atrophy and exopthalmos.

76
Q

What is another name for hemifacial microsomia?

A

Otomandibular dysplasia

77
Q

Hemifacial Microsomia is characterized by the acronym OMENS, what does this stand for?

A
  • Orbital distortion
  • Mandibular hypoplasia
  • Ear anomaly
  • Nerve involvement
  • Soft tissue deficiency
78
Q

What factors may contribute to difficulty intubating a child with hemifacial microsomia?

A
  • Mid-facial hypoplasia
  • Asymmetry of mouth opening
  • Retrognathic mandible
79
Q

What is the most common syndrome associated with hemifacial microsomia?

A

Goldenhar Syndrome

80
Q

What is a key feature of Treacher Collins Syndrome that differentiates it from other hemifacial microsomia syndromes?

A

Bilateral lower lid colobomas

81
Q

What syndrome is characterized by a triad of micrognathia, glossoptosis, and respiratory distress during the 1st 48 hours of life?

A

Pierre Robin Syndrome

82
Q

Which syndrome routinely involves a tongue suture placed for retraction?

A

Pierre Robin

83
Q

The difficult airway associated with Pierre Robin _______ with age.

A

improves

84
Q

The airway associated with Treacher Collins syndrome _______ with age.

A

worsens

85
Q

How is Pierre Robin treated?

A

Surgical advancement of the jaw over time.

86
Q

When is cleft lip typically repaired?

A

2-3 months of age

87
Q

When is cleft palate repaired?

A

6-10 months of age

88
Q

Palatal revision and alveolar bone grafts for cleft palate patients typically occur around ___ years of age.

A

10

89
Q

Is a bilateral or unilateral cleft a more difficult airway?

A

bilateral

90
Q

What intubation approach should be used in a cleft palate patient to avoid the cleft?

A

right paraglossal technique

91
Q

Awake extubations are standard of care for cleft lip/palate repairs. T/F?

A

True

92
Q

What four organ abnormalities are common for down syndrome patients?

A
  • Duodenal atresia
  • Congenital heart defects
  • Hypotonia
  • Hypothyroidism
93
Q

What are hallmark signs of down syndrome?

A
94
Q

What characteristics of down syndrome are of particular importance to anesthesia?

A
  • Subglottic stenosis
  • Obstructing upper airway
  • Atlantoaxial instability
  • Abnormal radial arteries
  • ↓HR from anesthesia
95
Q

What drugs should be ready on induction with down syndrome patients? Why?

A

Glycopyrrolate 0.01 mg/kg
Atropine 0.01 mg/kg

Down syndrome = Bradycardic induction

96
Q

Scoliosis repair is considered in all children with progressive curves greater than ______ degrees.

A

40 - 50 °

97
Q

What method is most commonly used to measure the magnitude of a scoliosis curve?

A

Cobb Angle

98
Q

What hemifacial microsomia disorder is commonly associated with scoliosis?

A

Goldenhar Syndrome

99
Q

What is Cook’s Children’s scoliosis repair anesthetic “recipe”?

A
100
Q

What volatile agent is not used in scoliosis repairs for children?

A

N₂O

Advanced Principles B (Summer '24) (8 decks)

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