Pediatric Anesthesia (Exam I) Flashcards
Resistance is inversely related to airway radius to the ____ power.
4th
Poiseuille’s Law
Laryngospasm occurs during inspiratory or expiratory effort?
Inspiratory
The following EtCO₂ waveform in a pediatric patient would be suggestive of what?
Bronchospasm
A polyphonic wheeze with prolonged expiration and increased respiratory effort would be suggestive of what?
bronchospasm
What should be done to the I:E ratio in the instance of bronchospasm?
I:E ratio should increase in bronchospasming patients to minimize air trapping.
What is the pediatric dose of epinephrine for bronchospasm?
0.05 - 0.5 mcg/kg q1min as needed
The following symptoms are associated with what type of spasm?
Laryngospasm
The following symptoms are associated with what type of spasm?
Bronchospasm
Inflammation & edema related to compression of the tracheal mucosa is after extubation is known as?
Post-extubation Croup
What are the risk factors for post-extubation croup?
- Larger ETT size
- Changes in position during surgery
- Repeated intubation attempts
- Age 1-4
- Longer (>1hr) surgeries
- Previous hx of croup
What are the treatment options for croup?
- Prevention: micro-cuff ETT (high volume/low pressure)
- Racemic Epi
- Dexamethasone
What is the pediatric dexamethasone dosage for croup?
0.5 mg/kg
What are the pulmonary consequences of CDH (Congenital Diaphragmatic Hernia) ?
- ↑ PVR
- Pulm HTN
_______ is caused by failure of the complete closure of the pleural and peritoneal canals.
CDH
The most common form of CDH occurs at the left posterolateral _____ ____ _______.
Foramen of Bochdalek
Foramen of Bochdalek CDH is the largest type and is associated with the greatest degree of pulmonary ________.
hypoplasia
80% of CDH are left-sided Bochdalek’s hernia. What other hernias can occur?
- Morgagni (2%)
- Paraesophageal (15 - 20%)
Which lung will be compressed in left posterolateral CDH?
Left lung (ipsilateral to the CDH)
What is the major cause of mortality in infants undergoing CDH repair without ECMO?
Pulmonary HTN
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?
Silo Pouch
Is single lung ventilation necessary for CDH repair?
Not necessarily.
Low flow, low pressure CO₂ insufflation on the ipsilateral lung can aid in returning abdominal viscera back where it needs to go.
Elevated _______ should be avoided in CDH surgeries.
PVR
What are some common causes of elevated PVR?
- Hypoxemia
- Acidosis
- Hypothermia
- Hypercarbia
What are some commonly used methods to avoid increased PVR in CDH patients?
- Hyperventilation
- Narcotics (SNS blunting)
What VAA should be avoided in CDH management?
N₂O
Which type of Transesophageal Fistula (TEF) is most common?
Type C
TEF is usually located where in relation to the carina?
1-2 rings above the carina
When does TEF occur gestationally?
Weeks 4-5
TEF is often associated with VACTERL. What does this acronym stand for?
- Vertebral anomalies
- Anus imperforate
- Congenital heart disease
- TracheoEsophageal fistula
- Renal abnormalities
- Limb abnormalities
How is TEF diagnosed prenatally?
- Polyhydramnios
- Absent/small gastric bubble
What signs/symptoms cause concern for TEF postnatally?
The 3 C’s
- Choking
- Coughing
- Cyanosis
How is TEF confirmed post-birth?
- Inability to pass NG tube into stomach more than 7cm.
- Imaging (air in esophagus & distal stomach) or bronchoscopy
The following image is likely for what?
TEF
What anesthetic airway maneuvers should be avoided prior to surgery for TEF?
- Mask ventilation
- Tracheal intubation
Likely to exacerbate distention.
What positioning is common for TEF and why?
Left Lateral Decubitus
Right thoracotomy approach that helps avoid the aortic arch.
Where should the ETT tip be placed in TEF patients?
Inbetween the fistual and carina
Gentle mask ventilation with high peak pressures should be used on induced TEF patients. T/F?
False. Ensure peak pressures are low
What newborn condition is often diagnosed between 2 - 8 weeks of age with non-bilious projectile vomiting?
Pyloric stenosis
What is pyloric stenosis?
Hypertrophy/Hyperplasia of muscular layer of pylorus resulting in gastric outlet obstruction.
What acid-base imbalance is typical for pyloric stenosis?
Metabolic alkalosis with hypokalemia & hypochloremia