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ST: Clinical Prep > 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
What VAA should be avoided in CDH management?
N₂O
26
Which type of Transesophageal Fistula (TEF) is most common?
Type C
27
TEF is usually located where in relation to the carina?
1-2 rings **above** the carina
28
When does TEF occur gestationally?
Weeks 4-5
29
TEF is often associated with VACTERL. What does this acronym stand for?
- **V**ertebral anomalies - **A**nus imperforate - **C**ongenital heart disease - **T**racheo**E**sophageal fistula - **R**enal abnormalities - **L**imb abnormalities
30
How is TEF diagnosed prenatally?
- Polyhydramnios - Absent/small gastric bubble
31
What signs/symptoms cause concern for TEF postnatally?
**The 3 C's** - Choking - Coughing - Cyanosis
32
How is TEF confirmed post-birth?
- Inability to pass NG tube into stomach more than 7cm. - Imaging (air in esophagus & distal stomach) or bronchoscopy
33
The following image is likely for what?
TEF
34
What anesthetic airway maneuvers should be avoided prior to surgery for TEF?
- Mask ventilation - Tracheal intubation *Likely to exacerbate distention*.
35
What positioning is common for TEF and why?
Left Lateral Decubitus *Right thoracotomy approach that helps avoid the aortic arch*.
36
Where should the ETT tip be placed in TEF patients?
Inbetween the fistual and carina
37
Gentle mask ventilation with high peak pressures should be used on induced TEF patients. T/F?
False. Ensure peak pressures are low
38
What newborn condition is often diagnosed between 2 - 8 weeks of age with non-bilious projectile vomiting?
Pyloric stenosis
39
What is pyloric stenosis?
Hypertrophy/Hyperplasia of muscular layer of pylorus resulting in gastric outlet obstruction.
40
What acid-base imbalance is typical for pyloric stenosis?
Metabolic alkalosis with hypokalemia & hypochloremia
41
Why does metabolic alkalosis occur with pyloric stenosis?
Kidney excretion of HCO₃⁻ & K⁺ to maintain normal blood pH and retain Na⁺.
42
Is pyloric stenosis a medical emergency typically?
No. 24-48 hours are typically taken to correct electrolyte imbalances
43
The "donut" sign is typical for what condition?
Pyloric stenosis
44
How should an infant with pyloric stenosis be induced?
RSI *Then suction right, center, then left*.
45
What narcotics are typically used for pyloric stenosis?
Trick question. **No Narcotics**!
46
What is the pediatric dose of lidocaine for induction?
Lidocaine 1-2 mg/kg
47
What is the pediatric dose of atropine for induction?
Atropine 0.2 mg/kg
48
What is the pediatric dose of propofol for induction?
2-4 mg/kg
49
What is the pediatric dose of succinylcholine for induction?
2mg/kg
50
What is the pediatric dose for rectal tylenol?
30-40 mg/kg
51
What type of fluids are used for hydrating infants post operative for pyloromyomectomy (until adequate oral intake occurs)?
Dextrose containing fluids (for calories & glucose).
52
Pyloric stenosis repair necessitates an ______ extubation.
awake
53
What condition is depicted below?
Gastroschisis
54
What condition is depicted below?
Omphalocele
55
Where are the herniated viscera typically located in gastroschisis patients?
Typically to the **right** of the umbilicus.
56
Between gastroschisis and omphalocele, which typically has the more normal bowel function?
omphalocele
57
The following are characteristics of...
Gastroschisis
58
The following are characteristics of...
Omphalocele
59
What are some non-genetic environmental factors that can cause neural tube defects?
- Folate deficiency - Anti-epileptic drugs - Retinoids - Maternal diabetes
60
____ _____ is characterized by abnormal or incomplete formation of midline structures over the back.
Spina Bifida
61
What are characteristics of spina bifida occulta?
- **Overlying tissue appears normal** - Possible hairy patch - Sacral dimple - Lipoma
62
What are characteristics of spina bifida aperta?
- **Obvious lesion on back** *Either meningocele or myelomeningocele*.
63
Differentiate a meningocele and a myelomeningocele.
64
Flip for picture of Spina Bifida sub-types.
65
Hydrocephalus is more common with which category of spina bifida?
Spina Bifida Aperta
66
Do nerve roots below the level of the lesion function for myelomeningocele?
No
67
What additional surgery is necessary for spina bifida w/ concomitant hydrocephalus.
VP shunt
68
What disorder is characterized by cerebellar herniation through foramen magnum into the cervical space?
Chiari Malformations
69
Chronic increasing of _____ is characteristic of chiari malformations.
ICP - Headache - Irritability - N/V
70
What are the four types of chiari malformations?
71
The following s/s are characteristic of what?
Arnold Chiari Malformation
72
What are the varying types of craniosynostosis?
73
"Cloverleaf" craniosynostosis, hypertelorism, proptosis, syndactaly, and hypoplasia of the midface are all symptoms characteristic of what?
Apert Syndrome
74
What is hypertelorism?
Larger than normal distance between the eyes
75
Crouzon syndrome is a syndrome similar to Apert except for what key differences?
Differing ophthalmic defects *especially optic atrophy and exopthalmos.*
76
What is another name for hemifacial microsomia?
Otomandibular dysplasia
77
Hemifacial Microsomia is characterized by the acronym OMENS, what does this stand for?
- **O**rbital distortion - **M**andibular hypoplasia - **E**ar anomaly - **N**erve involvement - **S**oft tissue deficiency
78
What factors may contribute to difficulty intubating a child with hemifacial microsomia?
- Mid-facial hypoplasia - Asymmetry of mouth opening - Retrognathic mandible
79
What is the most common syndrome associated with hemifacial microsomia?
Goldenhar Syndrome
80
What is a key feature of Treacher Collins Syndrome that differentiates it from other hemifacial microsomia syndromes?
Bilateral lower lid colobomas
81
What syndrome is characterized by a triad of micrognathia, glossoptosis, and respiratory distress during the 1st 48 hours of life?
Pierre Robin Syndrome
82
Which syndrome routinely involves a tongue suture placed for retraction?
Pierre Robin
83
The difficult airway associated with Pierre Robin _______ with age.
improves
84
The airway associated with Treacher Collins syndrome _______ with age.
worsens
85
How is Pierre Robin treated?
Surgical advancement of the jaw over time.
86
When is cleft lip typically repaired?
2-3 months of age
87
When is cleft palate repaired?
6-10 months of age
88
Palatal revision and alveolar bone grafts for cleft palate patients typically occur around ___ years of age.
10
89
Is a bilateral or unilateral cleft a more difficult airway?
bilateral
90
What intubation approach should be used in a cleft palate patient to avoid the cleft?
right paraglossal technique
91
Awake extubations are standard of care for cleft lip/palate repairs. T/F?
True
92
What four organ abnormalities are common for down syndrome patients?
- Duodenal atresia - Congenital heart defects - Hypotonia - Hypothyroidism
93
What are hallmark signs of down syndrome?
94
What characteristics of down syndrome are of particular importance to anesthesia?
- Subglottic stenosis - Obstructing upper airway - Atlantoaxial instability - Abnormal radial arteries - ↓HR from anesthesia
95
What drugs should be ready on induction with down syndrome patients? Why?
Glycopyrrolate 0.01 mg/kg Atropine 0.01 mg/kg Down syndrome = Bradycardic induction
96
Scoliosis repair is considered in all children with progressive curves greater than ______ degrees.
40 - 50 °
97
What method is most commonly used to measure the magnitude of a scoliosis curve?
Cobb Angle
98
What hemifacial microsomia disorder is commonly associated with scoliosis?
Goldenhar Syndrome
99
What is Cook's Children's scoliosis repair anesthetic "recipe"?
100
What volatile agent is not used in scoliosis repairs for children?
N₂O

ST: Clinical Prep (11 decks)

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