Pediatric Anesthesia Week 6 Flash Cards
In which population is Necrotizing Enterocolitis most common in?
Preterm Infants
Morbidity associated with Necrotizing Enterocolitis include…
- Short bowel syndrome
- Sepsis
- Adhesions associated with bowel obstruction
What are some risk factors associated with Necrotizing Enterocolitis?
- Birth asphyxia
- Hypotension
- Respiratory distress syndrome (RDS)
- PDA
- Recurrent apnea
- Intestinal ischemia
- Umbilical vessel cannulation
- Systemic infections
- Early feedings
What is Omphalocele?
- A birth defect where intestines are COVERED with the amnion and is located AT THE BASE of the umbilicus
- Failure of the gut to migrate from the yoke sac into the abdomen during 5TH TO 10TH WEEK OF GESTATION
What is Gastroschisis?
- A birth defect where intestines are NOT COVERED and exposed to hypothermia, infection, and dehydration and is located PERIUMBILICAL
- Develops as a result of OCCLUSION OF THE OMPHALOMESENTERIC ARTERY during 12TH TO 18TH WEEK OF GESTATION
Compare Omphalocele and Gastroschisis with regard to locaton, hernial sac, and associated congenital anomalies
Omphalocele:
- Location is at the base of the umbilicus
- Hernial sac is present
- Associated congenital anomalies are present and include:
- Trisomy 21 (Down's Syndrom)
- Cardiac anomalies
- Diaphragmatic hernia
- Bladder anomalies
Gastroschisis:
- Location is lateral to umbilicus
- Hernial sac is absent
- No known associated congenital anomaliesPerioperative management of Omphalocele and Gastroschisis centers around what 3 preventative measures?
- Hypothermia
- Dehydration
- Infection
In which order, Omphalocele or Gastroschisis, are hypothermia, dehydration, and infection most serious? Why?
More serious in Gastroschisis because the hernial sac is absent
Where is the fistula usually located in a patient with a trachea-esophageal fistula (TEF)?
LOWER SEGMENT of the esophagus, about 90%, where the esophagus inserts just above the carina onto the posterior wall of the trachea
Where is the proper placement of the ETT in a patient with tracheal-esophageal fistula? Describe the procedure for intubating the patient with a TEF?
- The tip of the ETT can be placed just distal to the TEF (in between the fistula and carina)
- Steps for proper placement:
- Insert ETT until mainstem occurs
- Confirm with unilateral breath sounds
- Slowly WITHDRAW until bilateral breathsounds are
present
The key to successful anesthetic management of the neonate with TEF is correct positioning of the ETT. What is the important consideration for intubating the infant with a TEF? What intubaton techniques are appropriate?
- AVOID POSITIVE PRESSURE VENTILATION
- Use 1 of 2 techniques:
- Inhalation induction followed by topical application of
lidocaine and intubate while the patient is
spontaneously breathing - Use an IV or inhalation induction and intubate the
trachea with muscle paralysis.
*The latter technique may lead to distension of the fistula and stomach after onset of positive pressure ventilation
- Inhalation induction followed by topical application of
What is Tracheomalacia (also known as Tracheobronchomalacia)? What patients are at risk for developing Tracheomalacia?
- “Malacia” means abnormal softening of tissue, so softening of the tracheal tissue
- Commonly seen in neonates/infants often in a association with esophageal atresia (TEF) or with extrinsic compression by vascular anomalies or mediastinal masses. May also be associated with hyperthyroidism
What is the anesthetic concern for the patient with Tracheomalacia?
AIRWAY OBSTRUCTION, possibly requiring urgent intubation
What is the etiology of Epiglottitis?
Due to a life-threatening infection by Haemophilus Influenza Type B bacteria
List 9 signs & symptoms of Epiglottitis?
- Upper airway obstruction
- Inspiratory stridor
- Chest retractions
- Tachypnea
- Drooling
- Cyanosis
- Difficulty swallowing
8 Insists on sitting - Restlessness
Children of what age are at highest risk of Epiglottitis?
Children ages 1 to 7 years old, occurs more frequently in children less than 3 years of age.
Where is the optimal location for intubation of a patient with Epiglottitis in the hospital? Why?
- The operating room
- Because total obstruction of the airway could occur at any moment. Attempt to visualize the epiglottis should not be taken unless in the area where emergency tracheostomy can be performed
What is the induction agent of choice and ETT size of choice in a patient with Epiglottitis?
An inhalation induction should be performed, followed by an intubation with ETT 1/2 to 1 size smaller than usual
How long would you expect the ETT to be left in place with a patient with Epiglottitis? What is one sign suggesting the patient is ready for extubation?
- ETT is left in place for 24 to 96 hours
- AIR LEAK usually appears around the ETT as swelling decreases
Where and when should the patient with Epiglottitis be extubated?
Extubation should be performed in the OR only after direct laryngoscopy has confirmed resolution of the swelling of the Epiglottis
