Pediatric difficult airway lecture

Question 1

Obligate nose breathers until when

Answer 1

5 months

Question 2

Describe the larynx

Answer 2

anterior and cephalad, c4 (c6 in adults)

Question 3

Describe airway

Answer 3

large epiglottis
Short trachea and neck
Large tongue
small pharynx
parynx is more anterior

Question 4

Narrowest portion of airway

Answer 4

Glottis, although cricoid ring is the narrowest fixed

Question 5

Type 1 muscle fiber in the pediatric lung

Answer 5

small number, only 25% compared to 55% in the adult

Question 6

02 consumption vs adults

Answer 6

peds- 6ml/kg/min
adults- 3ml/kg/min
SAME for co2

Question 7

What abnormality causes mandibular hypoplasia

Answer 7

pierre robin

Question 8

intubation considerations for hypoplasia mandible

Answer 8

nasal intubation
fiber optic
someone available to trach

Question 9

apert disease might also be associated with ___

Answer 9

cardiac and renal problems

Question 10

How will patients with cleft lip eat

Answer 10

bilat cleft lip will need a g tube

Question 11

cleft palate lift is associated with ___

Answer 11

congenital heart disease in 50%

Question 12

trisomy 21 is associated with

Answer 12

“cardiac” (what rachel said in lecture)
Apex: most common cardiac defect is AV septal defect, then VSD
Bradycardia is common during sevo inductions, treat with anticholinergic

Question 13

When are lips and palates fixed

Answer 13

lips-3 months
palate- 6 months

Question 14

pierre robin intubation consideratinos

Answer 14

keep spontaneous breathing!
no muscle relaxers wit tracheal intubation

Question 15

how to manage clefts

Answer 15

minimize narcotics
non respiratory depressants
LA
monitor overnight

Question 16

cleft lip vs palate considerations

Answer 16

lip no problems
palate - possible obstruciton

Question 17

Advantages of regional anesthesia

Answer 17

reduced concentrations of inhaled agents- decreased post op sedation, faster awakening
reduced use of opioids- decrease n/v, itching, post op sedation
improved gi functinos
reduced thromboembolic events

Question 18

contraindications of neuraxial blocks

Answer 18

coagulopathy
severe infections
hydrocephalus
allergy to LA
chemo
lesions at sight of puncture
demylenatiing disease
refusal
previous spinal instrumentation

Question 19

How to manage the fact that pedis cant tell you about the block to assess accuracy

Answer 19

use a test dose

Question 20

When to use CHG vs iodine

Answer 20

iodine only if <2 months, wash it off when done, let it dry before inserting needle

Question 21

conus medularis and dural sac in peds

Answer 21

L3
s3
L1/s1 in adults

Question 22

contraindications to caudal anesthesia

Answer 22

pilonidal cyst
abnormal superficial landmarks
myelomeningocele pts
hydrocephalus/ intracranial hnt
neuropathy
parent non consent

Question 23

caudal needle

Answer 23

blunt
tuohy
22g/20g angio cath

Question 24

pt position of caudal anesthesia

Answer 24

lateral with legs and hips flexed- but keep an eye on airway
or
prone

Question 25

for caudal anesthesia, the volume depends on ___ and the dose depends on ___

Answer 25

needed level of anesthesia
patients weight and concentration of the LA

Question 26

Max volume and dose for caudal anesthesia

Answer 26

25 ml
3 mg/kg

Question 27

volume for different levels of regional anesthesia

Answer 27

thoracic- 1.5ml/kg
lumbar- 1ml/kg
sacral- .5ml/kg

Question 28

LA toxicity treatment

Answer 28

20% intralipid solution
bolus 1.5ml/kg x2 if needed
0.25ml/kg/min for 1 hour

Question 29

Test dose

Answer 29

aspiration of blood (alone) is not reliable
0.1ml/kg of LA with epi 5mcg/ml added MAX dose 3ml
watch for hr increase of 1- bpm, bp increase of 15mmhg, t wave increase >25%, or bradycardia are all signs of IV injection

Question 30

neurotoxicity signs

Answer 30

HA
somnolence
vertigo
parasthesia
tremors
shivering
convulsions
cardiac: dysrhtymias, wide qrs, block, torsades, vt, cv collapse

Question 31

How to prevent risk of toxicity

Answer 31

avoid hypothermia, acidosis, hypercarbia, hyperkalemia
inject slowly
test dose

Question 32

Conditions with large tongue

Answer 32

“Big Tongue”
beckwith
trisomy 21

Question 33

conditions with small chins

Answer 33

“Please Get That Chin”
Pierre robin
Goldenhaar
Treacher collins
Cri du chat

Question 34

Conditions with C spine anomalies

Answer 34

“Kids Try Gold”
Klippel fiel
Trisomy 21
Goldenhaar

Question 35

Pierre robin syndrome

Answer 35

small mandible
big tongue
cleft palate

Question 36

Treacher collins syndrome

Answer 36

small mandible/ mouth
choanal atresia

Question 37

trisomy 21

Answer 37

small mouth large tongue
ao instability
small subglottic diameter

Question 38

klippel fiel

Answer 38

neck rigidity

Question 39

goldenhaar

Answer 39

c spine
small madnible

Question 40

main issues for cleft lip or palate

Answer 40

airway- difficult laryngoscope, mask ventilation, aspiration
other- failure to thrive