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AP + Phys > Pediatric difficult airway lecture > Flashcards

Pediatric difficult airway lecture Flashcards

1
Q

Obligate nose breathers until when

A

5 months

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2
Q

Describe the larynx

A

anterior and cephalad, c4 (c6 in adults)

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3
Q

Describe airway

A

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

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4
Q

Narrowest portion of airway

A

Glottis, although cricoid ring is the narrowest fixed

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5
Q

Type 1 muscle fiber in the pediatric lung

A

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

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6
Q

02 consumption vs adults

A

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

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7
Q

What abnormality causes mandibular hypoplasia

A

pierre robin
APEX: Please Get That Chin

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8
Q

intubation considerations for hypoplasia mandible

A

nasal intubation
fiber optic
someone available to trach

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9
Q

apert disease might also be associated with ___

A

cardiac and renal problems

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10
Q

How will patients with cleft lip eat

A

bilat cleft lip will need a g tube

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11
Q

cleft palate / lift is associated with ___

A

congenital heart disease in 50%

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12
Q

trisomy 21 is associated with

A

“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

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13
Q

When are lips and palates fixed

A

lips-3 months
palate- 6 months
APEX says lip at 1 month, palate at 1 year

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14
Q

pierre robin intubation consideratinos

A

keep spontaneous breathing!
no muscle relaxers wit tracheal intubation

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15
Q

how to manage clefts

A

minimize narcotics
non respiratory depressants
LA
monitor overnight

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16
Q

cleft lip vs palate considerations

A

lip no problems
palate - possible obstruciton

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17
Q

Advantages of regional anesthesia

A

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

18
Q

contraindications of neuraxial blocks

A

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

19
Q

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

A

use a test dose

20
Q

When to use CHG vs iodine

A

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

21
Q

conus medularis and dural sac in peds

A

L3
s3
L1/s1 in adults

22
Q

contraindications to caudal anesthesia

A

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

23
Q

caudal needle

A

blunt
tuohy
22g/20g angio cath

24
Q

pt position of caudal anesthesia

A

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

25
Q

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

A

needed level of anesthesia
patients weight and concentration of the LA

26
Q

Max volume and dose for caudal anesthesia

A

25 ml
3 mg/kg

27
Q

volume for different levels of regional anesthesia

A

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

28
Q

LA toxicity treatment

A

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

29
Q

Test dose

A

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 10 bpm, bp increase of 15mmhg, t wave increase >25%, or bradycardia are all signs of IV injection

30
Q

neurotoxicity signs

A

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

31
Q

How to prevent risk of toxicity

A

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

32
Q

Conditions with large tongue

A

“Big Tongue”
beckwith
trisomy 21

33
Q

conditions with small chins

A

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

34
Q

Conditions with C spine anomalies

A

“Kids Try Gold”
Klippel fiel
Trisomy 21
Goldenhaar

35
Q

Pierre robin syndrome

A

small mandible
big tongue
cleft palate

36
Q

Treacher collins syndrome

A

small mandible/ mouth
choanal atresia

37
Q

trisomy 21

A

small mouth large tongue
ao instability
small subglottic diameter

38
Q

klippel fiel

A

neck rigidity

39
Q

goldenhaar

A

c spine
small madnible

40
Q

main issues for cleft lip or palate

A

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

AP + Phys (38 decks)

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