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Pediatric Physiology - B. Stevens/Bernstein 2017 > Pediatric Difficult Airways - Quiz 4 > Flashcards

Pediatric Difficult Airways - Quiz 4 Flashcards

1
Q

Where is the larynx in infants vs adults?

A
  • Anterior and cephalad

- C4 (adults is at C6)

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2
Q

What is the main difference b/t infants and adults breathing?

A

Infants are obligate nasal breathers until around 5 mo old

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3
Q

Narrowest part of a child’s airway

A

glottis (just like adult)

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4
Q

functionally the narrowest portion of a child’s larynx

A

cricoid ring

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5
Q

Do children have increased or decreased lung compliance, compared to adult? Why?

A

reduced because of the small and limited number of alv

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6
Q

Do children have increased or decreased chest wall compliance compared to an adult? Why?

A

increased because of their cartilaginous rib cage

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7
Q

Why is an infant’s intercostal and diaphragmatic musculature weaker than an adult’s?

A

Infants have a smaller number of type I musc fibers

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8
Q

an adult has ___% Type 1 fibers; a full term infant has ___% of Type 1 musc fibers

A

adult 55%

infant 25%

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9
Q

How does the weaker resp musculature influence an infant’s breathing?

A

it promotes

  • chest wall collapse during inspiration
  • low residual lung volumes at expiration
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10
Q

What is a child’s constant tidal volume?

A

6 mL/kg

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11
Q

What is the anesthesia implication of a child’s decreased FRC?

A

limited O2 reserve during periods of apnea + higher rate of O2 consumption = prone to atelectasis and hypoxemia when apneic

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12
Q

T/F: a child’s hypercapnia and hypoxic resp drives are well developed.

A

False.

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13
Q

How much does a child’s CO2 increase during apnea?

A

6 mmHg during the first minute, then 3-4 mmHg each minute after

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14
Q

Neonate vs adult:

  1. O2 consumption
  2. alv ventilation
  3. CO2 production
  4. Tidal volume
  5. vital capacity
  6. FRC
A
  1. O2 consumption:
    - N: 6 ml/kg/min
    - A: 3 mL/kg/min
  2. alv vent:
    - N: 130 mL/kg/min
    - A: 60 mL/kg/min
  3. CO2 production
    - N: 6 mL/kg/min
    - A: 3 mL/kg/min
  4. Tidal volume:
    - N: 6 mL/kg
    - A: 6 mL/kg
  5. Vital capacity:
    - N: 35 mL/kg
    - A: 70 mL/kg
  6. FRC
    - N: 25 mL/kg
    - A: 40 mL/kg
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15
Q

What is a neonate’s PaO2 on room air?

A

65-85 mmHg

adult is 85-95 mmHg

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16
Q

What indicates the likelihood of upper airway obstruction in a child?

A

Ratio of volume of the oral cavity to the tongue

the oral cavity is basically a bony box with a soft tissue tongue

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17
Q

What is the anterior mandibular space?

A

The space within the mandible into which the soft tissue of the tongue can be displaced during laryngoscopy

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18
Q

How does an anterior larynx complicate intubation?

A

Because the larynx sits high under the base of the tongue, there is no space to displace the tongue, and the larynx will remain anterior to the laryngoscope blade

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19
Q

What disorder is characterized by mandibular hypoplasia, glossoptosis, and resp obstruction?

A

Pierre Robin Sequence

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20
Q

What changes the mass-to-volume ration of the supper airway in a similar manner to tongue hyperplasia or mandibular hyperplasia?

A

Maxillary hypoplasia

pt looks like they have an underbite

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21
Q

What syndrome is characterized by nasal obstruction and maxillary hypoplasia?

A

Apert syndrome

22
Q

What are the anesthetic implications of Apert Syndrome?

A
  • Intubation will be fine because mandible is normal

- masking may be hard b/c they obstruct when mouth is closed

23
Q

What does the temporomandibular joint do?

A

opens the upper airway and translocates the lower jaw forward

24
Q

What is the difference b/t fixed and truismus TMJ?

A

Fixed: congenital conditions or previous trauma
Trismus: pain or inflammation; can be overcome

25
Q

How can a line of sight be provided for intubation?

A

align the axis of the trachea and the oral cavity

26
Q

What syndrome is characterized by fixed microstomia caused by fibrofacial myositis and dermatomyositis

A

Freeman-Sheldon Syndrome

27
Q

4 congenital syndroms/disorders characterized by macroglossia

(Makes visualization of larynx difficult)

A
  1. Beckwih-Wiedeman Syndrome
  2. Down’s Syndrome
  3. Sturge-Weber Syndrome
  4. Dwarfism

(the pts also often have soft tissue tumors and AV malformations)

28
Q

3 Craniofacial abnormalities

A
  • Synostosis
  • Clefting
  • Hypoplasia
29
Q

What 3 syndromes have some degree of mid face hypoplasia, hypertelorism, and proptosis?

A
  • Apert
  • Crouzon
  • Pfeiffer’s
30
Q

What is unique about the palate and nasal passages of a person w Apert, Cruzon, or Pfeiffer’s syndrome?

A

Palate - high and arched

Nasal passages - small with some degree of choanal atresia (blockage)

31
Q

What is craniosynostosis?

A

one or more of the fibrous sutures in an infant (very young) skull prematurely fuses by turning into bone (ossification), thereby changing the growth pattern of the skull. Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures.

32
Q

5 characteristics of Crouzon Dz

A
  • Hypertelorism (eyes too far apart)
  • Craniostenosis
  • Shallow orbits
  • Proptosis (eyes bug out)
  • Midface hypoplasia
33
Q

6 characteristics of Apert disease

A
  • Hypertelorism (eyes too far apart)
  • Craniostenosis
  • Shallow orbits
  • Proptosis (eyes bug out)
  • Midface hypoplasia
    • All same as Crouzon Dz except: Apert also has
  • Syndactyly of all extremities
34
Q

With what is Apert syndrome associated?

A
  • Cardiac and renal problems
    • hydronephrosis or
    • Polycystic kidney disease (PCKD)
  • Esophageal atresia (sometimes)
35
Q

Anesthetic implications of craniosynostosis

A
  1. Difficult to mask r/t midface hypoplasia and proptosis
  2. Hold mouth open during induction (tongue will fill the small oral cavity when mouth closed)
  3. Topical lido before induction to maintain oral airway w lighter anes
  4. ETT should not be as difficult unless also neck mobility issues
36
Q

Which causes more possibility of airway obstructions: Cleft lip or cleft palate?

A

Palate

cleft lip alone usually doesn’t cause airway problems

37
Q

_____ % of pts w cleft lip and palate often have associated congenital heart disease

A

50%

38
Q

What are 2 side effects of cleft lip and palate?

A
  • Pulm aspiration

- Anemia r/t poor nutrition d/t feeding problems

39
Q

T/F: Difficulty w intubation decreases in a cleft lip/palate with age < 6 mo.

A

True

40
Q

What 2 things should an anesthetist remember when providing analgesia to a cleft lip/palate pt?

A
  1. minimize narcs

2. use nonresp depressant analgesics (Tylenol, precedes, toradol)

41
Q

At what ages are cleft lip and palate repaired?

A

Lip - 3 mo

Palate - 6 mo

42
Q

______% of pts w Pierre Robin sequence also have cleft palate

A

> 50%

43
Q

what may lead to resolution of airway problems in a pt w Pierre Robin sequence?

A

rapid facial growth b/t 3-12 mo of age

44
Q

How can airway obstructions r/t the tongue falling posteriorly against the parhyngeal wall be relieved at birth in a Pierre Robin baby?

A

place an oral airway and prone the baby

in extreme cases, may need trach

45
Q

True or False: if a Pierre Robin pt does not snore or have periods of apnea, the airway will likely remain patent during inhalation induction.

A

True

46
Q

What muscle relaxant is best when intubating a Pierre Robin pt?

A

none. keep pt spontaneously breathing

47
Q

What does OMENS stand for when referring to hemifacial mocrosomia?

A 
Orbital distortion
Mandibular hypoplasia
Ear anomaly
Nerve involvement (facial n. weakness)
Soft tissue deficiency
48
Q

Pts w hemifacial microstomia have unilateral defects in ______% of cases

A

85-90%

49
Q

What syndromes are associated w hemifacial microsomia?

A

Goldenhar’s Syndrome and Pruzansky

50
Q

disorder characterized by defect in the development of the first and second brachial arches

A

Goldenhar’s syndrome

51
Q

Disorder of the first and second pharyngeal arches that causes:

  • mandibularfacial dysostosis
  • maxillary, zygomatic, and mandibular hypoplasia
  • laterally slipping palpebral fissures
  • notched lower eyelids
  • Coloboma of the dyd
  • small mouth
  • high arched palate
  • hearing loss from atresia of the external auditory ear canal
  • absence of the medial lower eyelashes
  • often includes cleft palate and velopharyngeal incompetence
A

Treater Collins Syndrome

52
Q

Anesthesia implications of Treater Collins Syndrome

A
  • Masking and tubing are very difficult if not impossible w TMJ abnormalities
  • Keep pt breathing spontaneously
  • Do sedated fiberoptic intubation
  • May require LMA or fiberoptic through LMA or trach

Pediatric Physiology - B. Stevens/Bernstein 2017 (7 decks)

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