Pediatric dz (exam 3 Massey) Flashcards
1
Q
The perioperative period is stressful and anxiety-provoking for the child and family; many parents express more concern about ?
A
the risks of anesthesia than those of the surgery.
2
Q
What age group in relation to anxiety is described below?
o Maximum stress for parent
o Minimum stress for infants—not old enough to be frightened of strangers
A
0-6 months
3
Q
What age group has anxiety related to:
o Maximum fear of separation
o Not able to understand processes and explanations
o Significant postoperative emotional upset and behavior regression
o Begins to have magical thinking
o Cognitive development and increased temper tantrums
A
6 months to 4 years
4
Q
How do you evaluate a pediatric pt. and family to know if they can or should not be present for induction or procedure?
A
Each child and family must be evaluated individually; what is good for one child and family may not be good for the next.
5
Q
What age specific anxiety group is:
Beginning to understand processes and explanations.
fear of separation remains.
Concerned about body integrity.
A
4-8 year olds
6
Q
What age group: Tolerates separation well Understands processes and explanations May interpret everything literally May fear waking up during surgery or not waking up at all
A
8 years to adolescence
7
Q
what age group:
Independent
Issues regarding self-esteem and body image
Developing sexual characteristics and fear loss of dignity
Fear of unknown
A
Adolescence
8
Q
Croup is indicative of?
A
subglottic narrowing
9
Q
anesthetic implication of cyanosis?
A
right to left shunt!
10
Q
if a child has a history of squatting then what does that mean?
A
tetralogy of fallot
11
Q
What are the major objectives of pre-anesthetic medications?
A
o (1) allay anxiety
o (2) block autonomic (vagal) reflexes
o (3) reduce airway secretions
o (4) produce amnesia
o (5) provide prophylaxis against pulmonary aspiration of gastric contents
o (6) facilitate the induction of anesthesia
o (7) if necessary, provide analgesia.
12
Q
What is one of the major things that premedication does for a pediatric patient’s stress response? (prevents)
A
decrease the stress response to anesthesia and prevent cardiac arrhythmias.
13
Q
Factors to consider when selecting a drug or a combination of drugs for premedication include?
A
o the child’s age,
o ideal body weight,
o drug history, and allergic status;
o underlying medical or surgical conditions and how they might affect the response to premedication or how the premedication might alter anesthetic induction;
o parent and child expectations;
o the child’s emotional maturity, personality, anxiety level, cooperation, and physiologic and psychological status
14
Q
What is the dose (premedication) of ketamine for pediatrics: Nasal Oral IM Rectal
A
nasal = 3mg/kg Oral = 3-6mg/kg IM = 2-10mg/kg Rectal = 6-10mg/kg
15
Q
What is the dose (premedication) of lorazepam for pediatrics:
Oral
A
oral = 0.025-0.05mg/kg
16
Q
Diazepam dose for premed. pediatric:
oral
rectal
A
oral = 0.1-0.5mg/kg Rectal = 1mg/kg
17
Q
Midazolam premed. for pediatric patients: Nasal Oral IM Rectal
A
nasal = 0.2mg/kg oral = 0.25-0.75mg/kg IM = 0.1-0.15mg/kg Rectal = 0.5-1mg/kg
18
Q
What is special about nasal administration of benzodiazepine medication?
A
Use preservative free for nasal administration due to fears of neurotoxicity
19
Q
What antiholinergic’s cross the blood brain barrier and what s/s show due to this?
A
Atropine and Scopolamine.
may cause CNS excitation manifested as agitation, confusion, restlessness, ataxia, hallucinations, slurred speech, and memory loss if given in excessive doses.
20
Q
Dose for atropine and scopolamine?
A
atropine = 0.01 to 0.02mg/kg
scopolamine = 0.005 to 0.010mg/kg
21
Q
Which anticholinergic is more commonly used and why?
A
atropine, it blocks the vagus more effectively than scopolamine.
22
Q
which anticholinergic is a better sedative, antisialagogue, and amnestic?
A
Scopolamine
23
Q
Tell me about infants/pediatrics and HR and when to give WHAT medication related to this?
A
Infants who are at risk for or show early evidence of a slowing of the heart rate should receive the atropine before the heart rate actually decreases to ensure a prompt onset of effect to maintain cardiac output.
24
Q
Which anticholinergic does not cross the BBB?
A
Glycopyrrolate
25
twice as potent as atropine in decreasing the volume of oral secretions, and it's duration of effect is three times greater, what drug?
Glycopyrrolate
26
Dose of glyco?
0.01mg/kg
27
When will you actually use glyco?
to limit sialorrhea associated with ketamine
| not just for normal pediatric secretions bc dry mouth is significantly dis-comfortable for peds.
28
Traditional mask induction for a child is what mixture of N20 to O2?
Then what do you introduce after max affect?
2:1
| Then introduce sevo at 8%
29
Sevo considerations for a child if breathing on their own compared to controlled ventilation?
sevo is kept at 8% if child is breathing on their own (the body will adjust breathing rate as needed) but if controlled ventilation is started then Sevo should be decreased to avoid overdose.
30
Ideally all children should beath 100% oxygen before IV induction, if the face mask is met with resistance then what should you do?
hold the Y- connector of the circuit between your fingers over or near the child's face.
31
```
IV induction drugs and doses (mg/kg):
Etomidate
Ketamine
Methohexital
Propofol
Thiopental
```
```
Etomidate = 0.2-0.3
Ketamine = 1-2
Methohexital = 1-2.5
Propofol = 2.5-3.5
Thiopental = 5-8
```
32
Airway obstruction during anesthesia or loss of consciousness appears to be most frequently related to WHAT rather than WHAT?
loss of muscle tone in the pharyngeal and laryngeal structures rather than apposition of the tongue to the posterior pharyngeal wall.
33
If you place a child in "sniffing" position it will improve WHAT but not WHAT?
it will improve hypopharyngeal airway patency but DOES NOT NECESSARILY CHANGE THE POSITION OF THE TONGUE.
34
What is the most effective maneuver to improve airway patency and ventilation in children undergoing adenotonsillectomy.
Jaw Thrust
35
What position do you want an infant in for induction?
seated NOT laying or supine.
36
The progressive loss of tone with deepening anesthesia results in progressive airway obstruction primarily at the level of?
the soft palate and the epiglottis.
37
Important (but not the only) factor associated with laryngospasm?
Age: greater in infants than older children and adults, decreased risk with increasing age.
38
If laryngospasm occurs you will first use positive pressure ventilation with 100% oxygen and jaw thrust maneuver, if this fails what medication intervention will you do next?
In this order: Give IV or IM atropine (0.02mg/kg)
IV propofol (1mg/kg)
IV or IM sux (1-2mg/kg IV or 4 - 5 mg/kg IM)
39
What type of tubing for fluids should be used for kids?
You want to use buretrol IV tubing for fluids being given to kids 8 and under (to prevent giving too much fluid by accident).
(<1 y.o = 250ml, young children = 500ml, over 8 you can use macro or micro drip and 1,000ml bag)
40
Initial blood loss should be replaced with?
balanced salt solution at a rate of 3mL of solution for every 1 mL of blood loss. (3:1)
41
What is the smallest gauge IV you can infuse blood through rapidly?
22-gauge
42
how to calculate maintenance rate of fluids?
4-2-1 rule
4 ml/kg/hr for first 10 kg
2ml/kg/hr for second 10 kg (11-20 kg)
1ml/kg/hr for each kilogram > 20 kg
43
NPO deficit- how to calculate?
maint. rate (hourly requirement) x NPO hours.
| replace 50% in first hour and 25% in 2nd and 3rd hour.
44
In order to deep extubate a child what depth of inhaled anesthetic do you want?
at least 1.5-2 x MAC
45
Optimal position for transfer of a child after surgery would be what position?
lateral decubitus position known as the recovery position
46
What does/can sevo and desflurane cause for a child during emergence?
emergence agitation also known as emergence delirium.
47
```
Tell me the details of Emergence delirium?
%
age
anesthetic types
lasts
termination
```
a prevalence of 20% to 80%
has a peak incidence in children (of both sexes) at 2 to 6 years of age
is more common after certain anesthetics (sevoflurane ∼ desflurane ∼ isoflurane > halothane ∼ TIVA)
lasts 10 to 15 minutes, and is terminated either spontaneously or after an IV dose of propofol, midazolam, clonidine, dexmedetomidine, ketamine, opioids, or a host of other medications
48
The larynx in the pediatric neck?
The larynx has a higher position in the neck
49
narrowest portion of the larynx in the pediatric patient?
Cricoid cartilage (in adults it is the vocal cords)
50
Full- term neonates and their requirement for volatile anesthetics?
Full-term neonates require lower concentrations of volatile anesthetics than do infants 1 to 6 months of age
51
Neonate and infant requirements for sux is WHAT compared to older children?
WHY?
Neonates and infants require more succinylcholine on a per-kilogram basis than do older children to produce similar degrees of neuromuscular blockade because of the increased Extracellular Fluid volume and larger volume distribution characteristic of this age group.
52
Most practitioners limit the use of Sux to what kind of cases for those under ten? (2 types)
RSI
| treatment of laryngospasm
53
What two physiological things could increase the sensitivity of neonates to the effects of hypnotics.
An immature BBB
decreased ability to metabolize drugs
54
Protein binding of drugs in infants? What will this cause?
Protein binding of many drugs is decreased in infants, which can result in high circulating concentrations of unbound and pharmacologically active drugs.
(the unbound drug is the pharmacologically active drug!)
55
Preterm infant with RDS who does not respond to CPAP therapy, what do you do?
If CPAP therapy fails, the newborn is intubated and surfactant administered
56
Preterm infant with RDS, what do you want your Hct to be and what do you want in relation to hydration status?
Hct keep near 40% to optimize systemic oxygen delivery.
Excessive hydration should be avoided; so use colloids over crystalloids
57
What size tube should you use in children with a history of mechanical ventilation and why?
an endotracheal tube one to one half size smaller than that predicted for age should be used because subglottic stenosis may be present
58
What is the diff. between laryngomalacia & bronchomalacia?
Bronchomalacia is seen in infants who have had a prolonged stay in the neonatal intensive care unit (NCU)
Laryngomalacia is a congenital or acquired condition of excessive flaccidity of the laryngeal structures, especially the epiglottis and arytenoids
59
Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease of infancy. Is the choice of drugs for anesthesia or management of the airway more important?
management of the airway is more important than the choice of drugs for anesthesia
60
In newborns with BPD airway hyperreactivity is likely thus what kind of anesthesia should be in place before airway instrumentation?
deep plane of anesthesia
61
Most common metabolic problem occurring in newborn infants?
Hypoglycemia
62
What is a prudent level to keep all newborns glucose levels at or above?
40mg/dL
63
If an infant is symptomatic of hypoglycemia WITHOUT seizures what will you give them?
IV bolus 2mL/kg (200mg/kg) of 10% dextrose
64
If an infant is experiencing convulsions with hypoglycemia what will you give?
IV bolus of 4mL/kg of 10% dextrose is indicated.
65
What neonates are at higher risk of hypoglycemia intraoperatively?
less than 48 hours old
premature
small for gestational age
those born to diabetic mothers
66
What glucose blood level do you not want a newborn to go above?
Serum glucose concentrations in excess of 125 mg/dL can result in osmotic diuresis from glucosuria with subsequent dehydration as well as further release of insulin leading to rebound hypoglycemia
67
Clinical manifestations of hypocalcemia of the newborn?
irritability, jitteriness, seizures, and lethargy
68
ionized calcium levels in the newborn compared to total calcium levels when the newborn is hypocalcemic?
ionized calcium is decreased even as total calcium remains within normal limits.
69
If a newborn has hypotension WITHOUT an obvious cause what should you do?
give IV calcium
70
Giving IV calcium can cause what problem? Thus how should you administer calcium IV?
Cases of bradycardia and even asystole have been seen with rapid intravenous administration of calcium
Intravenous calcium should be given over 5 to 10 minutes with electrocardiographic monitoring
71
Apnea of prematurity (AOP) what is the drug therapy?
Methylxanthines are used which includes aminophylline, caffeine, and caffeine citrate
72
An infant with Congenital diaphragmatic hernia (CDH) can have profound hypoxemia, which reflects?
right to left shunting through the ductus arteriosus
73
CDH, how will you intubate?
preoxygenate
| awake or RSI
74
Should you employ venous access in the lower extremity on a newborn with CDH?
No, venous access should be avoided in the lower extremities bc venous return may be impaired as a result of compression of the IVC following reduction of the hernia
75
Nitrous oxide, use or avoid with CDH?
AVOID
76
MOST FREQUENT congenital anomaly of the esophagus is?
Esophageal atresia (EA)
77
If maternal polyhydramnios is present what should you suspect of the newborn?
EA
78
Intubation considerations in relation to EA?
Endotracheal intubation is avoided, if possible because of the potential to worsen distention of the stomach, which can lead to gastric rupture
79
Proper placement of a ETT in a newborn with EA is critical, where should it be placed?
above the carina but below the TEF
80
What do you want to maintain the Hct at of a EA newborn?
higher than 35%
| through 5% albumin and packed red blood cells
81
Gastroschisis can it be repaired a few days after the newborn is delivered?
urgent repair is required!
82
if you have exposed bowel as is the case with omphalocele and gastroschisis what two things are you trying to maintain for the newborn?
body temperature and continuation of fluid replacement.
83
Nitrous oxide use with omphalocele and gastroschisis?
AVOIDED (potential to diffuse into the bowel)
84
Can surgery for omphalocele take place a few days later after birth?
requires URGENT corrective surgery. (staged closure)
85
What is Hirschsprung's disease?
megacolon
| most common cause of lower intestinal obstruction in the full-term neonate
86
Hirschsprung's disease anesthesia can be maintained with a mixture of what?
air, oxygen, volatile agent, and muscle relaxant.
87
Hirschsprung's disease surgery can be quite lengthy, thus extra care should be taken in what area?
positioning of the newborn
88
What position is required for anorectal pull-through procedrues related to Hirschsprung's disease?
lithotomy position
89
Will you typically extubate at the end of a Hirschsprung's disease sugery?
extubation at the end of surgery is routine
90
anorectal anomalies what kind of induction is often employed?
RSI - especially if abdominal distention is significant!
91
What type of IV placement should be used for anorectal anomaly surgery and WHY?
placed in the upper extremities.
because surgical positioning of the legs may impede venous flow or limit access to the intravenous catheter insertion sites.
92
Most common GI abnormality appearing in the first 6 months of life?
Pyloric stenosis
93
How does pyloric stenosis present?
relentless postprandial, nonbilious projectile vomiting beginning at 2 to 5 weeks of age
94
Necrotizing enterocolitis, when do you perform surgery?
Surgery is reserved for neonates for whom MEDICAL MANAGEMENT FAILS, as evidenced by bowel perforation, sepsis (peritonitis), and progressive metabolic acidosis indicating bowel necrosis
95
Surgery for necrotizing enterocolitis, maintenance of anesthesia is generally limited to the use of what?
short-acting intravenous opioids (fentanyl) as tolerated, muscle relaxation, and replenishment of intravascular volume as needed.
96
Persistent jaundice accompanied by dark urine and acholic stool, what issue is present?
Biliary atresia
97
what are the cornerstone treatments for biliary atresia?
Kasai's operation (portoenterostomy) and liver transplantaion.
98
If ascites is present with biliary atresia (and probably anytime) what type of induction should take place?
RSI
99
with biliary atresia (and any liver problem) what type of labs should you be checking?
coagulation profile
CBC
electrolyte panel
and any abnormalities corrected accordingly.
100
Congenital cystic adenomatoid malformation or congenital lobar emphysema, what do you give pre-op and what should be avoided?
supplemental oxygen is administered and **positive pressure should be studiously avoided
101
What phase of the perioperative period is the most critical for infants with either congenital lobar emphysema or congenital cystic adenomatoid malformations is?
induction (inhalation inductions are recommended)
102
optimal technique for a smooth inhalation of a infant with Congenital lobar emphysema and congenital cystic adenomatoid malformation involves what inhalation agents?
Sevo and oxygen and WITHOUT if possible positive pressure ventilation.
103
positioning of infants with Congenital lobar emphysema and congenital cystic adenomatoid malformation and why?
Meticulous attention must be paid to avoidance of nerve and other compression injuries during positioning (usually lateral decubitus with the infant's ipsilateral arm placed directly over the head)
104
What is common in children with CP, and even if not present they will be treated with medication for it (why)?
Seizure disorder is common, and some children may be given antiepileptic medications even in the absence of seizures for off-label treatment of conditions such as spasticity and behavioral issues.
105
Do patients with CP tend to have prolonged recovery or quick recovery from NMB (due to metabolizing drugs quicker)?
Generally have prolonged recovery from neuromuscular blockade.
Thus administration and dosing of NMB should be done with caution.
106
Do you have precaution with anesthetic techniques used for patients with CP?
Almost any anesthetic technique can be used; volatile agents need not be avoided, because cerebral palsy is not associated with malignant hyperthermia. **Succinylcholine is not contraindicated but should be used with discretion.
107
What drug is an important adjunct in managing pain related to muscle spasm?
Diazepam
108
Medical therapy of hydrocephalus?
mainly consists of diuretic treatment (furosemide and acetazolamide decrease CSF production), although this remains controversial in children
109
Majority of children with hydrocephalus require surgery, what would this consist of?
either shunt placement or shuntless endoscopic third ventriculostomy (ETV)
110
MOST important anesthetic consideration in a child with hydrocephalus relates to what?
the presence and severity of increased ICP
111
Can you use inhalation induction for a child with hydrocephalus?
only if you have radiographic evidence (or the child is without symptoms) of severe intracranial hypertension.
112
What do volatile agents do to CBF and ICP?
Volatile agents are potent cerebral vasodilators and increase ICP by increasing cerebral blood flow.
113
Will you use ketamine if a child has Hydrocephalus (or anything with increased ICP)
No, bc it can cause sudden increase ICP and rapid neurologic decompensation.
114
If a child has a cerebrovascular anomaly should they have prolonged periods of fasting?
No, bc dehydration may precipitate cerebral ischemia
115
Most common form of neural tube defect? When does surgical closure take place?
Spina bifida
| 24-48 hours of birth
116
spina bifida is often associated with other congenital anomalies, what does this mean in relation to preop assessment?
you need a very comprehensive pre-op assessment to identify specific anesthetic risk
117
Tracheal extubation with spina bifida?
must take place only after the patient has regained adequate spontaneous respiratory effort and ventilation. (awake extubation only)
118
Craniosynostosis, what should you have in the operating room before skin incision takes place?
blood products
119
Craniosynostosis pre-op, what are you paying particular attention to?
potential intracranial hypertension as well as co-existing morbidities
120
Craniosynostosis - use nitrous oxide or not?
Nitrous oxide should be avoided
121
Cleft lip repair vs Cleft palate repair?
Cleft lip repair is typically performed between 6 and 12 weeks of age
Cleft palate repair is done at a later age, between 9 and 14 months
122
What is a universal feature in congenital mandibular hypoplasia?
airway compromise resulting from the constricted mandibular space with resultant glossoptosis (posterior prolapse of the tongue)
123
Treacher Collins syndrome is?
bilateral and symmetric underdevelopment...
124
Hemifacial microsomia is and what is nearly impossible in this patient?
unilateral facial asymmetry.
difficult to intubate but NEARLY IMPOSSIBLE to mask ventilate.
125
before the airway is secured with hemifacial microsomia (and midface hypoplasia) maintenance of WHAT is of utmost importance.
maintenance of spontaneous ventilation
126
classic presentation of acute epiglottitis?
The classic presentation of acute epiglottitis is that of a toxic-appearing, agitated child with a high fever and the so-called 4 Ds: dysphagia, dysphonia, dyspnea, and drooling. The child often assumes a characteristic tripod posture with the trunk leaning forward supported by the arms and a hyperextended neck with the chin thrust forward in an effort maximize airflow.
127
acute epiglottitis, is it considered an emergence?
AIRWAY EMERGENCY!
128
What position should the child with acute epiglottitis be kept in?
tripod position
129
Transportation of a child with acute epiglottitis?
expeditious transfer to the OR with oxygen, pulse ox, and other resuscitation tools available including meds and intbation.
(you do not transfer this child without everything you need to stop ANYWHERE along the way and respond to a closed airway)
130
more than just an ETT should be available when dealing with a kid with acute epiglottis, what else do you need?
emergent tracheotomy- needle cricothyrotomy must be immediately available.
131
Acute epiglottitis and inspiratory stridor?
late feature and should alert you to impending complete upper airway obstruction
132
What is the mainstay in the management of acute epiglottitis?
airway control, and its achievement should always involve a team of a pediatric anesthesia providers, a pediatric intensivist, and an otolaryngologist
133
When does extubation take place for a child with acute epiglotitis?
24-48 hours after antibiotics are started (with or without corticosteroids)
134
What causes epiglottitis? What causes Croup?
Epi is bacterial with sudden onset.
Croup is viral with a gradual onset.
135
what should all children with croup be treated with?
corticosteroids
136
Children with sever croup should be treated with what?
nebulized epi
| bc it bronchodilates
137
what are most cases of post intubation laryngeal edema due to?
ETT size that is too large
138
post intubation croup will manifest in what time period?
30-60 min after extubation
139
whats the deal with the use of dexamethasone in both the treatment and prevention of postintubation laryngeal edema?
slow onset of action
| compared to nebulized epi
140
**The most important anesthetic consideration in postintubation laryngeal edema is?
it's PREVENTION!
141
Why should such care, caution and extreme vigilance be used for every intubation of infants and young children?
bc most acquired cases of subglottic stenosis result from intubation-related trauma.
142
One must always be able to demonstrate an air leak around the endotracheal tube at or below a pressure of WHAT to minimize the risk of pressure ischemia and necrosis of the tracheal mucosa.
25 cm H20
143
If a foreign body has been aspirated you should look at what before anesthetic care (if you have time)
radiographic films
144
induction of a child with foreign body aspiration, what is generally preferred and what do you want to avoid?
inhalation induction of anesthesia with maintenance of spontaneous ventilation is generally preferred, positive pressure ventilation may force the foreign body into a potentially more precarious position.
145
What does of dex is given prophylactically to reduce subglottic edema?
Dex 0.4-1.0 mg/kg, maximum of 20mg
146
one of the most common causes of hoarsness and airway obstruction in children is?
laryngeal papillomatosis
147
What is often the first and most prominent symptom of laryngeal papillomatosis in children?
dysphonia or change in voice quality or altered cry in infants.
148
with what upper airway disorder is the child turned 90 degrees away from you, thus requiring you to pay meticulous attention to the airway bc you DO NOT have control of the airway the otolaryngologist does!
Laryngeal papillomatosis
149
What is the gold standard in the diagnosis of clefts?
Micro-laryngo-scopic examination
150
**What ultimately dictates the anesthetic technique used for a laryngeal cleft?
The safety of the patient
151
What is macroglossia? **When can induction of anesthesia occur?
true enlargement of the tongue.
Induction of anesthesia may occur only after endotracheal intubation, because the tongue is both enlarged and relatively fixed in position
152
Adenotonsillar hypertrophy is associated with obstructive sleep disorders (most common reason for snoring in children), WHAT premedicatoin is not contraindicated ?
NOT a contraindication to administrating preoperative ANXIOLYTIC medication. (benzos)
153
**What procedures can you USE nitrous oxide for induction?
Adenotonsillar hypertrophy
154
**When should you have elective surgery after a child has had a URI?
postpone surgery for 1-2 weeks in children with mild active or recent URI
155
**If a child with an URI must be intubated, what plane of anesthesia MUST they be in?
DEEP
156
**What are the grades of Vesicoureteral Reflux?
Grades I and II are considered mild, grade III moderate, and grades IV and V severe
157
**The most severe cases of VUR (grade V) rarely resolve without WHAT?
Surgical intervention
158
Most common renal cancer in children as well as the most common pediatric abdominal malignancy?
Wilm's tumor also called nephroblastoma
159
Tumors with hepatoblastoma (most common pediatric hepatic cancer) are typically unifocal and affect which lobe more often?
affect the right lobe more often than the left lobe of the liver
160
Hepatic resections are often associated with what kind of blood loss? Thus what must be determined and prepared for?
significant blood loss is common thus coagulation status must be determined and appropriate blood components reserved preop.
161
Most common extracranial solid tumor in childhood and most common neoplasm seen in infants, most common site is the adrenal glands, what is it?
Neuroblastoma
162
Most common primary bone malignancy in children and adolescents (primarily adolescents) after osteosarcoma, and what is the most common presenting symptom?
Ewing's sarcoma
| localized pain with palpable mass is the most common presenting symptom.
163
Anterior mediastinal mass: If deep sedation or general anesthesia is required what must be preserved?
spontaneous ventilation must be preserved, because airway patency may be entirely dependent on negative intrathoracic pressure
164
Most common chromosomal abnormality?
Down syndrome
165
Anesthesia issues if a child has juvenile idiopathic arthritis?
potentially difficult airway since temporomadibular joint arthritis typically limits mouth opening and can be compounded by a micrognathic mandible.
166
Should you use nitrous oxide with an anterior mediastinal mass?
Should be avoided
167
Management of anesthesia with down syndrome, what should always be available?
Oral airways should always be available to help in reestablishing airway patency
168
**Down syndrome and sevo induction?
Significant bradycardia occurs with inhaled sevoflurane induction in up to 50% of children with Down's syndrome.
(give the atropine with/before induction according to Massey)
169
higher incidence of MH reprensents cases in which what is used?
BOTH volatile anesthetic agent and sux.
170
When does MH reactions occur?
some are immediate, some occur in postop, it varies.
171
within how many min. can an increase in core temp. occur due to MH?
within 15 minutes upon exposure to culprit agents.
172
MH: due to hyperkalemia what may you see?
Dysrhytmias and peaked T waves on EKG
173
Early clinical signs of MH?
Masseter muscle spasm
hypercarbia that does not improve with compensatory increase in min. vent.
tachypnea if spont. breathing
sinus tachycardia
174
Diagnosis of MH is based on what? (initially)
clinical picture (because definitive diagnosis requires tissue biopsy.)
175
Only known antidote for MH is?
dantrolene
176
What is contained in a dantrolene vial and mixed with?
20mg of dantrolene
3 g of mannitol
which must be mixed with 60 mL of sterile water.
177
starting dose of dantrolene?
2.5mg/kg
178
What is containdicated during MH and why?
calcium channel blockers are contraindicated because they can worsen hyperkalemia
179
Metabolic disturbances such as metabolic acidosis and hyperkalemia should be treated with?
combination of sodium bicarbonate, regular insulin, B-agonists, and calcium chloride.
(this is to prevent progression to hyperkalemic cardiac arrest)
180
what does regular insulin do to potassium?
drives potassium into the cell
181
Dantrolene therapy post control of initial symptoms? (every 6 hour dose)
1mg/kg every 6 hours for 48 to 72 hours
182
if dantrolene is a cont. infusion (after initial symptoms are controlled) what is the rate?
0.1 to 0.3 mg/kg/hr
183
what patients should undergo caffeine-halothane contracture test? (2 types)
All patients with clinical MH / signs of anesthesia induced hypermetabolism.
those with significant masseter spasm
184
If you identify a susceptible patient to MH should they be treated prophylactically?
preoperative dantrolene is not indicated.
185
MH susceptibility has been identified or suspected, what do you change about the anesthetic plan?
nontriggering anesthetic plan must be initiated that includes elimination of triggering agents and thorough preparation of the anesthesia machine to minimize even trace residues of volatile agents.
186
MH susceptibility has been identified or suspected, what do you change about the anesthetic plan?
nontriggering anesthetic plan must be initiated that includes elimination of triggering agents and thorough preparation of the anesthesia machine to minimize even trace residues of volatile agents.
