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Mar: Sem 6 - Principles B > Pediatric General Surgery Part 3 > Flashcards

Pediatric General Surgery Part 3 Flashcards

1
Q

Causes of Neural Tube Defects

A
  • Genetic/ Environment factors
  • 10% are caused by chromosomal abnormalities
  • Environmental causes include: folate deficiency, maternal anti-epileptic drug, retinoins, maternal DM
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2
Q

Describe Spina Bifida

A
  • Abnormal or incomplete formation of midline structures over the back
  • Skin, bone, and neural elements can be involved individually or in combination of each other
  • Can be associated with brain anomalies
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3
Q

Describe Spina Bifida Occulta

A
  • Overlying skin appears normal and intact
  • Absence of herniation of neural tissue/ coverings
  • Hairy patch may be present
  • Sacral dimple
  • Lipoma
  • Spinal cord can end lower than usual
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4
Q

What is the most common type of spinal dysraphism?

A

Spina Bifida Aperta (1 in 1000 live births)

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5
Q

Describe Spina Bifida Aperta/ Cystica

A
  • Obvious lesion on the back
  • Meningocele contains CSF without spinal tissue
  • Myelomeningocele contains CSF and spinal nerves
  • Can be diagnosed antenatally or at birth
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6
Q

Differentiate between Spina Bifida Meningocele and Myelomeningocele.

A
  • Meningocele is a type of spina bifida where the meninges (protective membranes covering the spinal cord) herniate through a defect in the vertebral column.
  • Myelomeningocele is a more severe form of spina bifida where both the meninges and the spinal cord herniate through the vertebral defect.
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7
Q

Complications involved with spina bifida

A
  • Neurological impairment
  • Muscle weakness (paralysis)
  • Bowel/ Bladder Problems
  • Seizures
  • Ortho issues
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8
Q

80% of patients w/ Spina Bifida Aperta will have this neurological disorder.

A

Hydrocephalus

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9
Q

When would you want to repair a myelomeningocele?

A

Myelomeningocele must be repaired within the first few days or hours of birth to prevent infection or further trauma

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10
Q

Long term complications of Spina Bifida Aperta

A
  • Paraparesis
  • Neurogenic bowel or bladder
  • Renal insufficiency
  • Trophic limb changes
  • Joint contractures
  • Scoliosis requiring surgical intervention
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11
Q

Spina Bifida Anesthetic Consideration

A
  • Assess pre-op motor and sensory defects
  • Positioning for intubation and surgical procedure (may need support with foam donuts and towels to optimize)
  • Preserve function and further injury
  • Increased ICP a concern
  • May need to avoid NSAIDs if renal dysfunction
  • Can have considerable blood loss
  • Warming measures in place
  • Prone positioning with chest and abdominal rolls
  • Head can be turned to the side or placed in prone pillow
  • Secure your airway
  • Double check your IV’s and ETT after positioning
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12
Q

How would you intubate an infant with spinal bifida aperta-myelomenigocele?

A

Place a donut behind the patient’s back before intubation

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13
Q

Describe an Encephalocele

A
  • A herniation of neural tissue and meninges out of the skull through deficient skin and bone
  • The location can occur from occiput to frontal area
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14
Q

Anterior Encephalocele can affect these areas

A

Anterior- can be associated with brain, orbits, and or pituitary gland

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15
Q

Posterior Encephalocele can affect these areas

A

Posteriorly- associated with cerebral or cerebellar tissue

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16
Q

Describe mortality of Encephalocele

A

Most are associated with high mortality, and survivors have severe neurodevelopmental delay and hydrocephalus

17
Q

Treatment for Encephalocele

A

Surgical repair is the only treatment and can be done with a shunt if hydrocephalus is present

18
Q

Anesthetic Considerations for Encephalocele

A
  • Assess pre-op motor and sensory defects
  • Positioning for intubation and surgical procedure (may need support with foam donuts and towels to optimize)
  • Prone positioning depending on location
  • Make sure your ETT is secured well
  • Preserve function and prevent further injury
  • Can be considerable blood loss (2 IVs for resuscitation)
  • Warming measures in place
19
Q

Encephalocele located in this area may be hard to detect

A
  • Intranasal (can be mistaken as a nasal polyp)
  • Difficult airway
20
Q

What is Chiari Malformation?

A
  • Cerebellar herniation results when the cerebellar tonsils herniate through the foramen magnum from the posterior fossa to the cervical space
  • Bony abnormality in the posterior fossa and upper cervical spine
21
Q

What is Chiari Malformation often associated with?

A

Myelomeningocele

22
Q

What does Chiari Malformation lead to?

A

Chiari Malformation leads to an obstruction of CSF flow and eventually, hydrocephalus results

23
Q

What is hydrocephalus?

A

Hydrocephalus- a mismatch of CSF production and absorption that leads to an increased intracranial volume of CSF

24
Q

What causes hydrocephalus?

A

Hydrocephalus usually results from some obstruction or imbalance of absorption and production

25
Q

What are the types of hydrocephalus?

A

Hydrocephalus can be obstructive/noncommunicating or nonobstructive/communicating depending on its ability to cover the spinal column

26
Q

What happens if hydrocephalus is left untreated?

A

If untreated, it can lead to intracranial hypertension

27
Q

Hydrocephalus can result in a chronic increase in ICP. S/S:

A
  • Headache
  • Irritability
  • Vomiting
28
Q

Chiari Malformation Chart

A

Chiari Malformation Chart

29
Q

Arnold Chiari Malformation S/S

A
  • Vocal cord paralysis with stridor
  • Respiratory distress
  • Apnea
  • Abnormal swallowing
  • Aspiration
  • Opisthotonos (backward arching of neck/spine)
  • Cranial nerve deficits
30
Q

What is involved with Chiari Malformation Surgery?

A
  • Usually a decompressive suboccipital craniectomy with cervical laminectomies
  • Repaired in posterior fossa craniotomy positioning
  • Head placed in pins or placed on a padded horseshoe-shaped frame
31
Q

Chiari Malformation surgery anesthetic considerations. (long list)

A
  • 2 large IVs and arterial line
  • Nasal intubation may be preferred for prone positioning
  • Afrin to bilateral nares, nasal trumpet dilation, Magills for ETT advancement with DL
  • OGT placed and left to gravity during case
  • Eyes lubricated and clear Tegaderms placed over eyes
  • If increased ICP is a concern, avoid Ketamine, use controlled hyperventilation and narcotics to blunt the response to laryngoscopy
  • Chest rolls and pelvic rolls to free abdomen compression or pressure on femoral nerves or genitalia
  • SECURE your ETT well!
  • Avoid oral airway, sometimes a “soft” bite block is placed between lateral incisors, especially if cortical motor potentials are used
  • Avoid excessive intra-op fluid
  • Maintain normal temperature. The head is large BSA in infants

Mar: Sem 6 - Principles B (14 decks)

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