Pediatric General Surgery Part 6 Flashcards
Which gender is more prone to get cleft lip/palate
Male
What race is more prone to get cleft lip/palate?
- Asians
- Latin Americans
What race is least likely to get cleft lip/palate?
African Americans
Cleft lip and palate will form during which trimester of pregnancy?
First trimester
Primary cleft lip is usually repaired at age ______.
2-3 months
Primary cleft palate repair is usually done at age _________.
6-10 months
Palatal revision and alveolar bone grafts occur around age __________.
10 years
What type of ETT is used to intubate patients undergoing cleft lip/palate repair?
Oral Rae ETT (sutured midline to the chin)
What blade should be used to intubate a patient with cleft lip/palate?
Miller (straight blade)
Cleft Lip & Palate Anesthesia Considerations
- Post-op nasal trumpets (placed by surgeon) may be required to maintain airway patency and allow suctioning
- Extubation is done in the room awake and taken to PACU or straight to PICU
- High risk for upper airway obstruction immediately post extubation
- Arm restraints or “no no’s”
Physical characteristics of Down Syndrome patients.
- Short stature
- Epicanthal folds
- Short neck, atlantoaxial instability
- Small/low set ears
- Macroglossia
- Mandibular hypoplasia
- Hypotonia
What is the most common GI problem for Down Syndrome patients?
Duodenal Atresia
Duodenal atresia is a congenital condition that occurs when the duodenum, the first part of the small intestine, is blocked or narrowed
What percentage of Down Syndrome patients have congenital heart defects?
40-50%
Anesthetic Considerations For DS
- Subglottic stenosis, subglottic narrowing common (Size down ETT)
- Upper airway obstruction
- Post extubation stridor
- Small/abnormal radial vessels (use US)
- Bradycardia under anesthesia (have atropine/ robinul ready)
- Airway obstruction common and occurs easily when sedated
- Neuro exam pre-op and cervical x-rays to clear instabilities
Dose of Atropine to treat bradycardia in DS
0.01-0.02 mg/kg
