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S5 - Principles III - Test 4 > Pediatric Preanesthetic Eval, Premed, Induction > Flashcards

Pediatric Preanesthetic Eval, Premed, Induction Flashcards

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1
Q

pediatric age that tolerates separation and inhalation and induction well

A

infants 6-10 months

(no predmed needed)

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2
Q

postop behaviors seen in children 6 months-6 years

A

postop nightmares, eating disturbances, bedwetting

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3
Q

what med reduces instance of postop nightmares, bedwetting, and eating disturbances in kirs 6 mo-6 years old?

A

midazolam

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4
Q

how does a previous surgery impact a 2-6 year old’s response to subsequent surgeries?

A

evidence says previous surgery helps with preop anxiety, but according to Lisa this doesn’t always translate to practice

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5
Q

why might sedation make preop experience worse in children > 6 years

A

may interfere with ability to cooperate and worsen overall expereince

adolescents - want to be in control, may dislike sedation

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6
Q

special considerations for kids with home monitoring/oxygen use

A

higher risk for postop obstruction, need overnight monitoring

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7
Q

family history we want to know about for a peds pt

A
  • SIDS in family
  • hx prolonged paralysis, MH
  • genetic defects
  • sickle cell, CF, MD, bleeding tendencies
  • allergic reactions
  • drug addiction
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8
Q

pediatric complications of smoking exposure

A

increased risk of asthma, ear infections, eczema, hay fever, dental caries

increased airway complications during induction & emergence

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9
Q

why are clear liquids encouraged 2-3 hours preop?

A
  • less hypotension/ bradycardia
  • helps with motility
  • clear liquid ½ life is 15 minutes
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10
Q

can babies have breast milk 2 hours preop?

if not, how long do they have to wait?

A

no - increased lipid content causes delayed emptying

wait 4 hours

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11
Q

fasting guidelines for formula, milk, and solids

A

6 hours

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12
Q

preop fasting guidelines for gum/candy

A

none after midnight - increases gastric secretions

(but also maybe no evidence that this is true)

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13
Q

fasting goals - pH and volume

A

pH > 2.5

volume < 0.4 mL/kg

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14
Q

fasting goals - pH and volume

A

pH > 2.5

volume < 0.4 mL/kg

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15
Q

pts at increased risk of hypoglycemia

A
  • FTT
  • debilitated
  • receiving high glucose solutions preop
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16
Q

concerns of a preop URI

A

2-7x increased risk of respiratory complications (especially if < 1 year old)

  • bronchospasm, laryngospasm
  • hypoxemia
  • atelectasis
  • croup, stridor
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17
Q

when should surgery be postponed because of a URI?

A
  • s/s lower respiratory involvement
  • purulent rhinorrhea
  • acute onset (vs. chronic)
  • < 1 year old
  • fever
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18
Q

if you cancel a case because of URI, when should it be rescheduled for?

A

bronchial reactivity can last 7 weeks - but practically, delay 2 weeks and surgery is ok as long as the kid is getting better

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19
Q

is it safe to anesthetize a mild URI for a short procedure without intubation?

A

yes - increased spasms and desats but no worse than without URI, no increased morbidity

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20
Q

difference in allergic rhinitis and URI

A

rhinitis has clear nasal drainage, no fever, and statistically not the same risks as URI

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21
Q

most recommended preop Hct

exceptions to this

A

> 25%

if between 2-4 months old or chronic renal dailure, lower value acceptable

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22
Q

how does chronic anemia affect the oxyhgb dissociation curve?

A
  • increased 2,3-DPG
  • increased O2 extraction
  • increased CO

RIGHT SHIFT

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23
Q

should you transfuse preop to get a Hct of 30?

A

no - unnecessary risk of blood-borne disease transmission

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24
Q

when should you consider postponing surgery with a fever

A

with symptoms of acute onset - rhinitis, sore throat, earache, dehydration

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25
Q

interventions for pt with a slight fever and is asymptomatic

A

procede with anesthesia

reduce fever to decrease O2 demand (tylenol, motrin)

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26
Q

how do inhalation agents affect fever

A

blunt febrile response

(whatever that means)

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27
Q

when should preop sickle cell screening be done

A

if results unknown and HbSC in family, unknown status with low hct

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28
Q

what test is done to determine severity of HbSC if preop screen is positive

A

hemoglobin electrophoresis

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29
Q

preop considerations for sickle cell patients

A

should be admitted overnight for IVF, potential transfusion prior to surgery

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30
Q

transfusion goal for sickle cell pt

A

up to hgb 10/hct 30

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31
Q

T/F - a sickle cell screen can be positive with sickle cell trait

A

true - hemoglobin electrophoresis determines severity of screen positive

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32
Q

useful preop meds for kids with developmental delays

A

PO or IM “cocktail” of ketamine and glycopyrrolate

PO or nasal versed

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33
Q

preop considerations for diabetic kiddos

A
  • consult endocrinology for intraop blood sugar plan
  • schedule for first case of day
  • common: preop IV access, 5% glucose MIVF, ½ usual insulin dose
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34
Q

anesthesia considerations for kids with seizure disorders

A
  • anesthesia may alter seizure threshold and increase activity post-op
  • some drugs induce seizures
  • some seizure meds interact with anesthetics (CYP interactions)
35
Q

what should you do with TPN during surgery?

A

do not abruptly stop

decrease rate by ⅓ to ½

monitor glucose and electrolytes periop

36
Q

important history for pts with asthma

A
  • ER visits & hospitalizations
  • home meds and last doses
  • exacerbation triggers
  • steroid use
  • last wheezing
37
Q

meds kids with asthma should take the morning of surgery

A

bronchodilators (albuterol)

38
Q

airway considerations for pts with asthma

A

consider avoiding intubation or extubate while deep

LMA preferred if appropriate

39
Q

you go to preop to see a kid with asthma and he’s just wheezing away. can you go ahead with the surgery

A

nah, postopone

(((((unless this is his baseline after all the meds in the world))))

40
Q

not that you’re ever going to check a preop ABG for routine surgery on an asthmatic, but if you did and the PaCO2 was > 45, what does that mean

A

increased risk for postop resp failure

41
Q

what is BPD?

A

chronic lung disease related to prolonged mechanical ventilation, barotrauma, or O2 toxicity

usually former preemie or other special lil creature like swinderella

42
Q

respiratory changes in BPD pts

A
  • decreased FRC
  • prone to airway obstruction
  • hypoxic with stimulation (picture princess glitter sparkles turning purple just bc she could)
43
Q

s/s BPD

A

tachypnea

dyspnea

reactive airway

o2 dependence

44
Q

why might you need to get preop labs on BPD pts?

A

may be on diuretics

45
Q

what inhaled anesthetic should be avoid in BPD pts and why?

A

N2O - chronic air trapping

46
Q

*avoid hyperventilation almost always* but why especially in BPD pts

A

they’re chronically hypercarbic

they’re basically babies with COPD

47
Q

why might BPD babies need a smaller ETT?

A

may have subglottic stenosis, often undiagnosed

48
Q

if a kid shows up for a T&A and has a murmur that hasn’t been evaluated, what should you do?

what about if the pediatrician has evaluated and determined it to be innocent?

A

delay (elective) procedures until after CV consult

if the pediatrician says its innocent - proceed

49
Q

what is the only certain way to r/o a structural defect assoc. with a murmur

A

ECHO

50
Q

pts at risk for latex allergies

A
  • neural tube defects
  • frequent urine cath
  • hx multiple surgeries
  • tropical fruit allergies
51
Q

what is the most common cause of intraop anaphylaxis in peds?

A

latex allergy

52
Q

T/F - H2 blockers and steroids reliably prevent anaphylaxis assoc. with latex allergy

A

false

53
Q

best prevention for anaphylactic reaction from latex allergy

A

latex free environment

54
Q

considerations for drawing up meds in pts with latex allergies

A

some meds have latex in the vial - single vial puncture is safest

55
Q

fun fact: apparently in Alabama, biologic dad can’t consent for the baby if he isn’t married to mom

A

seems a little effed up to me

56
Q

dose for versed as a premed

A

0.3-0.5 mg/kg PO 20-30 min prior

max dose 15 mg

57
Q

how long does sedation from PO versed last

A

about an hour

58
Q

if the procedure is longer than ___ minutes, preop versed doesn’t affect recovery or discharge times

A

10 minutes

59
Q

dose of ketamine as a premed

how long before amnesia and analgesia seen

A

3-5 mg/kg IM

amnesia/analgesia in 5 minutes

60
Q

what meds should be given after preop ketamine to prevent:

  • nightmares
  • secretions
A

nightmares - versed

secretions - anticholinergic

61
Q

minimal dose of atropine

A

0.1 mg/kg (except preemies)

62
Q

tylenol dose

A

10-20 mg/kg PO

63
Q

precordial stethoscope placement

A

4-5th ICS

L sternal border

64
Q

steps for inhalation induction

A
  • pop-off open
  • high flows (8-10 L/min) via mask
  • 100% O2 (or N2O and > 30% O2)
  • begin with sevo at 2%, increase gradually (every 3-4 breaths) to 8%
65
Q

how long is high sevo (8%) with spontaneous ventilation maintained for inhalation induction?

A

until IV access obtained

66
Q

respiratory interventions for inhalation induction as pt gets deeper

A

PEEP and/or oral airway for upper airway obstruction

67
Q

how many people are required to be in the OR for an inhalation induction?

A

2

at least 1 anesthesia provider

68
Q

T/F - intubating a pediatric patient requires NMBs

A

false - vocal cords have to be relaxed but can be done with volatiles, propofol, narcotics

69
Q

propofol dosage healthy children can tolerate

A

4-5 mg/kg

70
Q

negative effects of increasing the sevo concentration too rapidly during inhalation induction

A
  • irritates airway, causes coughing
  • hemodynamic effects
71
Q

negative effects of increasing sevo too slowly during inhalation induction

A
  • prolonged induction, including excitation period
  • increased risk of airway obstruction, laryngospasm, vomiting
72
Q

why is inhalation induction considered higher risk than IV induction?

A

drags through stage 2 vs. IV induction, which quickly goes grom stage 1 to 3

higher risk for laryngospasm

73
Q

*during inhalation induction, keep them spontaneously breathing until the IV is placed*

A

:)

74
Q

*during inhalation induction, keep them spontaneously breathing until the IV is placed*

A

:)

75
Q

interventions with vital sign deterioration during inhalation induction

A

decrease or D/C anesthetic concentration

100% O2

treat bradycardia STAT

76
Q

how to treat bradycardia in a bebe with and without an IV

A

atropine

if no IV: IM atropine, dilute epi via ETT

77
Q

how to manage airway obstruction during inhalation induction

A
  • tight mask fit and seal
  • jaw thrust, oral/nasal airway
  • slightly close pop-off to generate 5-10 cm PEEP
  • after IV: positive pressure, lidocaine, propofol, succs, etc.
78
Q

what is modified single breath induction?

A

inhale and fully hold, exhale and fully hold, apply mask with max concentration (8% sevo), take a deep breath and hold, then breathe normally

79
Q

what is required for modified single-breath induction to work?

A
  • child’s cooperation
  • coach and practice before induction
  • circuit priming (high flow/8% sevo)
80
Q

which is faster - traditionl inhalation induction or modifed single-breath technique?

A

modifed single breath 3x faster than traditional inhalation induction

81
Q

common induction technique for MH susceptible or RSI kids

A

use 50% N2O/O2 mix

start IV, proceed with IV induction

82
Q

why is use of N2O not indicated for induction of a pt with a full stomach?

A

N2O causes N/V

83
Q

modified RSI

A

use of positive pressure ventilation with low PIPs to prevent desat before intubation

S5 - Principles III - Test 4 (7 decks)

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