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Summer 2020 - Advanced Anesthesia - Pediatrics > Pediatric Respiratory Wrap Up, GI, & Ortho Surgery - Quiz 3 > Flashcards

Pediatric Respiratory Wrap Up, GI, & Ortho Surgery - Quiz 3 Flashcards

1
Q

When are Tonsillectomies & Adenoidectomies (T&As) indicated?

A

Upper Airway Obstruction

Hypertrophy

Chronic URIs

OSA

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2
Q

What analgesics are used for T&As?

A

Morphine 0.1 mg/kg

&

Fentanyl 1-2 mcg/kg

(1/2 dose for OSA)

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3
Q

What is the Pediatric Decadron dose for T&As?

A

0.3 - 1 mg/kg

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4
Q

When can Post T&A bleeding occur?

A

Early: <24 hrs

&

Delayed/Secondary: 24hrs - 3wks…Peaks @ Day 7

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5
Q

What is the treatment for Post T&A bleeding?

A

Surgical Packing or Suturing

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6
Q

What increases the risk for Post T&A Bleeding?

A

Inflammation

Infection

Pre-Op NSAIDs

Coagulopathy

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7
Q

What are some causes of Post T&A Bleeding?

A

Inadequate Hemostasis

Major Vessel Injury

Thrombocytopathies

↑Fibrinolysis

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8
Q

How is Post T&A bleeding prevented?

A

Tonsilar Capsule Dissection

Meticulous Hemostasis

Avoid Sx during/after Acute Inflammation / Infection

Avoid Blind Suctioning

Avoid NSAIDs

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9
Q

What are symptoms of Post T&A Bleed?

A

Hypovolemia

Anemia

Agitation

Shock

Blood in Stomach

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10
Q

What induction meds shoud be available for intubating w/ Post T&A Bleed?

A

Ketamine

Etomidate

Propofol

Rocuronium

Sux

Atropine

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11
Q

What intubation supplies should be available for a Post T&A Bleed?

A

Suction x2

Blades/Handles x2

Multi-Stylet Cuffed ETT

Experienced Help

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12
Q

What is Choanal Atresia?

A

Occlusion of one or both Posterior Nares commonly r/t Craniosynostosis

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13
Q

How is Unilaterial Choanal Atresia detected?

A

Intractable Unilateral Nasal Drainage

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14
Q

How is Choanal Atresia treated?

A

Surgical Correction or Trach w/in first few days of life

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15
Q

How should kids w/ Choanal Atresia be Intubated?

A

Awake w/ Oral RAE Tube

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16
Q

What is the Post-Op management for Choanal Atresia Surgery?

A

Close Monitoring in ICU especially w/ Stent Placement

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17
Q

What is Gastroschisis?

A

Anterior Abd. Wall defect to the right of the Umbilical Cord.

Bowel has NO SAC & is exposed, matted, thickened, & covered in Inflammatory Coating

Usually an Isolated Lesion

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18
Q

What problems does Gastroschisis cause?

A

Malabsorption

Peritonitis

ECF & Heat Loss

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19
Q

Which part of the GI Tract does Gastroschisis affect?

A

Large & Small Intestines

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20
Q

What causes Gastroschisis?

A

Vascular Event

Abnormal Omphalomesenteric Artery or Right Umbilical Vein

Young Maternal Smoking/ETOH

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21
Q

How can Gastroschisis be diagnosed?

A

Ultrasound

↑Maternal Alpha Fetoprotein

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22
Q

What is an Omphalocele?

A

Central Defect of Umbilical Ring/Base

Abd. contents & Umbilical are WITHIN A SAC

Associated w/ Other Problems

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23
Q

How big is the Fascial Defect for an Omphalocele?

A

> 4cm

Less than 4cm = Umbilical Hernia

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24
Q

What abdominal contents are inside the Omphalocele Sac?

A

Stomach

Large & Small Intestine

Liver

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25
Q

Why does an Omphalocele form?

A

In a Fetus, the midgut starts to herniate at wk 7

By wk 12 it should start going back into the abd. cavity, but doesnt, forming an Omphalocele

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26
Q

With an Omphalocele, there are high incidences of other problems. What are they?

A

Beckwith-Wiedemann Syndrome

Reiger Syndrome

Prune Belly Syndrome

Trisomy 13, 15, 18, 21

Cardiac Problems

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27
Q

What is Beckwith-Wiedemann Syndrome?

A

Overgrowth of various body parts

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28
Q

What is the Survival Rate of having an Omphalocele with & without a Heart Defect?

A

With: 20%

Without: 70%

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29
Q

How is an Omphalocele treated?

A

Primary surgical closure of peritoneal cavity if guts can fit in abd. cavity

or

Paint & Wait (w/ Abx) until gut can fit

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30
Q

What are signs that indicate a Primary Omphalocele closure to be unsafe?

A

Intra-Abdominal Pressure > 20 mmHg

> 4 mmHg CVP Increase

EtCO2 > 50 mmHg

Peak Pressures > 35 cm H2O

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31
Q

What Maintenance fluid should be used for an Omphalocele closure?

A

D5 0.2%NS or D10 0.2%NS

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32
Q

How much fluid should be replaced for an Omphalacele Closure?

A

2-4x Maintenance w/ Isotonic Fluid or 8-15 mL/kg/hr

&

1-2 mL/kg/hr Urine Output

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33
Q

What are the Post-Op complications for an Omphalocele Closure?

A

Pneumonia

Necrotizing Enterocolitis

Renal Insufficiency

Abdominal Wall Breakdown

GERD

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34
Q

What is a Congenital Diaphragmatic Hernia?

A

Diaphragm defect r/t Polyhydramnios that lets abd. organs herniate into thoracic cavity

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35
Q

What are the Anomalies that are associated w/ a Congenital Diaphragmatic Hernia?

A

Gut Malrotation

CV Problems

CNS Problems

GI & GU Problems

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36
Q

What are the Most common types of Congenital Diaphragmatic Hernias?

A

Posterolateral > Para-Esophageal > Anteromedial

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37
Q

How do Congenital Diaphragmatic Hernias (CDHs) affect the Heart & Lungs?

A

LV Dysfunction

Bilateral Lung Hypoplasia

Pulm. HTN

Arteriolar Reactivity

38
Q

What is the Classic Triad of a CDH?

A

Dyspnea

Cyanosis

Dextrocardia

39
Q

What are signs of a CDH?

A

Chest Bulge

Scaphoid Abdomen Bulge

↓Breath Sounds

Distant Heart Sounds

Bowel Sounds in Chest

Mediastinal Shift

40
Q

Why should Hyperventilation w/ 100% O2 be avoided w/ CDH?

A

Damages Alveolar & Capillary Membranes

and

Worsens Pulm. HTN

41
Q

What are Primary Goals of Medical Management of CDH?

A

Maximize Arterial Oxygenation

Correct Acidosis

Prevent Hypothermia & Pain

42
Q

What are the special precautions when intubating a baby w/ a CDH?

A

Minimize Barotrauma from PPV

5-10 mL/kg TV

Permissive Hypercapnea (55-60 mmHg) unless R-L Shunt

Nitric Oxide

43
Q

What are the complications of ECMO for a baby?

A

Bleed @ Cannulation Site

Intracranial Hemorrhage & Brain Death

Sepsis

HTN

Survival Rate Long term is actually Lower (50-60%) w/ ECMO than Without (80%)

44
Q

What are the requirements for a Baby to go on ECMO?

A

> 2 kg & >35 wks gestation

45
Q

What is the problem w/ a Thoracoscopic CDH Repair vs. an Open CDH Repair?

A

Insufflation w/ Thoracoscopic Repair can ↑CO2 & cause Difficulty Ventilating

46
Q

What are the Surgical Complications of a CDH Repair?

A

Hypoxemia

Pulm. Hypoplasia

Pulm. HTN

Contralateral PTX

IVC Compression - Hypotension

47
Q

Which population is more at risk for Pyloric Stenosis?

A

Males w/ a parent who had it

48
Q

How does Pyloric Stenosis happen?

A

Thickening of Pylorus smooth muscle causing gradual obstruction of gastric outlet & forceful NonBilious Projectile Vomit that occurs @ 2-8 weeks of life

49
Q

How is Pyloric Stenosis diagnosed?

A

Palpation of Olive-Sized Mass in the Upper Abd. & Verified by Imaging

50
Q

What are the symptoms of Pyloric Stenosis?

A

Dehydration

Hyponatremia

Hypokalemia

Hypochloremic Metabolic Alkalosis

Severe Pyloric Stenosis = Acidosis

51
Q

How should Pyloric Stenosis be managed before surgery?

A

Not Surgical Emergency

Replace Fluids & Lytes w/ D5 0.45% NS + 40 KCL for 12-48 hrs

52
Q

What is a TracheoEsophageal Fistula (TEF) ?

A

Esophageal Atresia w/ or w/o a fistula b/t the Esophagus & Trachea

90% Survival Rate

53
Q

What is the most common type of TracheoEsophageal Fistula?

A

Type C - Upper Esophagus ends @ stomach & lower Esophagus attaches to Trachea

Gastric Distention is most common w/ this type

54
Q

Type E TracheoEsophageal Fistula goes unnoticed until later in life when recurrent _______ occur

A

Type E TracheoEsophageal Fistula goes unnoticed until later in life when recurrent Pneumonias occur

55
Q

What are signs and symptoms of a TEF?

A

Excessive Oral Secretions & Salivation

First Feed Choking

Coughing

Cyanosis

Aspiration

Gastric Distention

Pneumonia

56
Q

How is a TEF diagnosed?

A

Cant pass suction or OGT into stomach

&

CXR showing Cath in Esophagus

57
Q

What are the associated Anomalies of TEF?

A

VACTERL

V ertebral
A norectal
C ardiac
T EF
E sophageal Atresia
R enal
L imb

58
Q

Where should the ETT be for a TEF?

A

Above Carina & Below Fistula or use Right Main technique & withdraw until breath sounds are heard @ Left Axilla

59
Q

What is the patient position for a TEF procedure?

A

Left Lateral Decubitus for a Right Thoracotomy

60
Q

What are the Intra-Op Complications for a TEF?

A

Right Main Intubation

Fistula Intubation

ETT & Tracheal Obstruction

Atelectasis

Hypothermia

Hypoglycemia

Return to Fetal Circulation

61
Q

What should be avoided Post-Op for a TEF?

A

Head Extension

&

Suctioning beyond Anastomosis Level

62
Q

What are Long Term Complications of TEFs?

A

Esophageal Stricture

Tracheomalacia

GERD

Chronic Cough

Wheeze

Exercise Intolerance

63
Q

What causes Congenital Hip Dislocation?

A

Prolonged Displacement of Fetal Femoral Head from Acetabulum resulting in Joint Laxity to Irreducible Displacement

64
Q

How is a Congenital Hip Dislocation treated?

A

Pavlick Harness

or

Closed Reduction & Spica Cast - short procedure, little pain

65
Q

What is the Greatest Concern during a Closed Reduction & Spica Casting for a Congenital Hip Dislocation?

A

Loss of Airway from Repositioning the Baby

66
Q

What causes Congenital Clubfoot?

A

Shortened Medial & Achilles Tendon

Foot Points Down & Rotated Inward

67
Q

How is Congenital Clubfoot treated?

A

Surgical Manipulation & Casting @ 3-6 months

Lots of Post-Op Pain

68
Q

What is Osteogenesis Imperfecta?

A

Collagen Production Defect resutling in Abnormal Bones, Ligaments, Teeth, & Sclera

EASY to Fracture

69
Q

There are 4 types of Osteogensis Imperfecta. Which type is the most severe?

A

Type 2 - Perinatal Lethal Form - MOST do NOT survive

70
Q

What are signs & symptoms of Osteogenesis Imperfecta?

A

Bowing of Long Bones

Kyphoscoliosis

Otosclerosis

Deafness

Hypermetabolic - NOT MH

Decreased Clotting

71
Q

What is an important consideration when using Sux in Osteogenesis Imperfecta?

A

Fasiculations can cause Fractures

72
Q

What is Cerebral Palsy?

A

Static Encephalopathy & Nonprogressive Central Motor Deficit r/t Hypoxic or Anoxic Brain Injury during Prenatal Period

73
Q

What causes Cerebral Palsy?

A

Prematurity

Birth Trauma

Hypoglycemia

Infections

Congenital Vascular Malformation

74
Q

What is the Clinical Presentation of Cerebral Palsy?

A

Mental Retardation

Seizures

Skeletal Contractures/Spasms

Impaired Laryngeal/Pharyngeal Reflexes

Poor Dental Hygiene

75
Q

How does Cerebral Palsy affect Anesthetics?

A

Decreases MAC

&

Needs less Propofol

76
Q

How should a pt. w/ Cerebral Palsy be managed in regards to their Seizure Disorder?

A

Take Anti-Seizure meds (Phenobarbital, Dilantin, Tegretol) up to & day of surgery

77
Q

How is Cerebral Palsy related Skeletal Muscle Spasticity treated?

A

Dantrolene or Baclofen

78
Q

What should be evaluated when a child comes in with a fracture from blunt force trauma?

A

C-Spine or Organ Injury

79
Q

What is Myelodysplasia?

A

Congenital failure of Middle or Caudal End of Neural Tube to close resulting in

Spina Bifida

Meningocele

Myelomeningocele

80
Q

What is the difference b/t a Meningocele & Myelomeningocele?

A

Meningocele: Protruding meninges w/ Spinal Fluid in Sac

Myelomeningocele: More Severe w/ Nerves in Sac

81
Q

What are characteristics of a Meningocele?

A

Intact Neuro

Spinal Cord tethered by Sacral Nerve Roots

82
Q

What happens if a Meningocele is Unrepaired?

A

Orthopedic & Urologic Symptoms

83
Q

What are characteristics of a Myelomeningocele?

A

Upper Urinary Tract Dilation

Spasticity

Scoliosis

Varies in Deficits

84
Q

How should pts w/ Myelodysplasia be Induced & Intubated?

A

Lateral Intubation

Avoid NDNMBs Initially

Neurometric Monitoring

85
Q

What is Scoliosis?

A

Lateral & Rotational Deformity of Thoracolumbar Spine & Ribcage that are Idiopathic or r/t Rapid Growth

86
Q

How does Scoliosis affect the Respiratory System?

A

↓Lung Volumes

↓Chest Wall Compliance

V/Q Mismatch

Chronic Hypoxemia

↑Pulm. Vascular Resistance

Pulm. HTN

87
Q

What problems can arise w/ the Prone Position during Scoliosis Surgery?

A

Lung Compression

↑Intra-Abd Pressure

IVC Compression

Engorged Epidural Vein

↑Bleeding

↓Venous Return & CO

88
Q

With MEP monitoring for Scoliosis Surgery, what anesthetics are used?

A

Propofol

Remifentanil

Versed

Ketamine

No Gas

89
Q

What is the EBL for Scoliosis Surgery & How should it be managed?

A

EBL = 25 mL/kg

TXA

Deliberate Hypotension

Hourly H&H

Normothermia

Cell Saver

90
Q

What are common Post-Op problems of Scoliosis Surgery?

A

Mechanical Vent

Hypovolemia

Pain

Ileus

SIADH

Summer 2020 - Advanced Anesthesia - Pediatrics (6 decks)

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