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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
Why does an Omphalocele form?
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
26
With an Omphalocele, there are high incidences of other problems. What are they?
Beckwith-Wiedemann Syndrome Reiger Syndrome Prune Belly Syndrome Trisomy 13, 15, 18, 21 Cardiac Problems
27
What is Beckwith-Wiedemann Syndrome?
Overgrowth of various body parts
28
What is the Survival Rate of having an Omphalocele with & without a Heart Defect?
With: 20% Without: 70%
29
How is an Omphalocele treated?
Primary surgical closure of peritoneal cavity if guts can fit in abd. cavity or Paint & Wait (w/ Abx) until gut *can* fit
30
What are signs that indicate a Primary Omphalocele closure to be unsafe?
Intra-Abdominal Pressure \> 20 mmHg \> 4 mmHg CVP Increase EtCO2 \> 50 mmHg Peak Pressures \> 35 cm H2O
31
What Maintenance fluid should be used for an Omphalocele closure?
D5 0.2%NS or D10 0.2%NS
32
How much fluid should be replaced for an Omphalacele Closure?
2-4x Maintenance w/ Isotonic Fluid or 8-15 mL/kg/hr & 1-2 mL/kg/hr Urine Output
33
What are the Post-Op complications for an Omphalocele Closure?
Pneumonia Necrotizing Enterocolitis Renal Insufficiency Abdominal Wall Breakdown GERD
34
What is a Congenital Diaphragmatic Hernia?
Diaphragm defect r/t Polyhydramnios that lets abd. organs herniate into thoracic cavity
35
What are the Anomalies that are associated w/ a Congenital Diaphragmatic Hernia?
Gut Malrotation CV Problems CNS Problems GI & GU Problems
36
What are the Most common types of Congenital Diaphragmatic Hernias?
**Posterolateral** \> Para-Esophageal \> Anteromedial
37
How do Congenital Diaphragmatic Hernias (CDHs) affect the Heart & Lungs?
LV Dysfunction Bilateral Lung Hypoplasia Pulm. HTN Arteriolar Reactivity
38
What is the Classic Triad of a CDH?
Dyspnea Cyanosis Dextrocardia
39
What are signs of a CDH?
Chest Bulge Scaphoid Abdomen Bulge ↓Breath Sounds Distant Heart Sounds Bowel Sounds in Chest Mediastinal Shift
40
Why should Hyperventilation w/ 100% O2 be avoided w/ CDH?
Damages Alveolar & Capillary Membranes and Worsens Pulm. HTN
41
What are Primary Goals of Medical Management of CDH?
Maximize Arterial Oxygenation Correct Acidosis Prevent Hypothermia & Pain
42
What are the special precautions when intubating a baby w/ a CDH?
Minimize Barotrauma from PPV 5-10 mL/kg TV Permissive Hypercapnea (55-60 mmHg) _unless R-L Shunt_ Nitric Oxide
43
What are the complications of ECMO for a baby?
Bleed @ Cannulation Site Intracranial Hemorrhage & Brain Death Sepsis HTN Survival Rate Long term is actually *Lower* (50-60%) w/ ECMO than Without (80%)
44
What are the requirements for a Baby to go on ECMO?
\> 2 kg & \>35 wks gestation
45
What is the problem w/ a Thoracoscopic CDH Repair vs. an Open CDH Repair?
Insufflation w/ Thoracoscopic Repair can ↑CO2 & cause Difficulty Ventilating
46
What are the Surgical Complications of a CDH Repair?
Hypoxemia Pulm. Hypoplasia Pulm. HTN Contralateral PTX IVC Compression - Hypotension
47
Which population is more at risk for Pyloric Stenosis?
Males w/ a parent who had it
48
How does Pyloric Stenosis happen?
Thickening of Pylorus smooth muscle causing gradual obstruction of gastric outlet & forceful NonBilious Projectile Vomit that occurs @ 2-8 weeks of life
49
How is Pyloric Stenosis diagnosed?
Palpation of Olive-Sized Mass in the Upper Abd. & Verified by Imaging
50
What are the symptoms of Pyloric Stenosis?
Dehydration Hyponatremia Hypokalemia Hypochloremic Metabolic Alkalosis Severe Pyloric Stenosis = Acidosis
51
How should Pyloric Stenosis be managed before surgery?
Not Surgical Emergency Replace Fluids & Lytes w/ D5 0.45% NS + 40 KCL for 12-48 hrs
52
What is a TracheoEsophageal Fistula (TEF) ?
Esophageal Atresia w/ or w/o a fistula b/t the Esophagus & Trachea 90% Survival Rate
53
What is the most common type of TracheoEsophageal Fistula?
Type C - Upper Esophagus ends @ stomach & lower Esophagus attaches to Trachea Gastric Distention is most common w/ this type
54
Type E TracheoEsophageal Fistula goes unnoticed until later in life when recurrent _______ occur
Type E TracheoEsophageal Fistula goes unnoticed until later in life when recurrent **Pneumonias** occur
55
What are signs and symptoms of a TEF?
Excessive Oral Secretions & Salivation First Feed Choking Coughing Cyanosis Aspiration Gastric Distention Pneumonia
56
How is a TEF diagnosed?
Cant pass suction or OGT into stomach & CXR showing Cath in Esophagus
57
What are the associated Anomalies of TEF?
**VACTERL** ## Footnote _V_ ertebral _A_ norectal _C_ ardiac _T_ EF _E_ sophageal Atresia _R_ enal _L_ imb
58
Where should the ETT be for a TEF?
Above Carina & Below Fistula or use Right Main technique & withdraw until breath sounds are heard @ Left Axilla
59
What is the patient position for a TEF procedure?
Left Lateral Decubitus for a Right Thoracotomy
60
What are the Intra-Op Complications for a TEF?
Right Main Intubation Fistula Intubation ETT & Tracheal Obstruction Atelectasis Hypothermia Hypoglycemia Return to Fetal Circulation
61
What should be avoided Post-Op for a TEF?
Head Extension & Suctioning beyond Anastomosis Level
62
What are Long Term Complications of TEFs?
Esophageal Stricture Tracheomalacia GERD Chronic Cough Wheeze Exercise Intolerance
63
What causes Congenital Hip Dislocation?
Prolonged Displacement of Fetal Femoral Head from Acetabulum resulting in Joint Laxity to Irreducible Displacement
64
How is a Congenital Hip Dislocation treated?
Pavlick Harness or Closed Reduction & Spica Cast - short procedure, little pain
65
What is the Greatest Concern during a Closed Reduction & Spica Casting for a Congenital Hip Dislocation?
Loss of Airway from Repositioning the Baby
66
What causes Congenital Clubfoot?
Shortened Medial & Achilles Tendon Foot Points Down & Rotated Inward
67
How is Congenital Clubfoot treated?
Surgical Manipulation & Casting @ 3-6 months Lots of Post-Op Pain
68
What is Osteogenesis Imperfecta?
Collagen Production Defect resutling in Abnormal Bones, Ligaments, Teeth, & Sclera EASY to Fracture
69
There are 4 types of Osteogensis Imperfecta. Which type is the most severe?
Type 2 - Perinatal Lethal Form - MOST do NOT survive
70
What are signs & symptoms of Osteogenesis Imperfecta?
Bowing of Long Bones Kyphoscoliosis Otosclerosis Deafness Hypermetabolic - NOT MH Decreased Clotting
71
What is an important consideration when using Sux in Osteogenesis Imperfecta?
Fasiculations can cause Fractures
72
What is Cerebral Palsy?
Static Encephalopathy & Nonprogressive Central Motor Deficit r/t Hypoxic or Anoxic Brain Injury during Prenatal Period
73
What causes Cerebral Palsy?
Prematurity Birth Trauma Hypoglycemia Infections Congenital Vascular Malformation
74
What is the Clinical Presentation of Cerebral Palsy?
Mental Retardation Seizures Skeletal Contractures/Spasms Impaired Laryngeal/Pharyngeal Reflexes Poor Dental Hygiene
75
How does Cerebral Palsy affect Anesthetics?
Decreases MAC & Needs less Propofol
76
How should a pt. w/ Cerebral Palsy be managed in regards to their Seizure Disorder?
Take Anti-Seizure meds (Phenobarbital, Dilantin, Tegretol) up to & day of surgery
77
How is Cerebral Palsy related Skeletal Muscle Spasticity treated?
Dantrolene or Baclofen
78
What should be evaluated when a child comes in with a fracture from blunt force trauma?
C-Spine or Organ Injury
79
What is Myelodysplasia?
Congenital failure of Middle or Caudal End of Neural Tube to close resulting in Spina Bifida Meningocele Myelomeningocele
80
What is the difference b/t a Meningocele & Myelomeningocele?
**Meningocele**: Protruding meninges w/ Spinal Fluid in Sac **Myelomeningocele**: More Severe w/ Nerves in Sac
81
What are characteristics of a Meningocele?
Intact Neuro Spinal Cord tethered by Sacral Nerve Roots
82
What happens if a Meningocele is Unrepaired?
Orthopedic & Urologic Symptoms
83
What are characteristics of a Myelomeningocele?
Upper Urinary Tract Dilation Spasticity Scoliosis Varies in Deficits
84
How should pts w/ Myelodysplasia be Induced & Intubated?
Lateral Intubation Avoid NDNMBs Initially Neurometric Monitoring
85
What is Scoliosis?
Lateral & Rotational Deformity of Thoracolumbar Spine & Ribcage that are Idiopathic or r/t Rapid Growth
86
How does Scoliosis affect the Respiratory System?
↓Lung Volumes ↓Chest Wall Compliance V/Q Mismatch Chronic Hypoxemia ↑Pulm. Vascular Resistance Pulm. HTN
87
What problems can arise w/ the Prone Position during Scoliosis Surgery?
Lung Compression ↑Intra-Abd Pressure IVC Compression Engorged Epidural Vein ↑Bleeding ↓Venous Return & CO
88
With MEP monitoring for Scoliosis Surgery, what anesthetics are used?
Propofol Remifentanil Versed Ketamine No Gas
89
What is the EBL for Scoliosis Surgery & How should it be managed?
EBL = 25 mL/kg TXA Deliberate Hypotension Hourly H&H Normothermia Cell Saver
90
What are common Post-Op problems of Scoliosis Surgery?
Mechanical Vent Hypovolemia Pain Ileus SIADH

Summer 2020 - Advanced Anesthesia - Pediatrics (6 decks)

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