Pediatrics, ENT, & MH Flashcards
How long should you wait for elective procedure if patient has recently had a URI?
4-6 weeks (otherwise, higher risk of increased airway reactivity)
LMA or ETT in children with URIs?
LMA (ETT has higher risk of bronchospasm)
True or false: incidence of airway complications with children with active vs. recovery period of URI are almost identical?
True
Formula for calculating ETT size in children
4 + (Age/4)
Formula for estimating correct depth of ETT in children
12 + (Age/2) or weight in kg/5 + 12 or 3x diameter of ETT
What nerve stimulation causes laryngospasms?
Superior laryngeal nerve
Treatment for kid with high pitched inspiratory noises in PACU
Post-intubation croup: racemic epinephrine nebulization
Steeple sign on X-ray
Croup
Thumb sign on X-ray
Epiglottitis
Treatment of croup
Racemic epinephrine, steroids for long-term
Best ETT for laryngeal polyp excision using a CO2 laser?
Metal ETT or intermittent intubation and ventilation
What to do when you notice smoke from ETT during CO2 laser?
Extubate the trachea, flood the field with saline, then examine with fiberoptic
Scoliosis is associated with which of the following: seizure disorder, mental retardation, hirsutism, MV stenosis, pulmonary HTN
Pulmonary HTN (restrictive lung disease from rotated, constricted thorax)
Why do wake-up tests and MEPs together?
MEPs are prone to false positives, but are continuous monitors; wake-up tests are definitive but non-continuous
Risks of a wake-up test during spine surgery?
Unintentional extubation, dislodgement of lines and instruments, air embolism (inspiration drawing in air through vertebral veins)
4 year old with OSA, which is likely associated with this condition? Peritonsillar abscess, cor pulmonale, choanal atresia, subglottic hemangioma, laryngomalacia
Cor pulmonale (cardiorespiratory syndrome): right heart failure
Major concerns for peritonsillar abscesses?
Obstruction of glottic opening; rupture of abscess; therefore, spontaneous breathing is important on induction
Extrathoracic variable obstructions have what flow volume pattern?
Limited ability to pull air in on inspiration
Intrathoracic variable obstructions have what flow volume pattern?
Limited ability to push air out on expiration
Tracheomalacia flow-volume pattern?
Extrathoracic variable obstruction
Laryngomalacia flow-volume pattern?
Extrathoracic variable obstruction
Mediastinal masses flow volume pattern?
Intrathoracic variable obstruction
Choanal atresia flow volume pattern?
Normal or fixed obstruction on both inspiration and expiration
OSA flow volume pattern?
Intrathoracic variable obstruction (sawtoothing on expiration)
Which of the following congenital conditions are associated with a difficult intubation? Pierre-Robin syndrome, Treacher Collins syndrome, Carpenter syndrome, Crouzon disease, Niemann-Pick?
Pierre-Robin and Treacher-Collins (micrognathia and cleft palate), Carpenter, Crouzon
What do you worry about a patient with DiGeorge syndrome?
HypoPTH with hypocalcemia
DiGeorge syndrome clinical presentation?
CATCH-22: cardiac (tetrology), abnormal facies, thymic aplasia (increased infections), cleft palate, hypocalcemia, deletion on chromosome 22
Main risk of craniosynostosis surgery?
Bleeding (dividing skull along suture lines above the venous sinuses which can bleed)
When do you worry about Propofol infusion syndrome?
After 48 hours + use of propofol infusion
Landmark for caudal anesthesia?
Sacral hiatus
Minimum dose of 0.25% bupivicaine via caudal epidural injection helps with post-op pain after perineal surgery? upper abdominal surgery?
0.5cc/kg of anything greater than 0.175% bupivicaine for perineal surgical pain; 1.25cc/kg for upper abdominal
Morphine epidural dose in children?
0.1mg/kg
Which is associated with MH? Duchenne’s, ataxia telangiectasia, treacher-collins, central-core disease, osteogenesis imperfecta
Central-core disease (muscle dystrophy without muscle wasting)
Triggering agents for MH
Halogenated volatiles and succinylcholine
Mechanism for MH?
Calcium induced release of calcium (ryanodine receptors are stuck open, allowing for calcium to freely enter the cell from the sarcoplasmic reticulum)
Dose of dantrolene for MH?
2.5mg/kg
Which lab value is consistent with MH? hyperPO4, decreased CK, hemoglobinuria, hypokalemia, thrombocytopenia
Thrombocytopenia: tissues thromboplastin release leads to DIC with thrombocytopenia
Do muscle relaxants help with masseter muscle spasms of MH?
No (since calcium-induced release of calcium happens without a motor end-plate activation)
Halothane-caffeine contracture test is what?
Highly sensitive test for MH
What meds increase triggering threshold for MH?
Pancuronium and thiopental
What condition would you see an elevated mixed venous sat?
Severe sepsis (in early sepsis, may be decreased)
How long do you monitor a kid with known MH after anesthesia?
6 hours
Child with remote family hx of MH gets succ for an elective case and has masseter muscle spasm… what do you do?
Give dantrolene
