Peds

Question 1

Cobb angle

Answer 1

@ scoliosis
>10 = abnormal
>40-50 = surgery
>60-65 = pulmonary dyd
>70 = pHTN at exercise
> 110 = pHTn at rest

Question 2

Duchenne concerns

Answer 2

airway:
- impaired larngeal reflexes
- delayed gastric emptying
- macroglossia
- scoliosis
- decreased pulm reserve

cardiac:
- cardiomyopathies
- cor pulmonale
- arryhtmias

pulm:
- scoliosis
- aspriation
- weak cough - PNA
- decreased pulm rserve

Question 3

Airway duchennes

Answer 3

aspiration precautions
consider SV with ketamine
NO VOLATILE
NO SUX
sensitive to NMB

Question 4

cardiac status in respiratory papillomatosis

Answer 4

RVH and core pulmonale

Question 5

induce laryngeal papillomatosis

Answer 5

avoid sux @ child
difficult airway equipment
bronchodilator
preoxygenate
IM ketamine
IV
deep enough level to avoid bronchospasm
DL and tube

Question 6

URTI

Answer 6

severe symptoms (fever, productive cough, malaise, pulmonary invovlement) > delay 4-6 weeks

mild symptoms (nonproductive cough, mild nasal congestion, sneeze) w/ RF and ETT required > delay 2-4 weeks

mild symptoms and no ETT required to do case safely > proceed

Question 7

disorders linked to MH

Answer 7

central core disease
King Denborough Syndrome

Question 8

side effects of dantrolene aka why no ppx

Answer 8

n/v
pain at injection site

Question 9

oculocardiac reflex at strabismus

Answer 9

@ manipulatino fo eye and orbital strcutures
bradycardia

TX:
deepen anesthesia, fix hypercarbia and hypoxia, ask surgeon to stop, atropine, ask for lidocaine in rectus muscles

Question 10

monitors congenital diaphragmatic hernia

Answer 10

pre and post ductal sat
umbilical central line (avoid neck for possible ECMO)
ASA
aline

Question 11

CHD induction and airway

Answer 11

maintain SV, PPV may worsen
avoid worsening R to L shunting - avoid drops inSVR and increases in PVR
inhalational induction

Question 12

CHD intraop complications to anticipate

Answer 12

hypoxia
pHTN and RHF
PTX of healthy lung with reinflation of hypoplastic lung
hypotension with closure of thorax from abd organ compression of IVC

Question 13

pathophysiology of CHD

Answer 13

deficient b/l major airway and vessel branching not explained by compression of lungs
lung and vascular hypoplasia
lower number of alveoli - low compliance and decreased SA for air exchange, imparied oxygenation

Question 14

congenital anomalies with CHD

Answer 14

28% CNS - spina bifida, hydrcephalus
31-23% cardiac - ASD, VSD, CoAo, ToF
20% git/malrotation, atresia
15% GUT hypospadias

Question 15

transport to OR in epiglottitis

Answer 15

parents, anesthesiologist, surgeon
sitting up in bed
no IV yet
monitor
supplemental oxygen
rescue meds and equipment
ambubag

Question 16

induction and airway in epiglottits

Answer 16

NO RSI: most likely NPO is okay bc of clinical course, risky if airway not obtained immemediately
SV with inhalational with child on parents lap
ensure adequate depth
then place IV
then intubate
difficult airway euquipment, help and surgeon ready

Question 17

extubation criteria epiglottis

Answer 17

abx complete
24-48 hours
postive leak test
do in teh OR
surgeon drapped neck
fibreoptic view of airway
positive leak test
+ appropriate other
back to ICU after

Question 18

induce FB aspiration

Answer 18

RSI can move FB to obstruct all ventilation so avoid

SV with inhaled ventilation
consider glyco/atropine in young populaiton to eliminte high vagal repsonse

Question 19

Treat tet spell ToF

Answer 19

monitors
put knees to chest - increased SVR > want to decrease R to L shunt

Question 20

Induce and airway TOF

Answer 20

want to maintain SVR and reduce PVR to promote less R to L shunting

• slow controlled with adequate oxygenation, ventilation
• blunt SNS with fentanyl, lidocaine
• ketamine to ensure SVR maintained

Question 21

Maintenance anesthesia TOF

Answer 21

nitrous (volatiles promote PVR)
ketamine
oxygen