Peds Anesthesia

Question 1

Exceptions for dextrose in IVF

Answer 1

-

Question 2

Cortisol level

Answer 2

Higher in am than pm

Question 3

Greater hypoxia brain damage has been found in relation to

Answer 3

High blood glucose level

Question 4

What are the daily fluid requirements based on

Answer 4

1. Metabolic demand (high in peds)

2. High ratio of BSA to weight

Question 5

Maintenance fluid requirements

Answer 5

0-10 kg = (4ml/kg)
11-20 kg = (40ml + 2ml/kg)
>20 kg. = (60 ml + 1ml/kg)

Question 6

NPO deficit

Answer 6

Maintenance IVF x NPO hrs

Replace half in 1st hr and 1/4 over next two hours

Question 7

Blood loss replacement

Answer 7

3: 1 w/crystalloids
1: 1 w/ colloids or blood

Question 8

Very Minor surgery

IVF

Answer 8

BMT, frenulectomy

0.2 ml/kg/h

Question 9

Minor surgery

IVF calculation

Answer 9

Hernia

2-4 ml/kg

Question 10

Moderate surgery

Answer 10

4-6 ml/kg

ENT, lap

Question 11

Major surgery

Answer 11

6-10 ml/kg

Bowel ressection, intra abd surgery

Question 12

Massive 3rd space fluid loss

Answer 12

10-20 ml/kg/hr

Cranialfacial, spinal bifida

Question 13

ETT size

Length of insertion

Answer 13

Age/4 + 4 = ETT

3x tube size = length
Double black lines of ETT should line up with vocal cords
Confirm by auscultation

Question 14

RBC replacement

Answer 14

10-20 ml/kg

Question 15

FFP replacement

Answer 15

10-15 ml/kg

Question 16

Platelets

Answer 16

1unit/10kg

Question 17

Cryoprecipitate replacement

Answer 17

0.1 units/kg (up to 3 units)

Question 18

Symptoms of hypovolemia

Answer 18

Dec urine output
Tachy
Mottled skin
Cold extremities 
Dec BP late sign

Question 19

Peds can maintain BP until what % reduction in volume status

Answer 19

25%

Question 20

What is the bolus dose

Answer 20

5-20 ml/kg LR

5-10 ml/kg Albumin

Question 21

NPO
CL diet
Milk & solids
Breast milk

Answer 21

CL : 2 hrs for all ages
Solid/milk: 4 (3yr)
Breast milk: 3-4 hrs

Question 22

Why uncuffed ETT

Answer 22

• funnel shaped trachea
• narrowest cricoid
• risk of subglottic stenosis dec
• allows for lg diameter ETT - dec in airway resistance

Question 23

Uncooperative or infant induction

Answer 23

70% N2O (2L O2+ 6L N2O)

Sevo 8%

Question 24

What age group does not need pre op med

Answer 24

0-8/10 months, no separation anxiety

Question 25

Waht are the pitfalls of induction

Answer 25

1. Breath holding: don't assist respirations 2. Laryngospasm: partial vs complete 3. Anesthetic overdose

Question 26

Partial laryngospasm

Answer 26

Stridor: - gentle positive pressure - PEEP on a bag - deepen pt: Propofol 1-2 mg/kg

Question 27

Complete laryngospasm

Answer 27

Rocking of chest/abd but NO air exchange Deepen pt If no improvement: Positive pressure & Tighten APL Propofol IV Sux: IV/IM if pt continues to desat or become Brady & spasm does not break

Question 28

Anesthetic Overdose

Answer 28

Bradycardia, listen to pulse Ox , dec agent

Question 29

Which age group has the easiest intubation What blade to use

Answer 29

Toddlers | Miller 2, WIS 1, MAC 2 blade

Question 30

Infants intubation

Answer 30

Shoulder roll Stylet available Larynx more anterior

Question 31

Assessing for correct tube size

Answer 31

Pt should have audible leak @ 20cm H2O, but not much less than that Lg leak at

Question 32

Which VA increases post op delirium

Answer 32

Sevo

Question 33

When would u use LTA

Answer 33

Planning for deep extubation when case is

Question 34

Rx for emergence delirium

Answer 34

Narcotics: fentanyl: .05-1 mcq/kg or morphine 0.025-0.1 mg/kg Dexmedetomidine: .1-.3 mcq/kg Narcotics more effective than benzo

Question 35

Stridor Rx

Answer 35

Decadron 0.25-1mg/kg | Racemic epi 0.25-0.5 ml 2.25% solution nebulizer in 2.5 ml NS

Question 36

POC for urologic procedures

Answer 36

Caudal block w/light GA, superior to local nerve block or GA alone

Question 37

Where does caudal space lie

Answer 37

Under sacrococcygeal ligament that runs through the sacral hiatus under the skin

Question 38

Where does the dural sac ends

Answer 38

Ends at S1-2, May extend to S3 in neonates

Question 39

What are some additives that can be added to caudal anesthesia

Answer 39

Morphine 50-70 mcq/kg Clonidine 1-2 mcq/kg Dilaudid 15 mcq/kg

Question 40

What is used in caudal

Answer 40

Marcaine 0.25% , typically 1ml/kg up to 10 ml, may dilute to 15 ml max w/PF saline With or without epi

Question 41

What is used in TAP

Answer 41

0.5 ml/kg 0.25% bupivicane with epi

Question 42

What is programmed cell death that's induced by anesthesia

Answer 42

Apoptosis