Peds deck 3 Flashcards
preop neurologic assessment
- baseline - consider they are not going to interact with you in hospital setting the same as they would in social setting 2. austism? 3. CP? 4. hydrocephalus? - any recent changes ? 5. spina bifida?
in your preop assessment your asking about exercise tolerance and the mom says that the child cannot keep up with the other kids, she has to squat down and rest - what would this indicate to you
pt has tetralogy of fallot
if pt comes in for surgery with spina bifidia, you know these patient are at increased risk of having sensitivity/allergies to _______________
latex
musculoskeletal preop assessment
- any fx? 2. weakness/deficits prior to surgery? 3. scoliosis? 4. hypotonia or hypertonia - positioning/padding concerns
renal/endocrine preop questions
- UTI hx 2. renal dz? (fluid and electrolyte concerns) 3. dialysis? 4. DM hx? 5. thyroid issues?
considerations for surgery for the pediatric DM pt
- needs to be first case of the day 2. consult endocrine 3. IV fluids with dextrose (esp if took insulin DOS) 4. monitor glucose pre, peri, and post op (typically only monitor intraop if > 1 hour)
anesthetic considerations for the pediatric pt with sickle cell
- know if its mild or severe 2. need to be admitted preop for hydration/possible transfusion 3. keep hct around 30 4. keep the pt warm! 5. may need increased pain meds and O2 postop 6. ensure adequate oxygenation
what are some other preoperative things you should look into/ask about for pediatric pt coming for surgery
- recent fever? 2. are they teething? 3. chronic strep/tonsillitis? 4. anemia? 5. transfusion hx 6. immunosuppressant hx 7. chemo hx 8. bruising/bleeding tendencies
T/F: in peds if they are on immunosuppressants or chemotherapeutic agents they should take them day of surgery
TRUE
preop physical assessment
- general appearance (pale, jaundice) 2. breathing pattern - regular? nasal flaring? retractions? stridor? 3. abdominal distension? 4. pain? 5. anxiety level? 6. heart, lung assessment 7. airway: mallampati, visual exam, dental
if pt has abnormal lung sounds on phsyical assessment how should you proceed
- give preop nebulizer and reassess after the nebulizer 2. know that this pt is at increased risk for laryngospasm and bronchospasm 3. if still do not sound good after nebulizer, may need to have discussion with surgical team about delay
what is the lowest age you can get a good mallampati ?
5-Apr
preoperative dose of albuterol
- 2.5 mg 10 kg
preop dose of atropine
0.1 mg IM
preop dose of rantinidine
- 2 mg/kg PO (max 150) 2. 1 mg/kg IV (max 50)
preop dose of metoclopramide
- 0.15 mg/kg PO 2. 0.1 mg/kg IV (max 5-10)
pts with _____________ are EXTREMELY cardiac sensitive and will have bradycardia very quickly with INH induction, therefore; atropine preop is needed
trisomy 21 (down syndrome)
what pediatric pts do you draw H/H in?
- any child < 6 months 2. anticipated blood loss over 10%
infants around age ___________ have physiologic anemia
2-4 months
fluid balance panel should be drawn in what pts?
- any child with renal issues 2. any child on diuretics
preoperative labwork in peds to consider
- H/H 2. fluid balance panel 3. glucose level 4. coagulation studies
T/F: INH induction can be done with anyone, even if they have an IV
TRUE
there is an increased risk of ________________ with inhalational induction
spasm
if you need an oral airway with inhalational induction, you have to be careful when placing it because it increases risk of _____________
spasm
advantage of inhalational induction
- decreased need for IV meds 2. speeds turnover
T/F: if inducing anesthesia with IV agents you may need more than you would in an adult
TRUE
anesthesia implications for adenoid hypertrophy/enlarged nasal turbinates
- leads to problems with child breathing through nose (obligatory nose breathers) 2. increases resistance on inhalational induction
sensory innervation to the nasopharynx
- trigeminal (V) 2. IX (glossopharyngeal)
infants are obligatory nose breathers until ____________ age
6 months
what is the purpose of being an obligatory nose breather in early life
allows for the coordination of suckling while they breathe
sensory innervation to the nose
V - trigeminal
risks for asphyxia within the first 6 months of life due to inability to breath through nose
- stenosis 2. sinusitis 3. choanal atresia
children with ____________ are most at risk for sinusitis and impaired breathing within the first 6 months of life
CF
why are infants obligatory nose breathers in the first 6 months of life
- coordinating suckling while they breathe 2. anatomy - tongue rests against roof of mouth while quiet breathing.
considerations of the oropharynx in children
- lingual and palantine tonsils become enlarged in ALOT of kids 2. tongue is enlarged in proportion to oral cavity (even larger in those with down syndrome or beckwith weidiman)
innervation to the oropharnyx
IX (glossopharyngeal) & X (vagus)
anesthesia implications of the oropharynx in children
- tonsilar hypertrophy - esp if grade IV can cause huge problem with INH induction &/or DL 2. obstruction due to large tongue when going to sleep 3. cleft palate - laryngoscope wants to naturally fall into the cleft
what are the paired cartilages of the larynx? and what are the unpaired?
- paried: corniuclate, cuneform, arytenoids 2. unpaired: epiglottis, thyroid, cricoid
supraglottic sensory innervation of the larynx
internal branch of the SLN
infraglottic sensory innervation of the larynx
recurrent laryngeal nerve
motor innnervation to the cricothyroid muscle
external branch of SLN
motor innervation to all muscles of the larynx except cricothyroid
RLN
how is the epiglottis in the infant/neonate different that of the adult
- more narrow 2. omega shaped 3. angled away from the axis of the trachea
T/F: the epiglottis in the infant is easier to pick up with laryngoscope blade than in the adult
false; harder to pick up due to being narrowed
what is the narrowest point of the larynx in the infant
cricoid
what is the narrowest point of the larynx in the adult
rima glottidis
at what age does the narrowest part of the larynx shift from the cricoid to the rima glottidis
12-Oct
post extubation of infant, the child has croup –> what do you think has occured
too large of ETT which caused edema subglottically (due to narrowest part being cricoid)
lungs usually mature by ____________ weeks gestation
32
the diaphragm and chest wall has less __________ type fibers –> the child going into respiratory arrest very fast
1
