peds deck 8 Flashcards
dose of morphine in pediatrics
0.05-0.2 mg/kg
onset of morphine in peds
5-10 min
DOA of morphine in peds
2-4 hours
what is the concern with using morphine?
causes histamine release (avoid in asthma/hyperreactive airway)
dose of meperidine in peds
0.5-2 mg/kg
onset of meperidine
3 min
DOA of meperidine
45-90 min
what are the concerns with meperidine
- normeperidine (AM) can cause seizures 2. causes histamine release
_________________ is an opioid that can be given to decrease postop shivering
meperidine (0.5 mg/kg)
meperidine should be avoided in
those with seizure d/o
________________ pediatric disorders are a genetic liposomal storage disorder that results in a build up of glycosaminoglycans
mucopolysaccharidoses
which pediatric disorders are mucopolysaccharidoses
- Hurler’s syndrome 2. Hunter’s syndrome
s/sx of hurlers syndrome
- coarse facial features 2. macroglossia 3. short neck 4. tonsillar hypertrophy 5. narrowing of laryngeal inlet & tracheobronchial tree (laryngo/tracheomalasia) 6. odontoid hypoplasia 7. atlantoaxial subluxation 8. joint stiffness 9. cardiomyopathy and valve dz 10. metnal delays 11. hepatosplenomegaly
anesthetic implications with hurlers syndrome
- C-spine instability 2. difficult intubation/airway 3. post-obstructive pulmonary edema
hurlers syndrome is ____________ recessive; and hunters syndrome is ____________ recessive
autosomal; X-linked
S/Sx of hunter’s syndrome
- coarse facial features 2. macroglossia 3. macrocephaly 4. short neck 5. increased ICP 6. mental delays (varying degrees) 7. valvular heart disease 8. hepatosplenomegaly
anesthesia implications for hunters syndrome
- difficult to mask 2. difficult intubation
s/sx of apert syndrome
- midface hypoplasia 2. craniosynostosis 3. flat face 4. hypertelorism (lg distance btwn eyes) 5. kidney dz 6. syndactyly 7. esophageal atresia 8. congenital heart disease
anesthesia implications for the pt with apert syndrome
- diffult mask 2. difficult intubation 3. may present with tracheostomy 4. craniosynostosis - difficulty with positioning
s/sx of crouzon syndrome
- branchial arch syndrome 2. maxillary hypoplasia with inverted V-shaped palate 3. macroglossia 4. craniosynostosis 5. ocular proptosis
anesthetic implications for crouzon syndrome
- difficult intubation/airway 2. risk for eye injury
signs & sx of pierre robin syndrome
- micrognathia 2. glossoptosis (tongue farther back than should be –> obstx) 3. upper airway obstruction 4. usually presents with cleft palate 5. normal IQ 6. frequently have GERD
anesthesia implications for pierre robin syndrome.
very difficult airway/intubation
s/sx of treacher collins
- micrognathia 2. choanal atresia 3. down sloping eyes 4. sparse eyelashes 5. coloboma (defect in iris of eye) 6. absent or abnormally small ears ** 7. normal IQ 8. congenital heart defect
anesthetic implications for treacher collins
- difficult airway/intubation 2. associated cardiac dz
what is the most common chromosomal abnormality
Trisomy 21 (down syndrome)
95% of cases of trisomy 21 are due to _______________
nondisjunction of chromosome 21
what risk factor is associated with trisomy 21
increased maternal age
screening methods for trisomy 21
- US 2. alpha-fetoprotein levels 3. chorionic gonadotropin 4. unconjugated estriol levels
the average life expectancy of someone with trisomy 21 is ____________ years of age most commonly due to ________________
35; cardiac issues
s/sx of down syndrome
- small mouth 2. hypoplastic mandible 3. protruding tongue 4. duodenal atresia 5. pharyngeal hypotonia 6. palmar or simian hand creases 7. mental handicap 8. C-spine subluxation 9. cardiac dz –> risk of bradycardia under anesthesia and risk of pulmonary htn 10. hypothyroidism 11. microbrachycephaly (small head, flat in the back)
anesthetic considerations for pt with Trisomy 21
- may be difficult intubation (d/t atlantoaxial instability) 2. cardiac dz 3. less muscle relaxant required 4. increased risk of post-intubation stridor (due to tracheal/subglottic stenosis) 5. pretreatment atropine due to large risk of brady cardia 6. difficult bag (big tongue)
what do pts with trisomy 21, 18, and 13 all have in common
cardiac anomalies
s/sx of trisomy 18
- cardiac anomalies 2. developmental delays 3. retrognathia/micrognathia
anesthesia considerations with trisomy 18
difficult intubation
s/sx of CHARGE syndrome
- Colomba of the eye (defect in iris) 2. Heart defects 3. Atresia of nasal choane 4. Retarded growth/mental delay 5. GU (undescended testes/hypospadias) 6. ear abnormalities (deafness)
what are the common heart defects seen with CHARGE syndrome
conotruncal and Ao arch abnormalities
if bby is having issues breathing right after birth they will most likely be worked up for ___________________
CHARGE syndrome
anesthesia implications of CHARGE syndrome
- possible difficulties with airway (irrespective of atresia and cleft palate) 2. cardiac complications
s/sx of VACTERL
- vertebral - hypoplastic/hemi vertebrae 2. Anal - atresia or imperforate anus 3. CV - VSD, ASD, or TOF 4. Tracheoesophageal - esophageal atresia with transesophageal fistula 5. Renal - single kidney 6. Limb defects - syndactyly, polydactyly, forearm abn, displaced thumbs
anesthesia considerations with VACTERL
- vertebral anomalies can complicate airway management and regional 2. tracheoesophageal anomalies can complicate airway management 3. CV issues - need to keep normodynamic and take bubble precautions.
s/sx of DiGeorge syndrome
“CATCH22” 1. cardiac defects 2. Abnormal face (retrognathic and micrognathic) 3. thymic hypoplasia –> immunocompromise 4. cleft palate 5. hypocalcemia
what is the most important thing to assess if a pt presents that is dx with Digeorge syndrome
- cardiac 2. have they had cardiac eval? 3. last time they had? 4. anything we need to be concerned about?
anesthesia implications for DiGeorge
- strict aseptic technique/use of irradiated blood due to immunosuppression 2. cardiac defects 3. possible difficult airway due to retrognathia and/or micrognathia
_______________ is an inherited hemoglobinopathy producing hemoglobin S
sickle cell disease
T/F: all neonates are screened for sickle cell due to how common it is
TRUE
common sequelae of sickle cell dz
- vasoocclusive pain attacks 2. acute chest syndrome –> pulm htn –> R. Sided Heart failure 3. splenomegaly 4. cholelithiasis 5. chronic transfusions and increased iron loads 6. strokes
________________ is THE most common FATAL inherited disease
cystic fibrosis
10-15% of pts dx with _________________ have meconium ileus as a neonate
cystic fibrosis
anesthesia implications for Cystic fibrosis
- assess lung function 2. humidified gases should be used*** 3. if lung fx poor –> consider TIVA 4. preoperative/postoperative nebulizers may be indicated 5. often present with severe nasal polyps and chronic sinusitis 6. if regional an option = okay 7. careful titration of narcotics and respiratory depression
