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Advanced Principles A (Spring 2025) Cooper > Peds (Part 3) > Flashcards

Peds (Part 3) Flashcards

1
Q

What nerve is being stimulated that will cause a laryngospasm?

A

Superior Laryngeal nerve

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2
Q

Laryngospasms are common in patients with an ___.

A

URI

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3
Q

Preoperative factors increasing the likelihood of a laryngospasm

A
  • Secondhand smoke
  • Active/Recent URI
  • GERD
  • Mechanical irritants (secretions)
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4
Q

Ways we can prevent a laryngospasm

A
  • Avoid stimulation during stage 2
  • Topical lidocaine
  • IV Lido prior to extubation
  • Suction prior to extubation (not in stage 2)
  • Awake extubations
  • 100% O2 for 3-5 min prior to extubation
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5
Q

Incomplete Airway obstruction algorithm

A
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6
Q

What is the differences to the complete obstruction algorithm

A
  • More firm pressure from the start
  • Skip the propofol and give the succs
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7
Q

Meds we also give when administering succs for a laryngospasm

A
  • Glyco or Atropine

(Also deepen the gas/prop)

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8
Q

Bronchospasms are common in these 2 populations (children)

A
  • Asthma
  • URI
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9
Q

Manifestations of a bronchospasm

A
  1. Audible wheeze
  2. Prominent expiratory slope on ETCO2
  3. Increased ETCO2
  4. Decreased Saturation
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10
Q

Treatments for Bronchospasms that are different than laryngospasm

A
  • Albuterol
  • IV Mg
  • Steroids
  • Epi (5-10 mcg/kg)
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11
Q

Post-intubation Croup is commonly caused by ___.

A

Laryngeal Edema

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12
Q

What are some reasons why laryngeal edema (post-intubation croup) might occur?

A
  1. ETT too big
  2. Multiple DL attempts
  3. Positioning
  4. Length of surgery
  5. Age (< 4 yrs)
  6. URI
  7. Coughing with ETT in place
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13
Q

Treatments for Post-intubation croup

A
  • Steroids
  • Racemic Epi (2.25%)
  • Supplemental O2
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14
Q

When does post-intubation edema present?

How can we prevent it?

A

30-60 min following extubation

Maintain air leak < 25 cm H2O

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15
Q

Syndromes mentioned in this lecture that can indicate a difficult airway due to having a large tongue?

A
  • Beckwith Syndrome
  • Down Syndrome

Oral Airway

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16
Q

Difficult airway syndromes related to anomlies in the C-spine

A
  • Klippel-Feil
  • Trisomy 21
  • Goldenhar
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16
Q

Difficult airway syndromes related to having a small/underdeveloped mandible

A
  1. Pierre Robin
  2. Goldenhar
  3. Treacher collins
  4. Cri du chat
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17
Q

What is one thing we definitely don’t want to use for a known difficult airway?

18
Q

What age do we see peak incidence of foreign body aspiration?

A

6 months - 3 yrs

19
Q

Anesthesia considerations for a foreign body aspiration:

A
  • Inhalational induction
  • Maintain spont. ventilation
  • Increase FGF/VA
  • TIVA?
  • Prevent coughing/bucking
20
Q

Epiglottits or Croup?

22 months old:
Rapid Onset:
Viral in nature:
Supraglottic region affected:
Tx with ABX:
Laryngeal region affected:

A

22 months old: Croup
Rapid Onset: Epiglottitis
Viral in nature: Croup
Supraglottic region affected: Epiglottitis
Tx with ABX: Epiglottitis
Laryngeal region affected: Croup

21
Q

Clincal manifestations of Epiglottitis:

A
  • Drooling
  • Dyspnea
  • Dysphonia
  • Dysphagia
  • Dis High fever
22
Q

Clinical Manifestations of Croup:

A
  • Barking cough
  • Mild fever
  • Inspiratory stridor
23
Q

Which population of peds patients are at higher risk of OSA, Subglottic stenosis, atlantoaxial instability?

A

Trisomy 21

24
What is a common issue seen with Trisomy-21 patients?
Congenital Heart disease (40-50%) - Specifically AVSD --> VSD
25
Common adverse reaction seen with inhalational inductions on patients with Trisomy 21?
Bradycardia (Due to low levels of circulating catecholamines) | Glyco and Atropine AVAILABLE!
26
What is CHARGE syndrome?
**C**oloboma **H**eart defects **A**tresia of the choanal region **R**estriction of G/D **G**enitourinary problems **E**ar anomalies
27
DiGeorge/Catch 22 syndrome
Cardiac Abnormal Face Thymic hypoplasia (need irradiated blood) Cleft palate Hypocalcemia (d/t hypoparathyroidism) 22 q11.2 dene deletion
28
VACTERL Association:
**Vertebral Anomalies** Anal Atresia CV anomalies **Tracheoesophageal fistula** Esophageal Atresia Renal/Radial anomalies Limb defects | **Most common**
29
Important anesthetic consideration when doing a strabismus repair
- Stimulation of oculocardiac reflex
30
True or False: Continued stimulation of the oculocardiac reflex makes the negative outcomes exponentially more likely?
False: It actually begins to fatigue the response | 1st Step in managing this --> ASK THE SURGEON TO STOP
31
Important things to remember for retinopathy of prematurity:
- < 30 wks premature increases risk - Caused by liberal oxygen use - Keep sats 89-94% for preemies - Preductal O2 is a better indicator of saturation of retinal vessels (right hand)
32
Anesthetic considerations for children with OSA:
- Careful with giving premed - Dose Opioids on IBW (Careful titration) - Expect these pts to need extended observation
33
Important preop assessment for T&A procedure?
Hx of bleeding (family hx)
34
Dose of decadron for T&A procedure:
0.5 mg/kg
35
Awake or deep extubation for T&A?
Ideally deep
36
Anesthetic complications seen with T&A:
Bleeding - 6-24 hrs post op (primary) - 5-10 days after (secondary) Airway Fire: - Maintain FiO2 < 30% - Avoid N2O
37
Post-tonsillar bleed anesthetic considerations:
1. VOLUME! 2. RSI (Full stomach) 3. Pre-ox in Left lateral, head down position 4. Smaller ETT (1/2 size down) 5. Antiemetics 5. OG Tube 6. Awake Extubation
38
Does the cleft lip or cleft palate get fixed first?
LIP!
39
Olive shaped mass, most commonly seen in first-born males?
Pyloric Stenosis
40
Clinical s/s of Pyloric Stenosis:
1. Projectile Vomiting 2. Palpable pylorus 3. Visible peristaltic wave
41
Preoperative management for pyloric stenosis:
- Correct hypovolemia - Correct acid/base abnormalities - Correct hyponatremia
42
Considerations for inguinal hernia repair:
- Monitor for SB incarceration and testicular injury - Possible spinal/caudal block - Concern for postop apnea
43

Advanced Principles A (Spring 2025) Cooper (14 decks)

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