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AP Summer FINAL > Pre-Post Anesthesia Pediatric > Flashcards

Pre-Post Anesthesia Pediatric Flashcards

1
Q

What should we discuss about the patient’s preoperative history? (4)What are the two most important?

A
  1. Pre-existing medical conditions
  2. Past anesthetic history*
  3. Current medication/allergies*
  4. Family history* = most important
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2
Q

What is the most common complication during a peds induction?

A

AW obstruction with no IV access (inhalational induction)

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3
Q

What two diseases are characterized by small mandibular size and limited mouth opening?

A

Pierre Robin and Treacher Collins

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4
Q

What airway anatomy complication do you have to consider in Down’s patients?

A

Atlanto-occiptal instability

Limited range of motion of the mandible

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5
Q

How is the pediatric trachea different from an adult’s?

A

Tracheal cartilages are not fully developed so the trachea is more compliant; also smaller

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6
Q

What two pediatric diseases result in a partially closed airway?

A

Laryngomalacia

Tracheomalacia

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7
Q

How is the pediatric glottis different from an adult’s?

A

Anterior and cephalad

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8
Q

At what cervical level are the vocal cords of a neonate?

A

C3

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9
Q

At what cervical level are the vocal cords in a child?

A

C3-C4

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10
Q

At what cervical level are the vocal cords in an adult?

A

C4-C5

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11
Q

What structures in the pediatric airway are enlarged?

A

Head, tongue, and adenoids

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12
Q

How is the pediatric epiglottis different from an adult’s?

A

Long, narrow

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13
Q

What is the narrowest part of the pediatric airway?

A

Cricoid cartilage

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14
Q

What do Type 1 fibers in respiratory muscles do?

A

Function in endurance

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15
Q

Pediatrics have ____ Type 1 muscle fibers than adults. Why is this significant?

A

Fewer (20% of adults)

They will work very hard against an obstructed airway but only for a short time before they fatigue and cannot breathe.

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16
Q

How are the pediatric ribs different from an adult’s?

A

Horizontal and not well attached to the sternum or vertebral column

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17
Q

How are the pediatric vocal cords different from an adult’s?

A

Cords slant downward and anterior

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18
Q

What is the pediatric O2 consumption compared to adult O2 consumption?What is the pediatric CO2 production compared to adult CO2 production?

A

Increased

Increased

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19
Q

Alveolar ventilation is ___ of adults’. What variable is changed?

A

Two times that of adults.
RR is increased.
TV is the same per kg as adults’.

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20
Q

What does pediatric ventilation depend on?

A

Diaphragm

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21
Q

Where is the greatest resistance in the pediatric airway?

A

Nares

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22
Q

The O2 dissociation curve is shifted which direction in neonates? What does this mean?

A

Shifted to the left. Hemoglobin F has a greater ability to bind to O2 and hold onto it (P50=19 vs 27 in adult)

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23
Q

How does the FRC of pediatrics compare to that of adults?

A

FRC is the same. FRC = 28-30 cc/kg
BUT a 2 kg baby only has 60 cc in their FRC whereas an adult has 1.5 L so a pediatric patient will desaturate very quickly

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24
Q

What are 3 important questions to ask in the preop pulmonary physical exam?

A
  1. Recent URI?
  2. Asthma?
  3. Former preterm infant?
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25
When should elective surgery be cancelled?
1. Purulent rhinitis 2. Fever > 38.3 degrees C 3. Elevated WBC with bands (immature WBCs) 4. Infiltrate by CXR*Look for lower respiratory disease: bronchitis or pneumonia.
26
How many URIs does the average child have per year?
8
27
What % of US children have asthma?
5-10%
28
1. If a child is diagnosed with asthma, into which ASA class does that automatically put them?2. If child is on daily asthma medication?3. If child is on steroids for asthma?
1. Dx = ASA 2 2. Daily meds = ASA 3 3. Steroids = ASA 4
29
What should we do for an asthma pt? (3)
1. Optimize medications 2. Ensure no concurrent respiratory illness 3. Ensure patient compliance with meds 24-48 hours prep
30
What is defined as a preterm infant?
Any child born before 37 weeks gestation
31
If child was a premie, what age can the child have elective surgery and go home same day?
52 weeks PGA (post gestiational age)
32
What age does postop apnea begin to decline?
45 weeks PGA
33
What do you always want to know about a preterm infant?
Room Air sat
34
Premies younger than 52 weeks PGA must stay how long in hospital and must be monitored for what?
Minimum 12 hours | Checking : Desaturation, Bradycardia, Apnea
35
What membrane is affected with bronchopulmonary dysplasia? What are the characteristics of BPD? (6)
Hyaline Membrane Disease 1. Increased airway resistance 2. Poor lung compliance 3. VQ mismatch 4. Hypoxemia/O2 desaturation 5. Tachypnea/increased work of breathing 6. Chronic wheezing despite maximum medical tx
36
What should we do for bronchopulmonary dysplasia pts prep?
1. Optimize medications | 2. Ensure no concurrent illness
37
What is PCA?
Post-conceptual age
38
When is anemia especially a problem for the preterm infant?
When they experienced placenta previa or placenta abruption
39
What is the hematocrit of healthy, full-term babies? What is the hematocrit of anemic premies?
Healthy: 50-60 Anemic: 27-28
40
Premies are at greater risk for what 2 complications?
GERD | Aspiration pneumonitis
41
What grade murmurs do not require a workup?
Grades I and II and asymptomatic
42
What grade murmurs do require a workup and ECHO?
Grades III and greater OR if there are any symptoms
43
What grade murmur can you hear without the stethoscope on the chest?
Grade VI
44
What are the guidelines for sickle cell disease pts?
1. Get a baseline H/H 2. Transfuse to Hct 30% with PRBCs preop 3. Always have blood available in OR
45
What are fasting guidelines for < 6 months?
4 hrs for solids, milk, and formula | 2 hrs for clear liquids
46
What are fasting guidelines for 6-36 months?
6 hrs for solids, milk, and formula | 3 hrs for clear liquids
47
What are fasting guidelines for > 36 months?
8 hrs for solids, milk, and formula | 3 hrs for clear liquids
48
What is Pedialyte considered to be for fasting guidelines?
Clear liquid
49
At what age should we start giving premed Versed?
> 12 months (do not use Versed before 12 months of age
50
What are the benefits of premed?
1. Calms child and parents 2. Better acceptance of mask induction 3. Diminishes postop behavioral changes 4. Fewer tears & secretions = dec risk of laryngospasm during induction
51
What is normal dose of premed Versed?
Midazolam 0.5-0.7 mg/kg orally, max 15-20 mg 0.2 mg/kg nasally
52
What hypnotic agent can be used as a premed?
Ketamine 6-9 mg/kg orally
53
What premed is given rectally?
Methohexital (Brevital) 10%, 25 mg/kg(very unpredictable though --based on feces presence/absence)
54
What is an opioid premed?
Transmucosal fentanyl 10-15 mcg/kg (intranasal or lollipop)
55
On a healthy child, what labs should be done in preop?
None
56
If moderate blood loss is expected, what labs should be done preop?
Baseline H/H
57
What type of surgery is the exception to the guidelines for preop labs?
ENT, especially tonsillectomy bc of hemophilia dx
58
What % of ped surgeries are ambulatory?
75%
59
What anesthetic agent is most often used and why?
Sevoflurane bc it causes the least airway irritation
60
Which anesthetic prolongs emergence?
Halothane
61
Which anesthetic causes more laryngospasm, coughing, and emergence excitement?
Desflurane (petechiae from coughing so hard)
62
Do all cases require IV access?
No, ear tubes, for example, are only 5 minute procedures so no need
63
Forced drinking for hydration in PACU causes what?
Increased incidence of PONV (23% compared to 14% for elective drinkers)
64
For ped pain management, what medications are preferred and why?
NSAIDs preferred over opioids (minimize use of opioids if at all possible)
65
What is dose of Ibuprofen orally?
5 mg/kg PO
66
What is dose of IM & IV ketorolac?
IM: 1 mg/kgIV: 0.5 mg/kg*Be careful giving to tonsillectomy pts --> increased bleeding
67
What can surgeons do to help with pain management?
Local anesthetic wound infiltration
68
What is most common regional technique performed in peds? Advantages and disadvantages?
Caudal block Easy, good landmarks, predictable Occasional motor block in older pts
69
Onset and duration of caudal block
10-12 min4-6 hrs
70
On what pts do we perform caudal blocks? (age and weight)
< 7 years of age< 30 kg
71
What is a TAP block? What are three most common performed?
Transverse abdominis plane blockIlioinguinal, iliohypogastric, and penile
72
Which procedures/factors have the highest incidence of PONV?
``` ENT, esp middle ear Laparoscopic Eye Family hx Motion sickness ```
73
What is the dosage of Zofran?
0.1 mg/kg up to max 4 mg
74
What is dose of Reglan?
0.15 mg/kg IV
75
What is dose of promethazine?
0.5 mg/kg IV/PR
76
What is dose of decadron?
0.33 mg/kg
77
What is the recommendation for prevention of PONV in peds?
2 drug therapy
78
What is one of only drugs that has not shown neural toxicity?
Dexmedetomidine
79
Flick's study showed that infants who had 3 or more surgeries before age 2 had what?
3x incidence of learning disabilities
80
What has been proven to be neuroprotective?
Lithium, single dose
81
What other agents are possibly neuroprotective? (studies still ongoing)
Dexmedetomidinet | PA (tissue plasminogen activator) PlasminErythropoietin
82
What study used healthy children undergoing a single anesthetic and a single procedure comparing Sevo to regional anesthesia for hernia repairs?
GAS study
83
What study used sibling pairs undergoing a single anesthetic for hernia repairs?
PANDA study (Pediatric Anesthesia Neurodevelopment Assessment Study)

AP Summer FINAL (7 decks)

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