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AP Summer Final > Preop Evaluation of Pediatric Patient > Flashcards

Preop Evaluation of Pediatric Patient Flashcards

1
Q

What should you ask regarding the pediatric’s preop history? (4)

A

Pre-existing medical conditions
Past anesthetic history
Current medications/ allergies
Family history

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2
Q

What do you assess with respect to the airway? (6)

A

Tonsillar size
Airway obstruction
Mandible size/mouth opening
Loose teeth (5-8 y/o)
ROM of neck and mandible

Note: “Is this a trisomy 21 pt?”

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3
Q

What are the differences in the pediatric airway? (8)

A

Trachea small and compliant
Glottis anterior and cephalad
Small nares and jaw
Large head, tongue, and adenoids
Long narrow epiglottis
Cricoid ring narrowest part
Few Type I fibers in respiratory muscles
Horizontal ribs

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4
Q

Vocal cords slant _____ and ______.

A

downward

anterior

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5
Q

What are differences in pediatric airway physiology? (8)

A

Increased O2 consumption
Increased CO2 production
Diaphragm dependent ventilation
Alveolar ventilation twice of adult
Nares is greatest point of resistance
Diaphragm and intercostals easily fatigue
Chest wall too compliant
O2 dissociation curve shifted to left

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6
Q

Alveolar ventilation for peds is ___ cc/kg/min.

A

6

Twice of adults which is 3.5 cc/kg/min.

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7
Q

What is the FRC of pediatric pts?

A

25 - 30 cc/kg

Slightly reduced from adults whose are 30cc/kg.

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8
Q

What are important aspects of the pulmonary exam in the preop eval? (3)

A

URI?

Asthma

Former preterm infant?

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9
Q

In a child with URI, what could a runny nose be caused by? (3)

A

Infection
Allergy
Cold

Note: Look for lower respiratory disease such as bronchitis or pneumonia.

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10
Q

When should elective surgery be cancelled? (4)

A

Purulent rhinitis
Fever > 38C
Elevated WBC with bands
Infiltrate by CXR

pief

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11
Q

What percent of children have asthma?

How do you prepare the asthmatic pt for surgery? (3)

A

5-10%

Optimize meds
Ensure no concurrent respiratory illness
Ensure med compliance 24-48 hrs preop

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12
Q

What is ASA status at Children’s Hospital for child with:

asthma
on chronic asthma meds
on steroids

A

ASA 2

3

4

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13
Q

What are preop concerns for a former preterm infant? (5)

A
  • Determine estimated gestational age
  • Physical status
  • Lung disease presence
  • Cardiac disease presence
  • Currrent meds
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14
Q

Many former preterm infants get what type of IV site?

A

PIC lines

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15
Q

Preterm infant < ___ weeks are at increased risk of apnea.

A

37

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16
Q

What is pulmonary dysplasia characterized by in a former preterm infant? (6)

A

AW resistance
Lung compliance poor
Hypoxemia/O2 desaturation
Increased work of breathing (tachypnea)
Chronic wheezing
VQ mismatch

hail vc

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17
Q

Postoperative apnea is ______ proportional to post conceptual age.

A

inversely

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18
Q

If > ____ weeks of post conceptual age, day surgery.

If < ____ weeks of post conceptual age, monitor in hospital.

A

52

52

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19
Q

What labs should you check in the former preterm infant? (2)

A

Hct

K

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20
Q

How do you proceed with a former preterm infant with bronchopulmonary dysplasia? (2)

A

Optimize meds

Ensure no concurrent illness

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21
Q

Preterm infants are more prone to complications following ______ surgery than are term infants.

A

minor

Note: Ex-premature infants are always at increased risk.

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22
Q

What are the most common postop problems for ex-premature infants? (4)

A

Apnea (6)

Atelectasis (2)

Aspiration pneumonia (2)

Stridor (1)

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23
Q

What murmurs are asymptomatic and need no workup? (3)

A

I

II

6 Systolic ejection murmur

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24
Q

What murmur requires the need for a preop ECHO?

What do you need to determine the need for in this case? (2)

A

> Grade 3

SBE prophylaxis
Post-op cardiac follow-up

25
Q

How do you preoperatively prepare for the sickle cell patient (Hb SS)? (4)

A

Baseline H/H

No electropheresis–already known.

Transfuse to Hct 30% with PRBCs preoperatively

Have blood available

26
Q

What are preoperative anxiety predictors? (5)

A
  • Age (~12 months, stranger anxiety develops)
  • Parental anxiety
  • Temperament
  • Social adaptability
  • Lack of premed

splat

27
Q

What are the benefits of pre-medication? (4)

A

Calms child and parents
Better acceptance of mask induction
Less anxiety upon leaving parent
Diminishes post-op behavioral changes

28
Q

What are the disadvantages of premed? (2)

A

Cost
Paradoxical hyperreactivity

29
Q

What are common premedications for peds? (4)

A

Versed (0.5 mg/kg PO, 0.2mg/kg nasally but BURNS)

Ketamine (6-9 mg/kg PO)

Transmucosal fentanyl (10-15 mcg/kg)

Rectomethohexital 10% (25 mg/kg)

30
Q

What is the problem associated with methohexital?

A

Stool presence hinders absorption and less predictable.

31
Q

What are pre-op labs needed for a healthy child?

If moderate blood loss is expected?

A

None

Baseline H/H

32
Q

What labs are needed for ENT surgeries?

A

PT/PTT because at increased risk of hemophilia.

33
Q

60% of all pediatric surgery in US is _________.

A

ambulatory

34
Q

Patients are selected for ambulatory pediatric anesthesia based upon what? (3)

A

General medical condition

Nature, extent of surgery

Degree of postop care required

35
Q

What are the most common ambulatory procedures? (6)

A

ENT
General surgery
Urology
Opthalmology
Ortho
Plastic

eu goop

36
Q

What is the more popular induction technique for older children?

A

IV induction vs. inhalational.

37
Q

For a short procedure, what is the general anesthetic approach? (2)

A

Rapid PO intake

NO IV needed

38
Q

Should children drink before discharge from day surgery?

A

No, manadatory drinkers had increased PONV.

39
Q

What is the pain management for peds? (4)

A

Minimize opioids if possible

Acetominophen

NSAIDs

Ketorolac

40
Q

What is the dose for acetominophen for peds?

A

PO 20mg/kg

PR 40 mg/kg

41
Q

What is the dose for NSAIDS for peds?

Ketorolac?

A

5 mg/kg PO

IV: 0.5 mg/kg
IM: 1 mg/kg

42
Q

What are the requirements for a caudal block?

What is the duration?

What is the disadvantage?

A

< 7 y/o, < 30 kg

4-6 hours

Occasional motor block in older children.

43
Q

What are regional techniques? (3)

A

Caudal

Ilioinguinal/iliohypogastric block

Penile block (hypospadias repair, circumcision)

44
Q

What is minimum discharge criteria? (7)

A

Stable VS w/in 20% of baseline
No respiratory distress
Ambulation OK
No N/V
Pharyngeal reflexes intact
LOC intact
Written instructions and phone numbers

45
Q

What are discharge complications? (2)

A

Ineffective pain management

PONV

46
Q

What is the ped dose of Zofran?

A

0.1 mg/kg up to 4 mg

47
Q

What is the ped dose of droperidol?

A

50-75 mcg/kg

48
Q

What is the ped dose of metoclopramide?

A

0.15 mg/kg

49
Q

What is the ped dose of promethazine (Phenergan)?

A

0.5 mg/kg (IV/PR)

50
Q

What is the dose of prochlorperazine?

A

0.1 mg/kg PR

51
Q

What are adverse neural effects of anesthetics? (7)

A

Organelle damage
Impaired synaptogenesis
Reduced dendritic and axonal branching
Decreased myelin snthesis
Neurotransmitters altered
Electrophysiology changes
Apoptosis

RAINED O

52
Q

What are behavioral effects of neurotoxicity from anesthetics? (4)

A

Reduced exploratory behavior in environment
Impaired spatial learning
Reduced locomotor activity
Delayed social development

53
Q

What anesthetics may impair neurodevelopment? (5)

A

Inhaled agents (GABAa)
N2O (NMDA antagonist)
Ketamine (NMDA antagonist)
Benzos (GABAa)
Propofol (GABAa)

54
Q

What is impaired with anesthesia? (2)

A

Memory

Learning

55
Q

What are options for pediatrics relating to anesthesia to protect neurofunction? (5)

A

Delay surgery
Ignore findings as irrelevant in humans
Find less damaging drugs
Find neuroprotecting agents
Run randomized control trials in humans

56
Q

What has occurred in studies of peds with those not receiving opioids? (3)

A

Increased glucose

Increased lactate

Increased BUN

57
Q

What are 5 neuroprotectants?

A
  • Lithium (single dose pre-op)
  • Dexmedetomidine
  • tPA
  • Plasmin
  • Erythropoietin
58
Q

What study is investigating safety of spinal vs. general in peds undergoing hernia repair?

A

GAS study

59
Q

What study is investigating sibling response to anesthetics?

A

PANDA study

AP Summer Final (7 decks)

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