Preoperative Assessment of Newborns and Children Flashcards
When is indicated prophylaxis for endocarditis?
- Prosthetic valve material
- Previous endocarditis
- Some cases of congenital heart diseas
- Heart transplant with valvulopathy
In case of invasive dental procedures, respiratory procedures with manipulation of mucosa, procedure on infected tissues
Brief description and anesthetic implications of Arthrogruposis multiplex
Description: multiple congenital contractures. congenital heart disease
Anesthetic implications: possible airway problems due to limitations of mandibular movements
Brief description and anesthetic implications of Beckwith syndrome
Description: Birth weight > 4000 g; macroglossia, visceromegaly
Anesthetic implications: Airway problems due to large tongue; hypoglycemia common
Brief description and anesthetic implications of Asplenia syndrome
Description: asplenia. Complex congenital heart disease. Malrotation of abdominal organs
Anesthetic implications: Cyanotic congenital heart disease is common. Preoperative echocardiography is needed
Brief description and anesthetic implications of Cherubism
Description: asplenia. Fibrous dysplasia of the mandible and maxilla
Anesthetic implications: Intubation may be extremely difficult; tracheostomy may be the only way to secure the airway
Brief description and anesthetic implications of Congenital hypothyroidism
Description: Goiter; large tongue; respiratory depression; hypoglycemia; hypotension
Anesthetic implications: Airway obstruction secondary to large tongue, particularly in supine position; slow to awaken at the completion of surgery
Brief description and anesthetic implications of Crouzon disease
Description: Craniosynostosis, hypertelorism, hypoplastic mandible
Anesthetic implications: Intubation may be difficult
Brief description and anesthetic implications of Dandy-Walker syndrome
Description: Hydrocephalus
Anesthetic implications: Increased intracranial pressure rare in the newborn period; head may be enormously enlarged
Brief description and anesthetic implications of DiGeorge syndrome
Description: Thymus and parathyroids absent; hypocalcemia, immune deficiency; aortic arch abnormalities
Anesthetic implications: Irradiate all blood products to prevent graft-versus-host disease; stridor may be due to hypocalcemia
Brief description and anesthetic implications of Down syndrome (trisomy 21)
Description: Large tongue, unstable cervical spine, small mouth; high incidence of congenital heart disease, particularly atrioventricular canal; intestinal obstruction
Anesthetic implications: Intubation may be difficult; ? inline traction during intubation, ? cervical spine films prior to intubation in older children; echocardiography required
prior to surgery in the newborn
Brief description and anesthetic implications of Ehlers-Danlos
Description: Collagen abnormality-hyperelasticity and fragile tissue; dissecting aneurysm of aorta; bleeding diathesis; heart, lung, GI problems
Anesthetic implications: Poor tissue and clotting defects may lead to hemorrhage; spontaneous pneumothorax
Brief description and anesthetic implications of Ellis–van Creveld syndrome
Description: Ectodermal and skeletal defects; congenital heart disease; cleft lip and palate, mandibular hypoplasia; hepatosplenomegaly
Anesthetic implications: Airway problems, intubation may be difficult; chest wall anomalies cause poor lung function
Brief description and anesthetic implications of Epidermolysis bullosa
Description: Skin cleavage at dermal-epidermal junction, minor trauma denudes skin
Anesthetic implications: Do not use adhesive tape of any sort; avoid instrumentation of the airway if possible; use a well-padded mask or apply ointment to rim; secure IV,
monitoring devices with Kerlix; sterile technique
Brief description and anesthetic implications of Familial dysautonomia (Riley-Day syndrome)
Description: Poor suck and swallow; hyper- and hypotension; insensitivity to pain; absent sweating and lacrimation
Anesthetic implications: Recurrent aspiration and pneumonia; respiratory center insensitive to CO2; labile intraoperative blood pressure
Brief description and anesthetic implications of Fetal alcohol syndrome
Description: Growth retardation; microcephaly, craniofacial abnormalities; congenital heart disease; renal abnormalities
Anesthetic implications: Intubation is usually not difficult; ventricular septal defects are common and require prophylaxis for subacute bacterial endocarditis
Brief description and anesthetic implications of Glucose-6-phosphate deficiency
Description: Hemolytic anemia caused by drugs and infection
Anesthetic implications: Aspirin, sulfa, methylene blue cause anemia
Brief description and anesthetic implications of Goldenhar syndrome
Description: Hemifacial microsomia, congenital heart disease
Anesthetic implications: Very difficult intubation, vertebral instability
Brief description and anesthetic implications of Hemangioma with thrombocytopenia (Kasabach–Merritt syndrome)
Description: May involve the airway; bleeding, anemia
Anesthetic implications: Airway involvement may require radiation therapy; transfuse components as necessary
Brief description and anesthetic implications of Jeune syndrome (asphyxiating thoracic dystrophy)
Description: Severe thoracic malformations, renal failure
Anesthetic implications: Respiratory failure, prolonged mechanical ventilation; care with drugs excreted by kidneys
Brief description and anesthetic implications of Klippel-Feil syndrome
Description: Hemi or fused vertebra
Anesthetic implications: Intubation may be difficult
Brief description and anesthetic implications of Maple syrup urine disease
Description: Inability to metabolize leucine, isoleucine, and valine
Anesthetic implications:Acid-base imbalance; avoid preoperative fasting, start glucose early and check frequently
Brief description and anesthetic implications of Mucopolysaccharidoses (Hurler, Hunter, Morquio syndrome)
Description: Bony abnormalities, dwarfism, kyphoscoliosis, abnormal facies, congenital heart disease
Anesthetic implications: Very difficult intubations, unstable necks, respiratory failure perioperatively
Brief description and anesthetic implications of Myasthenia congenita
Description: muscle weakness and fatigue
Anesthetic implications: Avoid muscle relaxants and narcotics
Brief description and anesthetic implications of Osteogenesis imperfecta
Description: Pathologic fractures; abnormal platelets, vascular fragility
Anesthetic implications: Extreme caution when positioning and during intubation; blood pressure cuff may cause fractures
Brief description and anesthetic implications of Pierre Robin syndrome
Description: Cleft palate, micrognathia, glossoptosis, congenital heart disease
Anesthetic implications: Very difficult intubation, may require tongue suture or awake tracheostomy; best nursed in prone position
Brief description and anesthetic implications of Prader-Willi syndrome
Description: Hypotonia, obesity
Anesthetic implications: Hypoglycemia common; assisted ventilation may be required postoperatively
Brief description and anesthetic implications of Prune-belly syndrome
Description: Agenesis of the abdominal musculature, renal failure
Anesthetic implications: Respiratory failure common, postoperative ventilation, avoid respiratory depressants; avoid drugs excreted by the kidneys
Brief description and anesthetic implications of Treacher Collins syndrome
Description: Micrognathia, midface hypoplasia, congenital heart disease
Anesthetic implications: Very difficult intubation, may require tongue suture or awake tracheostomy; best nursed in prone position
Brief description and anesthetic implications of Thrombocytopenia with absent radius syndrome
Description: Episodic thrombocytopenia precipitated by stress, infection, surgery; congenital heart disease
Anesthetic implications: Platelet transfusions prior to surgery; prophylaxis for subacute bacterial endocarditis
Brief description and anesthetic implications of Trisomy 18 (Edwards syndrome)
Description: Congenital heart disease; micrognathia; renal malformations; most die in infancy
Anesthetic implications: Ethical considerations concerning surgery in a patient with a fatal anomaly;
assess cardiac status carefully
Brief description and anesthetic implications of VATER syndrome
Description: Vertebral, anal, tracheal esophageal fistula, renal, cardiac
Anesthetic implications: Examine carefully for associated anomalies
Epiglottis difrerences between infanta and adults
In infants the epiglottis tends to be relatively larger, longer, curvier (omega shape) and floppier
Describe the 1-2-2/7-8-9 rule
Patients weighing 1, 2 and 3 Kg Will generally need their endotracheal tube secured 7, 8 and 9 cm at the lips
Full-term and premature neonates demonstrate depressed respiratory CO2 response curves and secondary apnea in response to hypoxia
T or F
T
Acidosis, hypoxia and hypercarbia increase pulmonary resistence, potencially reversing transitonal circulation and restoring fetal patterns, a condition known as …
Persisten Fetal Circulation
or
Persisten Pulmonary Hypertension of the Newborn
How can hypoxia induce bradycardia in newborns?
Chemoreceptors located in the aortic arch and carotid bodies are stimulated by acute hypoxia and drecreased cardiac output normally inducing combined sympathetic and vagal responde, causing tachypnea, bradycardia and peripheral vasoconstriction.
In premature infants, a biphasic response with secondary respiratory depression, potencially to the poitn of apnea and often associated with exatreme bradycardia, may occur
Cerebral palsy and Duchene muscular dystrophy are contraindindications for succinylcholine
T or F
F
Succinylcholine is not contraindicated in Cerebral Palsy
Name 3 conditions that increase sensitivity to nondepolarizing agents
Myasthenia gravis
Duchene muscular dystrophy
Spinel muscle atrophy
Name 3 conditions that decreased the sensitivity to nondepolarizing agents
Burns
Myotonic dystophy
Spastic cerebral palsy
Which gene coding mutation is associated with malignant hyperthermia in patients with some types of neuromuscular diseases?
RYR1 - gene coding for ryanodine receptor
Why are neonates, particularly premature infants, highly sensitive to supplemental fluid and readily become hypervolemic with overly generous ressuscitation?
Becouse they have relatively low glomerular filtration rate and decreased urine-concentrating capacity
How is hypoglicemia in neonates defined?
Glicemia < 45 mg/dL in symptomatic neonates
Glicemia < 35 mg/dL in assymptomatic neonates
Neonates that are anesthetized with volatile agentes are at great risk of developing hypothermia because this agentes …
Decreased that brown fat metabolism
Name the risk factors for emergence delirium in children
- Toddler age
- Male sex
- Use of volatile agents
- Rapid emergence
- Certain types of surgery (particularly oropharingeal and ofthalmologic surgery)
