Resp Anatomy/Physiology

Question 1

Where is the pediatric larynx located?

Answer 1

C3-4 (adult is C4-5)

Question 2

What age should shoulder roll be used for intubation?

Answer 2

Definitely <6months, 6m-1yr optional use

Question 3

What is the shape of the infant’s/ped’s epiglottis?

Answer 3

Omega shaped

Question 4

T/F: Nares account for 80% of airway resistance in the infant?

Answer 4

False; only 25% (compared to 60% in adults)

Question 5

What three things account for <6month old diaphragmatic breathing?

Answer 5

1. Intercostal muscle contribute 20-40% of ventilation
2. Thorax is weak and unstable
3. Diaphragm contains smaller percentage of Type 1 muscle fibers

Question 6

Why is pre-oxygenation so important for peds?

Answer 6

FRC is small and not very functional

Question 7

What should be done/changed to combat the reduced FRC, peripheral airway collapse, impaired intercostal and diaphragm activity?

Answer 7

Add PEEP

Question 8

Rough ETT for newborn?, 1-6months?, 6m-1yr?

Answer 8

Newborn 3mm.
1-6m 3.5mm.
6m-1yr 3.5-4

Question 9

There should be an audible air leak around the cuff of the ETT at what pressure?

Answer 9

15-25 cm H2O

Question 10

Stimulation of what nerve causes laryngospasm?

Answer 10

Superior laryngeal nerve

Question 11

What causes laryngospasm in peds?

Answer 11

1. Inhalation of volatile agents
2. Excessive secretions in airway
3. Presence of URI
4. Manipulation of the airway
5. *Stimulation of visceral nerve endings in pelvis/abd/thorax

Question 12

What is first response to laryngospasm with LMA in place?

Answer 12

Remove LMA

Question 13

What age has highest prevalence of post intubation laryngeal edema?

Answer 13

Ages 1-4

Question 14

What is treatment of post intubation laryngeal edema?

Answer 14

1. Humidification of inspired gases
2. Racemic epi 0.5ml of 2.25% in 2-3ml NS
3. Reintubation
4. Tracheostomy

Question 15

What would be leading differential diagnosis in 3-6yr old patient with upper airway obstruction?

Answer 15

Epiglotitis

Question 16

What is etiology of epiglotitis?

Answer 16

Haemophilus influenzae Type B

Question 17

What are S/S of epiglotitis?

Answer 17

1. Rapid clinical progression of symptoms
2. Dysphagia
3. Drooling
4. Inspiratory stridor
5. Resp distress
6. High fever (>39C)

Question 18

What is treatment of epiglotitis?

Answer 18

O2, ABX, Urgent intubation of GA in OR, Antipyretics, fluids

Question 19

What is anesthetic management of child in ED with epiglotitis?

Answer 19

1. Transfer to OR
2. Sevo mask induction with child sitting/CPAP applied
3. IV Access, Atropine
4. ENT HAS TO BE PRESENT

Question 20

What equipment must be available for epiglotitis induction?

Answer 20

1. Rigid ventilating bronchoscope

2. Surgical airway equipment

Question 21

What age group is closely associated with laryngotracheobronchitis?

Answer 21

<2 years

Question 22

What is etiology of laryngotracheobronchitis (croup)?

Answer 22

Paraflu Type 1, Flu A, and RSV

Question 23

T/F: Croup is associated with fast/abrupt onset of symptoms?

Answer 23

False; slow progression with Hx URI progressing to hoarse cry or barking cough

Question 24

Treatment for laryngotrachealbronchitis?

Answer 24

1. Humidifed O2
2. Racemic Epi
3. Steroids
4. Antipyretics
5. Intubation rare

Question 25

What is most frequent site of foreign body aspiration?

Answer 25

Right mainstem

Question 26

Anesthetic management of foreign body aspiration?

Answer 26

1. Inhaled induction with airway obstruction. 2. IV induction without airway obstruction. 3. RSI 4. Topical Lidocaine 1% 1-2mg/kg

Question 27

T/F: Positive pressure must be used for foreign body aspiration?

Answer 27

False; PPV may cause foreign body to become trapped further

Question 28

What is the most common pediatric surgery we perform?

Answer 28

Tonsilectomy and adenoidectomy

Question 29

What is intraop steroid dose prior to extubation for T/A patient?

Answer 29

Decadron 0.5mg/kg up to 20 mg

Question 30

What time frame is considered "early" post-tonsillectomy bleeding?

Answer 30

Within 24% (most occurs within 6 hrs)

Question 31

What is the peak onset of delayed post-tonsillectomy bleeding?

Answer 31

Day 7

Question 32

What 4 things place a patient at higher risk of post-tonsillectomy bleeding?

Answer 32

1. Older patient 2. Presence of inflammation/infection. 3. Preop ASA/NSAIDs 4. Coagulopathy

Question 33

Clinical presentation of delayed post-tonsillectomy bleeding?

Answer 33

1. Hypovolemia 2. Anemia 3. Agitation 4. Shock 5. Full stomach (blood) 6. Active bleeding (poor glottis visualization)

Question 34

Anesthetic management of post-tonsillectomy bleeding?

Answer 34

1. RSI with cricoid pressure 2. 2 SXNs, 2 Blades/handles, experienced assistant 3. Emergence= suction stomach, awake extubation

Question 35

Choanal atresia is frequently associated with what other diagnosis?

Answer 35

Craniosynostosis (small cranium)

Question 36

How is unilateral atresia typically diagnosed?

Answer 36

Presence of intractable unilateral nasal drainage