Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds-Dr. Sames > TEST 4 > Flashcards

TEST 4 Flashcards

1
Q

What (6) pediatric syndrome are considered difficult airway algorithm and cricothyrotomy?

A

Pierre Robin Sequence

Treacher Collins Syndrome

Goldenhar Syndrome

Beckwith-Wedemann Syndrome

Klippel-Feil Syndrome

Apert Syndrome, Pfeiffer Syndrome, Crouzon Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Visualization of complete laryngeal opening

A

Grade 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Visualization of just the posterior area

A

Grade II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Visualization of just the epiglottis

A

Grade III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Visualization of just the soft palate

A

Grade IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How should you approach a difficult airway?

A

You should formulate a plan that includes several contingencies for failure or loss of airway.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Who should you have present when dealing with a difficult airway?

A

Have skilled help available

Have ENT surgeon experienced in performing pediatric bronchoscopy and tracheostomy. ,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should you have in close proximity when dealing with difficult airway?

A

Difficult airway cart with flexible fiberoptic bronchoscope in the OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When dealing with difficult airway clear ____________ about the airway management plan is required.

A

Clear communication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the preferred technique with difficult airway management?

A

Either awake but sedated or spontaneously breathing under GETA with adequate oxygenation while the airway is evaluated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What 3 medications combos are utilized with difficult airway management?

A

Combinations of benzo’s, opiods (Versed and Fentanyl)

Ketamine and Versed and Glyco

OR

Sevo and spray VC with Lidocaine (max 5mg/kg) - keep patient spontaneously breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Unexpected difficult intubation; although it is rare occasion, the practitioner should be prepared for _____________ event.

A

Life threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Because infants have increased/decreased FRC, the time between the loss of the airway and resultant hypoxemia with potential secondary neurologic injury is significantly increased/diminished compared to adults.

A

Decreased FRC

Diminished compared to adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Desaturation of 10 kg infants from SpO 90-0% within how many minutes?

How many minutes does it take SpO2 to go from 90-0% in a healthy 70kg adult?

A

4 minutes for 10 kg

10 minutes in healthy 70 kg adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is multi handed mask ventilation?

A

One person uses both hands for tight mask seal, chin lift and jaw thrust while to other is hand- ventilating with increased peak airway pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an Air- Q LMA?

A

A tool for use in both nonemergency (can ventilate but cannot intubate) and the emergency pathway (cannot ventilate nor intubate). Maybe used as a conduit for intubation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the special techniques for ventilation 5 different steps?

A
  1. Multi handed mask ventilation
  2. Air Q LMA
  3. Fiberoptic laryngoscopy, bullards, light wand
  4. Percutaneous needle cricohyrotomy
  5. Surgical airway (tracheostomy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Positioning of child during percutaneous cricothyrotomy?

A

Extend the head in the middle with rolled towel or folded sheet beneath the shoulders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where should you stand when performing a percutaneous cricothyrotomy?

A

To the left of the child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hand positioning of the practitioner during percutaneous cricothyrotomy?

A

Stabilize trachea with right hand

Cricothyroid membrane is located with the index fingertip of the left hand between thyroid and cricoid cartilage. Space v narrow (1mm) in infant only fingernail can discern it.

Trachea then stabilized between middle finger and thumb of L hand while fingernail of the index finger marks the cricothyroid membrane.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What gauge IV catheter is used for percutaneous cricotothyrotomy?

What should happen after inserted?

A

12-14 g through cricothyroid membrane and air is aspirated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is done after air is aspirated?

A

The catheter is advanced into the trachea though the membrane, and the needle is discarded; an intraluminal position is reconfirmed by attaching a 3mL syringe and aspirate for air.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

An adapter from a _______ ETT can be attached to an IV catheter and ventilation is accomplished by ______________________ .

A

3.0

Attached to a breathing circuit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What could you do if you don’t have a 3.0 ETT adapter?

A

An alternative would be to leave the barrel of the 3 mL syringe attached to the IV catheter, insert an 8.0 ETT adapter to the syringe barrel, and then attach to the breathing circuit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is trisomy 21

A

Down syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Characteristics of Down Syndrome children?

A

Small mouth, hyopolastic mandible, protruding tongue -> may be difficult to intubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Are Down syndrome considered mentally retarded?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How many have cardiac issues? And what are they?

A

50% have cardiac issues: VSD, ASD, Tetrology of Fallot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Down syndrome have hypotonia T/F?

A

True floppy “Down’s Dance”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Down syndrome children have increased risk of bradycardia on induction? T/F

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Down syndrome children can tolerate hyperextension of the head. T/F?

A

False, avoid hyperextension because they have Atlanta- occipital instability

Avoid shoulder roll because it can increase hyperextension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Down syndrome children have decreased risk of post intubation stridor? T/F?

A

False -> increased risk of post intubation stridor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Down syndrome children have increased/decreased risk of hypothyroidism, acute leukemia?

A

Increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Down syndrome patient needs _____/_____ evaluation of their cervical and temporomandibular anatomy d/t the unique risk of _____________ _____________ if neck pain or neurological symptoms exist (e.g. Abnormal gait, increased clumsiness, complaints of numbness/tingling/weakness of an extremities, etc)

A

CT/MRI

Atlanta occipital instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What do you want to avoid during any manipulation of the neck or airway during mask ventilation or intubation?

A

Avoid excessive flexion, rotation, or neck extension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the crease called in the hand of a Down syndrome child?

A

Simian crease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the difference in a simian crease and a normal palm

A

Simian crease is a single palmar crease compared to two creases in a normal palm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How often does a simian crease occur in normal people?

A

1 out of 30 normal people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What 2 conditions does a simian crease usually occur in?

A

Down syndrome, Aarskog syndrome, or fetal alcohol syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

MM

What are three major concerns related to anesthetizing the Down’s (trisomy 21) patient?

A

Intubation may be difficult owning to the large tongue, short neck, small mouth and subglottic stenosis (select ETT one size smaller than anticipated)

Neck flexion during laryngoscopy and intubation may result in antlanto occipitla (cervical spine) dislocation because of congenitally weak ligaments (consider getting cervical- spine films)

COngenital heart disease is present in 40% of patients (anesthesia compatible with the patients congenital heart defects could be delivered)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What does VACTERL (VATER) Syndrome stand for?

A 
V= vertebral abnormality
A= anal or intestinal atresia
C= cardiac anomalies
T E= tracheo- esophageal fistula 
R= renal malformations
L= limb defects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Babies who have been diagnosed as having VACTERL association usually have how many individual anomalies?

A

At least three or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What fistula is accepted as essential for the diagnosis?

A

TE fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are vertebral anomalies with VACTERL syndrome?

A

Defects of the spinal column

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What do the vertebral anomalies with VACTERL syndrome usually consis of?

A

Small (hypoplastic) vertebrae or hemivertebra where only have of the bone is formed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are VACTERL syndrome kids at risk for because their vertebral anomalies?

A

Risk of scoliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What might be difficult to place because the vertebral anomalies associated with VACTERL syndrome?

A

Difficult to place epidural for TEF repair (thoracotomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How prevalent is congenital heart disease with VACTERL syndrome?

A

Up to 75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the most common heart defects seen with VACTERL?

A

VSD
ASD
Tetrology of Fallot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How prevalent are renal/kidney defects with VACTERL syndrome?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the renal/kidney defects with VACTERL syndrome?

A

They can be severe with incomplete formation of one or both kidneys or urologic abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the limb defects commonly associated with VACTERL syndrome?

A

Absent or displaced thumbs, extra digits (polydactyl), fusion of digits (syndactyly) and forearm defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the growth like in VACTERL syndrome?

A

Small stature, difficulty gaining weight, but normal development and normal intelligence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What type of disorder is an autosomal recessive disorder (requires the presence of two copies of a gene mutation in order to express observable phenotype?

A

Cystic Fibrosis (CF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Cystic Fibrosis causes a disruption of ___________ transport in __________ cells in sweat ducts, airway, pancreatic duct, biliary tree -> elevated sweat chloride concentration (test for diagnosis), viscous mucous production, lung disease, intestinal obstruction, pancreatic insufficiency, biliary cirrhosis.

A

Electrolyte

Epithelial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What does a normal CFTR do?

A

Moves chloride ions to the outside of the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What does a mutant CFTR channel do?

A

Does not move chloride ions, causing sticky mucus to build up on the outside of the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What does CTFR channel stand for?

A

Cystic Fibrosis Transmembrane Conductance Regulator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the most common problem with cystic fibrosis?

A

Lung disease; mucus plugging d/t impaired ciliary clearance, chronic infection, inflammation, bronchial hyperactivity, increased airway resistance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the health problems associated with cystic fibrosis?

A 
Sinus problems
Nose polyps (growths) 
Salty sweat
Frequent lung infections 
Enlarged heart
Trouble breathing
Gallstones
Abnormal pancreas function
Trouble digesting food 
Fatty BM's
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are 4 additional problems with CF?

A
  1. Malnutrition with increased caloric demand d/t severe lung disease
  2. DM (pancreatic insufficiency)
  3. Coagulopathy (hepatic dysfunction)
  4. End- stage for pulmonary (organ transplantation needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

CF children require what kind of surgeries in their life?

A 
Nasal polypectomy 
ENT surgery
Central line placement
Bronchoscopy/ lavage
EGD & colonoscopy 
GI surgeries 
Cholecystecomy 
Tx of recurrent pneumothorax 
Organ transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Anesthesia considerations with CF? (8)

A
  1. Anxiolytics (CF patients are emotionally vulnerable)
  2. Hydrate well
  3. Give nebulized saline tx before and after surgery
  4. Circuit humidifier, optimize ventilation with high FiO2
  5. Expect high airway pressure (be careful with barotrauma/pneumothorax)
  6. Suction ETT under deep anesthesia
  7. Complete reversal of neuromuscular blockade (neostigmine and glyco) but avoid glycopyrrolate as antisialagogue
  8. Reverse isolation to keep our germs away from CF patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is cerebral palsy?

A

A term used to describe a group of chronic conditions affecting body movement and muscle coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What causes cerebral palsy?

A

Damage to one or more specific areas of the brain, usually occurring during fetal development; before, during, or shortly after birth; or during infancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Characteristics of hemiplegia?

A

Arm and leg on one side

Arm bent; hand spastic or floppy often of little use

She walks on tip toe or outside of foot on affected side

The other side is completely/almost normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Characteristics of paraplegia?

A

Both legs only

Or with slight involvement elsewhere (diplegic)

Upper body usually normal or with very minor signs

Child may develop contracture of ankles and feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Characteristic of quadriplegic?

A

Both arms and legs

When he walks, his arms, head, and even his mouth may twist strangely

Children with all 4 limbs affected have such severe brain damage that they may never be able to walk

The knees press together

Legs and feet turned inward

May develop contracture of ankles and feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Cerebral palsy is caused by problems in the muscles or nerves. T/F?

A

False -> due to faulty development or damage to motor areas in the brain disrupt the brain’s ability to adequately control movement and posture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

CP is a group of disorders that are often accompanied by disturbances of sensations, cognition, communication, perception, behavior and seizure disorder or mental impairment. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Antenatal risk factors for CP?

A

Prematurity and LBW
Intrauterine infections
Multiple gestation
Pregnancy complications

70-80% CP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Perinatal risk factors for development of CP

A

Birth asphyxia
Complicated labor and delivery

10% of CP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are postnatal risk factors for development of cerebral palsy?

A

Non accidental injury
Head trauma
Meningitis/encephalitis
Cardio- pulmonary arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are protective factors for OB care to help reduce risk of CP?

A

Management of pre eclampsia- MAG SULFATE
Management of infections- ANTIBIOTICS
Preterm labor- CORTICOSTEROIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the 5 types of CP?

A
  1. Athetoid
  2. Spastic
  3. Ataxia
  4. Rigidity
  5. Tremors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is athetoid?

A

Constant uncontrolled motion of head, limbs, and eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is spastic CP?

A

Tense, contracted muscles (most common type of CP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is ataxic CP?

A

Poor sense of balance often causing falls and stumbles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is tremor CP?

A

Uncontrollable shaking, interfering with coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is rigidity CP?

A

Tight muscles that resist effort to make them move

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

MM

At what age is cleft palate usually repaired?

A

Cleft palate repair is usually undertaken when the infant is 12- 18 months old, but sometimes younger.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is the syndrome where the cleft soft palate (no cleft lip) which leads with “breath-suck-swallow” pattern, choking and failure to thrive?

A

Pierre Robin Sequence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the main reason why Pierre Robin Sequence is a difficult intubation?

A

Micrognathia/retronagthia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

In Pierre Robin Sequence, what is it called when the tongue is placed back further in the mouth?

A

Glossoptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What can glossoptosis cause?

A

Partial/complete obstruction of airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Due to glossoptosis in Pierre Robin Sequence, what is often required?

A

Tracheostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the syndrome where the patient has down/slanting eyes, lower jaw is often small and receding (micrognathia/retrognathia)?

A

Treacher Collins Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

In Treacher Collins Syndrome, what is the underdevelopment or absence of cheekbones and the side wall and floor of the eye socket?

A

Macrostomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

In Treacher Collins Syndrome, what is underdeveloped, malformed ears called?

A

Microtia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

In Treacher Collins Syndrome, what describes the conditions where normal tissue in or around the eye (iris, retina, choroid, or optic disc) is missing from birth?

A

Coloboma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What 6 conditions does a patient with Treacher Collins Syndrome have?

A

Down-slanting “antimongoloid” palpebral fissures

Microtia, malformed ears

Coloboma of the lower lid of the eye

Macrostomia

Micro/retronathia

Cleft Palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Treacher Collins patients may require ___ __ and __ __ __ over multiple procedures.

A

Extensive bony and

Soft tissue reconstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

In Treacher Collins Syndrome, what reconstructions can occur before age 10, and as teenagers?

A

Before 10: orbital and zygomatic reconstruction

Teenagers: external ear reconstruction and mandibular advancements as when bony growth is complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Most children with Treacher Collins have normal __ and __; however it is important that there should be early hearing tests and speech interventions

A

Development and intelligence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the (3) characteristics that is associated with Goldenhar Syndrome?

A

Unilateral or bilateral underdevelopment of the mandible

Microtia (small ears)

Reduction in size and flattening of the maxilla (upper jaw)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is thought to be the cause of Goldenhar Syndrome?

A

Thought to be a vascular accident in the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Due to a vascular accident in the fetus in Goldenhaar Syndrome, it causes the blood supply to be cut off and production of __ __ in the areas of those tissues and while develop into the structures of the __ and __ __.

A

Blood clots

Ear

Lower jaw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What 3 conditions occurs with Beckwith-Wiedemann Syndrome (Visceromegaly)?

A

Macroglossia

Visceromegaly

Omphalocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

In Beckwith-Wiedemann Syndrome, macroglossia relatively improves with ___; May require partial ___

A

Growth

Glossectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is a life-threatening clinical syndrome of hyper metabolism involving the skeletal muscle?

A

Malignant Hyperthermia (MH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the function of the sarcoplasmic reticulum (SR) inside the skeletal muscle and cardiac muscle?

A

The SR of cardiac muscle and striated skeletal muscle functions as a storage and release area of calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is a structural unit of a myofibrils in a muscle called?

A

Sarcomere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is called the “powerhouse” of the cell?

A

Mitochondrion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Where is Ca 2+ stored?

A

Sarcoplasmic reticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

In Malignant Hyperthermia, there is uncontrolled and excessive Ca2+ release in the cardiac muscles. True or False.

A

FALSE. In the skeletal muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Due to an abundance of Ca2+ in the skeletal muscle, what two things can occur in MH?

A

Skeletal muscle contractions

Induce a drastic and uncontrolled increase in oxidative metabolism in skeletal muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

In MH, Excessive Calcium acts like “adding coal to a train furnace.” True or False

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Due to the uncontrolled and excessive calcium release in skeletal muscle, what (3) symptoms can occur with MH? And what can lead it to?

A

Overwhelms the body’s capacity to supply oxygen -> HYPOXIA

Elevates carbon dioxide -> Increased CO2

Causes excessive heat production (increased TEMP)

Eventually leads to CIRCULATORY ARREST and DEATH if not immediately treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What are the primary triggers of MH?

A

Succinylcholine

All volatile anesthetics (SEVO, ISO, DES, ENFL, Halothane)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

NO other drugs used in anesthesia today for intravenous or regional anesthesia are triggering agents for MH. True or False

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

(At the cellular level) Persons susceptible to MH, the __ ___ ___ or other genes involved in calcium regulation are altered, resulting in excessive calcium release from the SR in the presence of MH-triggering agents.

A

Ryanodine receptor gene 1 (RyR1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

In MH, what controls calcium release, causing an excessive Calcium overload in skeletal muscle and results in a massive metabolic reaction?

A

An abnormal ryanodine receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What (6) things occurs when there is an uncontrollable release of intramyoplasmic calcium?

A

Sustained muscle contracture

Hypermetabolic response

Increased oxygen consumption and CO2 production

Heat production

Muscle cell hypoxia

Eventually death

114
Q

In almost all cases, the first manifestation of MH occur in the PACU. True or False.

A

False in the OR.

115
Q

What are the (3) early signs of MH?

A

Tachycardia

HTN

Tachypnea

116
Q

Beside the first (3) signs, what are the next (4) consecutive early signs of MH?

A

Increased end-tidal CO2 (hypercapnia)

Increased O2 consumption

Increased heat production (body temperature increases at a rate of 1-2 degrees Celsius every five min

Metabolic and respiratory acidosis

117
Q

What could be (8) LATE SIGNS of MH?

A

Truncal and.or masseter rigidity

Hyperkalemia

Arrhythmias

Cola-colored urine (myoglobinuria)

Rhabdomyolysis (increased CPK-often exceeds 20,000 units/L in the first 12-24 hrs)

Coagulopathy (DIC)

Multiple organ dysfunction and failure

Eventually Death

118
Q

What are the INITIAL STEPS to treat MH?

A

Call for help!!!

Discontinue triggering anesthetic

Hyperventilate with 100% oxygen

Notify your surgeons, anesthesia team, nursing team

Ask for MH cart

119
Q

How do you TREAT an MH crisis? (8)

A

Administer dantrolene sodium (Ryanodex) ASAP

Place activated charcoal filters on circuit

Initiate TIVA

Hyperventilate (blow off CO2)

Aggressive IV hydration

Cool patient actively

Place A-line, Foley, central line

Send labs

120
Q

What is dantrolene sodium?

A

A ryaondine receptor 1 antagonist; an antidote to MH

121
Q

What is the mechanism of action of dantrolene sodium?

A

Blocks the ryanodine receptors, therefore inhibits abnormal calcium release from the SR, leading to muscle relaxation

122
Q

How many mg of dantrolene in Revonto

How many vials do you need for a 70 kg patients?

Water to reconstitute 1 vial?

Vials required to stock?

Price?

Shelf life?

A

20 mg

8 vials

60 ml

36

3000

3 years

123
Q

How many mg of dantrolene in Dantrium?

How many vials do you need for a 70 kg patients?

Water to reconstitute 1 vial?

Vials required to stock?

Price?

Shelf life?

A

20 mg

8 vials

60 ml

36

$3000

3 years

124
Q

How many mg of dantrolene in Ryanodex?

How many vials do you need for a 70 kg patients?

Water to reconstitute 1 vial?

Vials required to stock?

Price?

Shelf life?

A

250 mg

1 vial

5 ml

4

$6900

2 years

125
Q

What is the drug of choice of MH?

A

Ryanodex

126
Q

What is the initial dose of Ryanodex and are you able to repeat as needed?

A

2.5 mg/kg

YES

127
Q

What is the maximum cumulative dose of Ryanodex?

A

10 mg/kg

128
Q

MHAUS suggests no upper limit treatment doses, what does MHAUS recommend if patient does not respond to 10 mg/kg of Ryanodex?

A

Consider other etiologies

129
Q

For a 70 kg patient, what is the loading dose of Ryanodex?

A

3.5 ml or 175 mg of dantrolene sodium

130
Q

What (9) medications are in the MH cart? And What may you need to call the pharmacy for?

A

Ryanodex 250 mg vials x 3

Sterile preservative free water

Sodium bicarb 8.4%

Regular insulin (in refrigerator)

Dextrose

Furosemide

Calcium chloride/Calcium gluconate

Heparin

Lidocaine

131
Q

What is in the MH card Refrigerator?

A

Medications:
Regular insulin

Supplies:
Cold IV fluids (NS 1000 ml x 5)

5 ice packs

132
Q

With macroglossia in Beckwith-Wiedemann Syndrome, chronic airway obstruction may predispose to __ __.

A

Cor Pulmonale

133
Q

What is Visceromegaly?

A

Cardiomegaly

Nephromegaly

Hepatomegaly

Splenomegaly

Pancreatomegaly

134
Q

With Visceromegaly in Beckwith-Wiedemann Syndrome, ____ occurs due to increased insulin secretion.

A

Hypoglycemia

135
Q

With Beckwith-Wiedemann Syndrome, ___ increase the incidence of intra-abdominal tumoral

A

Omphalocele

136
Q

What is a bone disorder characterized by the abnormal fusion of two or more cervical vertebrae, which is present from birth?

A

Klippel-Feil Syndrome

137
Q

What are the three major features that result in Klippel-Feil Syndrome?

A

Short neck

Limited ROM in the neck

Low hairline at the back of the head

138
Q

In Klippel-Feil Syndrome, most affected people have __ or __ of the three characteristics.

A

One or two

139
Q

What are the (3) syndromes that encompass craniosynostosis?

A

Apert Syndrome

Pfeiffer Syndrome

Crouzon Syndrome

140
Q

What are the (3) major characteristics of Syndromic craniosynostosis include?

A

Skull deformities (premature closing of the cranial sutures)

Eyes abnormally far apart

Fusing or webbing of the digits and other abnormalities

141
Q

With craniosynostosis, long term, life-limiting or life threatening consequences may result from these abnormalities. True or False

A

True

142
Q

What type of Craniosynostosis if characterized by premature fusion of cranial sutures?

A

Type I

143
Q

What kind of symptoms do Type I Craniosynostosis exhibit?

A

Recessed cheekbones

Various toe and finger abnormalities

144
Q

Intelligence is affect with Type I Craniosynostosis. True or False

A

False; not usually affected.

145
Q

Does Type I Craniosynostosis have a good survival rate?

A

Yes. Significant

146
Q

What type of Craniosynostosis is characterizesd with “cloverleaf” shape of the skull?

A

Type II Craniosynostosis

147
Q

Why does the “cloverleaf” shape of the skull occur in Type II Craniosynostosis?

A

Due to extensive fusion of cranial sutures

148
Q

In Type II Craniosynostosis, the “cloverleaf” skull shape can hamper what (2) things?

A

Normal brain growth

Mental retardation

149
Q

What type of Craniosynostosis is occurring where the symptoms are similar to type 2, but “cloverleaf” skull shape is NOT present in thes patients?

A

Type III Craniosynostosis

150
Q

What are the (3) clinical characteristics with Pierre-Robin Sequence?

A

Micrognathia

Cleft palate

Glossoptosis (posterior displacement of tongue)

151
Q

What are the (2) clinical characteristics of Treacher-Collins Syndrome?

A

Hypoplasia of maxilla and mandible

Variable eye and ear deformities

152
Q

What are the (4) clinical characteristics of Hemifacial microsomia (Goldenhar’s)?

A

Unilateral/bilateral mandibular hypoplasia

Variable microphthalmia

Microtia

Macrostomia (wide mouth)

153
Q

What are (4) clinical characteristics with Beckwith-Wiedemann Syndrome?

A

Macroglossia

Visceromegaly/Organomegaly

Omphalocele

Hypoglycemia

154
Q

What is the surgical drainage of accumulated fluid in the middle ear?

A

Myringotomy

155
Q

What kind of tubes are often placed in the tympanic membrane as stents to allow for continued drainage of the middle ear in myringotomy?

A

Ventilating tubes

156
Q

Myringotomy is a very slow procedure requiring GETA with SEVO inhalation induction.

A

FALSE.

Brief procedure, requiring GETA and SEVO inhalation induction,

Mask ventilation w/ or w/o oral airway and

NO IV PLACEMENT

157
Q

Since myringotomy does NOT require IV catheter placement, how is fentanyl give? Dose?

A

Intranasal Fentanyl 1-2 mcg/kg

158
Q

What are the (2) major indications for surgical removal of tonsils and adenoids (Adenotonsillectomy T&A))?

A

Chronic or recurrent tonsillitis

Obstructive adenotonsillar hyperplasia

159
Q

Tonsillar hyperplasia may lead to ACUTE/CHRONIC airway obstruction resulting in what (6) things

A

CHRONIC

Sleep Apnea

CO2 retention

Cor pulmonale

FTT

Swallowing disorders

Speech abnormalies

160
Q

With T&A, children with ___ __ __ may be at risk for ENDOCARDITIS due to recurrent __ __ secondary to infected tonsils.

A

Cardiac valvular disease

Steptococcla bacteremia

161
Q

Surgical techniques of T&A vary and include what (6) techniques?

A

Guillotine and snare technique

Cold and hot knife dissection

Suction

Ultrasound coblation

Unipolar electrocautery

Bipolar electrocautery

162
Q

With T&A, what is the major advantage of electrocautery dissection?

A

Reduction in the incidence of intraop blood loss as well as primary and secondary hemorrhage

163
Q

What is a major disadvantage in T&A?

A

Greater pain and poor oral intake post op

164
Q

Due to risk of airway fire in T&A, make sure you keep what LOW?

A

FiO2

165
Q

Mortality associated with T&A is estimated to be 1:___ and 1: ___.

A

1:16,000 - 1:35, 000

166
Q

With T&A, what are (6) common morbidities?

A

Throat pain

Otalgia

Poor oral intake

Dehydration

Obstructive breathing (3 years and younger)

Post-op bleeding (>10 y)

167
Q

Children who are schedule for T&A have a HIGH incidence of __ and ___.

A

Airway reactivity

Laryngospasm

168
Q

Patients classier as Class 3 or greater of Tonsillar Size have more than __ of the pharyngeal occupied by ___ tonsils.

A

50% of pharyngeal

Hypertrophied tonsils

169
Q

Children with Class 3 Tonsillar Size are at INCREASED risk of developing ___.

A

Airway obstruction during Anesthetic induction

170
Q

What class of tonsillar size are classified as surgically removed tonsils?

A

0

171
Q

What class of tonsillar size are classified as tonsils hidden within tonsil pillars?

A

1

172
Q

What class of tonsillar size are classified as tonsils extending to the pillars?

A

2

173
Q

What class of tonsillar size are classified as tonsils are beyond the pillars?

A

3

174
Q

What class of tonsillar size are classified as tonsils extend to midline? “Kissing tonsils”

A

4

175
Q

What is the most common form of sleep-disordered breathing?

A

OSA

176
Q

What is OSA?

A

Partial or complete collapse of the UPPER airway that causes muscles controlling the soft palate and tongue to relax

177
Q

What are some causes of OSA for a child with T&A?

A

Large tonsils and adenoids make airflow difficult

178
Q

Patients with OSA experience with what (3) things?

A

Apnea

Hypoapnea

Flow limitations

179
Q

What is cessation of airflow lasting > or equal to 10 seconds?

A

Apnea

180
Q

What supplies are in the MH cart?

A
  1. Activated charcoal filters
  2. ABG syringes and blood tubes
  3. IV supplies
  4. A line and central line supplies
  5. Triple transducer kit
  6. Pressure bag
  7. Salem Sumps
  8. Esophageal stethoscope
  9. Bucket for ice
  10. Bladder irrigation set
  11. Foley with urine meter
  12. Sterile drape
  13. Test strips for urine myoglobin
  14. Urine collection container
181
Q

What is the other name for activated charcoal filters?

A

Vapor clean

182
Q

In less than 90 seconds, Vapor- clean activated charcoal filters reduce exposure to less than ________ of desflurane, sevoflurane, and isoflurane molecules from reaching the patient

A

5 ppm

183
Q

How do you treat malignant hyperthermia? (Cooling measures)

A

Begin cooling measures, administer iced solutions, ice packs to groin, axilla and neck, nasogastric lavage with iced solution, or more aggressive measures as needed

184
Q

Initial step for treatment of malignant hyperthermia?

A 
Call for help
Discontinue triggering anesthetic
Hyperventilate with 100% O2 
Notify your surgeons, anesthesia them and nursing team 
Ask for MH cart
185
Q

How to treat MH crisis? (7 steps)

A
  1. Administer dantrolene sodium ASAP
  2. Place activated charcoal filters on circuit
  3. Initiate TIVA
  4. Hyperventilate
  5. Aggressive IV hydration
  6. Cool patient actively
  7. Place A line, foley and central line
186
Q

What is supportive therapy for MH?

A
  1. Correct acidosis and hyperkalemia
  2. Send labs
  3. Monitor for rhabdomyolysis, arrhythmias, acute renal failure
  4. Prepare to transport to ICU
187
Q

How to treat acidosis and hyperkalemia?

A

Correct acidosis:

  • hyperventilate
  • increase minute volume to lower ETCO2
  • sodium bicarb 8.4% (1-2 mEq/kg)

Correct hyperkalemia:
- glucose/insulin: Peds: 0.1 units regular insulin/kg IV and 0.5 g/kg dextrose; Adults: 10 u reg insulin IV and 50 mL 50% dextrose. Check glucose hourly
CaCl2: 10 mg/kg or Ca2+ gluconate 30 mg/kg
- for refractory hyperkalemia, consider albuterol (or other beta agonist), kayexelate, dialysis, or ECMO if patient is in cardiac arrest

188
Q

What labs should be sent in MH and what should be monitored to monirot for rhabdo, arrhythmias, acute renal failure

A

ABG (metabolic status includes lactate, glucose, BE, K+)
BMP (basic metabolic panel)
Electrolytes (K+)
CBC
Serum myoglobin/urine myoglobin CPK (creatinine phosphokinase) Coags, D Dimer, fibrinogen

189
Q

What is rhabdomyolysis?

A

The rapid breakdown of muscle tissue

Complications can occur when, after the muscle is damaged, the cells release their contents rapidly into the blood–> hyperkalemia –> arrhythmia

Rhabdomyolysis has been known to cause damage to kidneys and DIC

190
Q

What is the earliest sign of rhabdomylysis

A

Myoglobinuria/myoglobinemia

191
Q

What is a myoglobin blood test?

A

It is a test to detect muscle damage

Myoglobin is filtered from the blood by the kidneys and is released into the urine. Sometimes a urine test is ordered to evaluate myoglobin levels in people who have had extensive damage to their skeletal muscles (rhabdomyolysis).

Urine myoglobin levels reflect the degree of muscle injury and, since myoglobin is toxic to the kidneys, reflect the risk of kidney damage.

192
Q

What is a CPK test?

A

Creatine phosphokinase

Serum CPK levels may not rise for several hours, serum CPK concentration may remain elevated for days and should be monitored until it returns to normal

193
Q

Once rhabdo has been diagnosed, what should you do to to prevent renal failure?

A

Treat with IV fluids and other supportive care: ie: furosemide, mannitol etc.

194
Q

How to prevent acute renal failure in rhabdo.(4 things)

A
  1. Force diuresis to help prevent acute renal failure
  2. Ensure urine output of 2.0 mL/kg/hr with mannitol, furosemide, and fluids as needed
  3. Furosemide 0.5-1 mg/kg once (max 20 mg)
  4. If CPK or K+ rise, assume myoglobinuria and give bicarbonate infusion of 1 mEq/kg/hr to alkalinize urine
195
Q

How much ryanodex should you give as supportive management to treat MH?

A

Continue ryanodex at 1.0 mg/kg every 4-8 hours for 24-48 hours titration to the desired effect (resolution of hyperthermia, acidosis, and myoglobinemia.

196
Q

What should you avoid while giving ryanodex?

A

Avoid calcium channel blocking agents with Ryanodex because life threatening hyperkalemia may result.

197
Q

Cooling for supportive management to treat MH?

A

Actively cool pt until core body temp is 38 degrees

  • iced normal saline 10mL/kg IV every 10 minutes X 30 minutes
  • surface cooling ice packs
  • –> axillary, groin, neck, head
  • –> hypothermia blanket
  • iced lavage of stomach via NGT
198
Q

How long should the child be managed in the ICU after MH and why?
What should you continue to do?

A

Observe the individual for at least 36 hours because of 25% chance of recrudescence following initial treatment. Obtain blood gases, serum concentration of electrolytes and CPK, blood and urine for myoglobin, and coagulation profile

Check values every 6-12 hours. The earliest sign of rhabdo is myoglobinuria/myoglobinema. Serum CPK levels may not rise for several hours, serum CPK concentration may remain elevated for days and should be monitored until it returns to Normal

199
Q

MH is genetically inherited in humans in an ___________ ___________ _________; about 1:________ people are thought to carry a ryanodine receptor 1 gene mutation, but it may be present in as many as 1:__________ .

A

Autosomal dominant pattern

1: 3000
1: 2000

200
Q

Both a _____________ predisposition and exposure to 1 or more MH triggering agents are assumed to be necessary to evoke an MH crisis during surgery

A

Genetic

201
Q

MH susceptibility is a result of a ___________ abnormality (there are multiple mutations); consequently, MH clusters appear in ________ groups.

A

Genetic

Family

202
Q

MH varies ______________ depending on the concentration of MH families in a given area.

A

Geographically

203
Q

Where are high incidence areas of MH in the United States?

A

Wisconsin
Nebraska
West Virginia
Michigan

204
Q

An MH episode may not occur with every exposure to “trigger” agents. T/F?

A

True

205
Q

What may clinical manifestation of MH depend on?

A

Genetic predisposition
Dose of trigger agents
Duration of exposure

206
Q

Up to 50% of individuals with MH susceptibility have undergone anesthesia eventfully despite use of one of the agents known to trigger MH. True/False

A

False; uneventfully

207
Q

A history of uneventful anesthesia with MH- triggering agents does rule out susceptibility to MH. T/F?

A

False; does not

208
Q

Clinically the demographic data suggests that the incidence or suspicion of MH was greater in children/adults compared with that in children/adults?

A

Children

Adults

209
Q

What is the incidence of MH in anesthetics for children?

A

1 in 10,000

210
Q

What is the incidence of MH in anesthetics for adults?

A

1 in 50,000

211
Q

According to Li et al. Found in their kids’ inpatient database study that children with MH were 69% ________ and had some form of __________ ________ or __________ .

A

Male
Muscular dystrophy
Strabismus

212
Q

What are 9 syndromes that share elements of MH?

A
  1. Hyperthyroidism
  2. Sepsis
  3. Pheochromocytoma
  4. Metastatic carcinoid
  5. Cocaine intoxication
  6. Heat stroke
  7. Masseter Spasm
  8. Neuroleptic malignant syndrome
  9. Serotonergic toxicity
213
Q

What is a decrease in airflow lasting > or equal to 10 seconds with a 30% O2 reduction in airflow and with at least 4% desat from baseline?

A

Hypopnea

214
Q

What is the narrowing of the upper airway and an indication of an impeding upper airway closure?

A

Flow limitation

215
Q

What is the AHI (Apnea Hypopnea Index)?

A

The summation of the # of obstructive apnea and hypopnea events?

Standard measure of OSA during a sleep study

216
Q

If the Pediatric AHI is a Score of 0, what does that entail?

A

No OSA

217
Q

If the Pediatric AHI is a Score of 1-5, what does that entail?

A

Mild OSA

218
Q

If the Pediatric AHI is a Score of 6-10, what does that entail?

A

Moderate OSA

219
Q

If the Pediatric AHI is a Score of >10, what does that entail?

A

Severe OSA

220
Q

For a child with T&A + OSA getting a pre-med, what should you do?

A

Observe closely and monitor with pulse ox

221
Q

Child with T&A and OSA, titrate __ carefully with RR and have the pt ___ breathe throughout the case.

A

Analgesia (fentanyl)

Spontaneously

222
Q

Remember: children with SEVERE OSA may have an ___ resp ___ to the SMALLER/LARGER amount of opioids than children without OSA.

A

Exaggerated respiratory depression

Smaller doses

223
Q

Pts with OSA experience recurrent episodes of what (2) things during sleep?

A

Hypoxia

Hypercapnia

224
Q

Pts with OSA experience episodes of hypoxia and hypercapnia during sleep, which impairs the __ at emergence from anesthesia.

A

Arousal mechanism

225
Q

How should you extubate a patient with OSA undergoing T&A?

A

FULLY AWAKE extubation after T&A of OSA patient?

226
Q

How should you approach anesthesia from induction to extubation with a patient with T&A with OSA?

What meds and actions would you do?

A

Suction stomach and pharynx

Nasal airway in place

Start case with Ketamine (0.5 mg/kg) and Fentanyl 0.5 mcg/kg

AWAKE EXTUBATION

Consider Precedex 0.5 mcg/kg

227
Q

With T&A and OSA, how should you prevent PONV?

A

Suction stomach

Hydrate well

Give airway dose of Dexamethasone 0.5 mg/kg (max of 10 mg)

And 0.1 mg/kg ondansetron (max 4 mg)

228
Q

What is the discharge policy for ambulatory T&A with OSA?

A

Will stay overnight with pulse Oximeter/apnea monitor

229
Q

What is the discharge policy for T&A patient’s WITHOUT OSA?

A

Stay 6-8 hrs for observation

230
Q

Post-tonsilectomy bleeding is a MEDICAL emergency. True or False.

A

False. SURGICAL

231
Q

What is primary post-tonsillectomy bleeding?

A

Within 24 hrs after T&A

232
Q

What is secondary post tonsillectomy bleeding?

A

5-10 days aft T&A, when the Eschar is covering the tonsillar beds retracts

233
Q

Primary or Secondary post-tonsillectomy bleeding is more serious, more brisk and profuse?

A

Primary

234
Q

What (6) circumstance you should consider if a child is having post-tonsillectomy bleeding?

A

Anxious parents

Upset surgeon

Frightened anemic child

Hypovolemic

Stomach full of blood

NO IV catheter

235
Q

Initially with post-tonsillectomy bleeding, what should you assess the child for?

A

Dizziness

Orthostatic hypotension

Estimated amount of hematemesis

236
Q

What (4) things should you before taking the child back in the OR with post-tonsillectomy bleeding?

A

Place IV

Draw lab samples

Type and Cross

Rehydrate

237
Q

What are (2) things you can give to a patient with post-tonsillectomy bleeding to improve CO and hemodynamic stability before RSI?

A

Vigorous fluid resuscitation with Crystalloids (20 ml/kg of balanced salt solution)

Colloids

238
Q

How should you intubate a patient with post-tonsillectomy bleeding?

A

RSI with SUX or Roc

Cricoid pressure

Suction fathered

Style, Cuffed ETT

239
Q

After an airway is secure with post-tonsillectomy, what should you place and do?

A

Place OGT and suction stomach

***Consider LARGE BLOOD CLOTS are often too large to be suctioned

240
Q

With post-tonsillectomy bleeding, the surgeon with find and repair the bleeding vessel which is VERY PAINFUL. True or False.

A

False. NOT painful

241
Q

What (2) medications should you give for a patient with post-tonsillectomy bleeding?

A

IV “airway” dose of Dexamethasone (0.5 mg/kg; max of 10)

0.1 mg/kg of IV Ondansetron (max of 4)

242
Q

How should you extubate a patient with post-tonsillectomy?

A

AWAKE extubation and Close observation

243
Q

(MM) Children with long standing OSA (caused by hypertrophied tonsils) show what anatomic changes in the heart
‘

A

Children with long standing hypoxemia and hypercarbia, pulmonary artery HTN and RV hypertrophy develop.

244
Q

Is it ok to have nitrous oxide for an electrocautery case?

A

NO!!!! It is combustible

245
Q

The use of regional anesthesia techniques in children has increased dramatically in the past two decades T/F?

A

True

246
Q

What is the advantage of supplementing GETA with central neuroaxial blocks and/or peripheral nerve blocks?

A

Pain free awakening and post op analgesia without potentially deleterious side effects such as NV/ altered sensorium associated with opioids

247
Q

What does regional help in children that have undergone thoracic or upper abdominal surgery?

A

Improves the pulmonary function

248
Q

What are amides?

A 
Lidocaine
Bupivicaine
Ropivicaine
Mepivicaine
Prilocaine
249
Q

How are amides metabolized?

A

By the liver by cytochrome P450 enzymes

250
Q

What medications are the esters?

A

Procaine
Tetracaine
2 Chloroprocaine

251
Q

How are the Esters metabolized?

A

By plasma cholinesterases

252
Q

What does the choice of LA depend on?

A

The desired speed of onset
Duration of action
Potential toxicity

253
Q

Bupivicaine remains a commonly used amide/ester LA for regional blockade in infants and children. After a single administration how long can analgesia be expected for?

A

Amide

Can be expected for up to 4 hours (maybe less in small infants)

254
Q

What is the most commonly used concentration of bupivicaine for peripheral nerve block?

A

0.25% with reduced concentration of 0.0625% to 0.1% for continuous epidural

255
Q

Robpivicaine 0.2% has gained more popularity because of the reduced risks of ____________ and ____________ toxicities compared with bupivicaine.

A

Cardiac and neurologic

256
Q

What two amides should you watch out for>?

A

Mepivicaine and Prilocaine

257
Q

Why should you be careful with Mepivicaine and prilocaine?

A

Neonates do not metabolize Mepivicaine and hepatic metabolism of prilocaine yields o touluidine which can produce methemoglobinemia, thereby rendering RBC’s less capable of carrying oxygen

258
Q

The decreased activity of methemoglobin reductase and increased susceptibility of fetal hemoglobin to oxidation make ______________ an unsuitable LA for use of neonates.

What is also one component of EMLA cream?

A

Prilocaine

Prilocaine

259
Q

MM

Which local anesthetic is not metabolized in neonates?

A

Mepivicaine is not metabolized in neonates; this is controversial, but generally accepted

The neonatal enzyme systems are adequately developed to metabolize most rugs, with the possible exception of Mepivicaine

260
Q

Plasma cholinesterase activity in infants is increased/decreased compared with adults thus the plasma half life of the ester LA may be shortened/prolonged?

A

Decreased

Prolonged

261
Q

2,3 Chloroprocaine (1.5% concentration) has been recommended for neonatal regional techniques not including epidural blockade. T/F?

A

False, Including

262
Q

Chloroprocaine comes in ____% ___% and ___% which one is the easiest to dilute and how?

A

1,2, and 3

3 % is easiest to dilute in 1:1 ratio to yield 1.5%

263
Q

With Local Anesthetics The pharmacokinetics are different in infants and small children compared with older children and adults in what 3 ways.

A

Absorption of the drug is rapid

The CO and regional tissue blood flow are higher

The epidural space contains less fat tissue to buffer the uptake

264
Q

Drugs sprayed into the airway are absorbed how?

A

Rapidly

265
Q

The volume of distribution of the drug is larger/smaller?

What would this do to the plasma levels of bupivacaine after administration of a standard 2.5mg/kg dose into the epidural space?

A

Larger

Plasma levels of bupivicaine after administration of a standard 2.5 mg/kg dose into the epidural space are therefore lower in infants than in young children’s and adults

266
Q

The greater Vd also extends the ____________ ______ _____.

A

Elimination half life

267
Q

The extend of protein binding of local anesthetics is less/more; __________ and _____________ levels are low in the neonate.

A

Less

Albumin and a1 acid glycoprotein

268
Q

What may further reduce the potential for protein binding?

A

Bilirubin

269
Q

When is caution advised when LA are being considered?

A

In the jaundiced neonate

270
Q

What should determine the dose of LA?

A 
The child's: 
Age
Physical status
Area to be anesthetized
Weight according to lean body mass
271
Q

If a large volume of LA is required for a particular procedure, a ________ concentration should be used?

A

Diluted

272
Q

Doses of amides should be decreased by _______ in infants if less than _________ _______ of age.

A

30%

6 months of age

273
Q

Injection of LA into very vascular area leads to greater blood concentrations. What is the mnemonic to remember the order of uptake?

A 
ICE Block
I= Intercostal
C= Caudal
E= Epidural
Block= Peripheral nerve blocks (brachial, femoral, sciatic, etc)

Greatest order to least order of uptake

274
Q

Max dose and duration of procaine?

A

10mg/kg

60-90 minutes

275
Q

Max dose and duration of 2- chloroprocaine

A

20mg/kg and 30- 60 minutes

276
Q

Max dose and duration of Tetracaine?

A

1.5mg/kg and 180-600 minutes

277
Q

Max dose and duration of lidocaine?

A

4.5mg/kg and 90-200 minutes

278
Q

Max dose and duration of mepivacaine?

A

7 mg/kg and 120-240 minutes

279
Q

Max dose and duration of bupivacaine?>

A

2.5 mg/kg and 180-600 minutes

280
Q

Max dose and duration of ropivicaine?

A

2.0 mg/kg and 120- 40 minutes

281
Q

Duration of action is based on what 4 things?

A
  1. Concentration
  2. Total dose
  3. Site of administration
    4, the child’s age

Peds-Dr. Sames (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions