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Pediatrics > Test 4 > Flashcards

Test 4 Flashcards

1
Q

Difference between apnea-hypopnea index of adults and peds

A

Peds require much less apnea episodes for diagnosis and increased severity

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2
Q

4 ways to actively cool the patient during acute MH episode

A

Lavage OG, bladder, open cavities

Administer cooled IV saline

Surface cooling

CPB in severe cases

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3
Q

Elements of syndrome similar to MH

Cocaine intoxication

A

Fever

Rigidity

Rhabdomyolysis

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4
Q

Type of craniosynostosis characterized by premature fusion of cranial sutures

A

Type 1

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5
Q

Why is tracheostomy often required for Pierre Robin Sequence

A

Glossoptosis (tongue further back in mouth)

Partial/complete obstruction

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6
Q

Causes of Goldenhar Syndrome

A

Vascular accident in the fetus

Blood supply cur off and clots in area of those tissues develop into the structures of the ear and lower jaw

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7
Q

Is suspicion of MH greater in adults or children

A

Children

1: 10,000 peds
1: 50,000 adults

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8
Q

Anesthetic agents absolutely contraindicated in patients with family history of MH

A

All volatiles

Succinylcholine

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9
Q

Adapter from what size ETT will fit an IV catheter to attach to a breathing circuit

A

3.0 ETT

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10
Q

Why is prilocaine unsuitable for neonates

A

Metabolism to O-toulidine leading to methemoglobinemia

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11
Q

Definition of MH

A

Life-threatening clinical syndrome of hyper metabolism involving skeletal muscle

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12
Q

How long does it take for activated charcoal filter to reduce exposure to volatiles once applied to circuit

A

<90 seconds

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13
Q

Type of cerebral palsy

Tense, contracted muscles

A

Spastic CP

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14
Q

Next treatment steps

A

Administer dantrolene sodium (Ryanodex)

Activated charcoal filters on circuit

TIVA

Hyperventilate

Aggressive IV hydration

Actively cool patient

Aline, central line, foley

Send labs

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15
Q

Drug of choice for MH

A

Ryanodex

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16
Q

MOA of cystic fibrosis

A

Mutant CFTR channel does not move chloride ions causing sticky mucus to build up

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17
Q

3 syndromes associated with Craniosynostosis

A

Apert

Pfieffer

Crouzon

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18
Q

Components of Elma cream

A

Prilocaine

Lidocaine

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19
Q

Why is the half life of ester LAs prolonged in infants

A

Decreased plasma cholinesterase activity

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20
Q

Adults insulin and dextrose dose for hyperkalemia

A

Regular insulin 10 units

50 ml D50

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21
Q

Intubation with Down’s syndrome kid

A

Avoid excessive flexion, rotation, or neck extension

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22
Q

Iced saline dosage for MH

A

10ml/kg every 10 minutes for 30 minutes

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23
Q

Development and intelligence in Treacher Collins

A

Normal development and intelligence

Need early hearing and speech interventions

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24
Q

Which drugs should be avoided in patient with family hx of MH

A

Succinylcholine and volatiles

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25
Q

How fast may temperature increase during MH episode

A

1-2 degrees Celsius every 5 minutes

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26
Q

Sown slanting eyes

Lower jaw small and receding

Macrostomia

Microtia

Coloboma

A

Treacher Collins Syndrome

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27
Q

Type of craniosynostosis

Cloverleaf shape of skull

Hampers normal brain growth

Mental retardation

A

Type 2

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28
Q

High incidence of MH in what areas of US

A

Wisconsin

Nebraska

West Virginia

Michigan

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29
Q

Most cases of cerebral palsy are related to what risk factor

A

Antenatal

  • prematurity and LBW
  • intrauterine infections
  • multiple gestation
  • pregnancy complications

70-80%

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30
Q

Induction of post tonsillectomy bleed patient

A

RSI

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31
Q

Cormack and Lehane laryngoscopic grading system

Visualization of just soft palate

A

Grade IV

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32
Q

Neonates do not metabolize which LA

A

Mepivacaine

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33
Q

OSA MOA

A

Partial or complete collapse of upper airway

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34
Q

Skull deformities (premature closure of cranial sutures)

Eyes abnormally far apart

Fusing or webbing of digits and other abnormalities

A

Craniosynostosis

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35
Q

Unilateral or bilateral underdevelopment of mandible, microtia, reduction in size and flattening of maxilla

A

Goldenhar Syndrome

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36
Q

Max recommended dosage and duration

2-Chloroprocaine

A

Max 20 mg/kg

30-60 minutes

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37
Q

Elements of syndrome similar to MH

Serotonergic toxicity is associated with what

A

SSRI

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38
Q

Decrease in airflow lasting > 10 seconds with 30% 02 reduction in airflow and at least 4% desaturation from baseline

A

Hypoapnea

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39
Q

Summation of number of obstructive apnea and hypopnea events

A

Apnea hypopnea index

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40
Q

Children scheduled for T&A have high incidence of

A

Airway reactivity

Laryngospasm

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41
Q

Primary triggers for MH

A

Succinylcholine

All volatile agents

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42
Q

Down syndrome are at increased risk of

A

Post intubation stridor

Hypothyroidism

Atlanto-occipital instability

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43
Q

Force diuresis with prevention of ARF with MH want UOP of what

A

2ml/kg/hr

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44
Q

Narrowing of upper airway and indication of impending upper airway closure

A

Flow limitation

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45
Q

Major advantage of electrocautery with adenotonsillectomy

A

Reduction in intraop blood loss

And post op primary and secondary hemorrhage

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46
Q

Analgesia from Bupivacaine can last how long in peds

A

Up to 4 hours

Less in small infants

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47
Q

Initial steps in treating MH

A

Call for help

DC triggering agent

Hyperventilate with 100% O2

Notify surgeon, anesthesia team, nursing

Ask for MH cart

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48
Q

Why might 2.5mg/kg dantrolene be administered to a patient preoperatively

A

To prevent, prophylactically an episode of MH

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49
Q

Single palmar crease

A

Simian crease

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50
Q

Max recommended dosage and duration

Procaine

A

Max 10 mg/kg

60-90 minutes

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51
Q

Type of cerebral palsy

Poor sense of balance, often causing falls and stumbles

A

Ataxic CP

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52
Q

Uncontrolled and excessive release of Ca in skeletal muscles leads to

A

Overwhelms the bodies capacity to supply O2 (HYPOXIA)

Elevates CO2 (high ETCO2)

Excessive heat production (INCREASED TEMP)

Circulatory arrest and death

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53
Q

To prevent PONV in child with T&A with OSA

A

Suction stomach

Hydrate well

IV airway Decadron dose

Zofran

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54
Q

3 major features result from Klippel-Feil Syndrome

A

Short neck

Limited ROM in neck

Low hairline at back of head

most have 1 or 2 of these

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55
Q

Simian crease associated with what

A

Downs

Fetal alcohol syndrome

Aarskog syndrome

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56
Q

Autosomal recessive disorder

Disruption of electrolyte transport in epithelial cells

A

Cystic fibrosis

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57
Q

Small mouth

Hypoplastic mandible

Protruding tongue

Possible difficult intubation

Atlanto-occipital instability

A

Downs Syndrome. Trisomy 21

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58
Q

Syndromes that share elements of MH

A

Hyperthyroidism

Sepsis

Pheochromocytoma

Metastatic carcinoid

Cocaine intoxication

Heat stroke

Masseter spasm

Neuroleptic malignant syndrome

Serotonergic toxicity

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59
Q

Supportive therapy for MH

A

Correct acidosis and hyperkalemia

Send labs

Monitor for rhabdo, arrhythmia, ARF

Prepare for transport to ICU

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60
Q

Cormack and Lehane laryngoscopic grading system

Visualizaiton of posterior area of cords

A

Grade II

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61
Q

3 concerns related to anesthetizing a downs patient

A

Possible difficult intubation (large tongue, short neck, small mouth, subglottic stenosis)

Atlanto-occipital dislocation

Congenital heart disease

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62
Q

Conditions where normal tissue in or around the eye (iris, retina, choroid, optic disc) is missing from birth

A

Coloboma

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63
Q

In event of PVC, dysrhythmia, or cardiac arrest with MH assume what

A

Hyperkalemia

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64
Q

Regional anesthesia and pulmonary function in kids having thoracic or upper abdominal procedures

A

Improves pulmonary function

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65
Q

Anesthesia considerations with cystic fibrosis

A

Anxiolytics

Hydrate

Nebulized saline pre and post op

Humidified circuit

High PIP expected

Suction ETT under deep GETA

AVOID GLYCOPYROLLATE

Reverse isolation

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66
Q

Late signs of MH

A

Truncal and/or masseter rigidity

Hyperkalemia

Arrhythmia

Myoglobinuria (coke colored urine)

Rhabdomyolysis (increased CPK)

Coagulopathy (DIC)

MOSF

Death

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67
Q

You continue giving ryanodex at what dose how often

A

1mg/kg every 4-8 hours for 24-48 hours

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68
Q

Which LA not metabolized in neonates

A

Mepivacaine

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69
Q

Secondary post tonsillectomy bleeding occurs when

A

5-10 days after T&A

Eschar covering tonsillar bed retracts

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70
Q

Correction of hyperkalemia

Peds

A

Regular insulin 0.1 unit/kg IV and D50 0.5gm/kg

CaCl 10 mg/kg

Ca gluconate 30mg/kg

Albuterol, kayexelate, dialysis, ECMO

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71
Q

Underdevelopment or absence of cheekbones and side wall and floor of eye socket

A

Macrostomia

72
Q

Primary post tonsillectomy bleeding occurs when

A

W/i first 24 hours

73
Q

Avoid what drugs with ryanodex. Why

A

Calcium channel blocking agents

Life threatening hyperkalemia may result

74
Q

Children with long standing OSA show what anatomic changes in heart?

Can be caused by what?

A

PA HTN and RVH

Can be caused by hypertrophied tonsils

75
Q

Cessation of airflow lasting <10seconds

76
Q

Hepatic metabolism of prilocaine makes what

A

O-toulidine

77
Q

7 early signs of MH

A

Tachycardia

Hypertension

Tachycardia

Increased ETCO2

Increased O2 consumption

Increased temperature 1-2 degrees every 5 minutes

Metabolic and respiratory acidosis

78
Q

Who is susceptible to MH

A

Autosomal dominant trait

Ryanodine receptor 1 gene mutation

79
Q

Ester LA half life in infants

80
Q

If you dont have a 3.0 ETT adapter how to you ventilate with cricothyrotomy with needle

A

3ml syringe attatched to IV catheter

Insert 8.0 ETT into syringe barrel

Attach to breathing circuit

81
Q

Max recommended dosage and duration

Tetracaine

A

Max 1.5 mg/kg

3-10 hours

82
Q

Patients classified as +3 or greater are at increased risk of what

A

Developing airway obstruction during anesthetic induction

83
Q

Dose of LA for peds should be based on

A

Age

Physical status

Area to be anesthetized

Weight by lean body mass

84
Q

Type of cerebral palsy

Constant, uncontrolled motion of head, limbs, and eyes

A

Athetoid CP

85
Q

Major disadvantage of electrocautery with adenotonsillectomy

A

Greater pain

Poor PO intake post-op

86
Q

Amide LA metabolism

A

Degraded by cytochrome P450

87
Q

Patient with MH crisis has PVCs. What is antiarrythmic drug of choice

A

Procainamide 15mg/kg IV

Or lidocaine

88
Q

At what age is chest palate usually repaired

A

12-18 months of age

89
Q

T&A performed for what reason

A

Chronic or recurrent tonsillitis and obstructive adenotonsillar hyperplasia

90
Q

Term to describe group of chronic conditions affecting body movement and muscle coordination

A

Cerebral palsy

91
Q

Diagnostic test for MH

How is it done

Is it sensitive

A

Halothane caffeine contracture test

Skeletal muscle biopsy placed in halothane

Sustained contraction of muscle is diagnostic

Not very sensitive and many false positives

92
Q

Preparations f Ryanodex

A

Dilute with 5 ml sterile water

250 mg/vial

93
Q

11 clinical manifestations of MH

A 
Hypercarbia
Tachycardia
Tachypnea
Hyperthermia
Hypertension
Cardiac dysrhythmias
Acidosis (metabolic)
Hyperkalemia
Skeletal muscle rigidity
Myoglobinuria
Hypoxemia
94
Q

Earliest sign of rhabdo is

A

Myoglobinuria/myoglobinemia

95
Q

Type of craniosynostosis

Similar to type 2 but cloverleaf skull not present

96
Q

Most common form of sleep-disordered breathing

A

Obstructive sleep apnea

97
Q

Chronic airway obstruction with tonsilar hyperplasia results in

A

OSA

CO2 retention

Cor pulmonale

Failure to thrive

Swallowing disorders

Speech abnormalities

98
Q

Type 1 craniosynostosis

Other abnormalities

Intelligence

Survival rate

A

Recessed cheekbones, finger and toe abnormalities

Normal intelligence

Significant survival rate

99
Q

Methods to correct acidosis

A

Hyperventilate

Sodium bicarb 8.4%. 1-2 mEq/kg

100
Q

Metabolisms of prilocaine

A

Hepatic metabolism of prilocaine can lead to methemoglobinemia

101
Q

Children of what gender and with what conditions are more susceptible to MH

A

69% male

Some form of muscular dystrophy or strabismus

102
Q

Tonsilar hyperplasia may lead to what

A

Chronic airway obstruction

103
Q

How to prevent ARF with MH

A

IV fluids

Force diuresis

Bicarb infusion if CPK or K rise

104
Q

How long do MH patients need to be observed in ICU

105
Q

Reduced risks of cardiac and neurologic toxicities compared with bupivacaine

A

Ropivacaine

106
Q

Bone disorder characterized by abnormal fusion of 2 or more cervical vertebrae present from birth

A

Klippel-Feil Syndrome

107
Q

VACTERL (VATER) syndrome

A

Vertebral anomalies

Anal or intestinal atresia

Cardiac anomalies

TEF

Renal malformations

Limb defects

108
Q

Post tonsillectomy bleeding is a

A

Surgical emergency

109
Q

Max recommended dosage and duration

Ropivacaine

A

2 mg/kg

2-4 hours

110
Q

Children with severe OSA produce what response to opioids

A

Exaggerated respiratory depression to smaller doses of opioids

111
Q

OSA pt having T&A discharge criteria

A

With OSA stay overnight with pulse ox and apnea monitor

Non OSA stay 6-8 hours for observation

112
Q

Woman in labor is ID as behind susceptible to MH. What anesthetic techniques are acceptable

A

Epidural without dantrolene pretreatment for routine labor

If GETA give dantrolene prophylactically and use non triggering agents

113
Q

Elements of syndrome similar to MH

Pheochromocytoma

A

Difference is marked BP swings

114
Q

Type of cerebral palsy

Uncontrollable shaking, interfering with coordination

A

Tremors CP

115
Q

A patient has just experienced masseter muscle rigidity from succinylcholine. What lab may confirm the diagnosis

A

Elevated CPK

> 20,000

116
Q

regional anesthesia considerations in jaundiced neonate

A

Bilirubin may further reduce potential for protein binding

Extends half life of LA

117
Q

Syndromes predicting difficult intubation

A

Pierre Robin Sequence

Treacher Collins

Goldenhar

Beckwith-Wiedemann

Kippel Fiel

Apert, Pfieffer, Crouzon

118
Q

When using bipolar electrocautery during adenotonsillectomy

A

Keep Fi02 low

High risk of airway fire

119
Q

Is halothane caffeine contracture test a good diagnostic test for MH

Why

A

No because too many false positives

120
Q

MH episode may not occur with every exposure to trigger agent. Clinical manifestations may depend on (3)

A

Genetic predisposition

Dose of trigger agents

Duration of exposure

121
Q

Which more serious primary or secondary post tonsillectomy bleed

A

Primary more serious

More brisk and more profuse

122
Q

Earliest sign of MH

A

Increased ETCO2

123
Q

Doses of amides should be decreased by how much in infants < 6 months old

A

Decrease by 30%

124
Q

Cormack and Lehane laryngoscopic grading system

Visualization of just epiglottis

125
Q

VATER Syndrome growth and development

A

Small stature

Normal development

Normal intelligence

126
Q

What size IV catheter for percutaneous cricothyrotomy

127
Q

Once the initial episode of MH is controlled the patient remains at risk for what 5 complications

A

Reoccurrence

DIC

Myoglobinuric renal failure

Skeletal muscle weakness

Electrolyte abnormalities

128
Q

Extubation of T&A

A

Fully awake

Suction stomach and pharynx

Have nasal airway in place

129
Q

Cause of cerebral palsy

A

Damage to one or more specific areas of brain

Usually during fetal development

130
Q

Macroglossia

Visceromegaly

Omphacele

A

Beckwith-Wiedemann Syndrome

131
Q

Myringotomy and ventilating tube insertion anesthetic plan

A

GETA

Sevo inhalation induction

No IV

Mask ventilation

Intranasal fentanyl

132
Q

Children with cardiac valvular disease and tonsilar hyperplasia

A

Risk for endocarditis due to recurrent strep bacteremia secondary to infected tonsils

133
Q

Ester LA metabolism

A

Hydrolyzed by plasma cholinesterases

134
Q

During preop you discover positive family history for MH. What 6 steps should be taken

A
  • standard premeds. Low normal HR
  • remove vaporizers, change absorbent, Flush 02 at 10l/min for >10 minutes
  • measure ETCO2
  • core body temp measurement
  • Aline and central line
  • observe closely in postop period
135
Q

Rapid breakdown of muscle tissue

A

Rhabdomyolysis

136
Q

Child undergoing surgery with halothane develops tachycardia, increased temperature, and skeletal muscle rigidity. What is drug of choice?

A

Dantrolene 2.5 mg/kg

137
Q

What syndrome can mimic MH

A

Neuroleptic malignant syndrome

But develops over 24-72 hours

138
Q

Type of cerebral palsy

Tight muscles that resist effort to make them move

A

Rigidity CP

139
Q

Elements of syndrome similar to MH

Metastatic carcinoid

A

Flushing

Diarrhea

Hypotension

140
Q

MH

Uncontrolled and excessive Ca release in skeletal muscles can lead to

A

Sustained muscle contraction

Drastic and uncontrolled increase in oxidative metabolism in skeletal muscle

141
Q

At what body temperature should cooling of MH patient be stopped? Why?

A

38 degrees Celsius

To prevent deleterious effects of hypothermia

142
Q

Max recommended dosage and duration

Mepivacaine

A

7mg/kg

2-4 hours

143
Q

Max recommended dosage and duration

Bupivacaine

A

Max 2.5 mg/kg

3-10 hours

144
Q

Pt with OSA and emergence

A

Episodes of hypoxia and hypercapnia during sleep impair arousal mechanism at emergence

145
Q

Dantrolene sodium drug class

A

Ryanodine receptor 1 antagonist

146
Q

Cormack and Lehane laryngoscopic grading system

Visualization of complete laryngeal opening

147
Q

In almost all cases when do first manifestations of MH occur

148
Q

Recommended ester for neonatal regional anesthesia and epidural

A

2,3 Chloroprocaine (1.5%)

149
Q

Most common type of CP

150
Q

Dantrolene MOA

A

Blocks ryanodine receptors and inhibits abnormal Ca release from SR

151
Q

Increased incidence of intra-abdominal tumors with this syndrome

A

Beckwith-Widemann Syndrome

152
Q

Block locations with highest to lowest vascular uptake

A

ICE Block

Intercostal

Caudal

Epidural

Block- peripheral nerve blocks

153
Q

What causes time between loss of airway and resultant hypoxemia causing neurologic injury to be significantly diminished in children

A

Increased metabolic rate

Decreased FRC

154
Q

Structural until of myofibril in muscle

155
Q

Elements of syndrome similar to MH

Sepsi

A

Early normal ABG

Late metabolic acidosis

156
Q

Hypoglycemia with visceromegaly

A

Increased insulin secretion

157
Q

Patients treated with what drugs are susceptible to neuroleptic malignant syndrome

A

Antipsychotic agents

Reflects dopamine depletion in CNS

158
Q

Functions as storage area and release area for calcium in cardiac and skeletal muscle

A

Sarcoplasmic Reticulum (SR)

159
Q

Intranasal fentanyl dose for myringotomy tube insertions

A

1-2 mcg/kg

160
Q

Power house of cell

A

Mitochondrion

161
Q

Hallmarks of cystic fibrosis

A

Elevated sweat chloride

Viscous mucus production

Lung disease

Intestinal obstruction

Pancreatic insufficiency

Biliary cirrhosis

162
Q

In person susceptible to MH what gene abnormality present

A

Ryanodine receptor gene 1 (RyR1)

163
Q

Desaturation of 10kg infant from sat 90% to 0% takes how long

A

4 minutes

Vs 10 minutes in 70kg adult

164
Q

Duration of action of LA is dependent on

A

Concentration

Total dose

Site of administration

Childs age

165
Q

8 actions for initial management of MH

A

DC volatile and succinylcholine

Hyperventilate

Dantrolene

Treat acidosis with bicarb

Lower body temp

Activated charcoal filters, new circuit, new absorbent

Monitor capnography and ABG

Treat hyperkalemia and dysrhythmia

166
Q

Cleft soft palate (no cleft lip)

Micrognathia/retrognathia

Glossoptosis

A

Pierre Robin Sequence

167
Q

Elements of syndrome similar to MH

Hyperthyroidism

A

Minimal ABG

CPK abnormalities

168
Q

How do pharmacokinetics of LA differ in children

A

Rapid absorption

Tissue blood flow higher

Epidural space has less fat to buffer LA

Larger volume of distribution

169
Q

Ryanodex dosage

A

2.5 mg/kg

Repeat as needed up to max of 10 mg/kg

170
Q

Earliest sign of rhabdo

A

Myoglobin blood test

CPK may not rise for several hours

171
Q

How and where does dantrolene work

A

Acts at ryanodine receptor to decrease calcium level in skeletal muscle by decreasing calcium from SR

Skeletal muscle relaxes when Ca supply to contractile proteins impaired

172
Q

Underdeveloped malformed ears

173
Q

Bupivacaine dos for peripheral nerve blocks

174
Q

Rhabdomyolysis can result in

A

Damage to kidneys

DIC

175
Q

Spontaneous or controlled ventilation in difficult airway

A

Spontaneous until secure

176
Q

Max recommended dosage and duration

Lidocaine

A

4.5mg/kg

90-200 minutes

177
Q

Does a history of uneventful anesthesia with MH triggering agents rule out susceptibility to MH

Pediatrics (6 decks)

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