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Pediatrics > peds deck 8 > Flashcards

peds deck 8 Flashcards

1
Q

dose of morphine in pediatrics

A

0.05-0.2 mg/kg

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2
Q

onset of morphine in peds

A

5-10 min

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3
Q

DOA of morphine in peds

A

2-4 hours

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4
Q

what is the concern with using morphine?

A

causes histamine release (avoid in asthma/hyperreactive airway)

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5
Q

dose of meperidine in peds

A

0.5-2 mg/kg

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6
Q

onset of meperidine

A

3 min

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7
Q

DOA of meperidine

A

45-90 min

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8
Q

what are the concerns with meperidine

A
  1. normeperidine (AM) can cause seizures 2. causes histamine release
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9
Q

_________________ is an opioid that can be given to decrease postop shivering

A

meperidine (0.5 mg/kg)

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10
Q

meperidine should be avoided in

A

those with seizure d/o

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11
Q

________________ pediatric disorders are a genetic liposomal storage disorder that results in a build up of glycosaminoglycans

A

mucopolysaccharidoses

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12
Q

which pediatric disorders are mucopolysaccharidoses

A
  1. Hurler’s syndrome 2. Hunter’s syndrome
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13
Q

s/sx of hurlers syndrome

A
  1. coarse facial features 2. macroglossia 3. short neck 4. tonsillar hypertrophy 5. narrowing of laryngeal inlet & tracheobronchial tree (laryngo/tracheomalasia) 6. odontoid hypoplasia 7. atlantoaxial subluxation 8. joint stiffness 9. cardiomyopathy and valve dz 10. metnal delays 11. hepatosplenomegaly
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14
Q

anesthetic implications with hurlers syndrome

A
  1. C-spine instability 2. difficult intubation/airway 3. post-obstructive pulmonary edema
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15
Q

hurlers syndrome is ____________ recessive; and hunters syndrome is ____________ recessive

A

autosomal; X-linked

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16
Q

S/Sx of hunter’s syndrome

A
  1. coarse facial features 2. macroglossia 3. macrocephaly 4. short neck 5. increased ICP 6. mental delays (varying degrees) 7. valvular heart disease 8. hepatosplenomegaly
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17
Q

anesthesia implications for hunters syndrome

A
  1. difficult to mask 2. difficult intubation
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18
Q

s/sx of apert syndrome

A
  1. midface hypoplasia 2. craniosynostosis 3. flat face 4. hypertelorism (lg distance btwn eyes) 5. kidney dz 6. syndactyly 7. esophageal atresia 8. congenital heart disease
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19
Q

anesthesia implications for the pt with apert syndrome

A
  1. diffult mask 2. difficult intubation 3. may present with tracheostomy 4. craniosynostosis - difficulty with positioning
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20
Q

s/sx of crouzon syndrome

A
  1. branchial arch syndrome 2. maxillary hypoplasia with inverted V-shaped palate 3. macroglossia 4. craniosynostosis 5. ocular proptosis
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21
Q

anesthetic implications for crouzon syndrome

A
  1. difficult intubation/airway 2. risk for eye injury
22
Q

signs & sx of pierre robin syndrome

A
  1. micrognathia 2. glossoptosis (tongue farther back than should be –> obstx) 3. upper airway obstruction 4. usually presents with cleft palate 5. normal IQ 6. frequently have GERD
23
Q

anesthesia implications for pierre robin syndrome.

A

very difficult airway/intubation

24
Q

s/sx of treacher collins

A
  1. micrognathia 2. choanal atresia 3. down sloping eyes 4. sparse eyelashes 5. coloboma (defect in iris of eye) 6. absent or abnormally small ears ** 7. normal IQ 8. congenital heart defect
25
Q

anesthetic implications for treacher collins

A
  1. difficult airway/intubation 2. associated cardiac dz
26
Q

what is the most common chromosomal abnormality

A

Trisomy 21 (down syndrome)

27
Q

95% of cases of trisomy 21 are due to _______________

A

nondisjunction of chromosome 21

28
Q

what risk factor is associated with trisomy 21

A

increased maternal age

29
Q

screening methods for trisomy 21

A
  1. US 2. alpha-fetoprotein levels 3. chorionic gonadotropin 4. unconjugated estriol levels
30
Q

the average life expectancy of someone with trisomy 21 is ____________ years of age most commonly due to ________________

A

35; cardiac issues

31
Q

s/sx of down syndrome

A
  1. small mouth 2. hypoplastic mandible 3. protruding tongue 4. duodenal atresia 5. pharyngeal hypotonia 6. palmar or simian hand creases 7. mental handicap 8. C-spine subluxation 9. cardiac dz –> risk of bradycardia under anesthesia and risk of pulmonary htn 10. hypothyroidism 11. microbrachycephaly (small head, flat in the back)
32
Q

anesthetic considerations for pt with Trisomy 21

A
  1. may be difficult intubation (d/t atlantoaxial instability) 2. cardiac dz 3. less muscle relaxant required 4. increased risk of post-intubation stridor (due to tracheal/subglottic stenosis) 5. pretreatment atropine due to large risk of brady cardia 6. difficult bag (big tongue)
33
Q

what do pts with trisomy 21, 18, and 13 all have in common

A

cardiac anomalies

34
Q

s/sx of trisomy 18

A
  1. cardiac anomalies 2. developmental delays 3. retrognathia/micrognathia
35
Q

anesthesia considerations with trisomy 18

A

difficult intubation

36
Q

s/sx of CHARGE syndrome

A
  1. Colomba of the eye (defect in iris) 2. Heart defects 3. Atresia of nasal choane 4. Retarded growth/mental delay 5. GU (undescended testes/hypospadias) 6. ear abnormalities (deafness)
37
Q

what are the common heart defects seen with CHARGE syndrome

A

conotruncal and Ao arch abnormalities

38
Q

if bby is having issues breathing right after birth they will most likely be worked up for ___________________

A

CHARGE syndrome

39
Q

anesthesia implications of CHARGE syndrome

A
  1. possible difficulties with airway (irrespective of atresia and cleft palate) 2. cardiac complications
40
Q

s/sx of VACTERL

A
  1. vertebral - hypoplastic/hemi vertebrae 2. Anal - atresia or imperforate anus 3. CV - VSD, ASD, or TOF 4. Tracheoesophageal - esophageal atresia with transesophageal fistula 5. Renal - single kidney 6. Limb defects - syndactyly, polydactyly, forearm abn, displaced thumbs
41
Q

anesthesia considerations with VACTERL

A
  1. vertebral anomalies can complicate airway management and regional 2. tracheoesophageal anomalies can complicate airway management 3. CV issues - need to keep normodynamic and take bubble precautions.
42
Q

s/sx of DiGeorge syndrome

A

“CATCH22” 1. cardiac defects 2. Abnormal face (retrognathic and micrognathic) 3. thymic hypoplasia –> immunocompromise 4. cleft palate 5. hypocalcemia

43
Q

what is the most important thing to assess if a pt presents that is dx with Digeorge syndrome

A
  1. cardiac 2. have they had cardiac eval? 3. last time they had? 4. anything we need to be concerned about?
44
Q

anesthesia implications for DiGeorge

A
  1. strict aseptic technique/use of irradiated blood due to immunosuppression 2. cardiac defects 3. possible difficult airway due to retrognathia and/or micrognathia
45
Q

_______________ is an inherited hemoglobinopathy producing hemoglobin S

A

sickle cell disease

46
Q

T/F: all neonates are screened for sickle cell due to how common it is

A

TRUE

47
Q

common sequelae of sickle cell dz

A
  1. vasoocclusive pain attacks 2. acute chest syndrome –> pulm htn –> R. Sided Heart failure 3. splenomegaly 4. cholelithiasis 5. chronic transfusions and increased iron loads 6. strokes
48
Q

________________ is THE most common FATAL inherited disease

A

cystic fibrosis

49
Q

10-15% of pts dx with _________________ have meconium ileus as a neonate

A

cystic fibrosis

50
Q

anesthesia implications for Cystic fibrosis

A
  1. assess lung function 2. humidified gases should be used*** 3. if lung fx poor –> consider TIVA 4. preoperative/postoperative nebulizers may be indicated 5. often present with severe nasal polyps and chronic sinusitis 6. if regional an option = okay 7. careful titration of narcotics and respiratory depression

Pediatrics (15 decks)

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