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Pediatrics > Orthopedic Surgeries > Flashcards

Orthopedic Surgeries Flashcards

1
Q

What is mainstay treatment for congenital hip dislocation?

A

Pavlick Harness.

Fluoro guided closed reduction and spica casting

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2
Q

Why might an LMA not be suitable for congenital hip dislocation surgery?

A

Manipulation of hips/casting may increase risk of laryngospasm=should use ETT

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3
Q

What is the greatest anesthetic concern during congenital hip dislocation surgery?

A

Loss of airway

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4
Q

What structural deformity causes congenital clubfoot?

A

Shortened medial tendons of the lower legs.

Shortened Achilles tendon

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5
Q

What type of regional anesthetic would be used for clubfoot repair?

A

Caudal block with bupivacaine 0.25% 1ml/kg

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6
Q

How many hours of analgesia would a caudal block provide for clubfoot repair?

A

4-6 hours

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7
Q

What is osteogenesis imperfecta?

A

Defect of collagen production resulting in abnormal bones, ligaments, teeth, and sclera

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8
Q

What are the four major facets of clinical presentation with osteogensis imperfecta?

A
  1. Bowing of long bones/kyphoscoliosis
  2. Otosclerosis/deafness.
  3. Hypermetabolic (not MH)
  4. Platelet abnormalities and decreased Factor VIII
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9
Q

T/F: Patients with osteogensis imperfecta typically need aggressive heat conservation measures and will need upper and lower warmers?

A

False; due to hypermetabolic state, should avoid anti-muscarinics and aggressive heat

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10
Q

Why should succinylcholine be avoided in patients with osteogensis imperfecta?

A

Can cause fractures d/t fasiculations

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11
Q

What is the etiology of cerebral palsy?

A

Prematurity, birth trauma, hypoglycemia, intrauterine and neonatal infections, congenital vascular malformations

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12
Q

What is phenobarbital’s effect on anesthesia?

A

Hepatic microsomal enzyme inducer and may go through NDNMBA faster.

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13
Q

Patients with a seizure disorder, what should be done with their medications?

A

Should be taken up to and including the day of the procedure

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14
Q

Name two medications often used for helping spasticity with CP patients?

A

Dantrolene and Baclofen

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15
Q

What three things make a fracture an urgent/emergent surgical repair?

A
  1. Vascular compromise
  2. Large hematoma
  3. Hypotension
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16
Q

What are 4 main anesthetic considerations for fracture repairs?

A
  1. RSI and ETT
  2. Analgesia as indicated (maybe caudal block as well)
  3. Availability of blood products
  4. Temperature conservation
17
Q

What is myelodysplasia?

A

Congenital failure of the middle or caudal end of the neural tube to close resulting in 1 of 3 disorders.

18
Q

What are the thee things myelodysplasia can result in?

A
  1. Spina Bifida
  2. Meningocele
  3. Myelomeningocele
19
Q

Clinical presentation of meningocele?

A

Neural function is intact.
Spinal cord is tethered by sacral nerve roots.
Results in orthopedic and/or urologic symptoms

20
Q

Clinical presentation of myelomeningocele?

A

Varying degrees of sensory and motor deficits.
Dilation of upper urinary tract.
Spasticity.
Scoliosis

21
Q

T/F: NDNMBA should be given full dose for myelodysplasia repair?

A

False; NDNMBA may be avoided or used sparingly d/t use of neurometric monitoring.

22
Q

When is surgical repair performed for myelodysplasia?

A

First day of life mostly due to lack of skin covering defect and being prone to infection and sepsis

23
Q

How should myelodysplasia patient be positioned during induction?

A

Foam head ring surrounding lower back to decrease pressure.

24
Q

What age is considered infantile scoliois?

A

<3 yrs

25
Q

What age is considered juvenile scoliosis?

A

3-10yrs

26
Q

What age is considered adolescent scoliosis?

A

> 10 yrs

27
Q

What are physiological derangements of scoliosis?

A
  1. Decreased lung volumes.
  2. Decreased chest wall compliance
  3. V/Q mismatch leading to chronic hypoxemia.
  4. Increased PVR, Pulm HTN leading to RV failure.
28
Q

What are problems with prone positioning for scoliosis repair?

A
  1. Compression of lungs
  2. Increased intra abd pressure
  3. Compression of IVC
  4. Epidural vein engorgement, increased bleeding
  5. Decreased venous return, and CO
29
Q

What is typical blood loss of scoliois repair?

A

25ml/kg

30
Q

What else should you considered after loss of one blood volume in scoliosis repair?

A
  1. Dilutional thrombocytopenia

2. Decreased factors V and VIII

31
Q

What are main issues with scoliosis repair post-operative management?

A
  1. Mech vent
  2. Hypovolemia
  3. Pain
  4. Ileus
  5. SIADH

Pediatrics (5 decks)

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