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Principles B - Summer '25 > Cote - Readings > Flashcards

Cote - Readings Flashcards

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1
Q

What anatomic features make infant laryngoscopy more challenging than adults?

A

Large occiput, cephalad–anterior larynx at C3–4, omega‑shaped epiglottis, funnel‑shaped sub‑glottic area. (Coté 4th ed., p 238)

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2
Q

In infants ≤ 6 kg, what airway equipment adjustments are recommended?

A

Use a straight or hyper‑angulated blade and a smaller uncuffed tube that leaks at 20–25 cm H₂O. (Coté 4th ed., p 239)

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3
Q

How does a 1 mm circumferential edema affect a 4 mm infant airway?

A

Halves the lumen; airway resistance rises steeply because R ∝ radius⁻⁵. (Coté 4th ed., p 242)

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4
Q

List the step‑wise difficult airway rescue sequence in children while maintaining spontaneous ventilation.

A

Mask ventilation → oral airway → LMA (size 1–2.5) → fiber‑optic/video‑guided intubation → surgical airway (cricothyrotomy if > 6 yrs). (Coté 4th ed., p 265)

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5
Q

Which airway lesions correspond to nasal, oropharyngeal, laryngeal, and lower airway obstruction respectively?

A

Choanal atresia (nasal), Pierre‑Robin sequence (oropharynx), sub‑glottic hemangioma/stenosis (laryngeal), tracheomalacia (lower). (Coté 4th ed., p 259)

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6
Q

Formula to calculate uncuffed ETT internal diameter (ID) in mm for children >1 yr?

A

Uncuffed ID ≈ 4.5 + (age ÷ 4). (Coté 4th ed., p 1106)

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7
Q

Formula to calculate cuffed ETT ID in mm for children >1 yr?

A

Cuffed ID ≈ 3 + (age ÷ 4). (Coté 4th ed., p 1106)

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8
Q

What leak pressure range confirms proper uncuffed tube sizing?

A

20–25 cm H₂O leak. (Coté 4th ed., p 251)

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9
Q

How should ETT size be adjusted in Down syndrome?

A

Select a tube ½‑size smaller because of sub‑glottic narrowing. (Coté 4th ed., p 251)

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10
Q

Why must cuff pressure be re‑checked when using micro‑cuff tubes with nitrous oxide?

A

N₂O diffuses into the ultra‑thin cuff quickly, raising pressure. (Coté 4th ed., p 253)

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11
Q

What does absence of a cuff leak at 10–25 cm H₂O despite deep anesthesia suggest?

A

Possible unrecognized sub‑glottic stenosis. (Coté 4th ed., p 252)

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12
Q

What ventilatory strategy limits barotrauma in congenital diaphragmatic hernia (CDH)?

A

Gentle pressure‑limited ventilation with PIP< 25 cm H₂O and permissive hypercapnia. (Coté 4th ed., p 759)

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13
Q

Why is bag‑mask ventilation contraindicated in newly born CDH patients?

A

It distends the stomach, worsening lung compression and hypoplasia. (Coté 4th ed., p 759)

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14
Q

Which two monitoring sites help detect ductal shunting in CDH?

A

Pre‑ductal (right hand) and post‑ductal (lower limb) pulse oximetry. (Coté 4th ed., p 760)

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15
Q

List three stabilization measures commonly used before CDH repair.

A

High‑frequency oscillatory ventilation, inhaled nitric oxide, and delayed surgical closure after physiologic stabilization. (Coté 4th ed., p 760)

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16
Q

What CDH prognostic markers indicate need for early ECMO?

A

PaO₂< 50 mm Hg on FiO₂1.0 or A‑a gradient> 500 mm Hg despite maximal support. (Coté 4th ed., p 288)

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17
Q

During TEF repair, where should the ETT tip be positioned?

A

Below the fistula but just above the carina (often right main‑stem then withdrawn until bilateral breath sounds). (Coté 4th ed., p 757)

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18
Q

Which anesthetic gas should be avoided in TEF and why?

A

Nitrous oxide—worsens gastric distention through the fistula. (Coté 4th ed., p 757)

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19
Q

What congenital association cluster should be sought in TEF patients?

A

VACTERL (Vertebral, Anal, Cardiac, Tracheo‑Esophageal, Renal, Limb anomalies). (Coté 4th ed., p 758)

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20
Q

Name a technique to occlude a large TEF when gastric distention is problematic.

A

Insert a Fogarty catheter retrograde via a gastrostomy to plug the fistula. (Coté 4th ed., p 757)

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21
Q

Analgesic strategy often chosen for TEF thoracotomy?

A

Caudal‑threaded thoracic epidural catheter for continuous infusion. (Coté 4th ed., p 758)

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22
Q

What cervical spine precaution is critical in Down syndrome anesthesia?

A

Avoid excessive neck flexion/extension because of atlanto‑axial instability; consider pre‑op lateral C‑spine films. (Coté 4th ed., p 260)

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23
Q

Which heart lesions are most common in Down syndrome?

A

Atrioventricular septal defect and ventricular septal defect (40–50 %). (Coté 4th ed., p 260)

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24
Q

What intra‑op side effect is common with anticholinesterase reversal in Down syndrome?

A

Bradycardia—keep glycopyrrolate ready. (Coté 4th ed., p 365)

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25
What OR preparation is mandatory for spina bifida patients?
Latex‑free environment due to high sensitization risk. (Coté 4th ed., p 564)
26
Describe autonomic dysreflexia seen in high‑level myelodysplasia.
Bladder or surgical stimulation triggers hypertension and reflex bradycardia; treat by deepening anesthesia and using rapid vasodilator. (Coté 4th ed., p 565)
27
How does severe kyphoscoliosis in myelodysplasia influence anesthesia?
Restrictive lung disease—assess vital capacity and use chest rolls in prone position. (Coté 4th ed., p 749)
28
Why must neck remain neutral in Chiari malformation?
Flexion can worsen tonsillar herniation and brain‑stem compression. (Coté 4th ed., p 605)
29
Post‑op ventilation is often needed in Chiari surgery because of what pathophysiology?
Central apnea from brain‑stem compression/edema. (Coté 4th ed., p 610)
30
Preferred induction position for an infant with occipital encephalocele?
Inhalational induction in the lateral position to avoid pressure on the sac. (Coté 4th ed., p 625)
31
What fluid management issue is key during encephalocele repair?
Replace large CSF losses with warmed isotonic crystalloid and maintain normothermia. (Coté 4th ed., p 626)
32
Which pre‑op pulmonary metric best predicts need for post‑op ventilation in scoliosis fusion?
FVC < 40 % of predicted. (Coté 4th ed., p 727)
33
Typical blood loss range during pediatric spinal fusion?
50–100 mL kg⁻¹; cell saver and tranexamic acid recommended. (Coté 4th ed., p 732)
34
What anesthetic technique optimizes MEP/SSEP monitoring in spine surgery?
TIVA with propofol + remifentanil, MAC ≤ 0.5, avoid nitrous oxide. (Coté 4th ed., p 734)
35
If neuro‑monitoring signals are lost, what classic clinical test is still performed?
Wake‑up or bite‑test for motor function verification. (Coté 4th ed., p 741)
36
Why is the airway often extremely difficult in craniofacial reconstruction?
Mid‑face hypoplasia and previous surgeries; awake or staged fiber‑optic approach is common. (Coté 4th ed., p 804)
37
What MAP target is used for deliberate hypotension to curb venous oozing in craniofacial cases?
MAP 50–55 mm Hg when tolerated. (Coté 4th ed., p 809)
38
Which intra‑op monitor detects venous air embolism when the head is elevated?
Precordial Doppler (or end‑tidal N₂ monitoring). (Coté 4th ed., p 810)
39
Post‑op plan for airway management after major craniofacial surgery?
ICU admission with delayed extubation due to anticipated airway edema. (Coté 4th ed., p 811)
40
What electrolyte and acid‑base abnormalities define classic pyloric stenosis?
Hypochloremic, hypokalemic metabolic alkalosis. (Coté 4th ed., p 861)
41
State the chloride and bicarbonate targets before surgery for pyloric stenosis.
Cl⁻ > 95 mEq/L and HCO₃⁻ < 30 mEq/L. (Coté 4th ed., p 861)
42
What induction technique is recommended for pyloric stenosis and why?
True RSI (after thorough orogastric suction) because the stomach is considered full. (Coté 4th ed., p 861)
43
Why are infants with pyloric stenosis at risk for post‑op apnea?
Alkalosis blunts respiratory drive; monitor overnight. (Coté 4th ed., p 861)
44
Presence of a protective sac: gastroschisis or omphalocele?
Omphalocele (gastroschisis lacks a sac; bowel is exposed). (Coté 4th ed., p 864)
45
What volume of crystalloid is typically required in the first hour for gastroschisis repair?
30–50 mL kg⁻¹ warmed crystalloid due to fluid and heat loss. (Coté 4th ed., p 864)
46
Which abdominal wall defect commonly associates with cardiac anomalies?
Omphalocele (~40 % incidence). (Coté 4th ed., p 865)
47
Why is nitrous oxide avoided during omphalocele repair?
To prevent distension of bowel loops and increased intra‑abdominal pressure. (Coté 4th ed., p 865)
48
When should staged silo reduction be chosen over primary closure in gastroschisis?
If peak inspiratory pressure > 25 cm H₂O or oxygen saturation drops after reduction indicating high intra‑abdominal pressure. (Coté 4th ed., p 865)
49
What formula estimates appropriate depth of oral ETT insertion (cm) in children >2 yrs?
Depth ≈ 12 + (age ÷ 2) cm. (Coté 4th ed., p 253)
50
Ideal leak pressure for a cuffed microcuff tube in infants?
Maintain cuff pressure ≤ 20 cm H₂O; adjust if leak heard above 30 cm H₂O. (Coté 4th ed., p 253)
51
Which supraglottic airway size is chosen for a 10 kg infant?
LMA size 1.5. (Coté 4th ed., p 255)
52
Name two physiologic reasons infants desaturate faster than adults under apnea.
Higher metabolic O₂ demand and lower functional residual capacity. (Coté 4th ed., p 242)
53
What is the calculation for allowable blood loss (ABL) in pediatric patients?
ABL = EBV × (start Hct – target Hct) ÷ start Hct. (Coté 4th ed., p 741)
54
Why is permissive hypercapnia (PaCO₂ 45–60 mm Hg) accepted in CDH pre‑repair?
Reduces ventilator pressures and barotrauma in hypoplastic lungs. (Coté 4th ed., p 760)
55
Target pre‑ductal SpO₂ range during CDH stabilization?
85–95 %. (Coté 4th ed., p 759)
56
Which lung volume is typically most reduced in infants with CDH?
Functional residual capacity. (Coté 4th ed., p 760)
57
Preferred induction technique for TEF with unprepared pouch?
Awake tracheal intubation or inhalational with maintained spontaneous ventilation to avoid gastric insufflation. (Coté 4th ed., p 758)
58
Which vertebral level is the common fistula located in TEF type C?
Between T2–T4 posterior trachea to distal esophagus. (Coté 4th ed., p 757)
59
At what atlanto‑dens interval (ADI) is cervical fusion usually recommended in Down syndrome?
ADI > 10 mm. (Coté 4th ed., p 260)
60
What percentage of Down syndrome children have congenital hypothyroidism?
~15 %. (Coté 4th ed., p 261)
61
Spinal level above which autonomic dysreflexia becomes likely in myelomeningocele?
Lesions above T6. (Coté 4th ed., p 565)
62
Which volatile agent markedly depletes spinal cord blood flow and should be minimized during spinal fusion in myelodysplasia?
Isoflurane > 1 MAC. (Coté 4th ed., p 732)
63
Which opioid-sparing analgesic technique is often beneficial after Chiari decompression?
Posterior fossa scalp block with ropivacaine. (Coté 4th ed., p 610)
64
Key temperature management strategy during giant encephalocele excision?
Use forced‑air warming and warmed fluids to counter high evaporative loss. (Coté 4th ed., p 626)
65
Neuromuscular scoliosis patients often require what pre‑operative respiratory therapy?
Incentive spirometry and airway clearance (e.g., cough‑assist). (Coté 4th ed., p 734)
66
What is the typical transfusion trigger hemoglobin during scoliosis fusion with neurologic monitoring?
Hb 7 g dL⁻¹ (higher if neuromonitoring signals decline). (Coté 4th ed., p 741)
67
Why is nitrous oxide avoided when MEP monitoring is used?
It depresses cortical motor pathways and reduces MEP amplitudes. (Coté 4th ed., p 732)
68
Estimated blood loss range for fronto‑orbital advancement in infants?
30–50 mL kg⁻¹. (Coté 4th ed., p 810)
69
In craniosynostosis repair, why should venous air embolism be suspected when end‑tidal CO₂ suddenly falls?
Entrained air obstructs pulmonary blood flow lowering ETCO₂. (Coté 4th ed., p 811)
70
Which antifibrinolytic regimen is superior in reducing transfusion for craniofacial surgery, TXA or ε‑aminocaproic acid?
TXA at 10 mg kg⁻¹ loading then 5 mg kg⁻¹ h⁻¹ infusion. (Coté 4th ed., p 809)
71
What fluid choice and rate are recommended for pre‑operative resuscitation in pyloric stenosis?
0.45 % saline + 5 % dextrose at 1.5 maintenance until labs normalize. (Coté 4th ed., p 861)
72
What is the typical post‑operative feeding protocol after pyloromyotomy?
Start clear feeds 3 h post‑op, advance to formula/breast milk as tolerated. (Coté 4th ed., p 861)
73
Main determinant for choosing silo reduction vs primary closure in gastroschisis?
Intra‑abdominal hypertension evidenced by PIP > 25 cm H₂O or low venous return. (Coté 4th ed., p 864)
74
Why is gastric decompression essential before omphalocele reduction?
Reduces intragastric volume improving respiratory mechanics during closure. (Coté 4th ed., p 865)
75
Which glucose abnormality is common in Beckwith‑Wiedemann syndrome associated with omphalocele?
Neonatal hypoglycemia due to hyperinsulinism. (Coté 4th ed., p 865)
76
Calculate estimated blood volume (EBV) for a 6‑month‑old infant (8 kg).
EBV ≈ 80 mL kg⁻¹ × 8 kg = 640 mL. (Coté 4th ed., p 741)
77
Which local anesthetic and maximum dose (mg kg⁻¹) is preferred for caudal block in neonates?
Ropivacaine 0.2 %, max 2.5 mg kg⁻¹. (Coté 4th ed., p 809)
78
Name two risk factors for postoperative apnea in former preterm infants.
Gestational age < 37 weeks and anemia (Hb < 10 g dL⁻¹). (Coté 4th ed., p 259)
79
What is the first‑line vasodilator for autonomic dysreflexia during myelomeningocele surgery?
Nitroprusside infusion titrated 0.3–1 µg kg⁻¹ min⁻¹. (Coté 4th ed., p 565)
80
State the recommended dose of tranexamic acid for pediatric spine fusion loading bolus.
10–15 mg kg⁻¹ over 15 min. (Coté 4th ed., p 741)
81
Define functional residual capacity (FRC).
Volume of air remaining in lungs at end‑expiration: ERV + RV. (Coté 4th ed., p 242)

Principles B - Summer '25 (6 decks)

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