Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Peds > Difficult airway- congenital abnormalites > Flashcards

Difficult airway- congenital abnormalites Flashcards

(77 cards)

Start Studying
1
Q

What level is the larynx in the infant?

A

C3-C4

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

Where is the larynx in the adult?

A

C5-C6

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

infants are obligate nasal breathers until around when?

A

5 months

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

What are the features of the pediatric airway?

A

-large epiglottis
-short trachea and neck
-prominent adenoids and tonsils
-rigid cricoid ring is functionally the narrowest portion of the larynx

-tongue is larger in proportion to mouth
-pharynx is smaller
-epiglottis is larger and floppier
-larynx is more anterior and superior
-trachea is narrow and less rigid

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

What physiologic lung values are increased in the neonate/infant/ped?

A

Increased O2 consumption (6 vs 3)

increased alveolar ventilation (130 vs 60)

Increased Co2 production (6 vs 3)

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

What physiologic lung values are decreased?

A

Vital capacity (35 vs 70)

FRC (25 vs 40)

PaO2 (65-85 vs 85-95)

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

What are peds prone to when apneic?

A

atelectasis and hypoxemia

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

During apnea, how does paco2 rise?

A

6 mmHg during the first minutes, the 3-4mmHg each min after

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

What percentage of type 1 slow twitch muscle fibers in the diaphragm does the ped have?

A

25%
-promotes chest wall collapse during inspiration and low residual lung volumes during expiration

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

What respiratory drives are not well developed in the ped?

A

hypercapnic and hypoxic

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

Which conditions have a large tongue?

A

-Beckwith syndrome
-Trisomy 21

“Big tongue”

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

Which conditions have a small mandible (micrognathia/mandibular hypoplasia)

A

-Pierre Robin
-Goldenhar
-Treacher Collins
-Cri du chat

“Please Get That Chin”

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

Which conditions have spine anomalies?

A

Klippel-Feil
Trisomy 21
Goldenhar

“Kids Try Gold”

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

The larger the tongue the more likely the ______

A

obstruction

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

What does an anterior larynx mean?

A

Larynx sits high under the base of the tongue: no space to displace the tongue; the larynx will remain anterior

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

What does the TMJ do?

A

opens the upper airway and translocates the lower jaw forward.

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

What are some syndromes with soft tissue abnormalities?

A

Freeman-Sheldon syndrome
Beckwith- Wiedeman Syndrome
Down syndrome
Sturge Weber
Dwarfism

-limits movement of the airways
-affects mouth opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some syndromes with craniosynostosis?

A

Apert syndrome
Crouzon syndrome
Pfeiffer syndrome

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

What are the features of Crouzon disease?

A

-Hypertelorism (increased distance btwn eyes)

-craniostenosis

-shallow orbits

-proptosis (abnormal protrusion of eyes)

-midface hypoplasia

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

What are the features of Apert disease

A

-Hypertelorism (increased distance btwn eyes)

-craniostenosis

-shallow orbits

-proptosis (abnormal protrusion of eyes)

-midface hypoplasia

-Syndactyly of extremities (webbing)

-cardiac and renal problems: dydronephrosis/polycystic kidney disease

-possible esophageal atresia

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

What are the anesthesia implications for craniosynosis?

A

OSA- may require trach
-need smaller ETT
-Difficult mask
-don’t close mouth or will obstruct
-topical lidocaine before oral airway
-ETT not difficult unless neck mobility issues

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

With what cleft abnormality will you see obstruction?

A

Cleft palate

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

What are the features of bilateral clefts?

A

Premaxilla angled anteriorly (makes blade insertion difficult)

If younger than 6 months- intubation won’t be as difficult

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

What are other associated diseases with cleft lip and palate?

A

-associated w congenital heart disease
-pulm aspiration
- anemia (d/t poor nutrition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is usually placed pre-op for a cleft palate and lip?
Tongue stitch before waking up bc correction can narrow the airway making it more likely for the tongue to obstruct the airway
26
What meds should be used for cleft lip and palate?
non-respiratory depressants -tylenol -dexmedetomidine -ketorolac
27
What age are cleft lips corrected?
3 months
28
What age are cleft palates repaired?
6 months
29
What happens in micrognathia?
Glossoptosis (downward displacement or retraction of the tongue) resp obstruction usually isolated but can be a part of stickler syndrome or velocardial syndrome
30
Describe Pierre Robin Sequence
Resp compromise: -hypoxia -arrest -pulm HTN -failure to thrive -25% have feeding problems -rapid facial growth btwn 3-12 months
31
What can be done at birth to relive obstruction for Pierre robin?
place oral airway and place prone extreme cases: tracheostomy
32
What are the intraoperative considerations for Pierre robins?
do not give muscle relaxants while attempting intubation keep pt breathing -fiberoptic
33
What is the OMENS classification?
-orbital distortion -mandibular hypolasia -ear anomaly -nerve involvement -soft tissue deficiency
34
What happens in hemifacial microsomia?
- varying degree of mandibular hypoplasia -auricular abnormalities -overlying soft tissue loss -facial nerve weakness -unilateral defects in 90% of cases normally right sided Variant of Goldenhar syndrome
35
Mandibular abnormalities: Pruzansky classifies 3 types:
1. Mild hypoplasia of the ramus with little abnormality of the mandibular body 2. Mandible has a small condylar head and ramus. Condyle is flat, glenoid fossa is poorly developed or absent, infratemporal surface assumes a flat contour 3. Mandible abnormality TMJ joint fails to form Ramus may exist as a thin bony lamina or may be completely absent the degree of mandibular hypoplasia is associated with increased difficulty of ET intubation
36
What is Goldenhar syndrome?
associated w abnormality on chromosome 5p15 defect in development of the 1st and 2nd branchial arches Main feature: macrostomia (failure of fusion of maxillary and mandibular process - vertebral abnormalities -limited neck extension -10% cardiac defects w outflow tract/septum issues -hydrocephalus -TEF if abnormality is bilateral- similar to Pierre robin
37
What is Treacher Collin syndrome?
Disorder or the 1st and 2nd pharyngeal arches -autosomal dominant mandibularfacial dysostosis (development of the bone) hypoplasia of maxillary, zygomatic, and mandibular - -laterally sloping palpebral fissures -notched lower eyelids -coloboma of eye (lens, retina, iris) -small mouth -high arched palate -hearing loss (atresia of auditiory canal) -absence of the medial lower eyelashes secondary problems: cleft palate, velopharyngeal incompetence
38
Anesthetic considerations for treacher collins syndrome:
mask ventilation and intubation difficult keep pt spontaneously breathing sedated fiberoptic intubation LMA or fiberoptic Trach
39
Craniofacial abnormality management
sevo prop ketamine precedex nebulized lido alfentanil nasal trumpet or nasal ray to deliver volatile anesthetics
40
What are the noncraniofacial abnormalities?
Mucopolysaccharidoses Beckwith-Wiedemann Down syndrome
41
What is Mucopolysaccharidoses
Lysosomal storage disorder: deficiency in the enzymes required for the stepwise breakdown of glycosaminoglycans (GAGs) Components of ground substance of bone and cartilage, lubricant for joint fluid, and the surface coating that initially binds growth factors to cells
42
How does Mucopolysaccharidoses affect the airway?
Airways: infiltration of GAG deposits leads to tongue enlargement, thickening and redundancy of the soft-tissue mucosa of the oropharynx, and blockage of nasal passages Progressive airway obstruction leads to severe respiratory compromise Mask ventilation and tracheal intubation become impossible
43
What are the features of MPS 1: Hurler syndrome?
Appear normal at birth During first year: course facial features, wide nasal bridge, flattened midface Hepatosplenomegaly, umbilical or inguinal hernias Skeletal abnormalities: dysostosis multiplex Typically present at 6 months to 2 yrs. with developmental delay, recurrent respiratory infections with chronic nasal discharge Rapidly enlarging head size, heart failure, hernias, lower spine deformities Age:2-3: joint stiffness and contractures, multiword sentences and walking: declines
44
MPS 1: Hurler syndrome continued
High pressure communicating hydrocephalus Craniosynostosis Loss of vision: corneal clouding early on Soft tissue thickening of the nose and pharynx, storage within the tonsils, adenoids, and abnormalities in tracheal cartilage cause progressive airway obstruction and sleep apnea Sleep apnea: hypoxemia at night, pulmonary HTN, cor pulmonale Cardiac abnormalities: age 5 Cardiomyopathy, endocardial fibroelastosis, valvular regurgitation Abnormal storage of GAG in coronary vessels cause narrowing Odontoid Dysplasia and anterior C1-C2 subluxation: can cause cord compression and sudden death.
45
What is the management for MPS?
FIRST CHOICE: AWAKE FOI Preop evaluation of upper airway, lungs, cervical spine, heart, and neurologic evaluation Periop morbidity and mortality most often related to difficult airway management and tracheal intubation Awake FOI first choice Spontaneous ventilating FOI Be aware of co-existing cardiac and liver disease and choose drugs accordingly Cautious use of narcotics as depressant effects could worsen pre-existing restrictive/obstructive ventilation defects Delayed awakening in Hunter’s Syndrome has been described
46
What is Beckwith-Wiedemann syndrome
Omphalocele, macroglossia, gigantism Hyperplasia of the kidneys and pancreas prone to hypoglycemia** Hepatosplenomegaly Eventration of diaphragm (higher than usual in anatomic position) Large protuberant tongue: can lead to airway obstruction microcephaly, macroglossia, umbilical hernia
47
Management of Beckwith-Wiedemann syndrome:
-keep spontaneously breathing -mask difficult d/t large tongue -have someone gold tongue -immediate post op s/p partial glossectomy- tongue may be bigger -Keep pt intubated nasally
48
Down syndrome
Smaller than normal for age Craniofacial: microbrachycephaly (small head) Short neck, oblique palpebral fissure Epicanthal folds, Brushfield’s spots (small white or greyish/brown spots on the periphery of the iris) Small low set ears Macroglossia Microdontia with fused teeth Mandibular hypoplasia Narrow nasopharynx with hypertrophic lymphatic tissue: tonsils and adenoids Generalized hypotonia pulm HTN atlantoaxial instability subglottic stenosis Smaller ETT
49
Most common heart abnormalities in down syndrome
Atrioventricular septal defect VSD TOF PDA strong underlying vagal tone: bradycardia common during induction
50
What is Klippel-Feil syndrome?
Severe limitation of flexion/extension of the neck as a result of fusion of cervical vertebrae and atlanto-occipital abnormalities Spinal canal stenosis Scoliosis Easy mask ventilation usually Intubation very difficult due to l imitation of neck movement Care must be taken in manipulation of neck as neurological injury can occur FOI vs LMA
51
What syndromes had the highest rate of tracheotomy?
Crouzon Apert Pfeiffer Next highest: Treacher Collins
52
what reduced risk of tracheotomy?
cleft palate
53
CAEC 8:
ett 3.5-4.5
54
CAEC 11:
ett 5.0-6.0
55
CAEC 14:
ett 6.5-7.0
56
indications for spinal anesthesia
hernia repair orchiopexy hypospadias circumcision exploratory lap muscle biopsy LE surgery
57
Where is the infant clonus medularis located?
L3
58
Where is the infant dural sac located?
S3
59
What is the volume of csf in neonates?
> 10mL/kg
60
what is the volume of csf in infants?
4mL/kg (<15kg)
61
what is the volume of csf in children?
3mL/kg
62
What is the volume of csf in adults and adolescents?
1.5-2ml/Kg
63
What size needle do you use for an infant and neonate spinal?
1.5 inch
64
Where should the spinal needle be placed?
L4-L5 interspace (iliac crests)
65
what is the most commonly used regional block in pediatric anesthesia?
caudal block -lower extremities, lower abdomen, lower thoracic dermatomes
66
what are contraindications to a caudal block?
pilonidal cyst abnormal superficial landmarks myelomeningocele hydrocephalus or intracranial htn neuropathies parental nonconsent
67
caudal anatomy: sacral hiatus
Results from the lack of dorsal fusion of the 5th and often 4th sacral vertebral arches V-shaped aperture Limited laterally the sacral cornua Covered by the sacrococcygeal membrane (sacral continuation of the ligamenta flava)
68
in a caudal block where is the needle placed?
sacral canal 22G/20G angio-catheter or tuohy needle
69
what is the positioning for a caudal block?
lateral- into fetal position prone
70
sacral level
0.5-0.75 mL/kg
71
Lumbar level
1-1.2 ml/kg
72
low thoracic
1.2-1.5ml/kg
73
max volume/max dose
25ml / 3mg/kg
74
toxicity treatment
20% intralipid bolus 1.5 ml/kg repeat 1-2 times if needed infusion 0.25ml/kg/min for 30-60 mins
75
what are signs of intravascular injection?
HR increase of 10 bpm BP increase of 15 mm Hg T wave ampitude increase of >25% of baseline or bradycardia are all signs of intravascular injection. Children are at an increased risk because of increased C.O. and increased systemic uptake of the agent.
76
signs of neurotoxicity
Neurotoxicity: HA, somnolence, vertigo, perioral or lingual parathesias, tremors, twitching, shivering or convulsions.
77
signs of cardiac toxicity
Cardiac toxicity: LA prevents the fast inward sodium channels in the myocardium from opening. Dysrhythmias, conduction block, widening QRS, torsades de pointes, VT, or cardiovascular collapse

Peds (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions