Exam 1: Pediatric General Surgery Part 6

Question 1

Which gender is more prone to get cleft lip/palate

Answer 1

Male

Question 2

What race is more prone to get cleft lip/palate?

Answer 2

• Asians
• Latin Americans

Question 3

What race is least likely to get cleft lip/palate?

Answer 3

African Americans

Question 4

Cleft lip and palate will form during which trimester of pregnancy?

Answer 4

First trimester

Question 5

Primary cleft lip is usually repaired at age ____.

Answer 5

2-3 months

Question 6

Primary cleft palate repair is usually done at age ____.

Answer 6

6-10 months

Question 7

Palatal revision and alveolar bone grafts occur around age ____.

Answer 7

10 years

Question 8

What type of ETT is used to intubate patients undergoing cleft lip/palate repair?

Answer 8

Oral Rae ETT (sutured midline to the chin)

Question 9

What blade should be used to intubate a patient with cleft lip/palate?

Answer 9

Miller (straight blade)
it can go all the way to the right side of the mouth. The Mac blade will be more midline and disrupt the palate (according to speaker)

Question 10

Cleft Lip & Palate Anesthesia Considerations

Answer 10

• Post-op nasal trumpets (placed by surgeon) may be required to maintain airway patency and allow suctioning
• Extubation is done in the room awake and taken to PACU or straight to PICU
• High risk for upper airway obstruction immediately post extubation
• Arm restraints or “no no’s”

Question 11

Physical characteristics of Down Syndrome patients.

Answer 11

• Short stature
• Epicanthal folds
• Short neck, atlantoaxial instability
• Small/low set ears
• congenital heart defects
• GI problems - duodenal atresia is most common
• Macroglossia
• Mandibular hypoplasia
• Hypotonia

Question 12

What is the most common GI problem for Down Syndrome patients?

Answer 12

Duodenal Atresia

Duodenal atresia is a congenital condition that occurs when the duodenum, the first part of the small intestine, is blocked or narrowed

Question 13

What percentage of Down Syndrome patients have congenital heart defects?

Answer 13

40-50%

Question 14

Anesthetic Considerations For Down Syndrome

Answer 14

• Atlantoaxial instability
• Subglottic stenosis, subglottic narrowing common (Size down ETT)
• Upper airway obstruction
• Post extubation stridor (Size down on ETT)
• Small/abnormal radial vessels (use US for ALine placement)
• Bradycardia under anesthesia (have atropine/ robinul ready)
• Airway obstruction common and occurs easily when sedated
• Neuro exam pre-op and cervical x-rays to clear instabilities

Question 15

Dose of Atropine to treat bradycardia in DS

Answer 15

0.01-0.02 mg/kg

Question 16

Dose of Robinul to treat bradycardia in DS

Answer 16

0.01 mg/kg