Exam 3 - Review Flashcards
(201 cards)
1
Q
fasting clear liquids
A
2 hours
2
Q
fasting breast milk
A
4 hours
3
Q
fasting infant formula
A
6 hours
4
Q
fasting solid (fatty or fried foods)
A
8 hours
5
Q
0–6 months age specific anxiety
A
Maximum stress for parent Minimum stress for infants—not old enough to be frightened of strangers
6
Q
6 months–4 years age specific anxiety
A
Maximum fear of separation Not able to understand processes and explanations Significant postoperative emotional upset and behavior regression Begins to have magical thinking Cognitive development and increased temper tantrums
7
Q
4–8 years age specific anxiety
A
Begins to understand processes and explanations Fear of separation remains Concerned about body integrity
8
Q
8 years–adolescence age specific anxiety
A
Tolerates separation well Understands processes and explanations May interpret everything literally May fear waking up during surgery or not waking up at all
9
Q
Adolescence age specific anxiety
A
Independent Issues regarding self-esteem and body image Developing sexual characteristics and fear loss of dignity Fear of unknown
10
Q
if a child has a history of squatting what might there be a concern for?
A
asthma cardiovascular problems
11
Q
Sickle cell disease needs
A
hydration, possible transfusion
12
Q
The major objectives of pre-anesthetic medication are to
A
(1) allay anxiety (2) block autonomic (vagal) reflexes (3) reduce airway secretions (4) produce amnesia (5) provide prophylaxis against pulmonary aspiration of gastric contents (6) facilitate the induction of anesthesia (7) if necessary, provide analgesia.
13
Q
premedication decrease the stress response to anesthesia by preventing what
A
cardiac arrhythmia
14
Q
Factors to consider when selecting a drug or a combination of drugs for premedication include: 6 things
A
childs age idea body weight drug history and allergic status underlying medical or surgical conditions and how they might affect the response to premedication or how the premedication might alter anesthetic induction parent and child expectation the childs emotional maturity personality, anxiety level, cooperation, and physiologic and phychological status.
15
Q
diazepam oral dose rectal dose
A
0.1-0.5mg/kg 1mg/kg
16
Q
midazolam oral dose nasal dose rectal dose intramuscular dose
A
0.25-0.75mg/kg 0.2mg/kg 0.5-1mg/kg 0.1-0.15mg/kg
17
Q
lorazepam oral dose
A
0.025-0.05mg/kg
18
Q
ketamine oral dose nasal rectal IM
A
3-6mg/kg 3mg/kg 6-10mg/kg 2-10mg/kg
19
Q
benzodiazepines - as premedication- why do we use preservative free for nasal administration
A
due to fears of neurotoxicity
20
Q
recommended doses of anticholinergics are
A
atropine 0.01-0.02mg/kg scopolamine 0.005-0.010mg/kg glyco 0.01mg/kg
21
Q
why is atropine more commony used
A
blocks the vagus more effectively
22
Q
when is scopolamine better
A
sedative, antisialagogue and amnestic
23
Q
when is glycopyrrolate better to be used
A
sialorrhea associated with ketamine
24
Q
if a child is seated on a parents or anesthesiologist lap during induction what is strongly recommended
A
this should be undertaken when the child is wearing diapers or sitting on a thick blanket
25
how do you engage the child and help make them feel less vulnerable during induction
have the child pick out a favorite lip balm have them seated on the or table distract them by telling them to blow up the balloon and taking deeper and deeper breaths.
26
airway obstruction during anesthesia is due to
loss of muscle tone in the pharyngeal and laryngeal structures rather than apposition of the tongue to the posterior wall
27
extension of the head at the atlantooccipital joint with anterior displacement of the cervical spine sniffing position improves hypo pharyngeal airway potency but does not necessarily change the position of
the tongue
28
what is the most effective means to improve airway latency and ventilation in children undergoing adentonsillectomy
jaw thrust
29
what is the concern with laryngospasm in children
life threatening complications
30
what are the factors associated with laryngospasm
Age: greater in infants than older children and adults; the risk decreases with increasing age Recent URTI (\<2 weeks) History of reactive airway disease Exposure to second-hand smokeAirway anomalies Airway surgery Airway devices (tracheal tubes, LMA) Stimulating the glottis during a light plane of anesthesia Secretions in the oropharynx (e.g., blood, excess saliva, gastric juice) Inhaled anesthesia (desflurane and isoflurane) Inexperienced anesthesia provider
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if its a short or long pediatric case can you use regular rubing
no! just because its a short case you should never use regular tubing.
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If positive pressure ventilation, 100% oxygen, and jaw thrust maneuver fail to break the laryngospasm, further intervention should be undertaken before desaturation and bradycardia develop. Appropriate treatment would include in the following order
IV or IM atropine (0.02 mg/kg), IV propofol (1 mg/kg), and IV or IM succinylcholine (1 to 2 mg/kg IV or 4 to 5 mg/kg IM).
33
For third-space losses,
the replacement volume is based on the severity of the losses: 1 to 2 mL/kg/hr for minor surgery, 2 to 5 mL/kg/hr for moderate surgery, and 6 to 10 mL/kg/hr for major surgery and large third-space losses.
34
how much balanced salt solution should be administered to a child for every 1 ml of fluid lost.
Initial blood loss may be replaced with balanced salt solution at a rate of 3 mL of solution for every 1 mL of blood loss.
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parental anxiety may be most extreme with children what age?
\<12 mos
36
the fear of death is greatest in :
teenagers/ adolescent (13-19 yr o)
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in peds, the larynx has a higher position in
the neck.
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the narrowest portion of the larynx in ped patients
the cricoid cartilage (as opposed to the VC's in adults)
39
Full term neonates require higher or lower concentrations of volatiles than infants 1-6 mos of age do?
lower \*younger the greater their metabolic rate
40
MAC in preterm neonates increases or decreases with decreasing gestational age?
decreases
41
MAC steadily increases until what age:
2-3 mos
42
After 3 mos, MAC steadily
declines with age \*there is a slight increase at puberty
43
Neonates and infants require more succinylcholine on a ______ basis than do older children to produce similar degrees of neuromusculuar blockade b/c of :
-more sux per kilogram basis -the increased ECF volume and larger volume distribution
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sux is limited to cases requiring
RSI and tx of laryngospasm b/c of risks for bradycardia and MH
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uptake of inhaled anesthetics is more rapid in infants than older children or adults b/c of the infants
high alveolar ventilation relative to FRC
46
Protein binding of many drugs in decreased in infants which can result in
high circulating concentrations of UNBOUND and pharmacologically active drugs
47
as a group, low gestation age NB's have immaturity of all organ systems and represent the most vulnerable of all peds patients with the highest
morbidity and mortality
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surfactant is produced by
Type 2 pneumocytes
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surfactant does
reduces alveolar surface tension -helps maintain alveolar stabiltiy
50
RDS is apparent within
minutes of birth
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during anesthesia, arterial O2 saturation should be maintained near pts
pre-op levels \*100% before = 100% during
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goal HCT to optimize systemic O2 delivery
40% (but you might see something like 45%)
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excessive hydration should be avoided; so use colloids over crystalloids. whats the replacement ratio?
3:1
54
Bronchopulmonary dysplasia (BPD) is a form of
chronic lung disease of infancy
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the canalicular phase of lung development is at how many weeks?
24-26 weeks
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BPD is a clinical dx defined as
-O2 dependence at 36 weeks post conceptual age or -O2 requirement to maintain PaO2 \> 50mmHG beyond 28 days of life in infants with birth weights of less than 1500g
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BPD tx is to maintain oxygenation of: why? prevents and promotes what?
PaO2 \> 55 mmHG and O2 sat \>94% prevents cor pulmonale (RHF) and promote growth of lung tissue and remodeling of pulmonary vascular bed
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IN children w/a hx of mechanical ventilation, an ET one to one half size smaller than that predicted for age should be use because:
subglottic stenosis may be present
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in the preterm newborn, airway hyperreactivity is likely. what plane of anesthesia must be established before airway instrumentation?
deep plane
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in the preterm newborn, fluids should be administered judiciously to avoid
pulmonary edema
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This dx is a congenital or acquired condition of excessive flaccidy of the laryngeal structures; specifically the epiglottis and arytenoids
Laryngomalacia
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Laryngomalacia is associated with
-excessive flaccidy of the laryngeal structures -epiglottis -arytenoids
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Cause of Laryngomalacia
-lack of neural control of laryngeal muscles or - from pressure on the laryngeal cartilage which leads to inadequate laryngeal rigidity and thus structural collapse during inspiration and exhalation
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Bronchomalacia is seen in infants who had a prolonged stay
in the NICU
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Key Difference b/w Laryngomalacia and Bronchomalacia:
-Laryngomalacia: congential -Bronchomalacia: NICU exposure
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the cartilage of the major airways is weak, and when infants with this condition bear down, the airways can become partially/completely compressed. This is known as
bronchomalacia \*\*generally associated with BPD
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Retinopathy of prematurity (ROP) is a vasoproliferative retinopathy that occurs almost exclusively in
preterm infants in whom retinal vasculogenesis is incomplete
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Most cited cause of ROP is exposure to
elevated tension of oxygen -injuring the developing retinal capillaries
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Two phases of ROP:
phase 1 : oxygen toxicity to immature retina causes an arrest of normal vascularization phase 2: increased metabolic demand of the growing retina is met w/relative hypoxia caused by the paucity of blood vessels
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ROP is classified into 5 stages of severity. What are the mildest and most severe forms?
stage 1 - mildest. a clear demarcation b/w vascular and avascular portions of the retina. stage 5 - most severe. complete retina detachment
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TX for ROP
transscleral cryotherapy and laser photocoagulation
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Cause for the most anxiety\*\*\* in children age 1-5yrs
Shy temperament
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Just as RDS is a result of immaturity of the pulmonary system, apnea of prematurity (AOP) is a result of immaturity of the respiratory control centers in the newborn
brainstem
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primary AOP (apnea of prematurity) versus central AOP. difference?
Primary - respiratory Central - neurological
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the mainstay of drug therapy for AOP
Methylxanthines
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Various forms of methylxanthines used include
aminophylline, caffeine, and caffeine citrate
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Postanesthetic apnea is seen mostly in infants born
preterm (where preterm birth is defined as birth at \<37 weeks of gestation)
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one of the most significant risk factors for postanesthetic apnea
a hematocrit of less than 30%
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the most common metabolic problem occurring in newborn infants \*\*\*
Hypoglycemia is
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Many neonates whose serum glucose levels are at or just below the lower limits of the normal range are
asymptomatic
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hypoglycemia in Infants with symptoms other than seizures should receive
an intravenous bolus of 2 mL/kg (200 mg/kg) of 10% dextrose.
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If the hypoglycemic infant is experiencing convulsions, they should receive
an intravenous bolus of 4 mL/kg of 10% dextrose
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Neonates risk factors for intraoperative hypoglycemia include:
-neonates who are are less than 48 hours old, -premature, or -small for gestational age, and in -those born to diabetic mothers,
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for the preterm nb - Maintenance fluid requirements may be met with a glucose-containing solution of 5% dextrose in 0.2 normal saline 4 mL/kg/hr or 10% dextrose in water 2 to 3 mL/kg/hr to prevent intraoperative
hypoglycemia
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Serum glucose concentrations in excess of 125 mg/dL can result in osmotic diuresis from glucosuria with subsequent dehydration as well as further release of insulin leading to
rebound hypoglycemia
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• Hypocalcemia occurs in newborns for a variety of reasons, and in many cases, ionized calcium is decreased even as total calcium remains
within normal limits
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• The clinical manifestations of hypocalcemia include
irritability, jitteriness, seizures, and lethargy
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\*\*Treatment with intravenous calcium should be considered for newborns who have
hypotension without an obvious cause
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o Cases of bradycardia and even asystole have been seen with rapid intravenous administration
of calcium\*\*\* IV Calcium should be given over 5-10mins
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o Intraoperative metabolic derangements such as alkalosis from hyperventilation and sodium bicarbonate administration can lead to hypocalcemia by
causing albumin binding of calcium that decreases ionized calcium concentration
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Hypotensive effects of citrate-induced hypocalcemia can be minimized by administering how much calcium gluconate for each milliliter of blood transfused??
(1 to 2 mg IV) / for each mL of blood transfused
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CDH - The most common findings include displacement of the
heart and fluid-filled gastrointestinal segments into the thorax - both stomach and bowel are often present
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CDH - These infants can have profound hypoxemia, which reflects the
RIGHT -TO-LEFT shunting through the ductus arteriosus; the cause is persistent fetal circulation resulting from lung parenchymal and vascular hypoplasia with resultant high pulmonary vascular resistance.
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For patients with CDH, Adequate sedation is achieved in an effort to minimize increases in
pulmonary vascular resistance
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Apnea of Prematurity is diagnosed if an infant exhibits
•apnea of longer than 15 to 20 seconds, -apnea associated with a heart rate of less than 80 to 100 beats per minute, or -apnea associated with significant decreases in oxygen saturation
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Intraoperative oxygen saturation goals for preterm infants undergoing surgery have well established guidelines, True or false?
False there are no established guidelines for specific intraoperative oxygen saturation goals
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For CDH - Venous access should be avoided in the
lower extremities, because venous return may be impaired as a result of compression of the inferior vena cava following reduction of the hernia \*\*\*
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with CDH is N2O okay to use?
Nitrous oxide should be avoided, because its diffusion into loops of intestine present in the chest may result in distention with subsequent compression of functional lung tissue (we don’t want NO to expand in a closed space)
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the most frequent congenital anomaly of the esophagus \*\*\*
Esophageal atresia (EA) is
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For EA - what should be avoided?
Endotracheal intubation is avoided, if possible, because of the potential to worsen distention of the stomach, which can lead to gastric rupture
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For EA - Awake intubation with spontaneous ventilation allows
optimal positioning of the endotracheal tube while minimizing the risk of ventilatory impairment associated with gastric distention resulting from positive pressure ventilation and passage of gases through the fistula
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with EA - Proper placement of the tracheal tube is critical; it should be above the carina but below
the TEF (fistula)\*\*\*
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EA - Intraoperative insensible and third-space fluid losses should be replaced with crystalloid at a rate of
6 to 8 mL/kg/hr
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EA - Blood loss may be replaced with 5% albumin and packed red cells to maintain a hematocrit of higher
than 35%\*\*\*
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Gastroschisis requires urgent
repair
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If inspiratory pressures are greater than _______ primary closure is not recommended
25 to 30 cm H2O or intravesical or intragastric pressures are greater than 20 cm H2O,
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In Hirschsprung's Disease Anesthesia can be maintained with a mixture of
air, oxygen, volatile agent, and muscle relaxant.
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In Hirschsprung's Disease Anesthesia Extra care should be taken in positioning, since these operations can be
quite lengthy
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In Hirschsprung's Disease Extubation at the end of surgery is
routine \*\*\*
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in Anorectal Anomolies, Intravenous catheters should be placed in upper extremities, because
surgical positioning of the legs may impede venous flow or limit access to the intravenous catheter insertion sites
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for an anorectal anomolies with significant abd distention, what type of intubation should be employed?
RSI
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one of the most common gastrointestinal abnormalities appearing in the first 6 months of life
Pyloric stenosis
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Initial tx of Pyloric Stenosis is aimed at repletion of IV Volume, electrolyte correction and Acid/Base abnormalities. Further resuscitation is given as
5% dextrose in 0.45% NaCl at 1.5 times the maintenance rate
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for patients with pyloric stenosis, what is the preferred induction plan?
-awake intubation or by use of -RSI after administration of hypnotic and succinylcholine
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Early signs and symptoms of this disease are often nonspecific and include recurrent apnea, lethargy, temperature instability, and glucose level instability.
Necrotizing Enterocolitis (NEC)
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NEC - Surgery is reserved for neonates for whom medical management fails, as evidenced by
bowel perforation, sepsis (peritonitis), and progressive metabolic acidosis indicating bowel necrosis
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Intraoperative care of a critically ill newborn w/NEC is often more a resuscitation effort than management of
general anesthesia \*\*\*
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for the infant with NEC, if not already intubated, induction should proceed with full-stomach precautions and awareness of the infant's
depleted intravascular volume and possible impaired contractility
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For NEC - Maintenance of anesthesia is generally limited to the use of
short-acting iv opioids (fentanyl) as tolerated, muscle relaxation, and replenishment of intravascular volume as needed
120
cornerstone TX for biliary atresia is a Kasai's operation (portoenterostomy) and what?
liver transplantation
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in biliary atresia liver function is down. thus, the pre-op evaluation and correction of what is important?
coagulolpathy -vit k may be given 1-2 days before the scheduled procedure
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Congenital lobar emphysema is the postnatal over distention of an otherwise normal lobe of the lung that compresses
adjacent normal lung units and leads to atelectasis
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in congenital diseases that lead to air trapping, what element of anesthesia management is avoided in their management?
positive pressure would cause barotrauma and collapse of alveoli
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o The recommended induction technique for infants with either congenital lobar emphysema or congenital cystic adenomatoid malformations is
inhalation with sevo and oxygen -w/o, if possible, any positive pressure
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for infants with either congenital lobar emphysema or congenital cystic adenomatoid malformations maintenance anesthesia plan includes:
spontaneous breathing with minimal pos. airway pressures
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for infants with either congenital lobar emphysema or congenital cystic adenomatoid malformations at induction WHO should be present ?
surgeon should be at induction in the event sudden decompensation warrants urgent thoracotomy
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Meticulous attention must be paid to avoidance of nerve and other compression injuries during positioning \*\*\* (usually lateral decubitus with the infant's ipsilateral arm placed directly over the head) for infants with what disease processes (2);
for infants with either congenital lobar emphysema or congenital cystic adenomatoid malformations
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most common type of cerebral palsy is
spastic cerebral palsy
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Administration and dosing of muscle relaxants should be done with caution, because these patients generally have prolonged recovery from neuromuscular blockade. this is true for what patients?
those with CP
130
CP is commonly associated with
seizure d/o -some children may be given antiepileptic medications even in the absence of seizures for tx of spasticity and behavior
131
what medication is an important adjunct in managing pain r/t muscle spasm?
Diazepam
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hydrocephalus results from
overproduction impaired circulation \*\*underabsorption of CSF
133
The most common cause of congenital hydrocephalus is
impaired circulation or obstruction of flow caused by structural abnormalities such as stenosis of the aqueduct of Sylvius, tumors, malformations (Chiari's malformation, Dandy-Walker malformation), and trauma-related defects
134
although this remains controversial in children with congenital hydrocephalus, Medical therapy mainly consists of
diuretic treatment (furosemide and acetazolamide decrease CSF production),
135
Volatile agents are potent cerebral vasodilators and increase ICP by
increasing cerebral blood flow \*\*\* (Isoflurane does it the least)
136
in patients with hydrocephalus what should our anesthesia mgmt plan consider (in regards to ICP)?
-KETAMINE is contraindicated -Volatiles are potent cerebral vasodilators and increase ICP by increasing CBF. -Succ may be used (transient and attenuated by "defasciulating" dose)
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for the patient with spina bifida, a comprehensive preoperative assessment is needed to identify specific anesthetic risks, because myelomeningoceles are often associated with
other congenital anomalies \*\*\*
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In the case of spina bifida, Tracheal extubation must take place only after the patient has
regained adequate spontaneous respiratory effort and ventilation \*\*\*
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Craniosynostosis is defined as premature closure of
one or more cranial sutures
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Four major sutures separate these bone plates: \*\*\*
(1) metopic suture separates the frontal bones (2) sagittal suture separates the parietal bones (3) coronal suture separates the frontal from the parietal bones (4) lambdoid suture separates the parietal bones from the occipital bone
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in the management of craniosynostosis, should N2O be used or avoided?
avoided
142
for crainiosynostosis what should be available, in the OR, before skin incision
blood products
143
feeding difficulty is universal with this anomaly
cleft lip & palate
144
Cleft lip repair is typically performed between 6 and 12 weeks of age, whereas cleft palate repair is done at
a later age, between 9 and 14 months \*\*\*
145
A universal feature in congenital mandibular hypoplasia is airway compromise resulting from the constricted
mandibular space with resultant glossoptosis (posterior prolapse of the tongue) \*\*\*
146
Pierre Robin , consists of three congenital orofacial abnormalities:
1. micrognathia (small mandible) or retrognathia (posterior displacement of mandible), 2. glossoptosis, 3. cleft palate (present in almost all cases)
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Hemifacial microsomia is the one of the most common congenital facial anomalies (second only to cleft lip and palate) It is a facial asymmetry disorder that _____ affects bone, muscle, and soft tissue structures
unilaterally
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Treacher Collins syndrome is a rare craniofacial anomaly with an autosomal dominant disorder mode of inheritance and variable expression There is \_\_\_\_\_and ______ underdevelopment of structures deriving from the first and second pharyngeal arch, groove, and pouch leading to hypoplasia of the supraorbital rims, zygoma, midfacial bones, and mandible as well as ear deformities and cleft palate
bilateral and symmetric
149
Patients with mandibular hypoplasia, especially in association with Treacher Collins syndrome and hemifacial microsomia, not only are difficult to intubate but may be nearly impossible
to mask ventilate \*\*\*
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The classic presentation of acute epiglottitis is that of a toxic-appearing, agitated child with a high fever and the so-called 4 Ds:
dysphagia, dysphonia, dyspnea, and drooling
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in epiglottitis o Inspiratory stridor is a late feature and should alert the practitioner to
impending complete upper airway obstruction
152
All experts now recommend routine administration of this drug in the treatment of croup
corticosteroid
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The most important anesthetic consideration in postintubation laryngeal edema is its
prevention \*\*\*
154
Dysphonia or change in voice quality (or altered cry in infants) is often the first and most prominent symptom of
laryngeal Papillomatosis
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Laryngeal papillomatosis is one of the most common causes of
hoarseness and airway obstruction in children
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rare congenital abnormalities in the separation between the posterior laryngotracheal wall and the adjacent esophagus
Laryngeal clefts
157
Laryngeal clefts are graded according to
* level of involvement, ranging from type I (interarytenoid defect superior to the true vocal folds) to type IV
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What are the typical manifestations of laryngeal clefts
* Stridor, choking, and regurgitation
* should be considered in any child with a history of feeding problems in association with respiratory complaints
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In management of Anesthesia for patients with Laryngeal Clefts what dictates the anesthetic technique?
The safety of the patient ultimately dictates the anesthetic technique
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\_\_\_\_\_\_\_\_\_\_\_ remains the gold standard in the diagnosis of laryngeal clefts
Microlaryngoscopic examination
161
Macroglossia is
* true enlargement of the tongue
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Symptoms of Macroglossia are
* Drooling, speech impairment, failure to thrive and stridor, with airway obstruction being the most feared consequence
* The child's ability to swallow, breath, and speak may be impaired to varying degrees depending on the extent of macroglossia
* Taste sensation may also be affected and cause feeding aversions
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In a pediatric patient with laryngeal cleft _____________ under general anesthesia is optimal for endoscopic examination because spontaneous movement of the vocal cords and surrounding structures is maintained
Spontaneous ventilation
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In a patient with macroglossia, management of anesthesia will entail
* Preparations for a difficult airway must be made for any child with macroglossia coming for surgery
* Induction of anesthesia may occur _only **after** endotracheal intubation_, because the **_tongue is both enlarged and relatively fixed in position_**
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\_\_\_\_\_\_\_\_\_\_\_\_ is the most common cause of snoring in children.
Adenotonsillar hypertrophy
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While daytime sleepiness is frequently reported in adults with obstructive sleep apnea, children will present with?
nonspecific behavioral difficulties such as **hyperactivity** and **learning disability**
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Adenotonsillar hypertrophy in association with obstructive sleep disorder is **NOT** a contraindication to administering preoperative anxiolytic medication. **True/False?**
**True**
168
In a patient with Adenotonsillar Hypertrophy, induction is ussually accomplished by?
Induction of general anesthesia is usually accomplished with inhalation of sevoflurane and oxygen with or without nitrous oxide
169
In anesthesia of a patient with Adenotonsillar Hypertrophy _\_\_\_\_\_\_\_\_\_\_\_\__ is often needed to counteract the effects of a reduced upper airway muscle tone.
_Moderate continuous positive pressure_
170
In anesthesia of a pediatric patient with Adenotonsillar hypertrophy the most preffered ett is ?
* _Cuffed endotracheal tubes_ may be **preferable** to uncuffed tubes to minimize the chance of aspiration of blood
171
* If intubation is required in a patient with upper Respiratory Tract Infection
* **_Trachea should be instrumented only under a deep plane of anesthesia _**
* A **_smaller_** _than expected endotracheal tube_ should be considered, because children with active or recent URI have a _higher incidence of postintubation laryngeal edema_
172
* Dexamethasone may also be given prophylactically with URIs to reduce
postintubation croup
173
* Vesicoureteral Reflex (VUR) is diagnosed based on evidence of contrast reflux and is graded into one of five levels of severity:
* _Grades I and II_ are considered **mild**, _grade III moderate_, and _grades IV and V_ **severe**
* * The most severe cases of **VUR (grade V)** _rarely resolve_
_without surgical intervention \*\*\*_
174
Developmental Dysplasia of the Hip
* During spica casting, infants are often elevated on a wood frame for cast application
Particular attention must be paid to securing any airway device and preventing
accidental fall from the wood frame
175
in thoracic insufficiency syndrome, _Surgery_ should be **_postponed_**
_if any acute respiratory illness is present_, since most patients already have compromised respiratory functions
176
* **Early assessment of postoperative neurologic function is important for patients who underwent VEPTR procedure due to what d/o?**
Thoracic insufficiency Syndrome
177
patients with idopathic juvenile arthritis, what are some reasons for anesthetic concerns for difficult airway?
* C.Spine mobility - check ROM
* TMJ - limits mouth opening
* can be compounded by micrognathic mandible
* Systemic complications such as pleuritis and pericarditis that affect periop cardiopulmonary funtion
178
* What is the _most common type of renal cancer in children_ as well as the most common pediatric abdominal malignancy \*\*\*
Wilms's tumor, or nephroblastoma,
179
with a Wilm's Tumor, the most common finding is
an abdominal mass that may or may not be painful
180
Wilm's tumor post op pain management recommendation
* **Continuous epidural analgesia** provides _excellent postoperative pain control_
181
* Hepatoblastoma is the most common pediatric hepatic
* Tumors are typically unifocal and affect which side/lobe more often?
**_right_ lobe more often** than the left lobe
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* Coagulation status must be determined, and appropriate blood components reserved preoperatively, especially since hepatic resections are often associated
with _significant bleeding_ \*\*\*
183
* Hallmark of neuroblastoma is the broad range of tumor
location and clinical behavior
184
* Neuroblastoma refers to a group of malignant neoplasms of the
sympathetic nervous system (SNS)
* These tumors can occur anywhere throughout the SNS
* The most common site is the adrenal glands (40% of cases), followed by abdominal, thoracic, cervical, and pelvic sympathetic ganglia
185
* The _most important consideration_ in the perioperative care of patients with Ewing's sarcoma is
**_pain control \*\*\*_**
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* Anesthetic management for tumors of the CNS is aimed at
_limiting further increase in ICP and preserving cerebral perfusion \*\*\*_
187
* the **_most common chromosomal abnormality \*\*\*_**
Down's syndrome is
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* in Down's Syndrome - Macroglossia compounded by potential micrognathia and midface hypoplasia predispose these children to rapid airway obstruction and hypoxemia with induction of anesthesia
* **Oral airways** _should_
_always be available_ to help in reestablishing airway patency \*\*
189
* The presence of atlantoaxial instability may not be apparent, because most patients are asymptomatic
* The parents should be questioned specifically about symptoms suggestive of **atlantoaxial subluxation**, such as
_neck pain, head tilt, and abnormal gait._
190
MH triggers
volatile anesthetic agents
succinylcholine
\*\*N2O is NOT
191
* MH Time of onset is also variable; some have immediate reactions upon exposure to triggers and others do not manifest _signs and symptoms of MH until well into the postoperative period_
* * (May not appear until they are in recovery: TRUE or FALSE?
TRUE
192
* _Calcium channel blockers_ are **contraindicated** in tx of MH because they can
_worsen hyperkalemia \*\*\*_
193
* All patients with clinical MH or signs of anesthesia-induced hypermetabolism as well as those with significant masseter spasm should undergo the
**_caffeine-halothane contracture test_** \*\*\* (Gold standard test for MH)
194
* _Preoperative dantrolene_ prophylaxis is _not indicated \*\*\*_
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