FINAL 3

Question 1

Acute bacterial infection involving lingular surface of epiglottis, aryepiglottic folds, and aretynoids.

Answer 1

Epiglottitis

Question 2

Another name for Epiglottitis is

Answer 2

Acute Supraglottis

Question 3

Is Epiglottis life threatening?

Answer 3

Yup

Question 4

4 Ds of Epiglottis

Answer 4

Dysphagia
Dysphonia
Dyspnea
Drooling

Question 5

Epiglottitis starts as

Answer 5

sore throat and dysphagia with thick, muffled voice

Question 6

Classic presentation of epiglottis

Answer 6

child sitting, dyspneic, mouth open, drooling, forward chin thrust, tripod position

Question 7

Induce Epiglottitis with ____ and _____

Answer 7

Sevo and oxygen

Question 8

Dose for atropine

Answer 8

0.02mg/kg

Question 9

Fluid bolus epiglottis pts with

Answer 9

20-30ml/kg

Question 10

Epiglottitis…ETT should be ________ than usual

Answer 10

1-2x smaller

Question 11

______ confirms epiglottitis diagnosis

Answer 11

cherry red edpiglottis

Question 12

Do you want to use muscle relaxants with epiglottitis?

Answer 12

nope- contraindicated, relaxation of pharyngeal muscle could block laryngeal airway

Question 13

Epiglottitis- maintain _______pressure ( ____ cmH20) to minimize collapse of airways.

Answer 13

positive pressure (10-15cm H2O)

Question 14

Epiglottitis. After stabilized, child may be sedated for _____hours to prevent extubation.

Answer 14

24hours

Question 15

Epiglottitis. Have emergency _____ kit available during intubation and and ____ doc around.

Answer 15

trach

ENT

Question 16

Abnormality of the POSTERIOR fossa causing cephalad displacement of the cerebellum through the formamen magnum

Answer 16

Chiara malformations

Question 17

What type of chiari malformation?
Caudal herniation of vermis, brainstem, and 4th ventricle. Associated with myelomeningocele and other anomilies. “ARNOLD CHIARI MALFORMATION”

Answer 17

Type 2

Question 18

What type of chiari?
Tonsillar herniation >5mm below the plane of the foramen magnum. No associated brainstem herniation or supratentorial anomalies. Low frequency of hydrocephalus.

Answer 18

Type 1

Question 19

What type of chiari?
Most severe.
Occipital encaphalocele containing dysmorphic cerebellar and brainstem tissue

Answer 19

Type 3

Question 20

What type of chiari?
Hypoplasia or aplasia of the cerebellum
“absent cerebellum”

Answer 20

Type 4

Question 21

What is the most common pediatric neurosurgical condition?

Answer 21

Hydrocephalus

Question 22

What happens with hydrocephalus?

Answer 22

Mismatch of CSF production and absorption, leading to increased intracranial CSF volume.

Question 23

Most hydrocephalus is due to (2 things). With the exception of _____

Answer 23

Obstruction
Inability to absorb CSF
Exeption: Choroid Plexus Papillomas

Question 24

Hydrocephalus is caused by (5 things)

Answer 24

Congenital Cause (like aqueductal stenosis)
Hemorrhage
Trauma
Infection
Tumors

Question 25

Classification of Hydrocephalus is based on______ ______________ 2 classifications

Answer 25

``` the ability of CSF to flow around spinal cord 1 Nonobstructive (communicating) 2 Obstructive (Noncommunicating) ```

Question 26

Treatment of hydrocephalus (2)

Answer 26

1. Treat cause (etiology) | 2. Surgical placement of ventricular drain or V-P shunt

Question 27

Most shunts carry CSF from ______ to _______

Answer 27

lateral ventricles to peritoneal cavity

Question 28

Anesthetic plan with Hydrocephalus Control ____ and relieve _______ Increased ICP increases risk for ______and ______ Avoid _______ (induction drug) Avoid _________(ventilation) Risk of ____ during placement of distal end of VP shunt

Answer 28

Control ICP and relieve obstruction Increased ICP increases risk for vomiting and aspiration Avoid Ketamine Avoid Hyperventilation Risk of VAE during placement of distal end of VP shunt

Question 29

Mannitol is used to treat i_______

Answer 29

increased ICP

Question 30

PO dose of midazolam and onset time

Answer 30

0.5-1mg/kg 10-20mins

Question 31

IV dose of midazolam

Answer 31

0.05mg/kg

Question 32

Art line- transduce at level of the

Answer 32

head

Question 33

Contraindications to nasal intubations

Answer 33

choanal stenosis possible basilar skull fracture transsphenoidal procedures sinusitis

Question 34

Ensure free _____ movement during prone positioning

Answer 34

abdominal

Question 35

VP shunts, temporal & parietal craniotomies will use what position

Answer 35

modified lateral

Question 36

Posterior fossa & spinal cord surgery will use what position?

Answer 36

Prone

Question 37

What position may be used in morbidly obese

Answer 37

Sitting

Question 38

2x MAC of isoflurane can cause

Answer 38

isoelectric EEG

Question 39

Volitile agents and vasodilators ___ CBF and ICP

Answer 39

increase

Question 40

Fentanyl dosage- loading and maintenance.

Answer 40

5-10 mcg/kg with 2-5mcg/kg/hr for maintenance

Question 41

Most blood loss begins at the ____ of neurosurgery

Answer 41

beginining

Question 42

VAE risk is greatest in the ____ position

Answer 42

sitting

Question 43

VAE Sx is sudden decrease in

Answer 43

ETCO2

Question 44

What is the most specific method to detect VAE

Answer 44

Echo

Question 45

VAE- use precordial dopper to monitor ___ sounds

Answer 45

RH

Question 46

VAE- The larger the press gradient between ______ site and ______ the greater the risk for air embolism

Answer 46

The larger the press gradient between operative site heart, the greater the risk for air embolism

Question 47

``` Put these in order from most sensitive to least sensitive for detection of air embolisms. ECG Systemic Blood Pressure ECHO ETCO2 ET-Nitrogen Respiratory Pattern Esophageal Stethoscope Right Atrial Pressure Precordial Doppler ```

Answer 47

``` Precordial Doppler Echo ET-Nitrogen ETCO2 RAP SBP Esophageal Stethoscope Respiratory Pattern ECG ```

Question 48

ETCO2 will _____ after VAE

Answer 48

Decrease

Question 49

Treatment for VAE- To prevent entrainment of air

Answer 49

``` Flood Field with Saline Bone Wax to exposed bone edges D/C N20 T-Burg Occude IJV, but don't occude carotid PEEP to Increase CVP Aspiration of air from CVP line- rarely works ```

Question 50

Emergence from neurosurgical anesthesia- avoid ___ to avoid _____ ICP. Also give Lidocaine ______mg/kg to help suppress____

Answer 50

vomiting increased 1.0-1.5mg/kg coughing

Question 51

Dose for Labetelol in adolescents | ____ with the use of esmolol in infants d/t _____

Answer 51

0.1-0.4mg/kg IV q 5-10 mins | Caution- HR dependent from CO

Question 52

Do you want to deep extubate neurosurgery patients?

Answer 52

Nope- Adequate spontaneous ventilation, oxygenation and wakefulness required before extubation