Part 2: Pediatric Anesthesia: Overview

Question 1

Consideration for pyloric stenosis?

Answer 1

• Averages 3-4 weeks
• Increased smooth-muscle fibers in the pylorus … present at birth
• Hypokalemic/hypochloremic alkolotic dehydration
• Adequate hydration and electrolyte replacement…Never an EMERGENCY
• Induction- make sure stomach empty, intubate, relaxation, adequate

Question 2

Consideration for diaphragmatic hernia?

Answer 2

• Onset within first few minutes to hours after birth.
• Large hernias cause development left lung Primary problem is resultant R>L shunt
• Life threatening event = pneumothorax, 20% cardiac abnormalities
• Correct acid – base problems, watch, airway pressures should be carefully managed to avoid barotrauma and new or persistent pneumothorax
• Careful vent, intubate, chest tube, NG tube,

Question 3

Consideration for omphalocele/gastrochisis?

Answer 3

• Omphalocele- GI contents remain in umbilical sac (better chance to close)
• Gastrochisis- GI contents herniate freely through the abdominal wall
• Heat loss; fluid loss (gastro>omph);
• Pressure against the diaphragm
• Pressure on the vena cava

Question 4

Consideration of tracheoesophageal fistula?

Answer 4

• Esophageal atresias – Abdominal defect may be large or small
• Airway management – mask ventilation, intubate, place ETT, avoid gastric distention
• Risks: Coughing/gag/resp distress, pneumonitis, gastric distention, cardiac abnormalities
• Portion of esphogas with fistula removed

Question 5

Consideration of epiglottitis/anesthesia?

Answer 5

• Go to Emergency Room
• NO ONE should upset or try to examine child if epiglottis is the diagnosis
• NO examination of airway, NO trip to X-ray
• Child should go directly to O.R.
• Sitting inhalation induction with 100% O2
• Oral tube should be used; then changed to nasal if desired
• “Accidental extubation” is almost always FATAL

Question 6

Consideration of Croup anesthesia?

Answer 6

• Also called “laryngotracheobbronchitis”
• Medical treatment is with nebulized racemic epinephrine
• Tracheostomy is preferred treatment since prolonged intubation has high incidence of subglottic stenosis

Question 7

Consideration of cleft lit/palate?

Answer 7

• Use RAE tube, table midline (ref for surgeon)
• Extubation must be done without need to manipulate surgical repair or instrument the airway
• No cough on extubation (laryngospasm), gently suction, triple airway maneuver, first few breath extubated critical

Question 8

Consideration of V-P Shunts?

Answer 8

• Intubation because of head shape

Question 9

Consideration of neurofibromatosis?

Answer 9

• Fibromatous nodules that arise from the nerve sheaths all over the body. Anesthesia concerns
o Location of other fibromas than those operated upon and their significance
o Increased blood loss - ? etiology

Question 10

Consderation of fractures and full stomachs?

Answer 10

• All should be considered full stomach and no waiting period is safe
• Rapid sequence induction and intubation followed by O.G. decompression is always safest