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AS - N934 Advanced Principles II > Pediatric Anesthesia > Flashcards

Pediatric Anesthesia Flashcards

(55 cards)

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1
Q

Otorhinolaryngology

A

Head & neck

OHN/ENT

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2
Q

Tonsillectomy & Adenoidectomy

A

T&A
Chronic lymphoid tissue inflammation & hypertrophy in the pharynx
Surgical intervention to relieve the obstruction & remove the infection focus
3rd most common surgical procedure

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3
Q

Common Tonsillitis Causes

A 
Streptococcus
Viral agents (adenovirus, influenza, Ebstein-Barr, parainfluenza, enteroviruses)
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4
Q

Tonsillitis S/S

A

Inflammation & swelling → respiratory obstruction

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5
Q

What’s currently the most common indication for T&As in America?

A

OSA 80% → chronic airway obstruction, CO2 retention, cor pulmonale, FTT, & speech abnormalities
Infection 20%

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6
Q

Considerations to admit T&A postop:

A 
< 3yo
Abnormal bleeding tendencies
Significant OSA
Airway abnormalities
Other systemic diseases
Excessive distance from hospital
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7
Q

Tonsillectomy Recommendations

A 
Dexamethasone 0.5mg/kg IV
NO periop Abx
Adequate pain management
- Avoid Codeine
- Ketorolac?
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8
Q

T&A Intraop Considerations

A

Standard induction
- Oral RAE cuffed ETT (consider reinforced)
- LMA
- Secure midline
Rotate HOB 45-90°
Mouth gag (requires stimulating jaw thrust)
- Adequate anesthesia
- Re-evaluate airway to ensure correct placement
- Throat pack in/out
Muscle relaxants okay
Relatively quick operation

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9
Q

T&A Analgesic Management + Dosages

A 
Fentanyl 1-2mcg/kg
Tylenol 10-15mg/kg IV
Dexamethasone 0.5-1mg/kg
Ondansetron 0.1mg/kg
Dexmedetomidine 0.1-0.5mcg/kg
Ketorolac or Ibuprofen
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10
Q

Tonsillectomy Methods

Cold Steel

A

Stainless steel scissors & scalpels
Toothed forceps & herd’s dissector/retractor used to dissect the tonsil tissue from its capsule
↑pain & hemorrhage risk

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11
Q

Tonsillectomy Methods

Electro-Dissection

A

Mono-polar or bipolar whole tonsil dissection
Cautery up to 300-400°C to induce hemostasis
Lateral thermal damage ↑postop pain & discomfort
Kinetic energy heats the intracellular & extracellular fluids & ruptures localized tissue cells

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12
Q

Tonsillectomy Methods

Microdebrider

A

Soft tissue shaver
90-95% tonsillar tissue removed (risk to return)
Natural biological dressing left in place over the pharyngeal muscles, preventing injury, inflammation, & infection
↓blood loss & pain

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13
Q

Tonsillectomy Methods

Coblation

A

Cold ablation
Energy used in plasma field to break the molecular bonds to excise or dissolve soft tissue at 40-70°C
Maintains surrounding tissue integrity
Provides dissection, cautery, suction, & hemostasis
Quick, precise, & smooth procedure

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14
Q

Tonsillectomy Methods

Radio Frequency

A

Cost-effective, easy to use, & time-saving alternative to laser
Mono polar radio frequency transferred via inserting probe into the tonsil tissue in 3-4 settings
Produces tonsil tissue scarring → reduces size

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15
Q

Tonsillectomy Methods

Laser

A

CO2 & KTP lasers
↓bleeding, pain, & discomfort
↑postop pain & 2° hemorrhage (bleeding after the scab formed or > 24hrs postop)

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16
Q

T&A Emergence

A

Laryngospasm, aspiration, & airway reactivity risk
OG to empty the stomach
Awake (able to protect airway) vs. deep extubation
Soft suction & prevent coughing
Recovery position - lateral w/ head down (allows blood to brain away from vocal cords)

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17
Q

What S/S present in children w/ restless?

A

Airway compromise or hypoxia

Careful opioid administration

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18
Q

Post-Tonsillectomy Bleeding

A

S/S include abdominal pain (especially w/ PONV prophylaxis)
1° hemorrhage w/in 24hrs
2° hemorrhage > 24hrs (5-10 days)
Ensure adequate IV access x2
Vigorous resuscitation to treat hypovolemia
Hemodynamic instability on induction
Labs: Hgb/Hct, type & cross, coags
RSI Propofol or Ketamine + Succinylcholine 2mg/kg IV
OG to empty stomach (blood)

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19
Q

Bilateral Myringotomy & Tympanostomy

A

BMT
Chronic otitis media common in young children → hearing loss & cholesteatoma formation
Myringotomy - creates an opening in the tympanic membrane to allow fluid to drain
Tympanostomy - ventilation tube placement w/ lumen to alleviate pressure from the middle ear & serves as stent to allow continual drainage until the tube are naturally extruded in 6mos-1yr

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20
Q

BMT Anesthetic Considerations

A

Often patients present w/ URI (reason they’re getting the surgery)
Short operation
Consider rectal Tylenol > PO Midazolam (outlasts the procedure)
Mask-only case
Place IV only when another procedure being done
Discontinue Sevo when turn to 2nd side

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21
Q

Myelodysplasia

A

Most common CNS defect that occurs during the 1st month gestation
Spina bifida - failure the neural tube to close resulting in the spinal cord & meninges herniating through a defect
Meningocele - contains ONLY meninges
Myelomeningocele - contains meninges & neural elements
Hydrocephalus often present & paralysis below the lesion
URGENT repair required w/in 24-48hrs d/t infection risk or worsening cord function

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22
Q

Myelodysplasia Risk Factors

A

Folate deficiency

Chromosomal abnormalities

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23
Q

Where does myelodysplasia most commonly occur (the region)?

Study These Flashcards
A

Lumbosacral region

24
Q

Myelodysplasia Repair

Anesthetic Considerations

Study These Flashcards
A 
Preop
- Assess lesion level & deficit
- Systems review & r/o additional congenital anomalies
- Labs:  CBC & type + screen
Intraop
- Routine monitors
- Avoid muscle relaxation when MEPs
- Supine or lateral for induction
- Prone to perform surgery
- Inhalational or IV induction
- Blood loss dependent on defect size
- Prone to hypothermia
- Latex free OR
Postop
- Goal to extubate
- Apnea monitoring
25
Hydrocephalus
Excess CSF builds-up w/in the fluid-containing ventricles | Hydro meaning water & cephalus meaning head
26
Hydrocephalus Causes
``` Congenital defect (Arnold-Chiari aqueduct stenosis) Acquired disease - trauma, infection, or tumor ```
27
Ventriculoscopy
Fiberoptic scope inserted via cranial burr holes to visualize lateral, 3rd, & occasional 4th ventricle Shunts also able to be positioned under U/S guidance
28
Ventriculo-Peritoneal Shunt
VP shunt Lateral ventricle → peritoneum *Most common Allows room for growth
29
Ventriculo-Atrial Shunt
VA shunt | Lateral ventricle → R atrium
30
Endoscopic 3rd Ventriculostomy
ETV | Burr hole created in the 3rd ventricle floor allowing CSF to flow directly into the basal cisterns
31
CSF Shunt Creation | Anesthetic Considerations
``` Preop - Assess baseline neuro status & ICP - Avoid premeds when ↑ICP - Assess vomiting history & dehydration - Review previous anesthesia records (repeat shunt revisions) - PIV x1-2 Induction - Standard monitoring - Fentanyl, Propofol, & Rocuronium - Isoflurane or Sevoflurane - GETA - Protect & pad the eyes - Cefazolin 30mg/kg IV ```
32
VP Shunt | Anesthetic Considerations
``` Maintenance - Avoid hyperventilation - Maintain paralysis or bolus Propofol when tunneling - VA shunts caution air embolism or PPV when vein open Emergence - Reverse paralytic - Antiemetics - Extubate - Neuro assessment ```
33
Humerus Fracture | Types
Proximal - break in upper part near shoulder Mid-shaft - break in the middle Distal - break occurs near the elbow (usually more complex elbow injury involving loose bone fragments)
34
Supracondyle Humerus Fractures
Most common elbow fracture in children Result from falling w/ an outstretched hand & extended elbow Complications include compartment syndrome, nerve palsies, & late deformities
35
Humerus Fracture | Anesthetic Considerations
``` Supine w/ HOB rotated 90° GETA Assess NPO status & RSI indications Pinning 30-60min Open reduction 30-90min Emergence timing based on cast or splint placed after closing ```
36
Scoliosis
Sideway spine curvature Idiopathic - no definite cause, most common form (> 70%), 1° affects adolescent girls Neuromuscular - caused by conditions w/ muscle weakness (CP, MD, SCI) or spasticity & associated w/ ↑blood loss
37
Scoliosis | Cobb Angle
Degree lateral curvature → impairs respiratory function > 45° Restrictive lung disease ↓TLC & VC
38
Posterior Spine Fusion | Instrumentation
Prevent curve progression & correct curvature Metal implants attached to the spine then connected to 1-2 rods Anterior (one-lung ventilation) vs. posterior approach Prone positioning 6 hours Significant blood loss risk - hypotensive technique, maintain BP w/in 20% baseline, admin TXA, cell save, autologous blood & hemodilution
39
Posterior Spine Fusion | Preop
Labs: CBC, coags, BMP, HCG Type & cross PRBCs 2 units available & cell saver
40
Posterior Spine Fusion | Intraop
``` Prone position w/ superman arms Bair hugger Nerve monitoring Bilateral soft bite blocks A-line & PIV x2 Cell saver, fluid warmer, & blood tubing Standard induction BIS & cerebral oxygen OG tube Multiple fluids & syringe channels ```
41
Posterior Spine Fusion | Evoked Potential Monitoring
``` Avoid volatile inhalational agents & N2O Dexmedetomidine & opioids are compatible Ketamine enhances amplitude Propofol ↑latency ↓EPs amplitude Continue monitoring 15-20min after surgical closure started ```
42
Posterior Spine Fusion | Postop
``` Dependent facial edema Plan to extubate when possible CXR when patient supine on inpatient bed Admit 3-6 days step-down or ICU Neuromuscular scoliosis patients potentially more sensitive & require postop ventilation 2° muscle weakness ```
43
Posterior Spine Fusion | Complications
``` Spinal cord ischemia Massive blood loss Embolism Accidental extubation Corneal abrasion Visual loss Neurological sequel w/ SSEP or MEPs loss ```
44
Hypertrophic Pyloric Stenosis
Pylorus thickening or swelling (muscle b/w the stomach & intestines) that causes severe & forceful vomiting in the first few months life Pylorus enlargement → narrowing (stenosis) of the opening from the stomach to the intestines ჻ blocks stomach contents from moving into the intestine
45
Hypertrophic Pyloric Stenosis | Clinical Presentation
Palpable obstruction lesion (olive-shaped) Usually diagnosed b/w 2-12 weeks old Post-prandial projectile emesis, palpable pylorus, visible peristaltic waves Surgical correction = pyloromyotomy Semi-elective surgery (urgent, but requires medical management 1st to correct dehydration & electrolyte imbalance)
46
Pyloric Stenosis
Persistent vomiting depletes Na+, K+, Cl¯, & H+ ions causing hyperchloremic metabolic alkalosis - Kidneys attempt to compensate via sodium bicarbonate excretion - Hyponatremia/dehydration worsen & kidneys attempt to conserve Na+ Avoid LR (lactate metabolized to bicarbonate)
47
Pyloric Stenosis | Anesthetic Considerations
IV to replace intravascular volume Suction stomach w/ OG prior to induction Twist/roll/tilt to remove all stomach contents RSI w/ cricoid pressure HIGH aspiration risk Pre-oxygenate → Propofol & Succinylcholine or Rocuronium Cuffed ETT Quick procedure Extubate awake - limit Fentanyl & Dexmedetomidine
48
Nissen Fundoplication
General abdominal procedure for children w/ gastric reflux that fail medical management Laparoscopic minimally invasive procedure to restore LES (valve b/w the esophagus & stomach) function Surgeon wraps the stomach around the esophagus
49
Nissen Fundoplication | Anesthetic Considerations
GETA Laparoscopic - insufflation, VAE, vagal response Minimal blood loss, fluid shifts, & pain Esophageal bougie to ensure no leaks after anastomosis
50
Circumcision
Foreskin removal Most common procedure Foreskin opened, adhesion removed, & foreskin separated from the glans Cut foreskin then cauterize & suture the skin edges
51
Circumcision | Anesthetic Considerations
Indications include phimosis, recurrent balanitis, or parental preference Local, regional, or GA (adults) ≈ 1 hour Most common complication = bleeding
52
Hypospadius
Malposition of the urethra meatus Urethral opening not located at the penis tip Underneath the penis tip more common than near the penis base
53
Hypospadius | Anesthetic Considerations
1-4+ hours General LMA or ETT Regional controversial
54
Cleft Lip & Palate
``` Repaired in stages - Lip 10-12 weeks - Palate 12-18mos - Alveolar bone graft - Pharyngoplasty 5-15yrs Difficulty feeding → malnutrition Impaired speech development Congenital heart defects ```
55
Cleft Lip & Palate | Anesthetic Considerations
Standard induction Potential difficult airway Oral RAE w/ flexible connector Mouth gag - reassess breath sounds once positioned No air bubbles Local anesthetic + Epi to reduce blood loss & provide analgesia Protect eyes Airway & tongue edema Awake extubation once protective airway reflexes intact

AS - N934 Advanced Principles II (18 decks)

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