Pediatric anesthesia pt3.0 Flashcards
(30 cards)
Laryngospasm occurs because of noxious stimuli of which nerve?
superior laryngeal nerve
What are the primary worrisome complications from laryngospasm?
- Respiratory Arrest
- Hypoxia
- Negative pressure pulmonary edema
What are preoperative risk factors for laryngospasm?
- 2nd hand smoke exposure
- URI
- Gastric reflux disease
- Mechanical irritants (secretions…)
What surgeries are at highest risk of laryngospasm?
Upper Airway surgical procedures
- T&A
- Nasal/sinus sx
- palatal procedures
- laryngoscopy/bronchoscopy
What preventative measures can mitigate the risk of laryngospasm?
- avoid noxious stimuli during light anesthesia and stage 2
- adequate anesthetic depth before airway placement
- Topical/IV lidocaine
- Suction prior to extubation
- Extubation when fully awake
- 100%O2 prior to extubation
What should be done immediately if you have incomplete/partial airway obstruction?
apply gentle positive pressure with 100% O2, eliminate noxious stimuli (suction)
With incomplete airway obstruction that shows no improvement, what should be done as one of the last resorts?
- Succinylcholine + atropine IV
- Ventilate 100%O2
- Intubate if needed
What should be done immediately with a complete airway obstruction?
- Larsons maneuver
- 100% O2 by mask
- Eliminate noxious stimuli
- Listen and watch for oxygen movement
With complete airway obstruction that is showing no improvement with initital intervention, what should be done?
- Succinylcholine + Atropine
- Ventilate 100%O2
- Intubate if needed
If failed intubation with complete airway obstruction, what should be done?
- Repeat laryngoscopy and spray cords with lidocaine
- If continued failure ⇒ CPR and consider cricothyrotomy or tracheostomy
What should typically be administered with succinylcholine, especially in pediatric populations?
Atropine or glycopyrrolate to prevent bradycardia
What dose of succinylcholine is typically given for pediatric laryngospasm?
IV: 0.25 - 0.5 mg/kg
IM: 3 - 4 mg/kg
What would you typically see on your ETCO2 monitor if a patient is experiencing bronchospasm?
Shark fin/upsloping waveform
also increased ETCO2 and decreased SpO2
What is the typical treatment for bronchospasm?
- Remove stimulus, deepen anesthetic
- Increase expiratory time and decrease PEEP
- Albuterol, corticosteroids
- Epi 5-10 mcg/kg
Post-intubation/extubation Croup is caused by?
- Too large ETT
- Multiple DL attempts
- Sx position/time
- Age
- Upper airway infection
What are the typical treatments for post-intubation/extubation croup?
- Steroids
- Nebulized epi (2.25%)
- Humidified O2
What can be done prior to extubation to assess for potential croup?
Make sure ETT has leak prior to extubation via leak test (deflate cuff, APL to 20cmH₂O, listen for leak)
What are signs of post-intubation croup?
- Barking cough
- Hoarseness
- Stridor
What syndromes are associated with a large tongue?
- Beckwith syndrome
- Trisomy 21 (down syndrome)
(Big Tongue)
What syndromes are associated with a small/underdeveloped mandible? (micrognathia)
- Goldenhar
- Treacher Collins
- Pierre Robin
- Cri du chat
( Got That Puny Chin)
What syndromes are associated with cervical spine anomaly?
- Klippel-feil
- Trisomy 21(down syndrome)
- Goldenhar
(Kids Try Gold)
If there is indication of a difficult airway in the pediatric population, which medication group is generally avoided?
Neuromuscular block drugs
Review this chart:
Signs of foreign body aspiration may include:
- Cough
- stridor
- wheezing
- decreased breath sounds
Typically 6mo - 3 yrs old
