Pediatric anesthesia pt3.1 Flashcards
(30 cards)
Why are children with trisomy 21 at high risk for difficult ventilation and intubation?
- Small mouth
- Large tongue
- Atlantoaxial instability
- subglottic stenosis
What is the most common congenital heart disease associated with trisomy 21?
AV septal defect
second most common: VSD
Trisomy 21 children have lower levels of circulating catecholamines which may lead to what?
Bradycardia is more common with inhalational induction
need slower induction (4% instead of 8% sevo), have glyco or atropine drawn and ready
What dose of glycopyrrolate is used for pediatric bradycardia? Atropine?
Glycopyrrolate 0.01mg/kg
Atropine 0.02mg/kg
What is the most common cardiac anomaly associated with down syndrome?
- atrioventricular septal defect
- first degree heart block
- bicuspid aortic valve
- single ventricle
- atrioventricular septal defect
VACTERL association consists of what?
- Vertebral anomalies
- Anal atresia
- Cardiovascular anomalies
- Tracheoesophageal fistula
- Esophageal atresia
- Renal anomalies
- Limb defects
atresia: normal body opening is absent, blocked, incomplete
What is CHARGE syndrome?
- Colomboma (hole in eye structures)
- Heart defects
- ChoAnal atresia (nasal passage obstruction)
- Restricted growth/development
- Genitourinary problems
- Ear anomalies
DiGeorge is also known as?
Catch22
- Cardiac problems
- Abnormal face
- Thymic hypoplasia
- Cleft palate
- Hypocalcemia (hypoparathyroid)
- 22q11.2 gene deletion
What considerations should be made regarding airway management in dental procedures?
Shared airway: nasal intubation
avoid with bleeding disorders
What consideration should be made regarding eye surgery such as strabismus repair?
- Risk for oculocardiac reflex that can lead to severe bradycardia
- PONV is also common
be prepared to treat with atropine or glycopyrrolate
Oculocardiac reflex can lead to what complications?
- Bradycardia
- AV block
- Ventricular ectopy
- Asystole
What cranial nerves mediate the oculocardiac reflex?
- Trigeminal (V) ophthalmic branch
- Vagus Nerve (X)
Five and dime (V & X)
Liberal oxygen use in neonates can lead to what complication?
Retinopathy
higher PaO2 can cause abnormal vascular growth, maintain SpO2 89-94%
Retinal maturation is complete by _____ post conception?
Retinal maturation is complete by ~44 weeks post conception?
Where is preductal oxygenation measured?
Right hand
preductal O2 correlates better with O2 sat of retinal vessels
Adenotonsillectomy is generally indicated by what?
- Obstruction
- Infection
- Mass/lesion
very common procedure in peds
What considerations should be made for a child undergoing T&A surgery?
- high risk of OSA
- URI/repeat infections
- Frequent bleeding, epistaxis
What airway/anesthetic choice is typically made with a T&A procedure?
- inhalational induction
- IV placement
- ETT: RAE tube
What is the typical dose of dexamethasone for pediatric patients?
Decadron: 0.5mg/kg
With a T&A what are significant anesthetic complications?
- Bleeding
-within 6-24 hrs
-can be 5-10 days after - Airway fire
-keep FiO2 <30%
-avoid N2O
What anesthetic considerations should be made with a post-tonsillar bleed?
- Surgical emergency
- RSI / full stomach
- PreO2 left lateral head-down position
- use ETT 1/2 size smaller
- OGT
- Antiemetics
When is a cleft lip typically repaired? When is the cleft palate repaired?
- Cleft lip: 3-6 months
- Cleft palate: 6-12 months
What anesthetic considerations should be made for cleft lip and palate?
- GETA: RAE tube
- Awake extubation
- avoid OPAs and blind suction
What is characterized by an olive-shaped mass just below the xiphoid process?
Pyloric stenosis
most common is first born males
