Pediatric Surgery Lecture 1 (Exam 1) Flashcards by Kaitlyn McDow

🍼Pediatric Anesthesia Lecture 1 👶
(Slides 4-35)

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How are the majority of pediatric patients are induced?

A. Intravenously
B. Mask inhalation
C. Spinal
D. Intramuscular

B. Mask inhalation

Slide 4

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Which of the following should we have on top of the anestheia machine for induction for every patient?
Select 4

A. Rocuronium
B. Succinylcholine
C. Cisatricurium
D. Lidocaine
E. Epinephrine
F. Atropine

B. Succinylcholine
D. Lidocaine (20mg/ml syringe)
E. Epinephrine ( 10mcg/ml syringe)
F. Atropine ( one 10ml syringe and baby atropine 0.1ml/kg in 1ml syringe)

Along with Flushes and IM needles

Slide 4

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Which equipment should NOT be included in a standard pediatric anesthesia setup?

A. Large and small EKG leads
B. Handle and blade(s)
C. A-line kit
D. Bear hugger blanket
E. Warming lights
F. Doughnut pillow
G. Suction

C. A-line kit

Oral airways
ETT +/- stylet
Masks
Temperature monitor
IV kit

Slide 5

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Which of the following are considered appropriate temperature monitoring methods in pediatric patients?
Select 4

A. Foley with temp probe
B. Skin surface sticker probe
C. Esophageal temp probe
D. Axillary temp probe
E. Oral thermometer
F. Nasal temp probe

A. Foley with temp probe
C. Esophageal temp probe
D. Axillary temp probe
F. Nasal temp probe

Slide 5

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What makes infant tracheas and bronchi more prone to collapse?

A. Increased cartilage rigidity
B. Increased airway tone
C. High compliance
D. Thick mucosal layers

C. High compliance of airway structures

Slide 6

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Which of the following are true about airway obstruction during pediatric anesthesia?
Select 3

A. It is rarely caused by muscle tone loss
B. Most commonly occurs at the hypopharynx
C. Pharyngeal and laryngeal muscle relaxation
D. Usually occurs during deep inhalation
E. Exacerbated by smaller airways and bronchi.

B. Most commonly occurs at the hypopharynx - level of the epiglottis
C. Pharyngeal and laryngeal muscle relaxation
E. Exacerbated by smaller airways and bronchi.

Slide 6

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Airway resistance in a crying child is most accurately described as being inversely related to:

A. Airway length
B. Airway radius to the 2nd power
C. Airway radius to the 4th power
D. Airway radius to the 5th power

D. Airway radius to the 5th power

Poiseuille’s Law - laminar flow is to the 4th power

A child’s airway (crying or in distress) is described as TURBULENT flow and therefore to the 5th power

Slide 7

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Laryngospasm differs from voluntary laryngeal closure in that it results from a(n) _______________ effort.

A. Expiratory
B. Inspiratory
C. Swallowing
D. Reflex

B. Inspiratory

Slide 8

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During laryngospasm, the _____________ folds are longitudinally separated from the vestibular folds.

A. Arytenoid
B. Cricothyroid
C. Vocal
D. Epiglottic

C. Vocal

Slide 8

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In laryngospasm, both the _______________ and _______________ laryngeal muscles do not contract.

A. Extrinsic, pharyngeal
B. Cricothyroid, thyroarytenoid
C. Pharyngeal, laryngeal
D. Extrinsic, intrinsic

D. Extrinsic, intrinsic

Slide 8

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During laryngospasm, the absence of contraction of the intrinsic _______________ and extrinsic _______________ muscles contributes to minimal structural opposition to the aryepiglottic and median thyrohyoid folds.

A. Cricothyroid; sternohyoid
B. Thyroarytenoid; thyrohyoid
C. Posterior cricoarytenoid; sternohyoid
D. Aryepiglottic; vocalis

B. Thyroarytenoid; thyrohyoid

Slide 8

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The hallmark sound of partial laryngospasm is a high-pitched inspiratory _______________.

A. Wheeze
B. Grunt
C. Stridor
D. Snore

C. Stridor

Mouse squeaking 🐁

slide 8

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What is the first action to take when managing a laryngospasm?

A. Administer succinylcholine
B. Begin CPAP
C. Administer 100% oxygen
D. Increase volatile anesthetic

C. Administer 100% oxygen and stop stimulation

CALL for HELP

Slide 9

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Which maneuver improves airway patency by lifting the tongue and epiglottis?

A. Valsalva
B. Sniffing position with chin lift/jaw thrust
C. Trendelenburg position
D. Mouth-to-mouth ventilation

B. Sniffing position with chin lift/jaw thrust

Improves airway patency and ventilation - this might be a two person job..

Slide 9

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What is the most effective way to deepen anesthesia quickly during a laryngospasm if IV access is present?

A. Aminister IV propofol
B. Administer IM ketamine
C. Increase volatile anesthetic
D. Increase fresh gas flow

A. Aminister IV propofol

“Deepen anesthetic - it may take a little bit longer for that SEVO to get on board versus the IV propofol you have in line.”

Slide 9

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CPAP helps break laryngospasm by:

A. Sedating the patient
B. Increasing the transverse diameter of the airway
C. Preventing breath-holding
D. Stimulating vagal tone

B. Increasing the transverse diameter of the airway

IPPV - Intermittent Positive pressure ventilation - Manual mode, APL at 5-10, when they inspire you give a little positive pressure with them. “manual CPAP”

Slide 9

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If you visualize the airway and do not see any obstruction you may need to treat the perisistent laryngospasm with ____________ and _________________.

A. Ephedrine; ketamine
B. Adenosine; Succinylcholine
C. Atropine; Succinylcholine
D. Rocuronium; glycopyrolate

C. Atropine; Succinylcholine

Slide 9

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Which of the following patient histories would most warrant concern for intraoperative bronchospasm?

A. Seasonal allergies controlled with antihistamines
B. A remote history of asthma with no recent symptoms
C. Severe asthma well controlled with recent ER visit
D. Mild uncontrolled asthma with recent coughing and wheezing

D. Mild (or severe) uncontrolled asthma with recent coughing and wheezing

Slide 10

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Which of the following are important history elements to ask when screening for intraoperative bronchospasm?
Select 4

A. Recent respiratory symptoms
B. Exercise limitations
C. Fear of anesthesia
D. History of bee stings
E. Use of asthma medications
F. Recent ER visits d/t asthma

A. Recent respiratory symptoms
B. Exercise limitations
E. Use of asthma medications
F. Recent ER visits d/t asthma

Slide 10

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What is the classic breath sound heard during an intraoperative bronchospasm?

A. Monophonic inspiratory wheeze
B. Crackles on inspiration
C. Polyphonic expiratory wheeze
D. Stridor

C. Polyphonic expiratory wheeze (multiple pitches)

Slide 11

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Which of the following are signs of intraoperative bronchospasm?
Select 3

A. Increased peak airway pressures
B. Active inspiration with increased effort
C. Decreased peak airway pressures
D. Slow up slope ETCO₂ waveform
E. Increased SpO₂
F. Prolonged expiration

A. Increased peak airway pressures
D. Slow up slope of ETCO₂ waveform
F. Prolonged expiration

Decreased SPO₂
Increased ETCO₂
Active expiration with increased respiratory effort or WOB

Shark-fin 🦈

Slide 11

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Which of the following agents is best avoided for induction in pediatric patients at risk for bronchospasm?

A. Sevoflurane
B. Isoflurane
C. Desflurane
D. Propofol

C. Desflurane

Increases airway resistance!

Slide 13

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Which IV medications are preferred for induction in patients at risk for bronchospasm?
Select 2

A. Ketamine
B. Propofol
C. Thiopental
D. Morphine

A. Ketamine
B. Propofol

Slide 13

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Which inhalation agents are preferred for induction in patients at risk for bronchospasm? Select 2 A. Desflurane B. Isoflorane C. Atracurium D. Sevoflurane

B. Isoflorane D. Sevoflurane ## Footnote Slide 13

Inhaled _______________ agonists may be administered intraoperatively to relieve bronchospasm. A. Alpha B. GABA C. Dopamine D. Beta

D. Beta ## Footnote Slide 13

Which of the following intraoperative interventions help manage bronchospasm? Select 3 A. Increase FiO₂ B. Increase PEEP C. Stimulate the vocal cords D. Deepen anesthesia E. Increase inspiratory time F. Remove the triggering stimulus

A. Increase FiO₂ - 100% O2 D. Deepen anesthesia (IV first then inhaled) F. Remove the triggering stimulus *- from tracheal and vocal cords* ## Footnote Slide 13

To minimize air trapping during bronchospasm, you should ***decrease PEEP*** and increase the _______________ to allow more time for exhalation. A. Respiratory rate B. FiO₂ C. I:E ratio D. Tidal volume

C. I:E ratio ## Footnote Slide 13

What is the recommended **IV epinephrine** dose range for treating severe bronchospasm or anaphylaxis? A. 0.05–0.5 mcg/kg B. 0.01–0.05 mcg/kg C. 0.5–1.0 mg/kg D. 1–5 mcg/kg

A. 0.05–0.5 mcg/kg *Given every minute* ## Footnote slide 14

In severe, refractory bronchospasm related to anaphylaxis, which of the following agents may be added to epinephrine? A. Lidocaine B. IV steroids C. Propofol D. Haloperidol

B. IV steroids ## Footnote Slide 14

Which of the following is a commonly used short-acting inhaled beta agonist (SABA) in pediatric anesthesia? A. Ipratropium B. Fluticasone C. Salmeterol D. Xopenex

D. Xopenex (levalbuterol) ..or Albuterol ## Footnote Slide 15

How many puffs are typically delivered on inspiration when using a spacer device for beta agonist administration during surgery? A. 1–2 puffs B. 2–4 puffs C. 4–8 puffs D. 10–12 puffs

C. 4–8 puffs ## Footnote Slide 15

# True or False You take a 60 mil syringe, pull out the plunger, drop in your Xopenex and screw that into the EtCO2 port again deliver those puffs during inspiration.

True

# The Neb Puzzle

## Footnote Slide 16/17

The jaw thrust maneuver helps relieve obstruction at the level of the _______________ by lifting the _______________. A. Vocal cords; thyroid cartilage B. Cricoid cartilage; vocal cords C. Hypopharynx; epiglottis D. Larynx; trachea

C. Hypopharynx; epiglottis ## Footnote Movie Slide

Which of the following describe proper elements of the single-hand jaw thrust technique? Select 3 A. Neck extension B. Clawing with middle, ring, and little fingers to lift the jaw C. Pressure over the submental area D. Mask seal using thumb and index finger E. Lifting the larynx to relieve obstruction

A. Neck extension - this brings the lower and upper rowsof teeth in close contact with each other B. Clawing with middle, ring, and little fingers to lift the jaw (mandibular body) - *this avoids putting pressure over the submental area* D. Mask seal using thumb and index finger This can be a difficult technique ## Footnote Movie slide

Which of the following are characteristics of laryngospasm? Select 5 A. Inspiratory airflow limitation B. Expiratory wheezing C. Stridor D. Retractions of intercostals E. Use of accessory muscles of inspiration F. No change in expiration G. Cyanosis has fast onset H. Prolonged expiration

A. Inspiratory airflow limitation C. Stridor D. Retractions of intercostals *at the suprasternal notch* F. No change in expiration G. Cyanosis has **fast** onset "You'll see this on induction if someone is at the beginning of laryngospasm, right at the base of their neck, that's suprasternal notch. You'll see a tracheal tug pulling right there...that's your cue to get a better position, head tilt, jaw thrust..." ## Footnote Slide 18

Which of the following are characteristics of bronchospasm? Select 5: A. Inspiratory obstruction B. Expiratory airflow limitation C. Wheeze or croup D. Use of accessory muscles E. Prolonged expiration F. No change in expiration G. Cyanosis has slow onset H. Retractions at the suprasternal notch

B. Expiratory airflow limitation C. Wheeze or croup D. Use of accessory muscles of inspiration E. Prolonged expiration G. Cyanosis has slow onset ## Footnote Slide 18

What is the primary cause of airway narrowing in post-extubation croup? A. Inflammation and edema B. Laryngeal muscle rigidity C. Bronchospasm D. Retropharyngeal abscess

A Inflammation and edema of *tracheal mucosa* ## Footnote Slide 19

A reduction in luminar airway radius of 2 mm increases airway resistance by a factor of: A. 4 B. 10 C. 16 D. 32

D. 32 Resistance is inversely related to radius to the fifth power, so *2 to the 5th power is 32 times.* ## Footnote Slide 19

Post-extubation croup can occur in approximately what percentage of children? A. 0.1% B. 1% C. 5% D. 10%

B. 1% ## Footnote slide 20

Which patient age range is at highest risk for post-extubation croup? A. Newborns (0–1 month) B. Infants (0–12 months) C. Children (1–4 years) D. Adolescents (12–18 years)

C. Children age 1–4 years "then patients aged 1 to 4 are at the highest risk d/t subglottic airway growth occuring rapidly, it is the narrowest part in children" ## Footnote Slide 20

If there is no leak and the pressure of the cuff is >25cm H20 this suggests: A. The tube is too short B. There is excessive bronchospasm C. Normal airway patency D. The ETT may be too large

D. The ETT may be too large for the airway "after intubation you will inflate the cuff and the MDA will listen for a leak. You'll continue to turn up your APL valve until you hit 20...they will make sure that a leak is present before filling the cuff. After there is air in that cuff, they'll make sure that it's not beyond 20 centimeters of water." ## Footnote Slide 20

Which of the following are risk factors for developing post-extubation croup? Select 3: A. ETT leak pressure > 15 cm H₂O B. Multiple intubation attempts C. Patients aged 4-10 years D. Surgery >1hr E. Previous history of croup

B. Multiple *or traumatic* intubation attempts D. Surgery >1hr E. Previous history of croup * Changes in position during surgery other than supine ## Footnote Slide 20

How long must a child be monitored after administration of racemic epinephrine for croup? A. 30 minutes B. 1 hour C. 2 hours D. Until discharge

B. 1 hour ## Footnote Slide 21

What is the correct dose of dexamethasone recommended for treatment of post-extubation croup? A. 0.5 mg/kg B. 1 mg/kg C. 1.5mg/kg D. 2 mg/kg

A. 0.5 mg/kg ## Footnote Slide 21

Which of the following are true about micro-cuff endotracheal tubes? Select 4: A. They are placed more distally to avoid cricoid pressure B. The cuff has varying surface contact C. They are more permeable to nitrous oxide D. They use high volume/low pressure E. They reduce the need for tube upsizing and reintubation F. They use low volume/high pressure

A. They are placed more **distally** to avoid cricoid pressure C. They are **more** permeable to nitrous oxide D. They use high volume/low pressure E. They reduce the need for tube upsizing and reintubation **Used for children < 2yrs old** ## Footnote Slide 21

Which of the following is a distinguishing feature of a micro-cuff ETT? A. Round balloon and Murphy eye B. Elliptical balloon and no Murphy eye C. Low volume, high pressure balloon D. More proximal balloon placement

B. Elliptical balloon and no Murphy eye Uniform surface contact - less damage, edema and swelling from the balloon ## Footnote Slide 21

Congenital diaphragmatic hernia (CDH) occurs in approximately: A. 1 in 100 live births B. 1 in 200 live births C. 1 in 2,000 live births D. 1 in 10,000 live births

C. 1 in 2,000 live births ## Footnote Slide 23

What developmental failure causes CDH? A. Incomplete neural tube closure B. Failure of pulmonary alveolarization C. Failure of tracheoesophageal separation D. Incomplete closure of the pleural and peritoneal canals

D. Incomplete closure of the pleural and peritoneal canals "The degree of abnormality depends of the inutero timing of herniation and the amount of abdominal contents that end up in the thorax. " ## Footnote Slide 23

What does the herniation of abdominal contents into the thorax primarily affect? A. GI motility B. Cardiac contractility C. Normal lung growth D. Fetal swallowing

C. Normal lung growth **and development** ## Footnote Slide 23

The herniation of abdominal organs into the thorax results in decreased formation of _______________ and _______________. A. Bronchi; alveoli B. Pulmonary capillaries; valves C. Trachea; esophagus D. Right and left atria

A. Bronchi; alveoli ## Footnote Slide 23

Decreased gas exchange in CDH leads to increased pulmonary vascular resistance and ultimately _______________. A. Bronchospasm B. Metabolic acidosis C. Primary pulmonary hypertension D. Left-sided heart failure

C. Primary pulmonary hypertension ## Footnote Slide 23

# True or false The contralateral lung is usually the only one affected by CDH

False Ipsilateral lung is usually the one affected but contralateral lung can be as well ## Footnote Slide 23

The most common location of a congenital diaphragmatic hernia is: A. Posterolateral Foramen of Bochdalek B. Morgagni foramen C. Esophageal hiatus D. Central tendon of the diaphragm

A. Posterolateral Foramen of Bochdalek 90% on the Left side (5x more likely) ## Footnote Slide 24

Infants with CDH are more likely to have which of the following associated conditions? A. Pyloric stenosis B. Bronchopulmonary dysplasia C. Chromosomal abnormalities D. Hydrocephalus

C. Chromosomal abnormalities (5%-15%) **..and Congential heart disease (20%-40%)** ## Footnote Slide 24

Approximately 2% of CDH cases are which type? A. Bochdalek B. Hiatal C. Paraesophageal D. Morgagni

D. Morgagni (anteromedial) ## Footnote Slide 24

CDH is associated with genetic syndromes such as trisomy 13, trisomy 18, tetrasomy, and _______________ mosaicism. A. 21p B. 10p C. 12p D. Xp

C. 12p *Congenital diaphragmatic hernias are associated with genito, urinary, gastrointestinal malformations* ## Footnote Slide 24

# True or false Remaining CDH occur through a paraesophageal hiatus (15%-20%)

True ## Footnote Slide 25

Most cases of congenital diaphragmatic hernia (CDH) are diagnosed: A. Prenatally via ultrasound B. Postoperatively C. Postnatally with MRI D. During labor via fetal scalp monitor

A. Prenatally via ultrasound ## Footnote Slide 26

Which of the following imaging findings support a diagnosis of congenital diaphragmatic hernia? Select 3: A. Intestinal loops in the retroperitoneal cavity B. Mediastinal shift away from herniation C. Polyhydramnios D. Tracheal deviation toward hernia E. Intrathoracic gastric bubble F. Oligohydrosis

B. Mediastinal shift away from herniation C. Polyhydramnios (large amounts of amniotic fluid) E. Intrathoracic gastric bubble ## Footnote slide 26

**Antenatal** diagnosis of congenital diaphragmatic hernia can be made by _______________, which may reveal intestinal loops or abdominal organs in the thoracic cavity and ipsilateral lung compression. A. MRI of the fetal spine B. Abdominal chest X-ray C. Amniocentesis D. Thoracentesis

B. Abdominal chest X-ray ## Footnote slide 26

# True or false A prenatal transvaginal ultrasound can also diagnos congenital diaphragmatic hernia.

True ## Footnote Slide 26

Which of the following is not a typical finding in a newborn with CDH? A. Respiratory distress B. Tachycardia C. Hyperinflated abdomen D. Tachypnea

C. Hyperinflated abdomen * Concave abdomen * Barrel chest ## Footnote Slide 29

What contributes to severe hypoxemia in CDH patients? A. Right-to-left shunting B. Pulmonary embolism C. Left-to-right shunting D. Tracheal atresia

A. Right-to-left shunting *and pulmonary hypertension* ## Footnote Slide 29

Which of the following physical findings is expected on auscultation of the affected side in CDH? A. Rales B. Wheezing C. Stridor D. Absent breath sounds

D. Absent breath sounds ## Footnote Slide 29

What is the current first-line focus in managing congenital diaphragmatic hernia (CDH)? A. Emergent surgical correction B. Intubation and rapid extubation C. Medical stabilization prior to surgery D. Routine CPAP and oxygen therapy

C. Medical stabilization prior to surgery ## Footnote Slide 30

Which of the following strategies are part of high frequesncy oscillatory ventilation for CDH? Select 2: A. Small frequent tidal volume B. CPAP to assist with alveolar recruitment C. High prolonged tidal volume D. Limit positive airway pressure

A. Small frequent tidal volume D. Limit positive airway pressure (avoid CPAP) ## Footnote Slide 30

Which therapy improves oxygenation by reducing pulmonary vascular resistance in CDH? A. IV lidocaine B. Beta agonists C. Steroids D. Inhaled nitric oxide

D. Inhaled nitric oxide ## Footnote Slide 30

What is the primary role of **prostaglandin E1** in CDH treatment? A. Increase preload B. Close the ductus arteriosus C. Maintain patent ductus arteriosis D. Treat lung infections

C. Maintain patent ductus arteriosis **and reduce RV afterload** ## Footnote Slide 30

ECMO is considered in severe CDH patients when PaO₂ is: A. < 100 mmHg on FiO₂ 0.6 B. < 75 mmHg on FiO₂ 1.0 C. < 60 mmHg on room air D. < 50 mmHg on FiO₂ 1.0

D. < 50 mmHg on FiO₂ 1.0 Severe lung hypoplasia and pulmonary HTN ## Footnote Slide 30

# True or False Hypoventilation helps reduce respiratory alkalosis and can further decrease pulmonary vascular resistance

False HYPERventilation helps reduce respiratory alkalosis. Decrease in CO2 helps vasodilate pulmonary vessesls ## Footnote Slide 30

What is the primary cause of morbidity and mortality in infants undergoing CDH repair without ECMO? A. Hypoglycemia B. Pulmonary hypertension C. Liver failure D. Sepsis

B. Pulmonary hypertension ## Footnote Slide 32

What is the typical surgical approach for CDH repair? A. Perineal approach B. Retroperitoneal approach C. Transabdominal approach D. Transvaginal repair

C. Transabdominal approach **with primary closure** ## Footnote slide 32

What complication may occur if the infant’s abdominal cavity is too small to accommodate all replaced bowel contents? A. Diarrhea B. Sepsis C. Diaphragmatic paralysis D. Decreased pulmonary compliance

D. Decreased pulmonary compliance ## Footnote Slide 32

When an infant’s abdomen cannot accommodate immediate replacement of bowel contents, a _______________ pouch is used to gradually reintroduce viscera. A. Silo B. Hernia C. Tension-release D. Vacuum-sealed

A. Silo ## Footnote Sslide 32

When might a chest tube be placed on the **contralateral side** before surgical repair of CDH? A. If there's abdominal distension B. If a pneumothorax exists C. For fluid drainage D. To aid in lung expansion

B. If a pneumothorax exists ## Footnote Slide 33

horacoscopic CDH repair is appropriate for infants who are: A. Premature B. Unstable and hypoxic C. Medically stable D. On ECMO

C. Medically stable ## Footnote Slide 33

Which technique is used during thoracoscopic CDH repair to facilitate return of abdominal contents **without requiring single lung ventilation**? A. High PEEP and jet ventilation B. Hyperventilation with paralytics C. D. Nitrous oxide with high-frequency oscillation D. Low-flow, low-pressure CO₂ insufflation

D. Low-flow, low-pressure CO₂ insufflation ## Footnote Slide 33

What is the correct positioning for the infant during thoracoscopic CDH repair? A. Supine with arms crossed B. Prone with head rotated C. Lateral decubitus D. Trendelenburg

C. Lateral decubitus **with upper arm elevated** ## Footnote Slide 33

What is the primary goal of oscillator ventilation in infants with CDH? A. Avoid volutrauma B. Increase tidal volume C. Increase PEEP D. Induce permissive hypercapnia

A. Avoid volutrauma **with low tidal volume and reduced peak pressures** ## Footnote Slide 34

Which of the following must be **avoided** to prevent increases in pulmonary vascular resistance (PVR) in CDH patients? Select 4 A. Hyperventilation B. Hypoxemia C. Acidosis D. Hypothermia E. Hyperthermia F. Bradycardia G. Hypercarbia

B. Hypoxemia C. Acidosis D. Hypothermia G. Hypercarbia ## Footnote Slide 34

How do narcotics help in lowering PVR in CDH anesthesia management? A. Blunt sympathetic discharge B. Increase PVR for better perfusion C. Stimulate cardiac output D. Facilitate weaning from ECMO

A. Blunt sympathetic discharge ... and let us not forget hyperventilation "If these patients are on the oscillator, you'll be doing a TIVA and even if they are not and they're on the conventional anesthesia vent, you still may be doing a high narcotic/ neuromuscular blockade anesthetic and that will just help reduce your sympathetic tone." ## Footnote Slide 34

Why should an NG tube be placed before induction if not already present in CDH patients? A. To suction bile B. To prevent aspiration C. To decompress the stomach and prevent air entry D. To facilitate feeding postoperatively

C. To decompress the stomach and prevent air entry ## Footnote Slide 34

Which anesthetic agent should be avoided in patients undergoing CDH repair? A. Sevoflurane B. Nitrous oxide C. Fentanyl D. Rocuronium

B. Nitrous oxide - It can expand intrathoracic bowel gas and worsen compression ## Footnote Slide 35

Which of the following are appropriate components of induction for a neonate with CDH? Select 4: A. Fentanyl B. Rocuronium C. Spontaneous ventilation D. Cisatracurium E. Desflurane F. Sevoflurane

A. Fentanyl (50 mcg/kg) B. Rocuronium 1.2 mg/kg D. Cisatracurium 2 mg/kg F. Sevoflurane ## Footnote Slide 35

Patients undergoing CDH repair typically return to the ICU _______________ and _______________ to maintain respiratory control. A. Extubated; sedated B. Intubated; paralyzed C. On BiPAP; monitored D. Awake; repositioned

B. Intubated; paralyzed (mulscle paralysis is maintained) ## Footnote Slide 35

Pediatric Surgery Lecture 1 (Exam 1) Flashcards

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