Pediatrics, ENT, & MH Flashcards Preview

Anesthesiology > Pediatrics, ENT, & MH > Flashcards

Flashcards in Pediatrics, ENT, & MH Deck (43):
1

How long should you wait for elective procedure if patient has recently had a URI?

4-6 weeks (otherwise, higher risk of increased airway reactivity)

2

LMA or ETT in children with URIs?

LMA (ETT has higher risk of bronchospasm)

3

True or false: incidence of airway complications with children with active vs. recovery period of URI are almost identical?

True

4

Formula for calculating ETT size in children

4 + (Age/4)

5

Formula for estimating correct depth of ETT in children

12 + (Age/2) or weight in kg/5 + 12 or 3x diameter of ETT

6

What nerve stimulation causes laryngospasms?

Superior laryngeal nerve

7

Treatment for kid with high pitched inspiratory noises in PACU

Post-intubation croup: racemic epinephrine nebulization

8

Steeple sign on X-ray

Croup

9

Thumb sign on X-ray

Epiglottitis

10

Treatment of croup

Racemic epinephrine, steroids for long-term

11

Best ETT for laryngeal polyp excision using a CO2 laser?

Metal ETT or intermittent intubation and ventilation

12

What to do when you notice smoke from ETT during CO2 laser?

Extubate the trachea, flood the field with saline, then examine with fiberoptic

13

Scoliosis is associated with which of the following: seizure disorder, mental retardation, hirsutism, MV stenosis, pulmonary HTN

Pulmonary HTN (restrictive lung disease from rotated, constricted thorax)

14

Why do wake-up tests and MEPs together?

MEPs are prone to false positives, but are continuous monitors; wake-up tests are definitive but non-continuous

15

Risks of a wake-up test during spine surgery?

Unintentional extubation, dislodgement of lines and instruments, air embolism (inspiration drawing in air through vertebral veins)

16

4 year old with OSA, which is likely associated with this condition? Peritonsillar abscess, cor pulmonale, choanal atresia, subglottic hemangioma, laryngomalacia

Cor pulmonale (cardiorespiratory syndrome): right heart failure

17

Major concerns for peritonsillar abscesses?

Obstruction of glottic opening; rupture of abscess; therefore, spontaneous breathing is important on induction

18

Extrathoracic variable obstructions have what flow volume pattern?

Limited ability to pull air in on inspiration

19

Intrathoracic variable obstructions have what flow volume pattern?

Limited ability to push air out on expiration

20

Tracheomalacia flow-volume pattern?

Extrathoracic variable obstruction

21

Laryngomalacia flow-volume pattern?

Extrathoracic variable obstruction

22

Mediastinal masses flow volume pattern?

Intrathoracic variable obstruction

23

Choanal atresia flow volume pattern?

Normal or fixed obstruction on both inspiration and expiration

24

OSA flow volume pattern?

Intrathoracic variable obstruction (sawtoothing on expiration)

25

Which of the following congenital conditions are associated with a difficult intubation? Pierre-Robin syndrome, Treacher Collins syndrome, Carpenter syndrome, Crouzon disease, Niemann-Pick?

Pierre-Robin and Treacher-Collins (micrognathia and cleft palate), Carpenter, Crouzon

26

What do you worry about a patient with DiGeorge syndrome?

HypoPTH with hypocalcemia

27

DiGeorge syndrome clinical presentation?

CATCH-22: cardiac (tetrology), abnormal facies, thymic aplasia (increased infections), cleft palate, hypocalcemia, deletion on chromosome 22

28

Main risk of craniosynostosis surgery?

Bleeding (dividing skull along suture lines above the venous sinuses which can bleed)

29

When do you worry about Propofol infusion syndrome?

After 48 hours + use of propofol infusion

30

Landmark for caudal anesthesia?

Sacral hiatus

31

Minimum dose of 0.25% bupivicaine via caudal epidural injection helps with post-op pain after perineal surgery? upper abdominal surgery?

0.5cc/kg of anything greater than 0.175% bupivicaine for perineal surgical pain; 1.25cc/kg for upper abdominal

32

Morphine epidural dose in children?

0.1mg/kg

33

Which is associated with MH? Duchenne's, ataxia telangiectasia, treacher-collins, central-core disease, osteogenesis imperfecta

Central-core disease (muscle dystrophy without muscle wasting)

34

Triggering agents for MH

Halogenated volatiles and succinylcholine

35

Mechanism for MH?

Calcium induced release of calcium (ryanodine receptors are stuck open, allowing for calcium to freely enter the cell from the sarcoplasmic reticulum)

36

Dose of dantrolene for MH?

2.5mg/kg

37

Which lab value is consistent with MH? hyperPO4, decreased CK, hemoglobinuria, hypokalemia, thrombocytopenia

Thrombocytopenia: tissues thromboplastin release leads to DIC with thrombocytopenia

38

Do muscle relaxants help with masseter muscle spasms of MH?

No (since calcium-induced release of calcium happens without a motor end-plate activation)

39

Halothane-caffeine contracture test is what?

Highly sensitive test for MH

40

What meds increase triggering threshold for MH?

Pancuronium and thiopental

41

What condition would you see an elevated mixed venous sat?

Severe sepsis (in early sepsis, may be decreased)

42

How long do you monitor a kid with known MH after anesthesia?

6 hours

43

Child with remote family hx of MH gets succ for an elective case and has masseter muscle spasm... what do you do?

Give dantrolene