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Pediatrics > peds deck 12 > Flashcards

peds deck 12 Flashcards

1
Q

induction of anesthesia for TEF w/o G-tube

A
  1. inhalational induction 2. followed by topical lidocaine intubation keeping spontaneous vent
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2
Q

induction of anesthesia for TEF with G-tube

A
  1. INH or IV induction with paralysis 2. then place ETT
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3
Q

your doing a TEF repair surgery and the SpO2 is low , and the EtCO2 is low, and you are having a difficult time ventilating, what should you suspect

A

ETT migration into fistula

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4
Q

__________________ is due to failure of the gut to migrate from the yolk sac to the abdomen during gestation

A

omphalocele

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5
Q

_________________ herniated viscera outside of the infant and is covered by a membrane. typically bowel is morphologically and fx’al normal

A

omphalocele

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6
Q

in an omphalocele the umbilical cord is found ________________, and with gastroschisis the umbilical cord is found __________________

A

at the apex of the sac; periumbilical usually to the right

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7
Q

which herniated bowel syndrome is associated with congenital anomalies, like Beckwith-wiedemann, congenital heart disease, and/or exstrophy of the bladder

A

omphalocele

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8
Q

pt presents for omphalocele repair, before taking the pt to the OR, what should you do?

A

have cardiac consult with echocardiogram due to increased risk of congenital anomalies

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9
Q

_________________ develops due to occlusion of the omphalomesenteric artery during gestation –> herniated bowel through the defect without a covering

A

gastroschisis

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10
Q

with bowel herniation, repair of ______________ can wait for several days; however, ______________ needs to be repaired within 12-24 hours

A

omphalocele; gastroschisis

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11
Q

T/F: gastroschisis frequently has other congenital anomalies associated with it

A

false; typically does not have other congenital anomalies associated with it; however omphalocele does

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12
Q

primary goal of neonate with gastroschisis post delivery

A
  1. protection of exposed bowel 2. minimization of fluid/temperature loss
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13
Q

anesthesia implications for gastroschisis

A
  1. pt will have considerable evaporative and 3rd space fluid losses 2. possibly need large amounts of full strength balanced salt solutions 3. cosnider albumin 4. infection risk (d/t exposed bowel) 5. RSI or awake intubation 6. need adequate NMBA 7. remain intubated postoperatively 8. avoid N2O
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14
Q

described the “staged procedure” that can be done for gastroschisis/omphalocele

A
  1. use a silo to contain/cover viscera 2. every 2-3 days size of silo is reduced into the abdomen 3. usually not intubated d/t allowing assessment of appropriate silo reduction without impairing ventilation/circulation
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15
Q

post-op considerations for gastroschisis & omphalocele

A
  1. may need ETT 3-7 days 2. risk of postop HTN and edema 3. monitor intrabdominal pressures (bladder pressure) due to risk of compartment syndrome
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16
Q

imperforate anus is typically seen with what other congenital anomalies

A
  1. VACTERL 2. CHD 3. GU anomalies 4. Trisomy 18 5. Down syndrome
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17
Q

anesthetic considerations for imperforate anus

A
  1. dependent on intervention needed (do they need diverting colostomy first?) 2. typically no NMBA –> stimulate muscle around anus before creating opening
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18
Q

s/sx of pyloric stenosis

A

infants present btwn 2-8 weeks with… 1. nonbilious projectile vomiting 2. hypokalemia 3. hypochloremic metabolic alkalosis 4. if present in newborn = hypoglycemia

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19
Q

T/F: pyloric stenosis is a surgical emergency

A

false - correct fluid and electrolytes first

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20
Q

anesthetic implications for pyloric stenosis

A
  1. F/E imbalances: hypochloremic metabolic alkalosis, hypokalemia, hyponatremia, possible hypocalcemia 2. RSI or awake intubation 3. very short procedure: desflurane, propofol 4. mininimal postop pain - no opioids 5. extubate when fully awake
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21
Q

________________ = THE most common cause of acute abdominal surgery in children

A

appendicitis

22
Q

anesthetic considerations for appendicitis

A
  1. dehydration due to fever and vomiting 2. 12% increase in fluids for every 1 degree C temp increase 3. if ruptured - pt will be septic 4. RSI with cricoid pressure
23
Q

risk factors for necrotizing enterocolitis

A
  1. prematurity with small birth weight (<1500 g) 2. hypoxemia (birth asphyxia, RDS) 3. CHD
24
Q

theorized pathophysiology of necrotizing enterocolitis

A

mucosal injury –> bacterial infection –> gas formation –> necrosis

25
Q

s/sx of necrotizing enterocolitis

A
  1. hemodynamic/temperature instability 2. poor feeding with residual volume/vomiting 3. abdominal distension 4. bloody stools 5. sepsis/lethargy
26
Q

anesthesia considerations for necrotizing enterocolitis

A
  1. preoperative fluid resuscitation 2. electrolyte imbalances: hyperglycemia, metabolic acidosis, prerenal azotemia 3. avoid N2O 4. careful with myocardial depressants/VD (esp if look septic) 5. RSI or awake intubation 6. broad spectrum antibiotics (zosyn) 7. ensure blood products are readily available
27
Q

________________ is one or more of the cranial sutures close prematurely

A

craniosynostosis

28
Q

place in order from the most common to least common craniosynostosis

A

sagittal > coronal > metopic

29
Q

______________ craniosynostosis is the one most commonly associated with syndromes

A
  1. coronal 2. also complex (incl more than one)
30
Q

craniosynostosis is more common in what gender

A

males

31
Q

two types of craniofacial reconstruction approaches

A
  1. total cranial vault reconstruction 2. strip craniectomy
32
Q

uncorrected cranial vault deformities may lead to

A
  1. increase ICP 2. hydrocephalus 3. psychosocial issues 4. vision loss 5. developmental delay
33
Q

anesthesia implications for craniofacial reconstruction surgery

A
  1. risk of extensive blood loss - have blood in the room 2. fluid management 3. keep the baby warm
34
Q

development of a myelodysplasia has been found to be correlated with insufficient _______________ during pregnancy

A

folate

35
Q

what are the different presentations of a myelodysplasia

A
  1. spina bifida 2. meningocele 3. meningomyocele 4. arnold chiari malformation
36
Q

______________ myelodysplasia where bones do not close,but CSF and neural tissue are not involved

A

spina bifida

37
Q

________________ myelodysplasia where there are lesions in the CSF but not the tissues

A

meningocele

38
Q

________________ myelodysplasia where there are lesions in both CSF and neural tissues typically have loss of bowel and bladder fx and can have anywhere from sensory loss to complete paralysis

A

meningomyelocele

39
Q

_______________ myelodysplasia that has a caudal displacement of the brain stem

A

arnold chiari malformation

40
Q

anesthetic considerations for meningomyelocele

A
  1. infection risk 2. fluid and electrolyte considerations (leak of CSF, long surgery) 3. positioning for intubation 4. blood loss - ensure blood in the room 5. increased risk for latex allergy
41
Q

positioning for intubation for myelomeningocele

A
  1. if smaller - can do supine with lesion in a foam donut 2. if larger - lateral decubitus
42
Q

______________ almost alway exists with myelodysplasia

A

arnold chiaria malformation

43
Q

______________ is an abnormality in the posterior fossa and is associated with obliteration of normal exit of CSF from the fourth ventricle –> hydrocephalus

A

arnold chiari

44
Q

s/sx associated with arnold chiaria malformation

A
  1. almost always myelodysplasia will have arnold chiari malf. 2. vocal cord paralysis –> stridor, respiratory distress, apnea 3. abnormal swallowing/pulmonary aspiration 4. cranial nerve defects –> abnormal response to hypoxia and hypercarbia 5. unusual breathing or BP patterns
45
Q

________________ is a neural tube defect that is failure of the neural tube to close and can occur anywhere on the head

A

encephalocele

46
Q

location of encephalocele most common in the US

A

occiput

47
Q

encephalocele are thought to be due to what?

A

prenatal exposure to teratogens

48
Q

sx of encephalocele

A
  1. hydrocephalus 2. spastic quadriplegia 3. microcephaly 4. ataxia 5. developmental delay 6. mental and growth retardation 7. seizures 8. vision problems
49
Q

anesthesia concerns with encephalocele

A
  1. potentiall difficult airway 2. difficult to position for surgery and DL 3. difficulty with fluid management
50
Q

eventual s/sx in pt with hydrocephalus

A
  1. increase in head size 2. increase in ICP 3. lethargy 4. vomiting 5. cardio-respiratory problems

Pediatrics (15 decks)

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