peds deck 12

Question 1

induction of anesthesia for TEF w/o G-tube

Answer 1

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

Question 2

induction of anesthesia for TEF with G-tube

Answer 2

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

Question 3

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

Answer 3

ETT migration into fistula

Question 4

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

Answer 4

omphalocele

Question 5

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

Answer 5

omphalocele

Question 6

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

Answer 6

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

Question 7

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

Answer 7

omphalocele

Question 8

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

Answer 8

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

Question 9

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

Answer 9

gastroschisis

Question 10

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

Answer 10

omphalocele; gastroschisis

Question 11

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

Answer 11

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

Question 12

primary goal of neonate with gastroschisis post delivery

Answer 12

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

Question 13

anesthesia implications for gastroschisis

Answer 13

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

Question 14

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

Answer 14

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

Question 15

post-op considerations for gastroschisis & omphalocele

Answer 15

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

Question 16

imperforate anus is typically seen with what other congenital anomalies

Answer 16

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

Question 17

anesthetic considerations for imperforate anus

Answer 17

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

Question 18

s/sx of pyloric stenosis

Answer 18

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

Question 19

T/F: pyloric stenosis is a surgical emergency

Answer 19

false - correct fluid and electrolytes first

Question 20

anesthetic implications for pyloric stenosis

Answer 20

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

Question 21

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

Answer 21

appendicitis

Question 22

anesthetic considerations for appendicitis

Answer 22

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

Question 23

risk factors for necrotizing enterocolitis

Answer 23

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

Question 24

theorized pathophysiology of necrotizing enterocolitis

Answer 24

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

Question 25

s/sx of necrotizing enterocolitis

Answer 25

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

Question 26

anesthesia considerations for necrotizing enterocolitis

Answer 26

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

Question 27

________________ is one or more of the cranial sutures close prematurely

Answer 27

craniosynostosis

Question 28

place in order from the most common to least common craniosynostosis

Answer 28

sagittal > coronal > metopic

Question 29

______________ craniosynostosis is the one most commonly associated with syndromes

Answer 29

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

Question 30

craniosynostosis is more common in what gender

Answer 30

males

Question 31

two types of craniofacial reconstruction approaches

Answer 31

1. total cranial vault reconstruction 2. strip craniectomy

Question 32

uncorrected cranial vault deformities may lead to

Answer 32

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

Question 33

anesthesia implications for craniofacial reconstruction surgery

Answer 33

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

Question 34

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

Answer 34

folate

Question 35

what are the different presentations of a myelodysplasia

Answer 35

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

Question 36

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

Answer 36

spina bifida

Question 37

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

Answer 37

meningocele

Question 38

________________ 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

Answer 38

meningomyelocele

Question 39

_______________ myelodysplasia that has a caudal displacement of the brain stem

Answer 39

arnold chiari malformation

Question 40

anesthetic considerations for meningomyelocele

Answer 40

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

Question 41

positioning for intubation for myelomeningocele

Answer 41

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

Question 42

______________ almost alway exists with myelodysplasia

Answer 42

arnold chiaria malformation

Question 43

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

Answer 43

arnold chiari

Question 44

s/sx associated with arnold chiaria malformation

Answer 44

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

Question 45

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

Answer 45

encephalocele

Question 46

location of encephalocele most common in the US

Answer 46

occiput

Question 47

encephalocele are thought to be due to what?

Answer 47

prenatal exposure to teratogens

Question 48

sx of encephalocele

Answer 48

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

Question 49

anesthesia concerns with encephalocele

Answer 49

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

Question 50

eventual s/sx in pt with hydrocephalus

Answer 50

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