Peds II Part I Flashcards
(109 cards)
1
Q
What is considered an ex premature infant?
A
<37 weeks and <60 weeks postconceptional age
2
Q
How long should expremature patients be monitored after general surgery?
A
12-24 hours for apnea and O2 desaturation
3
Q
what are the factors that increase risk of periop apnea
A
< 60 weeks postconceptual
anemia <12 gm Hgb
secondary diagnoses (intraventricular hemorrhage)
4
Q
should you avoid opioids in expremature infants in genral?
A
yes
5
Q
what caffeine dose can be used to decrease the frequency of apnea in expremature infants?
A
10mg/kg
6
Q
when can an expremature infant be discharged after general?
A
12 hrs free of apnea
7
Q
does regional increase risk of periop apnea?
A
no
8
Q
what valve is involved in Ebstein’s anomaly?
A
tricuspid
9
Q
what portions of the tricuspid valve leaflets are displaced into the RV?
A
septal and posterior
10
Q
is the anterior valve leaflet of the Tricuspid abnormal in Ebsteins anomaly?
A
yes
11
Q
describe the anterior valve of the tricuspid in Ebsteins anomaly
A
elongated and sail like with chordal attachments to the RV free wall
12
Q
is there an RV outflow tract obstruction in ebsteins?
A
maybe
13
Q
is the tricuspid valve regurgitant or stenotic in ebsteins?
A
usually regurgitant (may be stenotic)
14
Q
what type of interatrial communication is present in ebsteins?
A
R to L shunting
15
Q
what happens to the RA in Ebsteins?
A
dilated
16
Q
what happens to the RV in Ebsteins?
A
atrialized and reduced cavity
17
Q
neonatal clinical presentation of Ebsteins
A
systemic venous congestion
cyanosis
worsens after ductus arteriosis closes
18
Q
older children clinical presentation of Ebsteins
A
incidental murmur
19
Q
adolescent and adult presentation of Ebsteins
A
SVT to CHF
worsening cyanosis
occasional syncope
20
Q
what are the risks for Ebsteins?
A
paradoxical embolizaiton
brain abcess
CHF
sudden death
21
Q
What are the signs and symptoms of Ebsteins anomaly? (thats right…there is more)
A
cyanosis (depends on R to L shunt) systolic murmur (left lower sternal border) hepatomegaly tall broad P waves, 1st degree block PST and VT WPW (20%)
22
Q
treatment options of ebsteins
A
tricuspid valve repair to fontan procedure to transplant
23
Q
associated complications after Ebsteins anomaly repair
A
infective endocarditis
CHF
SVT
24
Q
what are the surgical goals of Ebstein anomaly repair?
A
repair or replace tricuspid valve
repair atrial defect
25
complications after ebsteins anomaly repair
3rd degree AV block
SVTs
residual tricuspid regurg
prosthetic valve dysfunction
26
is the effect of IV anesthetics effected in Ebsteins?
yes; usually delayed effect of IV anesthetics
27
what are the major anesthetic hazards associated with ebsteins?
depressed RV function
increases in R to L shunt
SVTs
28
Other goals of anesthetic management of Ebsteins
minimize mechanical metabolic affects of ventilation
| maintain RV contractility
29
3 most common cardiac anomalies related to trisomy 21
complete atrioventricular canal defect (40%)
ventricular septal defect (25%)
atrial septal defect (10-15%)
30
other associated cardiac anomalies with DS
tetralogy of Fallot and PDA
| all have propensity for increased pulmonary blood flow
31
what is one of the most common clicial features of DS?
hypotonia (can affect patency of airway)
32
other associated clinical features of DS that contribute to upper airway obstruction
large tongue
short neck
crowded midface
laryngomalacia
33
DS associated with ____ incidence of subglottic stenosis and tracheal stenosis
increased (may need smaller ETT)
34
risks and considerations of ligamentous laxity of atlantoaxial joint
- risk of C1-2 subluxation adn possible SCI
- postpone elective surgery for neuro consult if H&P contains problems or cervical xrays show atlantodens interval >5 *
- keep head and neck in a neutral position.
35
general findings associated with DS
low birth weight
| short stature
36
cardiovascular findings associated with DS
CHD
increased susceptibility to pulmonary hypertension
atropine sensitivity
37
respiratory findings associated with DS
```
high arched narrow palate
macroglossia
micrognathia
increased susceptibilty to resp infections
sublottic stenosis
postextubation stridor
upper airway obstruction, sleep apnea
```
38
GI findings associated with DS
dental abnormalities
duodenal obstruction
gastroesophageal reflux
hirschprung disease
39
CNS findings associated with DS
mental retardation
epilepsy
strabismus
40
Musculoskeletal findings assicated with DS
hypotonia
hyperextensibility or flexibility
dysplastic pelvis
atlantoaxial subluxation
41
immune system findings associated with DS
immunosuppression
| leukemia (acute lymphoblastic, acute myeloid forms)
42
hematological findings associated with DS
neonatal polycythemia
43
endocrine findings associated with DS
low circulating levels of catecholamines
| hypothyroidism
44
does prune belly occur more often in females or males?
males; 97% of the time
45
what infants does prune belly affect?
range from stillborn- full term
46
how often is there orthopedic involvement in prune belly?
50%
47
how often is there GI involvement in prune belly?
30%
48
how often is CHD and chromosomal defects associated with prune belly?
10%
49
what is the mechanism behind prune belly syndrome?
in utero, abdomen swells with fluid (oligohydramnios) reabsorbed by birth leaving wrinkled abdnomen.
50
what is the pathophysiology of prune belly?
unclear; urethral obstruction leads to dilation of urethra with bladder distention and ascites leading to abdominal distension in utero
51
respiratory effects of prune belly
abdominal overdistension in utero leads to weak abdominis muscles which interferes with infants ability to exhale forcefully
52
what characteristics of prune belly leads to an increased risk of aspiration pneumonia
cannot cough to clear secretions
53
how do you decrease risk of aspiration pneumonia in prune belly?
control feedings
prevent GI reflux
antibiotics
54
is constipation associated with prune belly
yes
55
what trisomy is associated with prune belly?
18 (60-80% are females)
56
Type I prune belly
severe renal disease
pulmonary hypoplasia
(both)
*incompatible with survival*
57
Type 2 prune belly
neonatal emergencies with sever uropathy and UTI
| requires mult surgeries
58
Type 3 prune belly
minimal problems as a newborn
| prone to infections later in childhood
59
anesthetic management of prune belly
```
avoid preop sedation
H2 antagonist and sodium citrate
awake intubation or RSI
(avoid muscle relaxants minimal opioids, avoid drugs requiring renal excretion)
controlled ventilation
maintenance with inhalational or IV
awake extubation
regional may be preferred
```
60
what is characterized by retrognathia, glossoptosis, and airway obstruction?
pierre-robin
61
what is glossoptosis
tongue falling to back of throat
62
what other syndrome is pierre-robin often associated wtih?
Stickler syndrome
63
what symptoms are associated with stickler syndrome
micrognathia
poor vision
collagen disorder with hyperflexible joints
64
what position may be required to releive airway obstruction for pierre robin?
reflux and feeding difficulties
65
what are GI complications associated with pierre robin?
reflux and feeding difficulties
66
what does tongue-lip management of pierre robin acheive?
relieve airway obstruction
| improve feeding
67
when can mandibular distraction be performed for pierre robin?
<6 months old
68
on average, how many years does it take to decannulate the tracheostomy with pierre-robin
3 years
69
airway management of pierre-robin
difficulty mask ventilation and intubation
70
what are some ventilation and intubation considerations associated with pierre robin?
- LMAs have been successful
- nasal intubation
- video laryngoscopy
- suture (0-silk) placed at base of tongue to displace tongue anteriorly
71
what is the anesthetic management of tongue-lip adhesion or mandibular distraction with pierre robin?
inhalation induction
SV
flexible fiberoptic
nasal intubation
72
special anesthetic considerations of tongue-lip adhesion with pierre robin
postop ventilation for several days; extubate in OR?
73
special anesthetic considerations for mandibular distraction with pierre robin?
distractors prevent effective mask ventilation
74
cleft lip
3-6mo
75
cleft palate
9-18months
76
palatoplasty
different techniques; all involve repair of hard/soft palates
77
pharyngoplasty
5-15 years
78
pharyngoplasty repairs what?
incompetent velopharyngeal sphincter that allows inappropriate nasal air escape during speech
79
anesthesia management for clefting
most are inhalational induction but can use IV if present
80
describe airway mangement for cleftin
mostly straight forward; difficulty can offur with craniofacial abnormalities or retrognathia
81
what factors can predict dificult DL view with clefting
bilateral clefts and retrognathia
82
describe respirations until the trachea is secured during repair of clefting
SV
83
what are options for securing airway for clefting repair?
intubating through LMA with fiberoptic scope; video laryngoscopy
84
what airway could potentially interfere with cleft repair?
LMA
85
which type of tube is preferred during clefting repair?
oral RAE
86
what increases due to fixed length of oral RAE tubes?
mainstem intubation
87
is there a standard for maintenance during clefting repair?
no
88
what are MAP requirements for clefting repair?
50-60
89
what concentration of epi is safe for the surgeon to infiltrate the palate with during a cleft repair?
10 mcg/kg (max dose)
90
what is of particular concern in terms of positioning during a cleft repair?
protecting the infants chest wall and extremeties
91
what should be placed prior to emergence following a cleft repair to reduce postop airway obstruction?
nasopharyngeal airway
92
what is a critical step prior to extubation of cleft repair?
ensure removal of throat pack
93
what is a post op cleft repair risk that would increase the likelihood of postop airway obstruction?
tongue, palate and pharyngeal edema
94
what is the best action if tongue, palate, and pharyngeal edema are present post cleft repair?
reintubation, MV, and reevaluate edema (may take several days)
95
acetaminophen dose for pain control in clefting
rectal: 20-40 mg/kg initially, then 20 mg/kg q 6hrs
oral: 10-15mg/kg q 4-6hrs
96
NSAIDS increase what?
risk of postop bleeding
97
dose of oral morphine for pain control in clefting
0.02mg/kg IV q 3-4 hrs; monitor for respiratory depression
98
what can also be used in postop pain control after clefting repair?
bilateral infraorbital nerve block
99
where does the maxillary division of the trigeminal nerve exit?
infraorbital foramen
100
what does the maxillary division of the trigeminal nerve supply?
sensory supply to upper lip, maxillary sinus, and part of nasal septum
101
other term for Treacher Collins
mandibulofacial dysostosis
102
characteristics of treacher collins
```
poorly developed supraorbital ridges
aplastic/hypoplastic zygomas
ear deformities
hearing loss
cleft palate (1/3rd)
mandibular and midface hypoplasia
```
103
what is the primary concern for patients with treacher collins?
airway (difficult to mask ventilate or intubate)
104
obstruction depends on what in treacher collins?
degree of maxillary and mandibular hypoplasia
choanal atresia
glossoptosis
105
what may be needed for those at risk for OSA and SIDS associated with treacher collins?
trach
106
when is the timing of major reconstrction for treacher collins?
childhood or adolescence
107
what are potential options for intubation of patient with treacher collins
bullard laryngoscopy, LMA, glidescope have been successful
108
what may be the BEST option for intubation of teacher collins patients
sedation and fiberoptic
109
what are potential opthalmic complications for patients with treacher collins during surgery?
orbital compression and perioperative blindness
