peds ortho surgery Flashcards
(40 cards)
Anesthesia management issues with ortho procedures
airway, positioning. blood loss/fluid therapy, temperature conservation, post-operative pain
Congenital dislocation of the hip cause
prolonged displacement of the fetal femoral head from the acetabulum resulting in posterior dislocation during hip flexion (common in breech deliveries). Severity ranges from joint laxity to irreducible displacement.
Treatment for congenital dislocation of the hip
Pavlick harness,
fluroscopy guided closed reduction and spica casting
What is the name of the click as femoral head moves in and out of acetabulum
Ortalani
anesthetic management for congenital hip dislocation
short procedure, not painful,
inhalation anesthetic maintained via mask, LMA, ETT,
Greatest concern is LOSS OF AIRWAY!!! d/t positioning changes
Pt in air on SPICA casting frame,
Pt need to be deep stage III
Disconnect circuit prior to positioning changes and DC N2O,
Prevent hypothermia
What is congenital clubfoot?
structural deformity-shortened medial tendons of the lower leg, shortened Achilles tendon,
Foot pointed downward, rotated inward,
Treatment for congenital clubfoot?
manipulation and casting,
surgical correction and casting at 3-6months
Anesthetic management for congenital clubfoot
General and Regional
IH and then one shot caudal w/ bupi 0.25% 1mL/kg,
Analgesia for 4-6 hrs, decrease IH requirement,
Fentanyl and Mag sulfate IV opioids instead of spinal (can also use dilaudid) ,
immense post op pain-may need caudal epidural catheter
Anesthetic management of congenital clubfoot continued
tourniquets used,
stabilization of ETT, continuous monitoring of breath sounds,
intraop glucose monitoring and use of glucose containing solution,
temp conversation.
Usually 3-6months that have surgery anc can take up to 4 hrs. if bilateral
What is osteogenesis imperfecta?
Defect of collagen production resulting in abnormal bones, ligaments, teeth, and slcera.
Patients suffer fractures after innocuous contact or trauma.
(fibroblasts don’t work well)
What is a fibroblast?
a type of biological cell that synthesizes the extracellular matrix and collagen, produces the structural framework (stroma) for animal tissues, and plays a critical role in wound healing.
osteogensis imperfecta clinical presentation
bowing of long bones and kyphoscoliosis,
otosclerosis and deafness,
hypermetabolic-not MH,
Plt abnormalities and decreased Factor VIII levels in 30%
OI anesthetic management
Gentle manipulation of cspine and airways is vital
-Atlantooccipital instability
-cervical and mandibular fractures occur easily
-airway cartilages and teeth easily damaged
Normal airway-routine IH or IV induction and intubation,
Difficult-awake fiberoptic,
Muscle relaxants only after adequate mask ventilation is established.
Analgesia fentanyl 2-5mcg/kg and mso4 0.1mg/kg
OI anesthetic management continued
meticulous attention to positioning and padding of extremities,
avoid aggressive heat conservation measures and anti muscarinics,
toruniquets are utilized,
succs induced fasiculations can cause fractures
What is cerebral palsy?
static encephalopathy, or any nonprogressive central motor deficit r/t hypoxic or anoxic cerebral damage in the perinatal period
Etiology of cerebral palsy
prematurity, birth trauma, hypoglycemia, intrauterine and neonatal infections, congenital vascular malformations
CP clinical presentation
associated with mental retardation, seizures disorders, abnormalities of vision, speech, hearing, behavior, and cognition,
skeletal muscle spasticity and contractures,
impairment of laryngeal and pharyngeal reflexes-GERD and aspiration
Poor dental hygiene
CP anesthetic management
all techniques and agents have been used safely,
mod-severe CP airway management should involve intubation r/t predisposition to aspiration,
succs does NOT produce an exaggerated K release,
response to NDNMBs is normal,
Tend to have lower MAC than children without.
CP drug interactions/implications
Seizure Disorder-
phenobarbital, phenytoin, carbamazepine should be taken up to and including the day of procedure,
phenobarbital is hepatic microsomal enzyme inducer,
Spasticity-
Dantrolene-direct acting skeletal muscle relaxant, inhibits Ca release from sarcoplasmic reticulum,
Baclofen-skeletal muscle relaxant, inhibits excitatory neurotransmitters
Common in pediatric population r/t trauma
fractures
child sustraining blunt force trauma must be evaluated for?
injury to cspine and other organ systems
surgical repair of fractures
urgent/emergent-vascular compromise, large hematoma, hypotension,
Delayed stabilized and admitted
most common fracture in children
elbow fx from monkey bar falls
anesthetic considerations for fractures
RSI and endotracheal intubation indicated in patients coming from ED for urgent/emergent repair,
analgesia as indicated-IV opioids or caudal,
availability of blood products as needed,
temp conservation,
in acute fx, often blocks are not used to nerve injury is easier to be detected
