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DH: Adv Principles A > Peds (Part 2) > Flashcards

Peds (Part 2) Flashcards

1
Q

True or False:

Children ages 1-3 years are more prone to seperation anxiety than children < 9 months

A

TRUE

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2
Q

What are the best methods of handling pre-op anxiety for various age groups?

1-3 years:
3-6 years:
7-12 years:

A

1-3 years: Distraction
3-6 years: Preop play
7-12 years: They require more explanation and want to actively participate

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3
Q

List of Predictors of difficult airway in children:

A
  • Mandibular protrusion
  • Atlantooccipital joint movement
  • Reduced mandibular space
  • Thick tongue
  • < 1 year old
  • ASA II-IV
  • Obesity
  • Facial and CV surgery hx
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4
Q

3 most common syndromes that indicate a difficult airway:

A
  1. Down Syndrome
  2. Treacher Collins
  3. Pierre-Robin
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5
Q

What are some common perioperative respiratory adverse events (PRAE) associated with URI’s?

A
  • Bronchospasm
  • Laryngospasm
  • Breath holding
  • Atelectasis
  • Pneumonia
  • Croup (post-ETT)
  • Unplanned hospital admission
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6
Q

How can we decrease the incidence of PRAEs if possible?

A

IV induction rather than inhalation induction

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7
Q

True of False:
LMAs put children at a higher risk of PRAEs over ETT?

A

False

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8
Q

Bronchial hyperreactivity can persist for up to ___ wks.

A

6+

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9
Q

Cancel or Proceed with caution?

Lethargic w/ Fever:
Persistent Cough:
Runny nose in older child:
Poor apetite:
Purulent drainage in 9 month old:

A

Lethargic w/ Fever: Cancel
Persistent Cough: Cancel
Runny nose in older child: Proceed
Poor apetite: Cancel
Purulent drainage in 9 month old: Cancel

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10
Q

How long (per current guidelines) should we wait to reschedule a patient with an URI?

A

At least 2 wks

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11
Q

Where, anatomically, should the oral airway extend from and to?

A

Tip of the mouth to the edge of the mandible

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12
Q

Common procedure where an oral RAE tube may be used?

A

Tonsils and adenoids

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13
Q

Formulas for determining uncuffed ETT size?

( > 2years old)

A
  1. (16 + age in yrs) / 4
  2. (Age in yrs/4) + 4

Then subtract 0.5 from that number and there is your ETT size

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14
Q

Typical tube size for 1-2 yrs

A

3.5

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15
Q

Tube size for neonates/ infants who are > 3kg and < 1 year?

A

3.0

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16
Q

How can we determine the correct intubating length/depth?

A
  • (Age in years / 2) + 12
  • ETT size x 3
  • (Kg / 5) + 12
  • (cm / 10) + 5
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17
Q

Determine ETT size and depth:

5 year old patient

A

ETT Size: 5.0 or 4.5

Length: 13-15 cm

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18
Q

Correct LMA sizes and inflation volumes:

A
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19
Q

Volume in ped circuit bag?

A

1 L

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20
Q

Dosages for emergency drugs?

A
  • Epi: 0.01 mg/kg
  • Atropine: 0.02 mg/kg
  • Glyco: 0.01 mg/kg
  • Succs: 2 mg/kg (IV) OR 4 mg/kg (IM)
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21
Q

Most common PO pre-med for peds?

A

0.25 - 1 mg/kg PO of Versed

20 minutes for sedation

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22
Q

Dose for Precedex and Ketamine as a pre-med?

A

Precedex: 1-2 mcg/kg intranasal

Ketamine: 5-10 mg/kg IM

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23
Q

Why would we specifically choose to do an IV induction over an Inhalation induction?

A
  • RSI for a full stomach
  • Known difficult airway
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24
Q

NMBD of choice for a child with a full stomach?

25
Steps to performing a Mask induction:
1. Pre-med 2. Place monitors 3. Sevo (& Nitrous) 4. IV placement 5. Medications 6. Airway placed
26
In terms of airway management, children are very prone to ___?
Upper Airway collapse
27
What is one abnormal clinical sign that we could visualize if the patient may be obstructing?
Thoracoabdominal asynchrony
28
Various ways we could relieve an airway obstruction:
- Head extension - Chin lift/jaw thrust - Mouth opening - CPAP - Lateral Decubitus - Assist devices (OPA/Nasal airway) - Deepen anesthestic
29
Maintenance fluid rate for a 37 kg child:
77 ml/hr
30
Examples of Peri-op fluid losses:
1. Surgical depenedent losses 2. Environmental (temp) 3. Cold, dry anesthetic gas 4. Neuroendocrine regulation (affected by gas)
31
Rate of 10% dextrose infusion for symptomatic hypoglycemia? What about if they are having siezures?
2 ml/kg 4 ml/kg
32
Cases in which a dextrose infusion may be beneficial for the patient?
- Premature infants - Infants with DM moms - Children w/ DM (insulin taken) - Infants taking glucose
33
EBV Table:
34
Incidence of apnea is higher in premature infants and neonates with Hct < ___
< 30%
35
MABL formula?
MABL = EBV x (Starting Hct - Target Hct) / Starting Hct (Maximum Allowable Blood Loss)
36
How much crystalloid should we use to replace blood lost? What about PRBCs?
3:1 for crystalloid 1:1 for PRBCs
37
What is the Hct of PRBCs?
about 60%
38
How much volume per kg of PRBCs will it take to raise your Hgb by 1 g/dL?
About 4 ml/kg
39
Determine how much volume of PRBCs should be given to this patient: Premature infant, 2 kg, Desired Hct of 25, Current Hct of 17
(25 - 17) x (100 x 2) / 60 = 26.667 mls of PRBCs
40
Contraindications for outpatient anesthesia? Why?
- Pre-mature infants < 35 wks gestation - babies < 60 weeks post-conceptual age At risk for post op apnea and must stay overnight
41
Cardiac related causes of perioperative arrest in children:
- Hypovolemia - Myocardial ischemia - Hyperkalemia - Sudden arrythmias
42
Respiratory related causes of perioperative arrest in children:
- Laryngospasm - Inadequate oxygenation - difficult intubation
43
What has been shown to directly correlate to respiratory complications in children in the OR?
Experience level of the anesthesia provider
44
Type of extubation in a reactive airway?
Deep extubation
45
Necessary equipment when transporting a child to PACU
1. Jackson-Reese 2. Precordial Stethescope 3. Pulse ox 4. Propofol 5. Other emergency meds
46
Metabolic contributors to Post-op apnea in pre-mature infants:
- Hypothermia - Hypoglycemia - Hypocalcemia - Acidosis - Resp. Instability
47
Tx for stabilizing respiratory rhythm
- Caffiene (20 mg/kg) - CPAP
48
Incidence rate of emergence agitation and delirium
10-80%
49
Possible factors contributing to agitation:
- Pain - Cold - Full bladder - Fear/anxiety - Seperation
50
Risk factors for emergence delirium:
1. Ages 2-9 2. Surgery Type 3. Anesthetic (Gas is #1 RF) 4. Pre-existing delirium 5. Anxiety 6. Pain
51
Tx for Emergence delirium:
- Treat pain - Alpha-2 agonists - Propofol - Time
52
Select the 3 correct statements regarding Regional anesthesia in the pediatric population. A. The child will be under GA before the block is completed B. The dose of Local and Epi are the same as an adult dose C. Dural puncture is much more easy to identify when the patient is under GA D. The risk of inadvertent placement is lower in the peds population when under GA E. Assessment of sensory level is much harder
A. The child will be under GA before the block is completed D. The risk of inadvertent placement is lower in the peds population when under GA E. Assessment of sensory level is much harder
53
CSF volume differences in the aduly vs peds population
Adult = 4 ml/kg Peds = 2 ml/kg | Higher dose = shorter DOA in peds
54
Most common method of RA in the peds population: How are these patients positioned?
Caudal Anesthesia Lateral position with knees flexed
55
Landmarks for caudal anesthesia
- Tip of coccyx (midline) - Sacral Cornu on both sides These structures form an equilateral triangle
56
Step-by-step for caudal anesthetic block:
1. Insert 22g needle angled 45 degrees to the skin 2. LOR felt when sacrococcygeal membrane is punctured 3. Reduce angle of needle 4. Advance cephalad 5. Aspirate 6. Inject LA
57
Approximate dose of LA that will provide T4/T6 dermatome coverage in caudal anesthesia
1.2-1.5 ml/kg of LA
58
Max concentration of LA in caudal anesthesia
2.5 mg/kg
59
Possible additives into caudal anesthetic:
- Epi (1: 200k) - Clonidine (1-2 mcg/kg) - Fentanyl

DH: Adv Principles A (27 decks)

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