Peds (Part 3) Flashcards by Monterrio Jones

What nerve is being stimulated that will cause a laryngospasm?

Superior Laryngeal nerve

How well did you know this?

Not at all

Perfectly

Laryngospasms are common in patients with an ___.

URI

How well did you know this?

Not at all

Perfectly

Preoperative factors increasing the likelihood of a laryngospasm

Secondhand smoke
Active/Recent URI
GERD
Mechanical irritants (secretions)

How well did you know this?

Not at all

Perfectly

Ways we can prevent a laryngospasm

Avoid stimulation during stage 2
Topical lidocaine
IV Lido prior to extubation
Suction prior to extubation (not in stage 2)
Awake extubations
100% O2 for 3-5 min prior to extubation

How well did you know this?

Not at all

Perfectly

Incomplete Airway obstruction algorithm

How well did you know this?

Not at all

Perfectly

What is the differences to the complete obstruction algorithm

More firm pressure from the start
Skip the propofol and give the succs

How well did you know this?

Not at all

Perfectly

Meds we also give when administering succs for a laryngospasm

Glyco or Atropine

(Also deepen the gas/prop)

How well did you know this?

Not at all

Perfectly

Bronchospasms are common in these 2 populations (children)

Asthma
URI

How well did you know this?

Not at all

Perfectly

Manifestations of a bronchospasm

Audible wheeze
Prominent expiratory slope on ETCO2
Increased ETCO2
Decreased Saturation

How well did you know this?

Not at all

Perfectly

Treatments for Bronchospasms that are different than laryngospasm

Albuterol
IV Mg
Steroids
Epi (5-10 mcg/kg)

How well did you know this?

Not at all

Perfectly

Post-intubation Croup is commonly caused by ___.

Laryngeal Edema

How well did you know this?

Not at all

Perfectly

What are some reasons why laryngeal edema (post-intubation croup) might occur?

ETT too big
Multiple DL attempts
Positioning
Length of surgery
Age (< 4 yrs)
URI
Coughing with ETT in place

How well did you know this?

Not at all

Perfectly

Treatments for Post-intubation croup

Steroids
Racemic Epi (2.25%)
Supplemental O2

How well did you know this?

Not at all

Perfectly

When does post-intubation edema present?

How can we prevent it?

30-60 min following extubation

Maintain air leak < 25 cm H2O

How well did you know this?

Not at all

Perfectly

Syndromes mentioned in this lecture that can indicate a difficult airway due to having a large tongue?

Beckwith Syndrome
Down Syndrome

Oral Airway

How well did you know this?

Not at all

Perfectly

Difficult airway syndromes related to anomlies in the C-spine

Klippel-Feil
Trisomy 21
Goldenhar

How well did you know this?

Not at all

Perfectly

Difficult airway syndromes related to having a small/underdeveloped mandible

Pierre Robin
Goldenhar
Treacher collins
Cri du chat

How well did you know this?

Not at all

Perfectly

What is one thing we definitely don’t want to use for a known difficult airway?

NMBDs

How well did you know this?

Not at all

Perfectly

What age do we see peak incidence of foreign body aspiration?

6 months - 3 yrs

How well did you know this?

Not at all

Perfectly

Anesthesia considerations for a foreign body aspiration:

Inhalational induction
Maintain spont. ventilation
Increase FGF/VA
TIVA?
Prevent coughing/bucking

How well did you know this?

Not at all

Perfectly

Epiglottits or Croup?

22 months old:
Rapid Onset:
Viral in nature:
Supraglottic region affected:
Tx with ABX:
Laryngeal region affected:

22 months old: Croup
Rapid Onset: Epiglottitis
Viral in nature: Croup
Supraglottic region affected: Epiglottitis
Tx with ABX: Epiglottitis
Laryngeal region affected: Croup

How well did you know this?

Not at all

Perfectly

Clincal manifestations of Epiglottitis:

Drooling
Dyspnea
Dysphonia
Dysphagia
Dis High fever

How well did you know this?

Not at all

Perfectly

Clinical Manifestations of Croup:

Barking cough
Mild fever
Inspiratory stridor

How well did you know this?

Not at all

Perfectly

Which population of peds patients are at higher risk of OSA, Subglottic stenosis, atlantoaxial instability?

Trisomy 21

How well did you know this?

Not at all

Perfectly

What is a common issue seen with Trisomy-21 patients?

Congenital Heart disease (40-50%) - Specifically AVSD --> VSD

Common adverse reaction seen with inhalational inductions on patients with Trisomy 21?

Bradycardia (Due to low levels of circulating catecholamines) | Glyco and Atropine AVAILABLE!

What is CHARGE syndrome?

**C**oloboma **H**eart defects **A**tresia of the choanal region **R**estriction of G/D **G**enitourinary problems **E**ar anomalies

DiGeorge/Catch 22 syndrome

Cardiac Abnormal Face Thymic hypoplasia (need irradiated blood) Cleft palate Hypocalcemia (d/t hypoparathyroidism) 22 q11.2 dene deletion

VACTERL Association:

**Vertebral Anomalies** Anal Atresia CV anomalies **Tracheoesophageal fistula** Esophageal Atresia Renal/Radial anomalies Limb defects | **Most common**

Important anesthetic consideration when doing a strabismus repair

- Stimulation of oculocardiac reflex

True or False: Continued stimulation of the oculocardiac reflex makes the negative outcomes exponentially more likely?

False: It actually begins to fatigue the response | 1st Step in managing this --> ASK THE SURGEON TO STOP

Important things to remember for retinopathy of prematurity:

- < 30 wks premature increases risk - Caused by liberal oxygen use - Keep sats 89-94% for preemies - Preductal O2 is a better indicator of saturation of retinal vessels (right hand)

Anesthetic considerations for children with OSA:

- Careful with giving premed - Dose Opioids on IBW (Careful titration) - Expect these pts to need extended observation

Important preop assessment for T&A procedure?

Hx of bleeding (family hx)

Dose of decadron for T&A procedure:

0.5 mg/kg

Awake or deep extubation for T&A?

Ideally deep

Anesthetic complications seen with T&A:

Bleeding - 6-24 hrs post op (primary) - 5-10 days after (secondary) Airway Fire: - Maintain FiO2 < 30% - Avoid N2O

Post-tonsillar bleed anesthetic considerations:

1. VOLUME! 2. RSI (Full stomach) 3. Pre-ox in Left lateral, head down position 4. Smaller ETT (1/2 size down) 5. Antiemetics 5. OG Tube 6. Awake Extubation

Does the cleft lip or cleft palate get fixed first?

LIP!

Olive shaped mass, most commonly seen in first-born males?

Pyloric Stenosis

Clinical s/s of Pyloric Stenosis:

1. Projectile Vomiting 2. Palpable pylorus 3. Visible peristaltic wave

Preoperative management for pyloric stenosis:

- Correct hypovolemia - Correct acid/base abnormalities - Correct hyponatremia

Considerations for inguinal hernia repair:

- Monitor for SB incarceration and testicular injury - Possible spinal/caudal block - Concern for postop apnea Caudal can be done/ inhalation induction

Difference between gastroschisis and omphalocele:

The defect in gastroschisis is NOT covered by an outer membrane, whereas omphalocele is. Gastroschisis is more urgent

Anesthetic concerns for omphalocele and gastroschisis:

- Dehydration - Hypothermia - Sepsis potential - Increased abd pressure - Post-op ventilation

Which two statements regarding anesthestic considerations for Omphalocele and gastroschisis are correct? A. Restrict fluid replacement B. Avoid the use of N2O C. Paralytics are not necessary for this surgery D. Place the pulse ox on the feet

B. Avoid the use of N2O D. Place the pulse ox on the feet

This disease process is a life-threatening emergency that primarily occurs in preterm babies gestational age < 32 weeks and weight < 1500 g:

Nectrotizing Enterocolitis (NEC)

NEC is more mosst common in premature neonates with what defect?

PDAs

Abnormal labs that may be present in NEC:

- Hyperkalemia - Hyponatremia - Metabolic Acidosis - Hyper/hypoglycemia - DIC

Anesthetic management for NEC:

- Avoid N20 - Caution with Volatiles - Inotropes - FLUID

Which of the 3 will you see non-bilious vomiting? - NEC - Malrotation and Midgut volvulus - Pyloric stenosis

Pyloric Stenosis

The patient comes in with suspected midgut volvulus, what procedure needs to be done?

Ladd Procedure

CDH prevents what?

Normal lung growth and development

What type of shunt can be seen in CDH patients?

R-L Shunt

Which lung is effected most in CDH?

Left lung (ipsilateral side) | 80% experience herniation

The median age of patients undergoing operationf for CDH is ___. During this procedure, ___ may be required.

4 days One Lung ventilation

Pulmonary considerations for CDH operation:

- Permissive hypercarbia (OLV) - Avoid inflating stomach with air - PIP < 25-30 - Post op: hyperoxegenate (PaO2: 150)

While attempting to pass an OGT into the stomach immediately after birth it will not pass. You also note a stomach bubble on ultrasound. What is the likely dx?

Tracheoesophageal fistula/ Esophageal Atresia

Most common TEF / EA?

Type C

How is a TEF repair performed? What is something we specifially will need to do?

Right sided thoracotomy Main-stem intubation --> OLV

Induction techniques for TEF/EA Repair:

- Head Up, frequent suctioning - Awake intubation, inhalation - Bronchoscopy after intubation

Imperforated anus is diagnosed when neonates...

Don't pass their meconium within the first few days after birth

Imperforated anus is often associated with which other disorder?

VACTERL

Do males or females require more immediate intervention with imperforate anus?

Males

Obstruction of CSF flow in the brain can cause this issue?

Neonatal Hydrocephalus (Increased ICP)

S/S of increased ICP

- Bulging fontanelle - irritability - somnolence - vomiting

Tx for Neonatal Hydrocephalus

VP Shunt to drain excess CSF

Induction technique for Neonatal hydrocephalus

RSI - CAREFUL WITH VA (Increase ICP due to increased CBF)

Myelomeningocele is a form of ___

Spina Bifida

Most common CNS defect within 1st month gestation

Myelomeningocele

Myelomeningocele patients have an increased sensitivity to what? They are also more prone to ___?

Latex Hypothermia