Peds week 7

Question 1

Bupivacaine - most commonly used concentration and length of analgesia

Answer 1

0.25%

4 hours

Question 2

Hepatic metabolism of prilocaine yields

Answer 2

O‐toluidine, which can produce methemoglobinemia,
thereby rendering RBCs less capable of carrying
oxygen
The decreased activity of methemoglobin reductase
and the increased susceptibility of fetal hemoglobin
to oxidization make prilocaine an unsuitable LA for
use of neonates. Prilocaine is also one component of
the EMLA cream

Question 3

Which LA is NOT metabolized in neonates?

Answer 3

Mepivacaine

neonates generally aren’t big on going to the Meps baseball games because their mascot is lame

Question 4

Plasma cholinesterase activity in infants is __
compared with adults, thus, the plasma half‐life of
the ester LA may be prolonged.

Answer 4

decreased

Question 5

___ (1.5% concentration) has been
recommended for neonatal regional techniques,
including epidural blockade

Answer 5

2,3‐Chloroprocaine

Question 6

How is the absorption and volume of distribution different in infants compared with older children and adults?

Answer 6

Absorption of the drugs is rapid, the CO and regional tissue
blood flow are higher, and the epidural space contains less
fat tissue to buffer the uptake. Drugs sprayed into the
airway are very rapidly absorbed.
 The volume of distribution of the drug is larger. Plasma
levels of Bupivacaine after administration of a standard
2.5 mg/kg dose into the epidural space are therefore lower
in infants than in young children and adults.
Coté

Question 7

Caution is advised when LA is being considered in the

jaundiced neonate because

Answer 7

Bilirubin may further reduce the potential for

protein binding.

Question 8

A greater volume of distribution extends the elimination __

Answer 8

half life

Question 9

protein binding is less because

Answer 9

albumin and α1‐acid glycoprotein levels are low in

the neonate.

Question 10

Is elimination of amide LA faster or slower in the neonate compared to the adult?

Answer 10

slower elimination

Question 11

Max dose lidocaine

Answer 11

4.5 mg/kg

Question 12

max dose bupivacaine

Answer 12

2.5 mg/kg

Question 13

max dose ropivacaine

Answer 13

2 mg/kg

Question 14

Because Bupivacaine is highly bound to plasma proteins (α1‐acid
glycoprotein), and the concentration of albumin and α1‐
acid glycoprotein are less in neonates, therefore__

Answer 14

increased free

(unbound) fraction of the LA that produces toxicity

Question 15

Intralipid dose

Answer 15

1.5 ml/kg of 20%, may repeat once, then infuse 0.25 ml/kg/min

Question 16

Where is the conus medullaris in the neonate?

Answer 16

L3

therefore, perform SAB at L4-L5 or L5-S1 to avoid the spinal cord

Question 17

At what year does the spinal cord achieve normal adult level of L1-2?

Answer 17

1 year of age

Question 18

What is the significance of a deep sacral dimple?

Answer 18

may be associated with spina bifida occulta, greatly increased chance of dural puncture, CAUDAL BLOCK IS CONTRAINDICATED

Question 19

in infants and young children, CSF volume as a percentage of body weight is greater than in adults, therefore-

Answer 19

comparativel larger dose of LA required for SAB

Question 20

CSF turnover rate is also greater, therefore-

Answer 20

more brief duration of SAB in infants

Question 21

SAB in infants is associated with hemodynamic STABILITY due to-

Answer 21

parasympathetic stronger than sympathetic = significant BP changes do not occur

Question 22

where to place caudal needle?

Answer 22

slightly caudal to the cornua of sacral hiatus

Question 23

What ligament “pops” as the needle enter the caudal canal and epidural space?

Answer 23

sacrococcygeal ligament

Question 24

what is the earliest sign of a high spinal?

Answer 24

decreasing oxygen sats

Question 25

dose for bupivacaine in caudal

Answer 25

0.5ml/kg for perineal surgery 1 ml/kg for abdominal surgery 0.25% with 1:200,000 epi

Question 26

volume for a ped epidural blood patch?

Answer 26

0.3 ml/kg

Question 27

Tonsillar hyperplasia may lead to

Answer 27

chronic airway obstruction, resulting in sleep apnea, carbon dioxide retention, cor pulmonale, failure to thrive, swallowing disorders, and speech abnormalities.

Question 28

``` Pts classified as +3 tonsillar size or greater, having more than 50% of the pharyngeal area occupied by hypertrophied tonsils, are at increased risk of developing ```

Answer 28

airway obstruction during anesthetic induction.

Question 29

Apnea –

Answer 29

–cessation of airflow lasting ≥ 10 seconds

Question 30

Hypopnea –

Answer 30

a decrease in airflow lasting ≥ 10 seconds with a 30% O2 reduction in airflow and with at least a 4% O2 desaturation from baseline

Question 31

``` The AHI (apnea hypopnea index) is the summation of the number of obstructive apnea and hypopnea events per hour of sleep ```

Answer 31

AHI >5 the severity of OSA predicts the nature of respiratory complications

Question 32

Primary Post‐Tonsillectomy bleeding occurs within

Answer 32

24 hours - MORE SERIOUS

Question 33

Secondary Post‐Tonsillectomy bleeding occurs within

Answer 33

5-10 days

Question 34

Children with long-standing OSA show what cardiac changes?

Answer 34

PA hypertension, RV hypertrophy

Question 35

What nerves to block for inguinal hernia repair?

Answer 35

ilioinguinal and iliohypogastric