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G935 > Physical Exam Anesthesia > Flashcards

Physical Exam Anesthesia Flashcards

(55 cards)

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1
Q

Preterm babies have an increased risk of:

A

Bronchopulmonary dysplasia (chronic breathing difficulties)

Congenital heart disease

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2
Q

Which medications require consult prior to day of surgery? (P GAAI)

A

Phentermine –> affect heart rate
GLP-1 Analogues (-glitides) → risk of aspiration
Anticoagulants
ACEI/ARBS –> refractory hypertension
Insulin/diabetes → hypoglycemia risk

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3
Q

Most common allergy to medications:

A

Antibiotics

Muscle relaxants

(does not include LA)

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4
Q

Is there a true allergy to opioids?

A

NO –> histamine release & GI reaction.

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5
Q

True anaphylaxis presents as

A

Rash & Breathing difficulty

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6
Q

Egg allergy is cross reactive to

A

propofol sensitivity

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7
Q

Tobacco use/exposure increases risk of

A

perio-operative adverse events

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8
Q

NPO guidelines

A

To eliminate risk of GI aspiration

2: clear liquids, no pulp
4: breast milk
6: formula/cows milk, chewed candies
6: light meals

8: fried, heavy fatty meals, meat, chocolate

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9
Q

PONV is genetic T/F?

A

TRUE there is a genetic component

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10
Q

What features may lead to problems with masking?

A

large soft tissues (tongue, T&A)
small mouth
facial deformity

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11
Q

What features may lead to problems with intubation?

A

Atlantooccipital restriction (Down Syndrome)
TMJ restriction

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12
Q

What is the 3-3-2 rule?

A

3 fingers Interincisal distance
3 fingers submandibular space
2 fingers thyroid to the floor of the mandible

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13
Q

How to test TMJ mobility?

A

Upper lip bite test

Class 1 = good, Class 3 = bad

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14
Q

Modified Mallampati:

A

1: Uvula & Throat
2: Uvula
3: Only base of uvula
4: Only hard palate

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15
Q

Adenoid Hypertrophy stage 3/4

A

Beware –> OSA & extreme sensitivity to narcotics

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16
Q

Pierre Robin Sequence

A

micrognathia, glossoptosis –> improves with age

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17
Q

Treacher Collins

A

small mandible –> improves with age

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18
Q

Mucopolysacchardoses

A

coarse facies, huge tongue.

–> airway worsens with age

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19
Q

Klippel-Feil

A

fused cervical vertebrae

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20
Q

Goldenhar Syndrome

A

hemifacial microsomia & limited TMJ mobility

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21
Q

Beckwidth-Weideman

A

macrosomia & large tongue

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22
Q

How common are heart murmurs?

A

72% prevalence

<1% true cardiac pathology

screen via auscultation

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23
Q

What type of murmurs are usually benign?

Study These Flashcards
A

SYSTOLIC

Asymptomatic

24
Q

Wheeze indicate

Study These Flashcards
A

small airway obstruction e.g. asthma, bronchospasm

25
Fine crackles indicate
fluid in lung (pulmonary edema)
26
Coarse crackles associated with
pneumonia, bronchiectasis
27
Decreased breath sounds
airway obstruction, or pneumothorax (one sided)
28
Infant Vitals
HR: 100-180 BP: Resp: 30-53
29
Toddler 1-2
HR: 90-140 BP: Resp: 20-37
30
Preschool 3-5
HR: 80-120 BP: Resp: 20-28
31
School age 6-9
HR: 75-118 BP: Resp: 18-25
32
POCUS =
Point of Care UltraSound --> check lungs, GI (npo), etc.
33
Upper Respiratory Infection concerns:
increases risk of Perioperative Respiratory Adverse Events (PRAE) up to 30% 2x likely of laryngospasm
34
URI Decision making (after resolution of symptoms)!!
URI --> 4 weeks Hospitalized --> 6 weeks COVID: Immunocompromised/Diabetic --> 8 weeks ICU admission --> 10-12weeks
35
Cyanotic Congenital Heart Defects
1) Truncus Arteriousus (1 outflow tract) 2) Transposition of the great vessels 3) Tricuspid atresia 4) Tetralogy of Fallot (Pulmonary Stenosis, Right Ventricular Hypertrophy, Overriding Aorta, Ventricular Septal Defect) 5) TAPVR → Total Anomalous Pulmonary Vascular Return 6) + Hypoplastic Left Heart (left side never developed)
36
Asthma Management
1) Symptoms: B-agonists 2) Disease-modifying: corticosteroids Avoid precipitating factors
37
Anesthesia considerations Asthma
Pre-op albuterol Adequate depth of anesthesia --> go deep Avoid opioids, succinylcholine (histamine release) Inhaled agents are generally bronchodilators
38
OSA screening Questions
1) Snoring? 2) Trouble breathing? 3) Stop breathing? 3+ --> OSA risk high, take PSG study for Gold standard Diagnosis (to find AHI)
39
Anesthesia considerations OSA
High risk of PRAE Increased sensitivity to opioids
40
When is overnight obs advised?
<3yo with OSA Severe OSA (AHI >10) + cardio or Trisomy 21/ comorbities
41
Cyanotic heart disease is
Right to left shunt (lungs bypassed)
42
Dental indications SBE?
manipulation of the gingival tissue, manipulation of the periapical region, or perforation of the oral mucosa
43
SBE not indicated for
injection through noninfected tissue shedding of deciduous teeth bleeding from trauma to lips or oral mucosa
44
SBE dosages review
Amox: 50mg/kg up to 2g Cephalexin: 50mg/kg up to 2g Azithromycin: 15mg/kg up to 500mg Doxycycline: 2.2mg/kg up to 100mg
45
Seizure considerations for GA
Take morning dose Anti-epileptic meds --> faster liver metabolism --> higher dose required for GA Phenytoin (rare) --> gingival hyperplasia
46
ASD considerations for GA
Hypersensitive and antisocial (like a cat) Challenges during Induction & recovery Child life & pre-op midazolam (up to 20mg)
47
CP considerations for GA
Motor disabilities --> positioning, airway concerns Cognitive impairement Delayed gastric emptying --> risk of *periop aspiration* Impaired thermoregulation (thin)
48
Trisomy 21 considerations for GA
Atlanto Occipital (AO) instability → can decapitate Large tongue, difficult airway & difficult IV Cardiac problems: ASD, VSD, AV canal
49
Obesity considerations for GA
1/5 USA children Difficult airway, difficult positive pressure ventilation, difficult IV Delayed gastric emptying --> aspiration risk Post-op PRAE
50
Obesity Dosing considerations
Varies per med: Lean body weight (LBW) → opioids (sensitivity), sedatives, neuromuscular blocking agents Total body weight (TBW) → reversal agents, antibiotics, succinylcholine
51
Metabolic considerations for GA
blood glucose levels
52
MH considerations for GA
hyperthermia, heart & renal failure risk Avoid *Halogenated inhalants --fluranes & succinylcholine* --> NITROUS OK
53
Mitochondrial considerations for GA
avoid use of Lactated ringers & propofol
54
Muscular disorder considerations for GA
avoid neuromuscular blockers
55
Heme/Onc considerations for GA
CBC, Coagulation, pre-op transfusion Consult for optimization

G935 (9 decks)

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