Principles Of Pediatric Anesthesia Quiz! Trivia

Administering an IV fluid bolus to an infant through the use of a pressure bag is not the best way. Infants have delicate veins that can be easily damaged by the high pressure exerted by a pressure bag. A more appropriate method is to use a syringe or an infusion pump to administer the fluid slowly and carefully, taking into consideration the infant's size and condition.

Halothane is an inhalational anesthetic that has been shown to cause more depression of the heart muscle compared to other inhalational agents. This means that it can negatively impact the heart's ability to contract and pump blood effectively. Additionally, halothane has been found to increase the risk of arrhythmia, or abnormal heart rhythms, when used in conjunction with epinephrine. The combination of halothane and epinephrine can increase the risk of arrhythmia by four times. Therefore, the statement that halothane causes more myocardial depression than other inhalational agents and increases the risk of arrhythmia associated with epinephrine is true.

Based on the symptoms described, including sneezing, yellow mucus, wheezing, and a temperature, it suggests that Madelyn may have an upper respiratory infection or a possible respiratory illness. These symptoms may indicate that Madelyn is not in optimal health for the surgery, as it could increase the risk of complications during and after the procedure. Therefore, it would be appropriate to talk to the surgeon about the possibility of cancelling the surgery until Madelyn's condition improves.

Vecuronium is a muscle relaxant that does not trigger Malignant Hyperthermia (MH). MH is a potentially life-threatening reaction to certain medications used during general anesthesia, such as succinylcholine and inhalation anesthetics like desflurane and isoflurane. MH causes a rapid increase in body temperature, muscle rigidity, and other symptoms. However, vecuronium does not have a known association with MH and is considered safe to use in patients at risk for this condition.

Using cloths dipped in 40°C water and placing them onto a child's head during a procedure would not be an appropriate way to reduce intra-op heat loss in a pediatric patient. This is because placing warm cloths on the head can lead to excessive heat loss through the scalp, which is a large surface area for heat transfer. It is important to use methods that provide controlled and regulated heat to the patient, such as the use of an overhead radiant heating unit, a water mattress with circulating warm water, or a Bair hugger placed on the child's body.

For a healthy pediatric patient with no pre-existing congenital anomalies, preoperative lab tests may not be necessary if the procedure is expected to have minimal blood loss. This is because in such cases, the risk of complications or abnormalities is low, and the benefits of performing the tests may not outweigh the potential discomfort or inconvenience for the patient. However, it is important to note that the decision to omit preop lab tests should be made by a healthcare professional based on a thorough assessment of the patient's medical history and the specific procedure being performed.

The correct answer is Sux 5 mg/kg and Atropine 0.02 mg/kg. These drugs are commonly used for pediatric inhalation induction when the child does not have IV access. Sux (Succinylcholine) is a neuromuscular blocking agent that helps achieve muscle relaxation during intubation. Atropine is a medication that can be used to increase heart rate and prevent bradycardia during the induction process. These drugs are essential in ensuring a smooth and safe induction for pediatric patients.

An appropriate size endotracheal tube (ETT) for a 9-year-old child weighing 33 kg would be 6. The size of the ETT is determined based on the age, weight, and height of the patient. In this case, a size 6 ETT is suitable for a child of this age and weight. The ETT should be of the appropriate size to ensure proper ventilation and oxygenation during anesthesia or respiratory support.

Muscular Dystrophy is associated with an increased risk of Malignant hyperthermia. Muscular Dystrophy is a group of genetic disorders that cause progressive weakness and loss of muscle mass. Malignant hyperthermia is a potentially life-threatening reaction to certain medications used during anesthesia, characterized by a rapid rise in body temperature and muscle rigidity. People with Muscular Dystrophy have a higher susceptibility to developing Malignant hyperthermia due to the underlying muscle abnormalities and dysfunction associated with the condition. Therefore, Muscular Dystrophy is the correct answer.

Chest wall rigidity is a common side effect associated with fentanyl during anesthesia. This refers to the tightening and stiffening of the muscles in the chest, making it difficult for the patient to breathe. It can lead to respiratory distress and compromise the patient's ability to maintain adequate oxygen levels. Anesthesiologists are concerned about this side effect because it can potentially result in serious complications if not promptly recognized and managed.

Pediatric cardiac arrests primarily occur during the induction phase. This phase refers to the initial administration of anesthesia and the process of preparing the patient for surgery. It involves the use of medications and techniques to induce unconsciousness and ensure a smooth transition to the maintenance phase. During induction, there is a higher risk of cardiac arrest due to factors such as the administration of anesthesia drugs and the stress of intubation. Therefore, it is crucial for healthcare providers to closely monitor the patient's vital signs and be prepared to respond quickly in case of any complications.

Fluid balance is not part of stage 2 PACU's standard monitoring. Stage 2 PACU, also known as the post-anesthesia care unit, is responsible for monitoring the patient's vital signs and ensuring their stability after surgery. This includes monitoring the patient's heart rate, oxygen saturation levels, and blood pressure. However, fluid balance monitoring, which involves assessing the patient's intake and output of fluids, is typically not included as part of the standard monitoring in stage 2 PACU.

ETCO2, or end-tidal carbon dioxide, is particularly important to monitor in children for several reasons. Firstly, it can provide the earliest indication of malignant hyperthermia (MH), a potentially life-threatening condition that can occur during anesthesia. Secondly, ETCO2 monitoring can detect hypoxia, which is the most common cause of pediatric arrest. Lastly, it allows healthcare providers to assess the adequacy of ventilation, ensuring that the child is receiving enough oxygen and having proper gas exchange. Therefore, the correct answer is "All the above."

Upper respiratory infections are the most common reason for the cancellation of pediatric procedures. This is because these infections can cause complications during the procedure, such as difficulty breathing or increased risk of infection. It is important to ensure that the child is in good health before proceeding with any medical procedure to minimize any potential risks or complications.

Drawing up drugs in 'unit dose' syringes during a pedi drug set up is recommended because it ensures accurate dosing and minimizes the risk of medication errors. Unit dose syringes contain pre-measured amounts of medication, which eliminates the need for manual calculations and reduces the chances of overdosing or underdosing. This practice also promotes patient safety by preventing contamination and cross-contamination of medications. Additionally, using unit dose syringes simplifies the administration process, saves time, and improves efficiency in pediatric medication management.

An appropriate dose of pre-op versed for a 6-year-old child weighing 24 kg would be 12 mg PO. PO stands for "per os" which means orally. This means that the child should take the medication by mouth. It is important to consider the weight and age of the child when determining the appropriate dose to ensure safety and effectiveness of the medication.

Most pediatric arrests are due to respiratory causes in children. This means that the majority of cardiac arrests in children are caused by problems with the respiratory system. This could include conditions such as choking, asthma, pneumonia, or other respiratory illnesses that can lead to a lack of oxygen and ultimately cardiac arrest. It is important to identify and address respiratory issues in children to prevent potential cardiac arrests.

An appropriate sized endotracheal tube (ETT) for a 3-year-old child weighing 18 kg would be 4.5. The size of the ETT is determined based on the weight and age of the child, as well as other factors such as the size of the child's airway. In this case, a 4.5 ETT would be suitable for the child's weight and age.

An appropriate hourly maintenance fluid rate for a child weighing 15 kg is 50 ml. This is because maintenance fluid requirements are usually calculated based on body weight, and a commonly used formula is 4-2-1, which means 4 ml/kg/hr for the first 10 kg, 2 ml/kg/hr for the next 10 kg, and 1 ml/kg/hr for every kg above 20 kg. Therefore, for a child weighing 15 kg, the appropriate hourly maintenance fluid rate would be 50 ml.

Airway examination and neck stability are the most important components of the physical exam for Down syndrome patients because individuals with Down syndrome often have anatomical abnormalities that can affect their airway and neck stability. They may have a smaller airway, a larger tongue, and decreased muscle tone in the neck, which can increase the risk of airway obstruction and breathing difficulties. Therefore, it is crucial to assess the airway and neck stability in order to ensure the safety and well-being of Down syndrome patients during medical examinations and procedures.

Neonates have a more permeable blood-brain barrier, allowing opioids to enter the brain more easily. Additionally, their metabolic capabilities are decreased, resulting in slower breakdown and elimination of opioids from the body. Lastly, neonates have increased sensitivity of their respiratory centers, making them more susceptible to the respiratory depressant effects of opioids. Therefore, all of these reasons combined explain why opioids appear to be more potent in neonates.

Children 1-4 years old is not a risk factor associated with cardiac arrests in pediatric patients. This age group is generally considered to have a lower risk compared to other age groups. Risk factors such as emergency surgery, ASA 3-5 (American Society of Anesthesiologists physical status classification), and congenital airway deformities are known to increase the risk of cardiac arrests in pediatric patients.

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Based on the given information, the murmur heard in the 7-year-old child is described as short and soft. A short, soft, systolic murmur is typically considered innocent or benign in children. Innocent murmurs are common in children and are usually harmless, often due to the normal flow of blood through the heart. Therefore, the correct classification for this murmur would be innocent.

For a normal inhalational induction, the N2O concentration should be at 70% and the O2 concentration should be at 30% to start out with. This is because a higher concentration of N2O helps to provide analgesia and reduce the patient's awareness during the induction process. On the other hand, a lower concentration of oxygen is used to prevent the risk of fire or explosion.

A size 22 IV catheter would be the best choice for a 3-year-old child. IV catheters are used to administer fluids or medications directly into the bloodstream. The size of the catheter is determined by the gauge, which refers to the diameter of the needle. A size 22 gauge is smaller than a size 24 and larger than a size 20 or 18. In pediatric patients, it is important to use a smaller gauge to minimize discomfort and potential complications. Therefore, a size 22 IV catheter would be the most appropriate choice for a 3-year-old child.

Using an adult semi-closed system on an infant who weighs less than 10 kg is not safe because it would result in too much dead space, leading to increased work of breathing. Dead space refers to the portion of the respiratory system where no gas exchange occurs, and in an infant, the dead space-to-tidal volume ratio is higher compared to adults. This means that a larger proportion of the inspired air is not participating in gas exchange, resulting in inefficient ventilation and increased effort required for breathing. This can put a strain on the infant's respiratory system and potentially lead to respiratory distress.

An appropriate size LMA for an infant weighing 9 kg would be 1.5. The size of the LMA is determined based on the weight of the patient, and in this case, the infant weighs 9 kg. The LMA size 1.5 is suitable for infants in this weight range, providing a secure airway and effective ventilation during medical procedures.

In this scenario, the best approach would be to first address the parent's anxiety and nervousness. By calming the parent, it will create a more stable and supportive environment for the child. Once the parent is calmer, they can then help in reassuring the child and making them feel more comfortable. This approach recognizes the importance of the parent's role in providing emotional support to the child and establishes a foundation of trust and cooperation for the pre-op procedure.

Approximately 40-60% of children with Down syndrome will have associated cardiac anomalies. This means that a significant number of children with Down syndrome will have some form of heart defect or abnormality. It is important for healthcare professionals to be aware of this statistic and closely monitor the cardiac health of children with Down syndrome to ensure early detection and appropriate treatment of any cardiac anomalies.

An appropriate size LMA for a child weighing 27 kg would be 2.5. The size of the LMA is determined based on the weight of the child, and in this case, a child weighing 27 kg would require a size 2.5 LMA.

The correct answer is 2 mac. The Macintosh (mac) blade is commonly used for intubation in children. The size of the blade is determined by the age and size of the child. In this case, for an 8-year-old child, a 2 mac blade would be appropriate. The mac blade is designed to lift the epiglottis and provide a clear view of the vocal cords, making intubation easier and safer.

The preferred combination of narcotics and inhalational agents commonly used by pediatric anesthetists is 1-2 mcg/kg Fentanyl and 0.5 MAC isoflurane. This combination provides effective pain relief and anesthesia for pediatric patients during surgery. Fentanyl is a potent opioid analgesic that helps to manage pain, while isoflurane is an inhalational anesthetic that produces general anesthesia. The dosage of fentanyl and the MAC level of isoflurane are carefully adjusted based on the individual patient's needs and the type of surgery being performed. This combination has been found to be safe and effective in pediatric anesthesia practice.

The ideal position for induction of a frightened 4-year-old child who refuses to lie flat on the OR table is to have the child sit in the center of the OR table while the healthcare professional sits nearby and wraps their arm around the child to induce anesthesia via mask inhalation. This approach allows the child to feel secure and supported while receiving the anesthesia, which can help alleviate their fear and anxiety.

The best choice for induction in this scenario is to place an IV prior to the procedure for safe induction. This is because an appendectomy is an emergent surgery and requires a rapid and controlled induction of anesthesia. Inhalational induction may not be suitable as the patient is not likely to cooperate with IV placement. IM induction with ketamine is not the best choice as it may not provide the required depth of anesthesia and control during the procedure. Therefore, the safest and most appropriate option is to place an IV prior to the surgery.

Ketamine would be the best choice for the induction of a pediatric patient coming in for emergent surgery following an MVA, especially considering the child's history of severe asthma and current wheezing. Ketamine is a dissociative anesthetic that provides both analgesia and sedation, making it a suitable option for patients with respiratory issues. It has bronchodilatory effects and does not suppress the respiratory drive, which is important in this case. Additionally, ketamine has a favorable safety profile and is known for its rapid onset and short duration of action, making it ideal for emergent situations.

The Jackson-Rees Circuit would be the most appropriate choice for a child weighing less than 10 kg. This circuit is specifically designed for pediatric patients and provides controlled ventilation with low resistance. It allows for precise control of oxygen and anesthetic gas delivery, making it suitable for small patients. The other options mentioned, such as the Small semi-closed Circuit, Mapleson A, and Standard adult semi closed system, are not specifically designed for pediatric patients and may not provide the same level of control and safety.

The O2 sat probe should not be placed on the left hand for the procedure. This is because during the repair of a patent PDA, the left hand may be used for arterial line placement or for obtaining blood samples. Placing the O2 sat probe on the left hand may interfere with these procedures and compromise patient care.

Infants typically have a blunted response to exogenously administered catecholamines such as ephedrine. This is because they have lower catecholamine stores compared to adults. Catecholamines are hormones that play a role in the body's response to stress and regulate various physiological processes. Due to their lower levels of these hormones, infants may not exhibit the same level of response as adults would.

Atropine is the correct choice for pre-op medication in a 3-week-old child undergoing surgery to correct pyloric stenosis. Atropine is commonly used to reduce salivation and respiratory secretions, and it also helps to prevent bradycardia during anesthesia. The dose of 0.08 mg IM is appropriate for a child of this age and weight. Ketamine, Versed, and Fentanyl are not typically used as pre-op medications in infants of this age.

High dose opioid therapy during maintenance of anesthesia may be appropriate for a child with cardiac instability who requires surgical intervention because opioids can provide effective analgesia and sedation while minimizing the stress response and hemodynamic instability associated with surgery. Opioids have minimal effects on the cardiovascular system and can help maintain hemodynamic stability in patients with cardiac instability. Additionally, opioids have a predictable and reversible effect, making them a suitable choice for patients who may need rapid adjustment of anesthesia depth.

All the above options would be appropriate pre-op medications for a child with a latex allergy. Benadryl can help alleviate allergic symptoms, Prednisone can reduce inflammation and allergic reactions, and Zantac can help prevent gastric acid secretion. Using all of these medications together can provide comprehensive pre-operative care for a child with a latex allergy.

Malignant Hyperthermia is a severe reaction that occurs due to the activation of ryanodine receptors. These receptors are responsible for releasing calcium from the sarcoplasmic reticulum in muscle cells. When these receptors are activated, there is an excessive release of calcium into the intracellular space, leading to intracellular hypercalcemia. This abnormal increase in calcium levels can result in muscle rigidity, hypermetabolism, and a rapid rise in body temperature, which are characteristic symptoms of malignant hyperthermia.

The first action when preparing to do a pre-op assessment on a 3 yr old child should be to review the chart. This is important to gather information about the child's medical history, any previous surgeries, allergies, or any other relevant information that may impact the pre-op assessment and anesthesia plan. Reviewing the chart helps in ensuring the safety and well-being of the child during the procedure.

Based on the given information, Trevor's sniffles and runny nose are attributed to his seasonal allergies rather than an upper respiratory infection. He does not have a fever or wheezes, and he appears to be otherwise healthy and engaged in play. Therefore, it is safe to proceed with the procedure.

The correct answer is "We will most likely keep her overnight on a pulse oximeter just to watch her." This answer is the most appropriate because it acknowledges the need for monitoring the child after the procedure. Premature babies may have a higher risk of complications and it is important to observe their vital signs, including oxygen saturation levels, to ensure their safety. Keeping the child overnight on a pulse oximeter allows healthcare providers to closely monitor her and intervene if necessary.

Radiation is the correct answer because it refers to the transfer of heat through electromagnetic waves. During surgery, pediatric patients may experience heat loss through radiation as their body heat is emitted to the surrounding environment. Conduction refers to the transfer of heat through direct contact, while convection involves heat transfer through the movement of fluids or gases. While both conduction and convection can contribute to heat loss during surgery, radiation is considered the greatest contributor in the pediatric population.

An appropriate starting dose of dantrolene for a 3-year-old child weighing 14 kg would be 35 mg. The dosage of dantrolene is usually calculated based on the child's weight, and a common starting dose is around 1-2 mg/kg. In this case, 35 mg is within the appropriate range for a child weighing 14 kg.

An 11 month old child would likely experience the greatest amount of separation anxiety because this is the age when separation anxiety typically peaks. At this stage, infants have developed a strong attachment to their primary caregiver and may become distressed when separated from them. They may cry, cling, or display other signs of anxiety when the caregiver is not present. This is a normal and temporary phase of development that typically improves as the child grows older.

Starting an IV is the correct answer because once the pediatric patient is tubed during an inhalational induction, it is important to establish intravenous access as a priority. This is necessary for administering medications, fluids, and emergency drugs if needed. It allows for immediate access to the bloodstream in case of any complications or emergencies during the procedure.