Podcast
Questions and Answers
What are some factors that may contribute to emergence agitation in children? (Select all that apply)
What are some factors that may contribute to emergence agitation in children? (Select all that apply)
- Pain (correct)
- Cold (correct)
- Fear (correct)
- Parental presence
Which of the following factors may contribute to emergence agitation in children? (Select all that apply)
Which of the following factors may contribute to emergence agitation in children? (Select all that apply)
- Pain (correct)
- Cold (correct)
- Fear and anxiety due to parental separation (correct)
- Excessive noise in the environment
Which of the following treatments have been described as useful in the management of emergence agitation and delirium in children? (Select all that apply)
Which of the following treatments have been described as useful in the management of emergence agitation and delirium in children? (Select all that apply)
- Propofol (correct)
- Clonidine (correct)
- Midazolam (correct)
- Ketamine
What are common factors contributing to emergence agitation in children?
What are common factors contributing to emergence agitation in children?
Which of the following factors can contribute to emergence agitation in children? (Select all that apply)
Which of the following factors can contribute to emergence agitation in children? (Select all that apply)
Which of the following are effective in managing emergence agitation and delirium in children? (Select all that apply)
Which of the following are effective in managing emergence agitation and delirium in children? (Select all that apply)
Agitation is best measured with which of the following scales?
Agitation is best measured with which of the following scales?
What is the median effective dose (ED50) for the loss of eyelash reflex in infants aged 1 to 6 months?
What is the median effective dose (ED50) for the loss of eyelash reflex in infants aged 1 to 6 months?
What is the median effective dose (ED50) for the loss of eyelash reflex in infants aged 1 to 6 months?
What is the median effective dose (ED50) for the loss of eyelash reflex in infants aged 1 to 6 months?
Which of these statements about the median effective dose (ED50) for loss of eyelash reflex in infants and children is correct? (Select all that apply)
Which of these statements about the median effective dose (ED50) for loss of eyelash reflex in infants and children is correct? (Select all that apply)
Has the use of propofol been associated with profound hypotension in neonates?
Has the use of propofol been associated with profound hypotension in neonates?
Which of the following strategies is considered most effective to reduce pain when using propofol?
Which of the following strategies is considered most effective to reduce pain when using propofol?
Which of the following strategies is considered most effective for reducing pain associated with propofol injection?
Which of the following strategies is considered most effective for reducing pain associated with propofol injection?
What syndrome is potentially associated with high-dose infusions of propofol for an extended period?
What syndrome is potentially associated with high-dose infusions of propofol for an extended period?
Which of the following components are associated with propofol infusion syndrome? (Select all that apply)
Which of the following components are associated with propofol infusion syndrome? (Select all that apply)
Which of the following advantages are associated with TIVA? (Select all that apply)
Which of the following advantages are associated with TIVA? (Select all that apply)
Which of the following dosages of Ketamine are correct for induction of anesthesia? (Select all that apply)
Which of the following dosages of Ketamine are correct for induction of anesthesia? (Select all that apply)
What concerns have limited the widespread use of Etomidate as an anesthetic in children?
What concerns have limited the widespread use of Etomidate as an anesthetic in children?
What effects do α2 Agonists have on the body? (Select all that apply)
What effects do α2 Agonists have on the body? (Select all that apply)
What is the recommended dosage of clonidine to be administered orally before induction?
What is the recommended dosage of clonidine to be administered orally before induction?
Is clonidine superior to midazolam as a premedicant in terms of sedation, postoperative agitation, and postoperative pain?
Is clonidine superior to midazolam as a premedicant in terms of sedation, postoperative agitation, and postoperative pain?
What is one of the primary advantages of using dexmedetomidine over clonidine?
What is one of the primary advantages of using dexmedetomidine over clonidine?
What effect does dexmedetomidine have compared to clonidine?
What effect does dexmedetomidine have compared to clonidine?
What is a key advantage of dexmedetomidine over clonidine?
What is a key advantage of dexmedetomidine over clonidine?
What is the typical loading dose of dexmedetomidine administered over 10 minutes?
What is the typical loading dose of dexmedetomidine administered over 10 minutes?
What procedures has dexmedetomidine been used for?
What procedures has dexmedetomidine been used for?
What is the suggested bolus dose of dexmedetomidine followed by an infusion according to the provided information?
What is the suggested bolus dose of dexmedetomidine followed by an infusion according to the provided information?
What is the typical dose range for intranasal dexmedetomidine premedication in micrograms per kilogram?
What is the typical dose range for intranasal dexmedetomidine premedication in micrograms per kilogram?
Which of the following processes are involved in the metabolism of morphine? (Select all that apply)
Which of the following processes are involved in the metabolism of morphine? (Select all that apply)
What is the most worrisome adverse effect of morphine?
What is the most worrisome adverse effect of morphine?
What percentage of Caucasians are poor metabolizers who experience only poor analgesia from codeine?
What percentage of Caucasians are poor metabolizers who experience only poor analgesia from codeine?
Which group of individuals is reported to have the highest percentage of ultrarapid metabolizers at 30%?
Which group of individuals is reported to have the highest percentage of ultrarapid metabolizers at 30%?
What serious risk is associated with ultra-rapid metabolizers of codeine, particularly in children?
What serious risk is associated with ultra-rapid metabolizers of codeine, particularly in children?
Does codeine have a warning against its use in children after tonsillectomy?
Does codeine have a warning against its use in children after tonsillectomy?
What is a concern regarding the use of meperidine that has led to its declining use?
What is a concern regarding the use of meperidine that has led to its declining use?
What is the minimum dosage of fentanyl in μg/kg that can be used to maintain cardiovascular stability?
What is the minimum dosage of fentanyl in μg/kg that can be used to maintain cardiovascular stability?
Is it true that the clearance of alfentanil in preterm neonates is markedly reduced and the volume of distribution is greater than in older infants?
Is it true that the clearance of alfentanil in preterm neonates is markedly reduced and the volume of distribution is greater than in older infants?
Sufentanil is used mainly for which type of surgery in pediatric patients?
Sufentanil is used mainly for which type of surgery in pediatric patients?
Which of the following statements about remifentanil is true?
Which of the following statements about remifentanil is true?
Which statement about remifentanil is correct?
Which statement about remifentanil is correct?
Is it true that neonates are able to clear remifentanil more rapidly than older children?
Is it true that neonates are able to clear remifentanil more rapidly than older children?
What technique in neonates allows the provision of a deep opioid-induced plane of anesthesia while avoiding cardiovascular depression and the need for postoperative ventilation?
What technique in neonates allows the provision of a deep opioid-induced plane of anesthesia while avoiding cardiovascular depression and the need for postoperative ventilation?
Is a combination of 3 μg/kg remifentanil with 3 to 4 mg/kg propofol an alternative to succinylcholine to facilitate endotracheal intubation?
Is a combination of 3 μg/kg remifentanil with 3 to 4 mg/kg propofol an alternative to succinylcholine to facilitate endotracheal intubation?
What are the two primary actions of the enantiomers of Tramadol?
What are the two primary actions of the enantiomers of Tramadol?
The FDA has warned against using tramadol after tonsillectomy in children with which condition?
The FDA has warned against using tramadol after tonsillectomy in children with which condition?
What are the correct dosages of succinylcholine for infants and children older than 6 months? (Select all that apply)
What are the correct dosages of succinylcholine for infants and children older than 6 months? (Select all that apply)
Does succinylcholine have a faster onset of relaxation when administered intralingually compared to its administration from peripheral skeletal muscle?
Does succinylcholine have a faster onset of relaxation when administered intralingually compared to its administration from peripheral skeletal muscle?
Which of the following statements about cardiac arrhythmias and administration of atropine and succinylcholine is accurate?
Which of the following statements about cardiac arrhythmias and administration of atropine and succinylcholine is accurate?
Match the complications of Succinylcholine to their descriptions:
Match the complications of Succinylcholine to their descriptions:
Match the following neuromuscular blockers with their method of excretion:
Match the following neuromuscular blockers with their method of excretion:
Vecuronium causes histamine release.
Vecuronium causes histamine release.
Sugammadex is a _______ that rapidly encapsulates rocuronium. Which statement about Sugammadex is correct?
Sugammadex is a _______ that rapidly encapsulates rocuronium. Which statement about Sugammadex is correct?
What effects have been demonstrated in animals, including nonhuman primates exposed to anesthesia in early life?
What effects have been demonstrated in animals, including nonhuman primates exposed to anesthesia in early life?
What was the outcome reported by the GAS trial regarding the difference in IQ and psychometric tests of children after anesthesia for hernia repair?
What was the outcome reported by the GAS trial regarding the difference in IQ and psychometric tests of children after anesthesia for hernia repair?
What is the primary concern associated with long QT syndrome (LQTS) in neonates?
What is the primary concern associated with long QT syndrome (LQTS) in neonates?
Which statement reflects the current stance on routine preoperative ECGs for healthy children?
Which statement reflects the current stance on routine preoperative ECGs for healthy children?
What is the controversy surrounding neonatal screening for long QT syndrome (LQTS)?
What is the controversy surrounding neonatal screening for long QT syndrome (LQTS)?
How is long QT syndrome (LQTS) primarily diagnosed in neonates?
How is long QT syndrome (LQTS) primarily diagnosed in neonates?
What is the purpose of routine neonatal screening for long QT syndrome (LQTS) despite ongoing debates?
What is the purpose of routine neonatal screening for long QT syndrome (LQTS) despite ongoing debates?
Which of the following is NOT considered a common perioperative respiratory adverse event associated with URI?
Which of the following is NOT considered a common perioperative respiratory adverse event associated with URI?
Which respiratory adverse event is characterized by a temporary cessation of breathing?
Which respiratory adverse event is characterized by a temporary cessation of breathing?
What is a potential outcome of experiencing arterial oxygen desaturation during the perioperative period?
What is a potential outcome of experiencing arterial oxygen desaturation during the perioperative period?
Which of these events may require unplanned hospitalization after a respiratory complication during surgery?
Which of these events may require unplanned hospitalization after a respiratory complication during surgery?
Which of the following events is NOT typically associated with the risk of perioperative respiratory complications?
Which of the following events is NOT typically associated with the risk of perioperative respiratory complications?
Which of the following signs are considered serious signs of upper respiratory infection (URI)?
Which of the following signs are considered serious signs of upper respiratory infection (URI)?
A productive cough is a sign that indicates a serious upper respiratory infection.
A productive cough is a sign that indicates a serious upper respiratory infection.
What is an increased risk condition associated with serious signs of URI?
What is an increased risk condition associated with serious signs of URI?
Symptoms such as fever, productive cough, and _______ runny nose often indicate a serious upper respiratory infection.
Symptoms such as fever, productive cough, and _______ runny nose often indicate a serious upper respiratory infection.
Match the symptoms with their classification:
Match the symptoms with their classification:
Which of the following are considered primary pulmonary morbidities that should be assessed?
Which of the following are considered primary pulmonary morbidities that should be assessed?
Bronchopulmonary dysplasia is a secondary pulmonary morbidity.
Bronchopulmonary dysplasia is a secondary pulmonary morbidity.
What should an anesthesiologist inquire about concerning a patient's history before a procedure?
What should an anesthesiologist inquire about concerning a patient's history before a procedure?
Passive smoke exposure can contribute to ______ in patients.
Passive smoke exposure can contribute to ______ in patients.
Match the condition with its description:
Match the condition with its description:
Which types of surgeries are associated with an increased risk of PRAE?
Which types of surgeries are associated with an increased risk of PRAE?
Upper abdominal surgeries do not affect the risk of PRAE.
Upper abdominal surgeries do not affect the risk of PRAE.
What surgical specialties are linked to a greater risk of PRAE?
What surgical specialties are linked to a greater risk of PRAE?
____ and thoracic surgeries are known to increase the risk of PRAE.
____ and thoracic surgeries are known to increase the risk of PRAE.
Match the types of surgeries with their associated risk of PRAE:
Match the types of surgeries with their associated risk of PRAE:
What is one proposed treatment to decrease the incidence of perioperative bronchospasm in children?
What is one proposed treatment to decrease the incidence of perioperative bronchospasm in children?
Salbutamol is effective only for the treatment of perioperative bronchospasm, not for prevention.
Salbutamol is effective only for the treatment of perioperative bronchospasm, not for prevention.
What type of patients is salbutamol particularly effective in?
What type of patients is salbutamol particularly effective in?
________ has been shown to be effective in the prevention and treatment of perioperative bronchospasm in children.
________ has been shown to be effective in the prevention and treatment of perioperative bronchospasm in children.
Match the treatments with their purpose:
Match the treatments with their purpose:
Endotracheal intubation in patients with bronchial hyperreactivity has been shown to be associated with a higher incidence of PRAE when compared with ventilation via a face mask or LMA.
Endotracheal intubation in patients with bronchial hyperreactivity has been shown to be associated with a higher incidence of PRAE when compared with ventilation via a face mask or LMA.
Midazolam is the most commonly used benzodiazepine for premedication(up to a maximum of 15 mg);
Midazolam is the most commonly used benzodiazepine for premedication(up to a maximum of 15 mg);
Clonidine can be administered
Clonidine can be administered
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Study Notes
Preoperative ECG in Children
- Routine requests for preoperative electrocardiograms (ECGs) are discouraged for healthy pediatric patients.
- This recommendation aims to reduce unnecessary procedures and costs among low-risk children.
Long QT Syndrome (LQTS) Controversy
- Long QT syndrome (LQTS) is a significant concern as a potential leading cause of sudden cardiac arrest in children.
- There is ongoing debate regarding the necessity of routine neonatal screening for LQTS despite its implications for safety.
- The controversy revolves around balancing the benefits of early detection against the risks and costs of widespread screening.
Common Perioperative Respiratory Adverse Events (PRAEs) Associated with URI
- Laryngospasm: Reflex contraction of the vocal cords leading to airway obstruction, often triggered by irritation or anesthesia.
- Bronchospasm: Constriction of the smooth muscles in the bronchial tubes, causing difficulty in breathing, frequently seen in patients with a history of asthma or reactive airway disease.
- Breath Holding: Involuntary cessation of breathing, which can occur during anesthesia induction or after extubation, potentially compromising oxygenation.
- Atelectasis: Collapse of lung tissue due to inadequate expansion, common in the post-operative period, can lead to decreased lung volumes and impaired gas exchange.
- Arterial Oxygen Desaturation: Lower than normal oxygen levels in the blood, which can occur during surgery, especially with respiratory complications or inadequate ventilation.
- Bacterial Pneumonia: Infection of the lungs that can develop postoperatively, particularly in patients with pre-existing respiratory conditions or aspiration risk.
- Unplanned Hospital Admission: Unforeseen requirement for extended care post-surgery due to complications like respiratory events, indicating the seriousness of monitoring patients with URI.
Preoperative ECG for Healthy Children
- Routine electrocardiograms (ECGs) are not recommended for healthy children undergoing surgery.
- Ongoing debate exists regarding the necessity of routine neonatal screening for long QT syndrome (LQTS).
Long QT Syndrome (LQTS)
- LQTS is identified as a leading suspected cause of sudden cardiac events in children.
- Emphasis on the importance of careful screening to detect LQTS early in high-risk populations.
Perioperative Respiratory Adverse Events (PRAEs)
- Common PRAEs related to upper respiratory infections (URI) include:
- Laryngospasm
- Bronchospasm
- Breath holding
- Atelectasis
- Arterial oxygen desaturation
- Bacterial pneumonia
- Unplanned hospital admissions
Risk Factors for PRAEs
- Children exhibiting serious signs of URI are at higher risk for experiencing PRAEs.
- Key indicators of serious URI include:
- Fever
- Productive cough
- Green runny nose
- Otitis media (ear infection)
Key Considerations for Anesthesiologists
- Elicit comprehensive patient history, focusing on pulmonary conditions.
- Recognize bronchial asthma as a potential primary pulmonary morbidity impacting anesthesia management.
- Prematurity can lead to various complications affecting respiratory function, requiring careful monitoring.
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease often seen in premature infants that may complicate anesthesia.
- Cystic fibrosis is a genetic disorder affecting the lungs and digestive system, necessitating special considerations during anesthesia.
- Be aware of pulmonary hypertension, a condition that can increase surgical risk and affect anesthetic choices.
- Assess for exposure to passive smoke, which can exacerbate respiratory issues and influence perioperative care.
Salbutamol in Perioperative Care
- Salbutamol is effective for both preventing and treating bronchospasm in children with bronchial hyperreactivity during surgery.
- It acts as a bronchodilator, relaxing muscles in the airways to improve airflow.
Intravenous Lidocaine
- Intravenous lidocaine at a dose of 1 mg/kg is suggested to diminish the frequency of perioperative acute respiratory events (PRAE).
- This application of lidocaine provides an additional method to enhance respiratory safety during surgical procedures.
Preoperative Electrocardiograms
- Routine ECGs are not recommended for healthy children.
- Controversy exists regarding neonatal screening for long QT syndrome (LQTS).
Long QT Syndrome (LQTS)
- LQTS is a leading suspected cause of sudden cardiac events in children.
Perioperative Respiratory Adverse Events (PRAEs)
- Certain surgeries, including ENT, eye, upper abdominal, and thoracic surgeries, elevate the risk of PRAEs.
- Effective treatments for bronchospasm in children include salbutamol, used for both prevention and treatment.
- Intravenous lidocaine (1 mg/kg) has been suggested to reduce PRAE incidence.
Common PRAEs Associated with Upper Respiratory Infections (URI)
- Common adverse events include:
- Laryngospasm
- Bronchospasm
- Breath holding
- Atelectasis
- Arterial oxygen desaturation
- Bacterial pneumonia
- Unplanned hospital admissions
Risk Factors for PRAEs
- Children showing signs of serious URI, such as fever, productive cough, green nasal discharge, or otitis media, face increased PRAE risk.
- Anesthesiologists should inquire about any history or signs of primary pulmonary morbidity, including:
- Bronchial asthma
- Prematurity
- Bronchopulmonary dysplasia
- Cystic fibrosis
- Pulmonary hypertension
- Exposure to passive smoke is a notable risk factor for respiratory complications.
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