Emergence Agitation in Children

Questions and Answers

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)

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)

Propofol (correct)

Clonidine (correct)

Midazolam (correct)

Ketamine

What are common factors contributing to emergence agitation in children?

All of the above Signup and view all the answers

Which of the following factors can contribute to emergence agitation in children? (Select all that apply)

Pain Signup and view all the answers

Which of the following are effective in managing emergence agitation and delirium in children? (Select all that apply)

TIVA Signup and view all the answers

Agitation is best measured with which of the following scales?

Cornell Scale for Depression in Dementia Signup and view all the answers

What is the median effective dose (ED50) for the loss of eyelash reflex in infants aged 1 to 6 months?

3 mg/kg Signup and view all the answers

What is the median effective dose (ED50) for the loss of eyelash reflex in infants aged 1 to 6 months?

3 mg/kg Signup and view all the answers

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)

Infants aged 1 to 6 months - 3 mg/kg Signup and view all the answers

Has the use of propofol been associated with profound hypotension in neonates?

Yes, it has been associated. Signup and view all the answers

Which of the following strategies is considered most effective to reduce pain when using propofol?

All of the above Signup and view all the answers

Which of the following strategies is considered most effective for reducing pain associated with propofol injection?

All of the above Signup and view all the answers

What syndrome is potentially associated with high-dose infusions of propofol for an extended period?

Propofol infusion syndrome Signup and view all the answers

Which of the following components are associated with propofol infusion syndrome? (Select all that apply)

Lipemia Signup and view all the answers

Which of the following advantages are associated with TIVA? (Select all that apply)

Reduced emergence agitation Signup and view all the answers

Which of the following dosages of Ketamine are correct for induction of anesthesia? (Select all that apply)

5-10 mg/kg intramuscularly Signup and view all the answers

What concerns have limited the widespread use of Etomidate as an anesthetic in children?

Anaphylactoid reactions and suppression of adrenal function Signup and view all the answers

What effects do α2 Agonists have on the body? (Select all that apply)

Dose-dependent reduction in heart rate Signup and view all the answers

What is the recommended dosage of clonidine to be administered orally before induction?

4 mcg/kg Signup and view all the answers

Is clonidine superior to midazolam as a premedicant in terms of sedation, postoperative agitation, and postoperative pain?

Yes, it is superior in all aspects Signup and view all the answers

What is one of the primary advantages of using dexmedetomidine over clonidine?

It has greater selectivity for the α2 adrenoceptor. Signup and view all the answers

What effect does dexmedetomidine have compared to clonidine?

Less hypotension Signup and view all the answers

What is a key advantage of dexmedetomidine over clonidine?

Less hypotension Signup and view all the answers

What is the typical loading dose of dexmedetomidine administered over 10 minutes?

1 to 2 µg/kg Signup and view all the answers

What procedures has dexmedetomidine been used for?

Cardiac catheterization Signup and view all the answers

What is the suggested bolus dose of dexmedetomidine followed by an infusion according to the provided information?

1-2 mcg/kg bolus followed by 0.5-1 mcg/kg/h infusion Signup and view all the answers

What is the typical dose range for intranasal dexmedetomidine premedication in micrograms per kilogram?

1 to 2 µg/kg Signup and view all the answers

Which of the following processes are involved in the metabolism of morphine? (Select all that apply)

Glucuronidation Signup and view all the answers

What is the most worrisome adverse effect of morphine?

Respiratory depression Signup and view all the answers

What percentage of Caucasians are poor metabolizers who experience only poor analgesia from codeine?

10% Signup and view all the answers

Which group of individuals is reported to have the highest percentage of ultrarapid metabolizers at 30%?

Ethiopians Signup and view all the answers

What serious risk is associated with ultra-rapid metabolizers of codeine, particularly in children?

Death in children Signup and view all the answers

Does codeine have a warning against its use in children after tonsillectomy?

Yes, it has a warning. Signup and view all the answers

What is a concern regarding the use of meperidine that has led to its declining use?

It may cause seizures due to the accumulation of normeperidine. Signup and view all the answers

What is the minimum dosage of fentanyl in μg/kg that can be used to maintain cardiovascular stability?

10 μg/kg Signup and view all the answers

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?

True Signup and view all the answers

Sufentanil is used mainly for which type of surgery in pediatric patients?

Cardiac surgery Signup and view all the answers

Which of the following statements about remifentanil is true?

The elimination half-life is 3 to 6 minutes. Signup and view all the answers

Which statement about remifentanil is correct?

It is not affected by butyrylcholinesterase deficiency. Signup and view all the answers

Is it true that neonates are able to clear remifentanil more rapidly than older children?

True Signup and view all the answers

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?

Target-controlled infusion of opioids Signup and view all the answers

Is a combination of 3 μg/kg remifentanil with 3 to 4 mg/kg propofol an alternative to succinylcholine to facilitate endotracheal intubation?

3 μg/kg remifentanil with 3 to 4 mg/kg propofol Signup and view all the answers

What are the two primary actions of the enantiomers of Tramadol?

Agonizing mu receptors and inhibiting uptake of serotonin and noradrenalin Signup and view all the answers

The FDA has warned against using tramadol after tonsillectomy in children with which condition?

Sleep apnea Signup and view all the answers

What are the correct dosages of succinylcholine for infants and children older than 6 months? (Select all that apply)

Intramuscularly 5 mg/kg for infants Signup and view all the answers

Does succinylcholine have a faster onset of relaxation when administered intralingually compared to its administration from peripheral skeletal muscle?

Yes, it is absorbed more rapidly from the tongue. Signup and view all the answers

Which of the following statements about cardiac arrhythmias and administration of atropine and succinylcholine is accurate?

Cardiac sinus arrest is more likely after repeated doses of succinylcholine. Signup and view all the answers

Match the complications of Succinylcholine to their descriptions:

Rhabdomyolysis = Breakdown of muscle tissue leading to the release of muscle fiber contents into the bloodstream Hyperkalemia = Elevated potassium levels in the blood, which can lead to cardiac issues malignant hyperthermia = A severe reaction to specific anesthetics, leading to a rapid increase in metabolic rate halothane = masseter spasm particularly when used Whith SC Signup and view all the answers

Match the following neuromuscular blockers with their method of excretion:

Atracurium = Hofmann elimination Rocuronium = Hepatic metabolism Signup and view all the answers

Vecuronium causes histamine release.

False Signup and view all the answers

Sugammadex is a _______ that rapidly encapsulates rocuronium. Which statement about Sugammadex is correct?

It is a cyclodextrin. Signup and view all the answers

What effects have been demonstrated in animals, including nonhuman primates exposed to anesthesia in early life?

Deficits in learning Signup and view all the answers

What was the outcome reported by the GAS trial regarding the difference in IQ and psychometric tests of children after anesthesia for hernia repair?

no evidence Signup and view all the answers

What is the primary concern associated with long QT syndrome (LQTS) in neonates?

It is the leading suspected cause of sudden cardiac death. Signup and view all the answers

Which statement reflects the current stance on routine preoperative ECGs for healthy children?

Routine ECGs are not recommended for healthy children. Signup and view all the answers

What is the controversy surrounding neonatal screening for long QT syndrome (LQTS)?

The cost versus the benefit of widespread screening. Signup and view all the answers

How is long QT syndrome (LQTS) primarily diagnosed in neonates?

Using electrocardiograms (ECGs) as part of routine checks. Signup and view all the answers

What is the purpose of routine neonatal screening for long QT syndrome (LQTS) despite ongoing debates?

To identify potential risks of sudden cardiac events. Signup and view all the answers

Which of the following is NOT considered a common perioperative respiratory adverse event associated with URI?

Histamine release Signup and view all the answers

Which respiratory adverse event is characterized by a temporary cessation of breathing?

Breath holding Signup and view all the answers

What is a potential outcome of experiencing arterial oxygen desaturation during the perioperative period?

Increased risk of respiratory failure Signup and view all the answers

Which of these events may require unplanned hospitalization after a respiratory complication during surgery?

All of the above Signup and view all the answers

Which of the following events is NOT typically associated with the risk of perioperative respiratory complications?

Severe allergic reaction Signup and view all the answers

Which of the following signs are considered serious signs of upper respiratory infection (URI)?

Fever Signup and view all the answers

A productive cough is a sign that indicates a serious upper respiratory infection.

True Signup and view all the answers

What is an increased risk condition associated with serious signs of URI?

PRAE Signup and view all the answers

Symptoms such as fever, productive cough, and _______ runny nose often indicate a serious upper respiratory infection.

green Signup and view all the answers

Match the symptoms with their classification:

Fever = Serious Sign of URI Green runny nose = Serious Sign of URI Dry cough = Not a Serious Sign of URI Otitis media = Serious Sign of URI Signup and view all the answers

Which of the following are considered primary pulmonary morbidities that should be assessed?

Cystic fibrosis Signup and view all the answers

Bronchopulmonary dysplasia is a secondary pulmonary morbidity.

False Signup and view all the answers

What should an anesthesiologist inquire about concerning a patient's history before a procedure?

History or signs of primary pulmonary morbidity. Signup and view all the answers

Passive smoke exposure can contribute to ______ in patients.

pulmonary morbidity Signup and view all the answers

Match the condition with its description:

Bronchial asthma = A chronic inflammatory disease of the airways Cystic fibrosis = A genetic disorder affecting the lungs and digestive system Pulmonary hypertension = High blood pressure in the lungs' blood vessels Prematurity = Born before 37 weeks of pregnancy Signup and view all the answers

Which types of surgeries are associated with an increased risk of PRAE?

Ear, nose and throat surgeries Signup and view all the answers

Upper abdominal surgeries do not affect the risk of PRAE.

False Signup and view all the answers

What surgical specialties are linked to a greater risk of PRAE?

Ear, nose and throat, eye surgery, upper abdominal and thoracic surgeries Signup and view all the answers

____ and thoracic surgeries are known to increase the risk of PRAE.

Upper abdominal Signup and view all the answers

Match the types of surgeries with their associated risk of PRAE:

Ear, nose and throat surgeries = Increases risk of PRAE Eye surgeries = Increases risk of PRAE Orthopedic surgeries = No significant effect on PRAE Upper abdominal surgeries = Increases risk of PRAE Thoracic surgeries = Increases risk of PRAE Signup and view all the answers

What is one proposed treatment to decrease the incidence of perioperative bronchospasm in children?

Intravenous lidocaine Signup and view all the answers

Salbutamol is effective only for the treatment of perioperative bronchospasm, not for prevention.

False Signup and view all the answers

What type of patients is salbutamol particularly effective in?

Children with bronchial hyperreactivity Signup and view all the answers

________ has been shown to be effective in the prevention and treatment of perioperative bronchospasm in children.

Salbutamol Signup and view all the answers

Match the treatments with their purpose:

Salbutamol = Prevention and treatment of bronchospasm Intravenous Lidocaine = Decrease incidence of PRAE Nitrous oxide = Anesthetic agent Aspirin = Pain and inflammation relief Signup and view all the answers

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.

True Signup and view all the answers

Midazolam is the most commonly used benzodiazepine for premedication(up to a maximum of 15 mg);

orally = 0.5 mg/kg intravenous = 0.05-0.1 mg/kg intranasal = 0.3 mg/kg rectal = 0.5 mg/kg Signup and view all the answers

Clonidine can be administered

orally = 4mcg kg intranasally = 4mcg kg Not used = Not used = 5 mcg kg Signup and view all the answers

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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Description

This quiz explores various factors contributing to emergence agitation and delirium in children, as well as the treatments that can be effective for management. Participants will select all relevant factors and treatments from the options provided. Enhance your understanding of this vital topic in pediatric care.