pediatric anesthesia a brief review of common disorders
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Pediatric Anesthesia A Brief Review of Common Disorders. By: Christine Mazza, T4. Diseases with Difficult Airways. Pierre Robin – micrognathia , glossoptosis , cleft palate Nasal airway, tongue suture, LMA Pre-op cardiac eval required - PowerPoint PPT PresentationTRANSCRIPT
Pediatric AnesthesiaA Brief Review of Common Disorders
By: Christine Mazza, T4
Diseases with Difficult Airways• Pierre Robin – micrognathia, glossoptosis, cleft palate
– Nasal airway, tongue suture, LMA– Pre-op cardiac eval required
• Treacher-Collins – facial and pharyngeal hypoplasia, aplastic zygomatic arches, micrognathia, choanal atresia– Narrowing of airway above larynx, LMA useful– Pre-op cardiac eval required
• Hurler’s – short thick neck, course facies, macroglossia, large tonsils and adenoids– Post-op subglottic edema common– Cardiac eval pre-op
Diseases with Difficult Airways• Goldenhar Syndrome – unilateral (usually) disruption in formation of
craniofacial structures and vertebral abnormalities– Difficult airway– Pre-op eval of heart and c-spine
• TE fistula – part of VATER syndrome– Awake intubation preferred– Insert tube deeply and pull back until fistula is occluded but both lungs are
ventilated• CDH – dyspnea, cyanosis, scaphoid abdomen, BS in chest
– Use minimal pressure ventilation to avoid pneumothorax; if sudden cyanosis, assume pneumothorax
Review in Pictures
Cardiac Abnormalities• Cyanotic Defects (R L) – defect between arterial and venous circulation with outflow
obstruction on venous side– Tetralogy of Fallot, truncus arteriosis, transposition of the great vessels– Pre-op treatment of dz, endocarditis prophylaxis, remove air bubbles from IV tubing– OXYGEN! Hydration, gentle ventilation
• Acyanotic Defects (L R) – single defect between arterial and venous circulation so that blood flows from high to low pressure– ASD, VSD, PDA, cushion defects– Pre-op treatment of dz, endocarditis prophylaxis, remove air bubbles from IV tubing– PPV, low FiO2 as tolerated
• PPHN – persistence or return of fetal circulation after birth– Basically same treatment as Cyanotic defects above– Increase pulm blood flow, hyperventilate
Genetic/Hematological Diseases• Hemophilia A – most common inherited coagulation disorder
– Oral medications, general anesthesia– Intubation acceptable, but be wary of hemorrhage
• Sickle Cell– Pre-op: HYDRATION, transfuse to increase Hct to 30– Intra-op: HYDRATION, oxygenation, replace blood loss when necessary
• Porphyria – demyelination, flaccid paralysis, weakness, autonomic dysfunction – NO barbituates, steroids, etomidate, enflurane, ketamine– Ok to use opiates, local, N2O, isoflurane, helothane, atropine– Exaggerated response to muscle relaxants
• Trisomy 21 – microcephaly, macroglossia, CHD, duodenal atresia, atlanto-axial instability, congenital subglottic stenosis– Difficult airway –consider ETT 1 size down– Decreased MAC, exaggerated response to muscle relaxants– Pre-op cardiac work up, c-spine films?
Resources• Bell, C.; Kain, Z. The Pediatric Anesthesia Handbook Mosby-Year Book, Inc,
St. Louis: 1997.• Infosino, Andrew. “Pediatric Upper Airways and Congenital Anomalies”.
Anesthesiology Clinicals of North America. 20 (2002): 747-766.• Macksey, Lynn Fitzgerald. Pediatric Anesthetic and Emergency Drug Guide.
Jones and Bartlett Publishers, Ontario Canada: 2009.• Stoelting, R; Dierdorf, S. Handbook for Anesthesia and Co-Existing Disease.
Churchill Livingstone Publishing, Philadelphia: 2002.• http://www.theaba.org/Home/anesthesiology_initial_certification