Order Pediatric Anesthesia Discussion Assignment

Order Pediatric Anesthesia Discussion Assignment
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Order Pediatric Anesthesia Discussion Assignment
1. A 42-day-old infant is brought to the operating room (OR) for repair of
hypertrophic pyloric stenosis. After appropriate rapid sequence induction and
intubation of the trachea, the surgeons begin the procedure. One hour into the
procedure you notice that the infant’s body temperature has dropped from
37°C to 35.5°C. Which of the following is the LEAST effective method of
maintaining thermal homeostasis in an infant?
A. Raising the room temperature from 24°C to 29°C
B. Running maintenance IV fluids through a fluid warmer
C. Wrapping the infant’s head in plastic
D. Applying a forced-air warming device to exposed body areas
E. Using a circulating warm-water mattress
2. When considering premedication with midazolam in the pediatric patient, all of
the following are true EXCEPT which one?
A. Midazolam’s fast onset of action is due to its water insolubility.
B. Midazolam can be administered via the oral, nasal, intramuscular (IM), buccal,
intravenous (IV), and rectal routes.
C. As age decreases, required midazolam dose in mg/kg for effective anxiolysis
D. Oral midazolam has a bioavailability of 30% compared with IV administration.
E. Time to peak plasma concentration of rectally administered midazolam is 15-
20 minutes.
3. Of the various types of Mapleson circuits, which one has the fresh gas inflow
furthest from the patient/T-piece?
A. Mapleson A
B. Mapleson B
C. Mapleson C
D. Mapleson D
E. Mapleson E
4. Of the various types of Mapleson circuits, which has a spring-loaded pop-off
valve located at the distal end of the circuit (furthest from the patient/Tpiece?)
A. Mapleson A
B. Mapleson B
C. Mapleson C
D. Mapleson D
E. Mapleson E
5. 5. The Bain modification is a coaxial circuit where fresh gas flows through an
inner tube through the corrugated reservoir tubing of which Mapleson circuit?
A. Mapleson A
B. Mapleson B
C. Mapleson C
D. Mapleson D
E. Mapleson E
6. All of the following are acceptable agents for induction of anesthesia in children
EXCEPT which one?
A. Sevoflurane
B. Ketamine
C. Halothane
D. Desflurane
E. Methohexital
Order Pediatric Anesthesia Discussion Assignment
7. When evaluating a 4-month-old for elective circumcision revision in the
preoperative area, the patient’s mother tells you that she fed the child
expressed breastmilk fortified with formula powder 3.5 hours ago. According to
the ASA NPO status guidelines, how many hours must pass between this
feeding and the induction of general anesthesia?
A. 2 hours
B. 4 hours
C. 6 hours
D. 8 hours
E. 12 hours
The following vignette applies to questions 8, 9, and 10.
A 2-year-old, 12.5-kg girl with history of a ventriculoperitoneal shunt that was
placed in infancy for congenital aqueductal stenosis presents to your OR for
emergent shunt revision in the setting of lethargy, vomiting, and irritability. Her
parents tell you she “ate some crackers” 2 hours ago. The patient is otherwise
healthy with no known drug allergies.
8. 8. The MOST appropriate medication and dosage for neuromuscular blockade
for rapid sequence intubation in this patient is which of the following?
A. Rocuronium 10 mg IV
B. Rocuronium 25 mg IV
C. Succinylcholine 12.5 mg IV
D. Succinylcholine 25 mg IV
E. Succinylcholine 25 mg IM
9. The MOST appropriate blade and endotracheal tube for this patient would be
which of the following?
A. Miller 1 blade, size 4.0 uncuffed endotracheal tube
B. Miller 1 blade, size 4.0 cuffed endotracheal tube
C. Miller 1 blade, size 4.5 cuffed endotracheal tube
D. Wis-Hipple 1.5 blade, size 4.0 cuffed endotracheal tube
E. Wis-Hipple 1.5 blade, size 5.0 uncuffed endotracheal tube
10. After successful intubation and initiation of general anesthesia, you decide you
would like to attempt to decrease the patient’s chance of emergence excitation.
With that in mind, which of the following would be the least appropriate choice
for maintenance anesthesia?
A. Desflurane at 0.5 minimum alveolar concentration (MAC), dexmedetomidine
infusion at 0.5 μg/kg/h
B. Propofol and fentanyl total IV anesthesia
C. Sevoflurane at 1.0 MAC, oxygen, and air
D. Isoflurane at 1.0 MAC, oxygen, and air
E. Ketamine infusion, 50% nitrous oxide/50% oxygen
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