BCA Pediatric Anesthesia Considerations 2 — Questions and Answers
Question 1: What is the most common cause of cardiac arrest in pediatric patients during anesthesia?
- Malignant hyperthermia
- Laryngospasm leading to hypoxia (Correct answer)
- Anaphylaxis to succinylcholine
- Ventricular fibrillation from volatile agents
Correct answer: Laryngospasm leading to hypoxia
Laryngospasm causing hypoxia is the leading cause of anesthesia-related cardiac arrest in children.
Question 2: In a 4-year-old child, which inhalation agent has the lowest blood-gas partition coefficient, allowing for fastest induction?
- Isoflurane
- Sevoflurane
- Desflurane (Correct answer)
- Halothane
Correct answer: Desflurane
Desflurane has the lowest blood-gas partition coefficient (0.42), enabling the fastest emergence, though it is not typically used for inhalation induction due to airway irritability.
Question 3: A 3-year-old (15 kg) requires fluid resuscitation for hemorrhagic shock. What is the initial IV crystalloid bolus dose?
- 75 mL (5 mL/kg)
- 150 mL (10 mL/kg)
- 300 mL (20 mL/kg) (Correct answer)
- 450 mL (30 mL/kg)
Correct answer: 300 mL (20 mL/kg)
PALS guidelines recommend 20 mL/kg isotonic crystalloid as the initial bolus for pediatric hemorrhagic or distributive shock.
Question 4: Which condition is MOST associated with subglottic stenosis in a neonate requiring intubation?
- Trisomy 21 (Down syndrome)
- Pierre Robin sequence
- Prior prolonged intubation in the NICU (Correct answer)
- Treacher Collins syndrome
Correct answer: Prior prolonged intubation in the NICU
Prolonged neonatal intubation is the most common acquired cause of subglottic stenosis due to mucosal pressure injury.
Question 5: At what corrected gestational age is a formerly premature infant considered safe to receive outpatient surgery without mandatory postoperative apnea monitoring?
- 44 weeks
- 50 weeks
- 60 weeks (Correct answer)
- 52 weeks
Correct answer: 60 weeks
Most institutions require former preemies to reach 60 weeks postconceptual age before outpatient anesthesia without overnight apnea monitoring.
Question 6: Which agent is preferred for rapid sequence induction in a pediatric patient with a full stomach when succinylcholine is contraindicated?
- Vecuronium 0.1 mg/kg
- Rocuronium 1.2 mg/kg (Correct answer)
- Cisatracurium 0.2 mg/kg
- Pancuronium 0.1 mg/kg
Correct answer: Rocuronium 1.2 mg/kg
High-dose rocuronium (1.2 mg/kg) provides intubating conditions within 60 seconds and is the preferred succinylcholine alternative for pediatric RSI.
Question 7: A child with a known peanut allergy presents for appendectomy. Which anesthetic agent carries the highest risk of cross-reactivity?
- Propofol (Correct answer)
- Midazolam
- Ketamine
- Dexmedetomidine
Correct answer: Propofol
Propofol's lipid emulsion contains soybean oil and egg lecithin; while cross-reactivity with peanut allergy is debated, it warrants caution and informed discussion.
BCA Pediatric Anesthesia Considerations 2
What is the most common cause of cardiac arrest in pediatric patients during anesthesia?