Pediatric and Neonatal Anesthesia Flashcards

What is the recommended glucose-containing fluid strategy for neonates undergoing major surgery?

Answer: Use isotonic balanced crystalloid for volume replacement and a separate low-rate glucose infusion

Neonates require a background glucose infusion (4–8 mg/kg/min) to prevent hypoglycemia, while isotonic fluid is used separately for deficit and blood loss replacement.

A child develops stridor immediately after extubation. The FIRST step in management is:

Answer: Apply 100% oxygen and CPAP/jaw thrust

Initial management of post-extubation stridor is supportive: 100% oxygen, continuous positive airway pressure, and positioning to relieve obstruction.

What anatomical feature makes bag-mask ventilation more challenging in neonates compared to adults?

Answer: Larger occiput that flexes the neck when supine

The large occiput of neonates causes neck flexion when supine, which occludes the airway; a small shoulder roll is used to achieve neutral or sniffing position.

Which regional anesthetic technique is most appropriate for providing postoperative analgesia after lower abdominal surgery in a neonate?

Answer: Lumbar epidural via caudal approach

Caudal epidural block via the sacral hiatus is technically simple, reliable, and the most commonly used regional technique for lower abdominal and perineal surgery in neonates.

A 3-year-old child weighing 15 kg receives a caudal block with 0.25% bupivacaine. What is the maximum safe volume using the Armitage formula for mid-abdominal coverage?

Answer: 1.0 mL/kg (15 mL)

The Armitage formula recommends 1.0 mL/kg for mid-abdominal dermatomal coverage in caudal epidural blocks in children.

What is the primary concern with using nitrous oxide in neonates with suspected bowel obstruction?

Answer: Diffusion into air-filled spaces causing bowel distension

Nitrous oxide diffuses into closed air-containing spaces 30 times faster than nitrogen exits, causing distension of obstructed bowel loops and worsening the surgical field.

Which condition is most likely to cause unexpected perioperative hyperkalemia in a pediatric patient?

Answer: Succinylcholine administration in a child with an undetected myopathy

Succinylcholine can trigger massive potassium release from abnormal muscle membranes in undiagnosed myopathies, causing life-threatening hyperkalemia.