EDAIC Pediatric and Neonatal Anesthesia 3 — Questions and Answers
Question 1: What is the most common cause of intraoperative bradycardia in infants?
- Hypovolemia
- Hypoxia (Correct answer)
- Vagal stimulation
- Hyperkalemia
Correct answer: Hypoxia
Hypoxia is the most common cause of bradycardia in infants; the first step in management is ensuring adequate oxygenation and ventilation.
Question 2: A 4-year-old child (18 kg) requires atropine for refractory bradycardia during anesthesia. What is the correct IV dose?
- 0.09 mg (0.005 mg/kg)
- 0.18 mg (0.01 mg/kg)
- 0.36 mg (0.02 mg/kg) (Correct answer)
- 0.72 mg (0.04 mg/kg)
Correct answer: 0.36 mg (0.02 mg/kg)
The recommended IV dose of atropine for pediatric bradycardia is 0.02 mg/kg (minimum 0.1 mg), giving 0.36 mg for an 18 kg child.
Question 3: Which condition is an absolute contraindication to succinylcholine in pediatric patients?
- Hyperkalemia from renal failure
- Undiagnosed skeletal muscle myopathy (Correct answer)
- Open globe injury
- Severe burns more than 24 hours old
Correct answer: Undiagnosed skeletal muscle myopathy
Undiagnosed skeletal muscle myopathy (e.g., Duchenne's) can cause life-threatening hyperkalemia and rhabdomyolysis with succinylcholine.
Question 4: In a child with tetralogy of Fallot presenting for non-cardiac surgery, which induction agent is MOST appropriate?
- Thiopental
- Ketamine (Correct answer)
- Propofol
- Etomidate
Correct answer: Ketamine
Ketamine maintains or increases systemic vascular resistance, which is beneficial in right-to-left shunting lesions like tetralogy of Fallot by reducing the degree of shunting.
Question 5: What is the significance of the Sellick maneuver (cricoid pressure) in pediatric rapid sequence induction?
- It reliably prevents regurgitation in all age groups
- Its effectiveness is unproven and it may worsen laryngoscopy view (Correct answer)
- It is more effective in neonates than adults
- It reduces the dose of induction agent required
Correct answer: Its effectiveness is unproven and it may worsen laryngoscopy view
The effectiveness of cricoid pressure in preventing aspiration is unproven and it may worsen the laryngoscopic view; its routine use is controversial.
Question 6: A neonate born at 30 weeks gestation is now 8 weeks old and requires inguinal hernia repair. What is the postconceptional age and what does this imply?
- 38 weeks — can be treated as full-term for anesthesia purposes
- 38 weeks — still at high risk for postoperative apnea requiring monitoring (Correct answer)
- 44 weeks — safe for day surgery without monitoring
- 44 weeks — requires ICU admission postoperatively
Correct answer: 38 weeks — still at high risk for postoperative apnea requiring monitoring
At 38 weeks postconceptional age, this infant remains at significant risk for postoperative apnea and requires at least 12–24 hours of monitored observation.
Question 7: Which neuromuscular blocking agent is preferred for rapid sequence intubation when succinylcholine is contraindicated in pediatric patients?
- Vecuronium 0.1 mg/kg
- Rocuronium 1.2 mg/kg (Correct answer)
- Cisatracurium 0.2 mg/kg
- Mivacurium 0.25 mg/kg
Correct answer: Rocuronium 1.2 mg/kg
High-dose rocuronium (1.2 mg/kg) provides intubating conditions comparable to succinylcholine and can be reversed with sugammadex if needed.
EDAIC Pediatric and Neonatal Anesthesia 3
What is the most common cause of intraoperative bradycardia in infants?