Term 8 Week 3 (w/c Jun 2, 2014)
Welcome to a new week of Gasclass! This week we’ll talk about a short series of pediatric anesthesia cases.
Case 1: You are on-call and paged by ENT because they want to book a 2 yo child for extraction of foreign body.
How will you manage this situation?
As mentioned on twitter, there are two options for induction: inhalational or IV.
You induce the child with an inhalational induction because they do not have an IV. After placing an IV asleep, you continue to deepen the anesthetic under spontaneous ventilation and test the depth with laryngoscopy. While going in with the laryngoscope and about to spray the cords, you notice a piece of white-yellow food (possibly nut?) just at the laryngeal inlet below the epiglottis.
What would you like to do at this point?
Case 2: General surgery has booked a 2 mo boy for pyloromyotomy. They have asked for a preop consult because of a diagnosis of sickle cell disease.
What are your considerations for this surgery? What are your goals for preoptimization?
Thanks for all the responses! Common themes seemed to be:
– this is non urgent surgery and patient’s fluid status and electrolytes should be preoptimized
– concerns for sickle cell disease: warm, hydrated, good analgesia (? Regional techniques), crossmatch may be difficult if previous transfusions and alloantibodies
– consultation with hematology for optimization preop (physiologic anemia of infancy, preop transfusion)
– might benefit from postop ICU monitoring?
Case 3: you are doing a tonsils and adenoids list.
What are your criteria for suitability for outpatient T&A vs inpatient admission? How do you assess for pediatric OSA?
The next child, a 4yo boy, has been snoring so loudly his parents say “the walls shake” as well as having overall daytime somnolence, decrease in activities and witnessed “breath holding” spells when asleep. He has not had any investigations (sleep study, overnight oximetry) or treatments. He is average weight but parents feel he would not be cooperative with a preinduction IV. He has grade IV kissing tonsils on exam, with audible noisey breathing at rest.
What investigations (if any) would you like? What is your anesthetic plan?
Remember to tag your tweets with #gasclass! There are no right or wrong answers.