Pediatric Anes. Pt. 2 (Exam 4 Final) Flashcards by Kimberly Diane Hill (2025)

When should a pregnancy test (UPT) typically be considered before pediatric surgery?Select 2A. All girls under age 10B. Girls over 10 years regardless of menstruationC. Girls aged 12 and older D. Only when requested by the parentE. Those who have started menstruating

C. Girls aged 12 and older E. Those who have started menstruating"...pregnancy tests really depend on facility guidelines. Most say once they're 12 years or older, or have had their first menstruation, then we would do a pregnancy test. Some facilities allow the parents to refuse the pregnancy test. Others do not. We have to have a written consent"## Footnoteslide 10

Which of the following is the best follow-up question to end a pediatric pre-op interview with parents?A. “What is your child's favorite snack?”B. “Can you repeat your child’s medical history?”C. “Is there anything important I forgot to ask?”D. “Are you sure your child doesn’t need labs?”

C. “Is there anything important I forgot to ask?”## FootnoteSlide 10

You should look at facial features, the size and shape of their____________, their __________, their maxilla, this might you a hint that this could be a difficult airway. A. Tongue, cheeksB. Head, mandibleC. Nose, eyesD. Larynx, esophagus

B. Head, mandible## Footnoteslide 11

Which of the following is a primary goal during a pediatric airway exam?Select 2A. Mallampati B. Determine BMI percentileC. Assess visual acuityD. Loose teeth E. Measure oxygen saturation during exertion

A. Mallampati D. Loose teeth## Footnoteslide 12

Why is it important to assess for loose teeth in pediatric patients prior to anesthesia?Select 2A. To improve nutritional assessmentB. To identify risk for dental cariesC. To prevent dislodgement D. To document dental maturityE. To document location of loose tooth

C. To prevent dislodgement or *aspiration during airway manipulation*E. To document location of loose tooth "...it's important to document where the loose tooth is. And I always try to get an idea of how loose it is. If it's really loose,**we may pull it even before intubation** just to avoid having that tooth become dislodged during intubation or during the surgery."## Footnoteslide 12

Which patient characteristics would make you more cautious during intubation due to airway concerns? (Select 3)A. History of cardiac surgeryB. Age < 1 yearC. Athletic buildD. ObesityE. Normal facial symmetry

A. History of cardiac surgeryB. Age < 1 yearD. Obesity* Maxillofacial surgery* Mallampati classification"So be aware of that, obesity, and any historyof maxillofacial or even cardiac surgery, because a lot of those kids have anomalies that are associated with difficult airway## Footnoteslide 12

Which of the following are predictors of a difficult pediatric airway? (Select 3)A. Mallampati class IB. Mandibular protrusionC. Limited neck mobilityD. Increased tongue thicknessE. ASA I status

B. Mandibular protrusionC. Limited neck mobility - *Movement of the atlantooccipital joint*D. Increased tongue thickness* ASA II-IV* Reduced mandibular space"some predictors of difficult airway in children, looking at their mandible, their overall chin, jaw look, if they're able to move their head around well."## Footnoteslide 12

# Syndromes associated with difficult airwayWhich of the following syndromes is most commonly associated with **macroglossia (large tongue)** and **atlantooccipital abnormalities**, increasing the risk of difficult airway?A. Treacher Collins syndromeB. Pierre-Robin sequenceC. Down syndromeD. Edwards syndrome

C. Down syndrome (Trisomy 21)"sometimes kids will have an x-ray of their neck to show that they've had clearance or if they have a problem."| (I've only mentioned the ones she pointed out from her lecture)## FootnoteSlide 13

Which of the following syndromes is characterized by **micrognathia (small chin)**, glossoptosis, cleft palate, and cervical dysfunction?A. Freeman-Sheldon syndromeB. Pierre-Robin sequenceC. Hunter syndromeD. Arthrogyroposis

B. Pierre-Robin sequence## FootnoteSlide 13

Which of the following are common airway features associated with **Treacher Collins syndrome**?Select 3A. MicrognathiaB. Large tongueC. Small oral openingD. Zygomatic hypoplasiaE. Cervical fusion

A. MicrognathiaC. Small oral openingD. Zygomatic hypoplasia## FootnoteSlide 13

What airway device or technique is recommended when intubating a pediatric patient with syndromes such as Pierre-Robin sequence or Treacher Collins syndrome?A. Standard direct laryngoscopy with a Miller bladeB. Nasal intubation without visualizationC. Video laryngoscopy or fiberoptic intubationD. Supraglottic airway as the primary plan

C. Video laryngoscopy or fiberoptic intubation## Footnoteslide 13

Which of the following are key components of a preoperative physical exam in children?Select 3A. Respiratory system evaluationB. Assessment of hydration statusC. Thyroid palpationD. Cardiovascular examE. Deep tendon reflexes

A. Respiratory system evaluationB. Assessment of hydration statusD. Cardiovascular examNervous System## Footnoteslide 14

Which of the following statements about pediatric upper respiratory infections (URIs) is most accurate?A. URIs are more commonly caused by viral infectionsB. Viral URIs typically require antibiotic therapy to reduce airway reactivityC. URIs in children are most commonly caused by bacterial pathogensD. Bacterial URIs do not increase the risk of perioperative respiratory complications

A. URIs are more commonly caused by viral infections *and may lead to increased airway reactivity during anesthesia***Virus causes inflammation, airway edema, and increased secretions**## FootnoteSlide 15

Which of the following are considered perioperative respiratory adverse events (PRAEs) commonly associated with pediatric upper respiratory infections (URIs)?Select 4A. Bacterial pneumoniaB. Breath holdingC. BradycardiaD. Postintubation croupE. Venous oxygen desaturationF. Deep vein thrombosisG. Bacterial pneumonia

A. Bacterial pneumoniaB. Breath holdingD. Postintubation croupG. Bacterial pneumonia* Bronchospasm* Laryngospasm## Footnoteslide 15

Which of the following are common complications seen in children with URIs undergoing anesthesia?Select 3A. AtelectasisB. Decreased renal functionC. UrticariaD. Planned hospital admissionE. Arterial oxygen desaturationF. Unplanned hospital admissionG. Hypertension

A. AtelectasisE. Arterial oxygen desaturationF. Unplanned hospital admission## FootnoteSlide 15

Which airway management technique is associated with a higher incidence of perioperative respiratory adverse events in children with a URI?A. Nasal cannulaB. Laryngeal mask airway (LMA)C. Non-invasive ventilationD. Endotracheal tube (ETT)

D. Endotracheal tube (ETT)## Footnoteslide 15

Which induction technique is associated with a lower incidence of perioperative respiratory adverse events in pediatric patients with a URI?A. Inhalational inductionB. Ketamine-only inductionC. Intravenous inductionD. Rapid sequence induction

C. Intravenous induction## FootnoteSilde 15

According to current recommendations, how long should elective surgery be postponed after resolution of URI symptoms?A. 1 weekB. 2 weeksC. 4 daysD. 6 weeks

B. 2 weeks "If it's a healthy patient, an ASA-1 patient with a clear runny nose and no fever, then typically we'll continue with theanesthetic.""If the patient is febrile, if they have really purulent drainage coming out, **if they have a lot of comorbidities, then typically we will cancel the case and reschedule 2 weeks, sometimes 4 weeks out"**## Footnoteslide 16

Bronchial hyperreactivity can persist for up to ______________+ weeks after a URI.A. 1B. 2C. 4D. 6

D. 6+## Footnoteslide 16

# MatchingInstructions: Match each clinical sign or patient characteristic with the appropriate action regarding proceeding with anesthesia. 1.Runny nose2.Purulent nasal drainage3.Clear lungs4.Wheezing5.Older child6.Child < 1 year or previous preemie7.No changes in behavior8.FeverOptions:A. Proceed with CautionB. Cancel the Case

1.A2.B3.A4.B5.A6.B7.A8.B## Footnoteslide 16

Which of the following features would classify a child's illness as a severe cold in the preoperative setting?A. Runny nose and dry coughB. Wheezing and feverC. Dry cough and watery congestionD. Moist cough and clear lungs

B. Wheezing and fever## Footnoteslide 17

Children with a ______________ cold and no high-risk features may proceed with surgery after pretreatment with salbutamol.A. SevereB. ModerateC. MildD. Persistent

C. Mild* Runny nose* Dry cough* Watery congestion## Footnoteslide 17

Which of the following is a recommended anesthetic strategy in a child with URI symptoms who requires surgery?A. Always intubate the child earlyB. Avoid using an LMAC. Use desflurane for rapid emergenceD. Avoid endotracheal intubation if possible

D. Avoid endotracheal intubation if possible* Avoid Desflurane* Use LMA* Use propofol* Use lidocaine## Footnoteslide 17

Which of the following are considered risk factors that may delay surgery in a child with a moderate cold? (Select 3)A. Age under 1 yearB. No smoking exposureC. ENT or eye surgeryD. No change in behaviorE. Need for endotracheal intubation

A. Age under 1 yearC. ENT or eye surgeryE. Need for endotracheal intubation* Passive smoking* Pulmonal comorbidity## Footnoteslide 17

According to the decision algorithm, when should surgery be postponed for ≥2 weeks?A. The child has clear lungs and a dry coughB. The child has purulent congestion and dry coughC. The child has a mild cold with watery congestionD. The child has wheezing, purulent congestion, and fever

D. The child has wheezing, purulent congestion, and fever**Severe Cold*** Malaise* Moist Cough## FootnoteSlide 17

Which of the following are considered benefit factors that may support proceeding with surgery in a child with a moderate cold? (Select 3)A. ENT surgery is strongly indicated B. Pulmonary comorbidity is well-controlledC. The anesthesia team has expertise managing children with coldsD. Parent expresses strong desire to avoid reschedulingE. Parental compliance is highF. Fever resolved within 24 hours

A. ENT surgery is strongly indicated *(e.g., adenoids/tonsils are the infectious focus)*C. The anesthesia team has expertise managing children with coldsE. Parental compliance is high## FootnoteSlide 17

# Matching

Clear liquids → B. 2 hoursBreast milk → D. 4 hoursInfant formula, nonhuman milk, or light meal → A. 6 hoursRegular meal, including fatty foods → C. 8 hours## FootnoteSlide 18

Which of the following statements best reflects appropriate NPO practices for pediatric patients?A. Clear liquids are encouraged up to 2 hours before surgery to prevent dehydration.B. Breast milk is treated the same as infant formula in preoperative fasting guidelines.C. Pediatric patients should remain completely NPO for 6–8 hours regardless of intake type.D. Pediatric patients should not receive any oral intake once scheduled for surgery.

A. Clear liquids are encouraged up to 2 hours before surgery to prevent dehydration."The big thing with our pediatric patients islooking at formula versus breast milk versus clear liquids. We do actually like ourpediatric patients, especially our infants, to have some hydration and not go sixor eight hours completely NPO"## Footnoteslide 18

Informed consent requires discussion of all _________ and _________ of both the procedure and the anesthetic.A. Risks; benefitsB. Feelings; reactionsC. Advantages; medicationsD. Symptoms; treatment options

A. Risks; benefits* What the family can anticipate * Our role is to protect the child* Reassure the safety of the child## FootnoteSlide 19

Which of the following is the most appropriate way to explain anesthesia risk to a child and their family during informed consent?A. "There’s no risk—anesthesia is completely safe."B. "You are more likely to crash your car than have any issues with anesthesia."C. "There are always risks with anesthesia, ranging from small to serious."D. "Let’s just sign the form so we can get started."

C. "There are always risks with anesthesia, ranging from small to serious"## FootnoteSlide 19

Which action helps make the preoperative conversation more engaging for the pediatric patient?A. Ignoring the child unless they ask a questionB. Asking the child directly about allergies or medical historyC. Only addressing the parentsD. Focusing solely on technical terms and physiology

B. Asking the child directly about allergies or medical history## FootnoteSlide 19

# True of FalseDuring preoperative evaluation its important to discuss specific monitoring devices

True"Let them know we are going to be monitoring all these vital signs...monitoring heart rate, blood pressure, oxygen levels"## FootnoteSlide 19

Which of the following best reflects best practices when preparing pediatric airway equipment for a case?A. Only one size of each airway device should be set out in advance to conserve space.B. All equipment must be pre-connected and ready for immediate use.C. Only suction and an ETT are needed in most pediatric cases.D. Airway equipment should be available in multiple sizes

D. Airway equipment should be available in multiple sizes, *even if not all are set out.*## FootnoteSlide 22

Which of the following airway devices are commonly found in a pediatric anesthesia cart? (Select 4)A. Endotracheal tubes B. Oral airwaysC. Cricothyrotomy kitsD. Supraglottic airway devices E. Chest tubesF. Nasal airways

A. Endotracheal tubes in multiple sizesB. Oral airwaysD. Supraglottic airway devices F. Nasal airways## FootnoteSlide 22

Which of the following equipment items are important to have available when preparing for a pediatric anesthetic? (Select 3)A. BronchoscopeB. SuctionC. Adult defibrillator padsD. MasksE. Anesthesia machine with desfluraneF. Laryngoscope

B. SuctionD. MasksF. Laryngoscope## FootnoteSlide 22

What is the most important consideration when selecting the correct mask size for a pediatric patient?A. The mask should be large enough to cover the entire face, including the eyes.B. The mask should only cover the mouth for easier ventilation.C. The mask should cover the nose and mouth without extending into the eyes.D. The mask should be loose to avoid pressure on the face.

C. The mask should snugly cover the nose and mouth without extending into the eyes."You want it to cover the nose and mouth without occluding either of those.You don't want it to protrude too far up in the eyes so you're not getting a goodseal. So you see how this mask fits all around the patient's face without occludingany of the airway"## Footnoteslide 24

How do you determine the appropriate size for an oral airway in a pediatric patient?A. Measure from the corner of the mouth to the earlobeB. Measure from the nostril to the chinC. Measure from the tip of the mouth to the angle of the mandibleD. Match to the size of the child’s thumb

C. Measure from the tip of the mouth to the angle of the mandible"...make sure you're using an oral airway more in an *unconscious patient*. Awake patients do not like you putting this hard piece of plastic in their mouth."## FootnoteSlide 25

If the oral airway used is too small for the pediatric patient it may press on the ___________ and cause occlusion of the ___________ vein, making the tongue swell.A. epiglottis; jugularB. tongue; lingualC. tonsil; facialD. soft palate; carotid

B. tongue; lingual## Footnoteslide 25

If the oral airway used is too large for the pediatric patient, it may protrude from the mouth and press on the ___________, potentially worsening the airway obstruction.A. epiglottisB. vocal cordsC. soft palateD. larynx

A. epiglottis| Picture B## Footnoteslide 25

A nasal airway can be sized using either the distance from the ______________ to the mandible, or by comparing to the child's ______________ finger.A. tip of the chin; indexB. nostril; ringC. tip of the nose; pinkyD. nasal bridge; thumb

C. tip of the nose; pinky**Not commonly used**## FootnoteSlide 25

A nasal airway that is too large may cause ______________ around the nostril, indicating excessive pressure and poor fit.A. bruisingB. blanchingC. swellingD. bleeding

B. blanching## FootnoteSlide 25

What type of endotracheal tube is most commonly used in pediatric anesthesia today?A. Cuffed ETTB. Uncuffed ETTC. Nasopharyngeal airwayD. Tracheostomy tube

A. Cuffed ETT"A few of the older anesthesiologists that still sit cases will use uncuffed ET tubes, butoverall most people use a cuffed ET tube."## FootnoteSlide 28

In which type of surgical procedure is an **right angled oral RAE** tube most commonly used?A. Orthopedic surgeryB. Abdominal surgeryC. ENT procedures D. Neurosurgery

C. ENT procedures *(tonsils and adenoids)*"...oral ray for all ENT procedures, so it just bends straight down and is a little bit out of the way."## FootnoteSlide 28

A nasal RAE tube is typically used during which type of surgery?A. CraniotomyB. Dental surgeryC. Spinal fusionD. Umbilical hernia repair

B. Dental surgery"We use nasal ray tubes for dental procedures. If you do get a nasal tube, you want some McGill forceps."| McGill forceps## FootnoteSlide 28

The ____________ blade is a straight laryngoscope blade commonly used in **neonates and toddlers.**Select 2A. Wis-Hipple B. MACC. Miller D. D-bladeE. Seldinger

A. Wis-Hipple C. Miller## FootnoteSlide 28

What is the recommended internal diameter (ID) of the **uncuffed** endotracheal tube for neonates > 3 kg and infants under 1 year of age?A. 3.0 mmB. 3.5 mmC. 4.0 mmD. 4.5 mm

A. 3.0 mm## FootnoteSlide 29

What is the recommended formula to estimate the internal diameter (ID) of an uncuffed ETT for a **child older than 2 years?**A. (Age in years + 10) / 2B. (16 + age in years) / 4C. Age in years × 3D. Age in months / 2

B. (16 + age in years) / 4OR (age in years/4) + 4## FootnoteSlide 29

To determine the appropriate size for a **cuffed** endotracheal tube, what should you do **after** calculating the uncuffed size?A. Add 0.5 mmB. Subtract 1 mmC. Subtract 0.5 mmD. Double the size

C. Subtract 0.5 mm## Footnoteslide 29

For a child aged 4 years, what is the estimated uncuffed ETT size using the (age/4 + 4) formula?A. 3.5 mmB. 4.0 mmC. 4.5 mmD. 5.0 mm

D. 5.0 mm4/4 = 1+4 = 5mm## Footnoteslide 29

Which of the following formulas can be used to estimate ETT depth (lip placement) based on age?A. Age × 2 + 10B. Age / 2 + 12C. Age × 3 + 1D. Age + 5

B. Age / 2 + 12## FootnoteSlidef 29

Another way to estimate ETT length is by multiplying the internal diameter (ID) of the tube by what factor?A. 2B. 2.5C. 3D. 4

C. 3ORHeight (cm)/10 + 5Weight (kg)/5 + 12## FootnoteSlide 29

# matchingMatch the Age with ETT tube size

1 → C 2 → B3 → F4 → G5 → E6 → A7 → D## FootnoteSlide 30

Column A: Patient Weight (kg)< 55-1010-2020-3030-5050-7070-100Column B: LMA Size and Suggested Inflation VolumeA. Size 3, up to 20 mLB. Size 5, up to 40 mLC. Size 1, up to 4 mLD. Size 2.5, up to 14 mLE. Size 2, up to 10 mLF. Size 1.5, up to 7 mLG. Size 4, up to 30 mL

size 1 rarely used if less than 5kg then just going to tube them## Footnoteslide 31

What size bag typically come on a pediatric circuit? A. 1.5 literB. 2literC. 3liter D. 1liter

D. 1 liter

When considering which bag to use on a circuit you want to make sure that... A. you can giver proper volumes w/o over ventilating B. tidal volumes can reach at least 500C. you can give bigger volumes so you and ventilate less often D. you can give big volumes and over ventilate

A. you can giver proper volumes w/o over ventilating## Footnoteslide 32

During airway set up, you also want to make sure you have different sizes of A. hard suctionB. soft suctionC. EKG leadsD. blood pressure cuffs

B. soft suction## Footnoteslide 32

When do you start the IV on a patient under the age of 12? A. pre opB. post opC. after inductionD. during emergence

C. after induction"were going to do a mask induction and then start the IV"## Footnoteslide 33

What size fluid bag is approriate for a IV set up? A. 100mLB. 1000mLC. 250mLD. 500mL

D. 500mL## Footnoteslide 33

We will use a _____ drip tubing for the smaller patients vs a _______ drip like adult patientA. micro; macroB. macro;micro

A. micro; macro## Footnoteslide 33

What will be set the buretrol to? A. 15-30ml/kgB. 5-10ml/kgC. 10-20ml/kgD. 20-30ml/kg

C. 10-20ml/kg*so if you have a 5kg patient then it'll be 50ml"## Footnoteslide 33

What are the commonly used drugs that we will draw up for our patient? (select 2)A. phenylephrineB. propofolC. fentanylD. norepinephrine

B. propofol (5-10mL syringes)C. fentanylplus or minus a paralytic (roc)## Footnoteslide 34

According to lecture what is a common drug that we diliute for the pediatric patient? A. fentanylB. propofolC. Rocuronium D. dexamethasone

A. fentanyldiluted in 10mL syringe so 10mcg/mlMake sure it is LABELED and passed to whoever is pushing drugs or taking over your case Also would advise you to go by what is normally done at your facility## Footnoteslide 34

What are some additional medications commonly given in pediatric cases? (select 4) A. robaxinB. ofirmevC. dexamethazoneD. ondansetronE. dexmedetomidine

B. ofirmevC. dexamethazoneD. ondansetronE. dexmedetomidineand antibiotics if needed## Footnoteslide 34

What drug could you draw up for a LTA (laryngotracheal airway)? A. 0.75% ropivacaineB. 4% lidocaineC. 2% bupivacaineD. 3% chloroprocaine

B. 4% lidocaine## Footnoteslide 34

True or false: You should always have emergency meds readily available with syringes and IM needles next to them

True## Footnoteslide 35

What is the dose of epinephrine for pediatric patients? A. 0.01mg/kgB. 0.1mg/kgC. 1mgD. 0.02mg/kg

A. 0.01mg/kg## Footnoteslide 35

What is the emergency dose of succinylcholine IV and IM (select 2) A. 1.5mg/kg IVB. 2mg/kg IVC. 3mg/kg IMD. 4mg/kg IM

B. 2mg/kg IVD. 4mg/kg IM## Footnoteslide 35

What is the pediatric emergency dose for atropine A. 0.2mg/kgB. 0.03mg/kgC. 0.02mg/kgD. 0.01mg/kg

C. 0.02mg/kg## Footnoteslide 35

What is the emergency dose for glycopyrrolate for pediatrics A. 0.04mg/kgB. 0.1mg/kgC. 0.02mg/kgD. 0.01mg/kg

D. 0.01mg/kg## Footnoteslide 35

What are things you can do to prepare the OR? (select 2)A. make sure OR is warmB. bair hugger is on bed C. one size blood pressure cuff D. one size EKG monitors

A. make sure OR is warmB. bair hugger is on bed different sizes of BP and EKG## Footnoteslide 36

How many sat probes do we typically put on our neonates A.1B. 2C. none

B. 2Its good to have 2 because it is hard to get to them after they are draped## Footnoteslide 37

What type of ekg do we use for our pediatric patients A. 3 lead B. 5 lead C. 12 leadD. pulse ox is fine

A. 3 lead## Footnoteslide 37

What is an additional standard monitor we have on our pediatric patients A. BIS monitorB. temperature probeC. nerve stimulatorD. laryngeal nerve monitor

B. temperature probeBIS monitor is questionable and not frequently used in pediatric patient## Footnoteslide 37

Why is a pre-cordial stethoscope a great tool to have for pediatric cases (select 2)A. post op monitoringB. listening to heart sounds before inductionC. can't get to your patient D. hard time hearing breath sounds

C. can't get to your patient D. hard time hearing breath sounds## Footnoteslide 37

# True or falseIt is important to have what you need set up because the faster you can get them settled and off to sleep the better for patient and family

true## Footnoteslide 38

Midazolam (the most admistered benzodiazepine) has a PO dose of ________ and an onset of _______ for the pediatric patientA. 1-1.25mg/kg; 5minB. 0.25-1mg/kg; 20 minC. 0.25-1mg/kg; 5 minD. 1-1.25mg/kg; 20 min

B. 0.25-1mg/kg; 20 minmost people give 0.5mg/kgintranasally works between 15-20 min## Footnoteslide 40

Dexmedetomidine is an Alpha 2 adrenergic agonist and has a dose of ______ intranasal for the pediatric patientA. 1-2mcg/kgB. 2-4mcg/kgC. 0.25-1mcg/kgD. 0.5-1mcg/kg

A. 1-2mcg/kg## Footnoteslide 40

Ketamine for the pediatric patient preop has a dose of____ **IM**A. 1-2mg/kgB. 0.5-4mg/kgC. 3-7mg/kgD. 5-10mg/kg

D. 5-10mg/kg## Footnoteslide 40

A key concept for parental presence disscussed in lecture isA. IV access before the ORB. letting parent be interactive and hold the mask C. educationD. vital signs

C. education## Footnote41

Most pediatric patients get inhaled induction if they are what age?A. 12yrs and under B. 13yrs and under C. 15yrs and underD. 18yrs and under

A. 12yrs and under## Footnoteslide 42

Why do we tend to do inhalation induction over IV inductionA. better relaxationB. more traumatizing for the patientC. more pulmonary safeD. not to traumatize them with IV insertion

D. not to traumatize them with IV insertion| most kids wont hold still## Footnoteslide 42

What is the main reason we would choose an IV induction vs inhaled on a pediatric patient (<12y/o)A. difficult airwayB. planned surgery C. RSI/ full stomach D. ear tubes

C. RSI/ full stomach difficult airway is a valid reason but "for smaller pediatric patients even if its a difficult airway we will still do inhalation because difficult intubation doesnt mean difficult ventilation"## Footnoteslide 42

What is considered the most popular technique on anesthesia for the pediatric patient? A. IVB. neuraxialC. regionalD. inhalation

D. inhalation## Footnoteslide 43

What is a good starting dose of nitrous when doing a mask induction (select 2)A. 50%B. 30%C. 70%D. 80%

A. 50%- use on teenagersB. 30%- what she normally uses## Footnoteslide 43

Which patient population would be best to NOT use 30% nitrous when starting Mask inductionA. 15B. 10C. 5D. 12

A. 15"teenagers do not do well with 30 nitrous they dont really do well with less than 50% they get so disinhibited that they become a little more anxious and uncooperative"## Footnoteslide 43

When should you discontinue to nitrous? A. after LOCB. prior to LOCC. after intubationD. 5 min before case end

B. Prior to LOC and intubationand administer sevofluarne in 100%oxygen## Footnoteslide 43

When is the IV placed? A. preopB. after intubationC. during stage 2D. during stage 3

D. during stage 3IV placed after patient is through stage 2, prior to airway placement## Footnoteslide 43

What should occur after IV is in place? A. intubationB. continue with the case C. 100% oxygen3. turn nitrous back on

C. 100% oxygen then intubation## Footnoteslide 43

If the need for an IV in preop arrises what are 2 things we can do to help the pediatric patient (select 2)A. a parent to hold them downB. PO midazolamC. a lollipopD. EMLA cream

B. PO midazolamD. EMLA cream## Footnoteslide 47

What situations should the IV be placed in Preop (select 2)A. patient ate some Mcdonalds before comingB. they have a history of GERDC. the patient drank water 4 hours ago D. the patient has breast milk 4 hours ago

A. patient ate some Mcdonalds before coming (full stomach)B. they have a history of GERD## Footnoteslide 47

What is the NMBD of choice for the pediatric pateint requiring RSIA. PancuroniumB. Vecuronium C. RocuroniumD. succinylcholine

D. succinylcholine"even though it comes with that box warning about hyperkalemia and cardiac arrest still it's our drug of choice for RSI"dont forget the cricoid pressure## Footnoteslide 48

List the steps in order for Mask induction Airway Sevo +/- N2OMedications +/- PO midazolam Place monitorsIV placement

+/- PO premed (midazolam)Place monitors (at least pulse ox the other 2 can wait)Sevo +/- N2O (nitrous off then go 100% FiO2)IV placement (once they are through stage 2)MedicationsAirway## Footnoteslide 49

List in order of IV induction place monitors +/- IV premedication medicationsPreoxygenation airway

+/- IV PremedPlace monitorsPreoxygenationMedicationsAirway## Footnoteslide 49

Due to upper airway anatomy like, big tongue, big tonsils and adnoids, occiput, superior larynx, what is common in pediatric patients A. collapseB. increase diameterC. easier ventilation D. easy intubation

A. collapse (obstruction)large occiput makes them flex forward## Footnoteslide 50

During assisted ventilation with a mask, it is important to A. ensure asynchronus movement of chest and abdomenB. visualize chest wall and abdomen movement C. deliver big tidal volumes D. make sure they are using their abdominals for effort

B. visualize chest wall and abdomen movement make sure you assess to make sure there is no obstruction evidenced by them using their abdominal muscles, or asynchronus abdominal and chest movement## Footnoteslide 50

All of the following are ways to help relieve obstruction EXCEPTA. chin liftB. jaw thrustC. closed mouthD. CPAPE. lateral decubatis positionF. oral/nasopharyngeal airwaysG. deepen anesthetic

C. closed mouth MOUTH OPENING## Footnoteslide 50

What is one thing the anesthesia provider can listen for to recognize an obstruction A. inspiratoy and expiratory stridorB. murmurC. burpingD. crying

A. inspiratoy and expiratory stridor## Footnoteslide 50

# True or falseSniffing position in pediatrics can be difficult due to their occiput so we need to be creative on how to align their axis

true## Footnoteslide 51

What is a way to open an airway and align the axis A. trendelenburgB. prone C. flat on back D. shoulder roll

D. shoulder roll## Footnoteslide 52

During masking, our pointer finger and thumb make a ___ and ____A. E; hold the jaw upB. E; rest on the mandibleC.C; assist in keeping the airway openD. C; hold the mask

D. C; hold the mask## Footnoteside 55

During masking, our three fingers besides the pointer finger and thumb make a ___ and ____A. E; hold the jaw upB. E; rest on the mandibleC.E; rest on the soft tissueD. C; hold the mask

B. E; rest on the mandible**not press on soft tissue** or it will cause obstructionhold the mask like a "tea cup" so when you need to jaw thrust you just reach the pinky behind there## Footnoteslide 55

Visualizing the airway is ______ difficult than an adult A. moreB. lessC. same

A. more## Footnoteslide 56

During intubation you want to move _______ and ________ due to the blades being bigger than what the patient needsA.slow and aggressiveB. fast and furious C. slow and gentleD. fast and gentle

C. slow and gentlebut don't take a lot of time## Footnoteslide 56

When placing the ETT you want to make sure the balloon is____A. 2-3 cm past the vocal cords B. just past the vocal cords C. half way past the vocal cordsD. above the vocal cords

B. just past the vocal cords make sure the stylet is not too deep in the tube or it could hurt the lungsmake sure the whole balloon is just pass the vocal cords## Footnoteslide 56

Another extremely important concept for intubating a pediatric patient isA. its okay to let go of tube to turn on ventilator B. a slight movement in head before taping is okayC. theres more space in the trachea so the odds on right mainsteming is very low D. NEVER let go of the tube before taping

D. NEVER let go of the tube before taping "you want to make sure you're still holding on to the ET tube with the pediatric patients before you're doing all this and make sure someone listens before you tape one of the big things i recommend after you get the tube inand you're holding it is to make sure you hold the ET tube against the corner of the mouth really tightly and that way you know it's secure right there in the corner of the mouth and when you tape you tape very close to the corner of the mouth"## Footnoteslide 56

Which of the following are goals of perioperative fluid management? (Select 3)A. Meet maintenance fluid requirementsB. Control intraoperative bleedingC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative lossesE. Maintain normoglycemiaF. Reduce postoperative nausea and vomiting

A. Meet maintenance fluid requirementsC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative losses## FootnoteSlide 59

For a 25 kg patient, how much total maintenance fluid should be given per hour?A. 55 mL/hrB. 65 mL/hrC. 75 mL/hrD. 85 mL/hr

**B. 65 mL/hr**Explanation 4-2-1 ruleFirst 10 kg: 10 × 4 = 40 mLNext 10 kg: 10 × 2 = 20 mLRemaining 5 kg: 5 × 1 = 5 mLTotal = 40 + 20 + 5 = 65 mL/hr## FootnoteSlide 59/60

What is a known limitation of the 4-2-1 rule in pediatric fluid management?A. It underestimates fluid needs in healthy adultsB. It overestimates maintenance needs in sick childrenC. It requires invasive hemodynamic monitoringD. It does not consider weight-based calculations

B. It overestimates maintenance needs in sick children## FootnoteSlide 61

Which of the following contribute to increased perioperative fluid losses? (Select 3)A. Environmental temperatureB. Cold, dry anesthetic gasesC. Use of regional anesthesia aloneD. Neuroendocrine regulation affected by anesthetic agentsE. Warm, humidified oxygen

A. Environmental temperatureB. Cold, dry anesthetic gasesD. Neuroendocrine regulation affected by anesthetic agents## FootnoteSlide 61

IVF is used to replace intraoperative blood loss and fluid loss resulting from __ and __.A. Fever and dehydrationB. Sweating and urinationC. Evaporation and third spacingD. Bleeding and vomiting

C. Evaporation and third spacing## FootnoteSlide 61

What is essential to monitor during perioperative fluid management to guide ongoing therapy?A. Anesthetic depthB. Oxygen tank pressureC. Physiological parametersD. Patient allergies

C. Physiological parameters*Dr. M: loss as long as the patient's tolerating it well and we want to continually assess and monitor the patient for anyphysiological changes looking at their heart rate and blood pressure to see if we're maintaining our fluid step as well*## FootnoteSlide 61

How is the preoperative fluid deficit calculated in a pediatric patient?A. Maintenance fluid rate × weight in kgB. Maintenance fluid rate × NPO hoursC. Bolus dose based on BMID. Fixed 10 mL/kg/hr replacement

B. Maintenance fluid rate × NPO hours*or off IV fluids if they're inpatient*## FootnoteSlide 62

Match the hour with the correct proportion of fluid deficit to be replaced:

1st hour → B. 1/22nd hour → A. 1/43rd hour → C. 1/4## FootnoteSlide 62

Which of the following are appropriate for replacing fluid deficits in pediatric patients? (Select 2)A. Normal SalineB. Lactated Ringer’sC. D5WD. Hypertonic salineE. LR + dextrose

A. Normal SalineB. Lactated Ringer’s## FootnoteSlide 63

Which type of fluid should generally be avoided when giving boluses to neonates and older children according to lecture?A. Normal SalineB. Lactated Ringer’sC. Dextrose-containing fluidsD. Balanced electrolyte solutions

C. Dextrose-containing fluids## FootnoteSlide 63

Which of the following are goals of perioperative fluid management? (Select 3)A. Meet maintenance fluid requirementsB. Control intraoperative bleedingC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative lossesE. Maintain normoglycemiaF. Reduce postoperative nausea and vomiting

A. Meet maintenance fluid requirementsC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative losses## FootnoteSlide 59

In which pediatric population is routine dextrose administration not advised during anesthesia?A. Critically ill infantsB. Healthy childrenC. Diabetic childrenD. Premature infants

B. Healthy children## FootnoteSlide 65

____ and those ____ may develop hypoglycemia due to prolonged periods of fasting.A. Healthy toddlers; >15 kgB. Critically ill infants; < 10 kgC. Neonates ; with diabetesD. Premature infants; > 5 kg

B. Critically ill infants; < 10 kg**Critically ill infants** and those weighing **< 10 kg** may develop hypoglycemia with prolonged periods of fasting

Match the clinical scenario with the appropriate dextrose treatment:

A → 3 Routine intraoperative use in infants = 2.5% dextrose-containing isotonic solutions intraopB → 2 Symptomatic hypoglycemia: IV 10% dextrose 2 ml/kgC → 1 If seizures are present, give 10% dextrose 4 ml/kg## FootnoteSlide 65

n which of the following cases should glucose-containing fluids be considered? (Select 4)A. Healthy toddlers under 20 kgB. Premature infantsC. Infants of diabetic mothersD. Children receiving pre-op insulinE. Children on parenteral nutrition

B. Premature infantsC. Infants of diabetic mothersD. Children receiving pre-op insulinE. Children on parenteral nutrition## FootnoteSlide 65

Match each age group with its estimated blood volume (EBV) range:

A → 5B → 3C → 4D → 2E → 1## FootnoteSlide 66

The incidence of apnea is higher in neonates and premature infants with hematocrit values less than __.A. 20%B. 25%C. 30%D. 35%

C. 30%## FootnoteSlide 67

# True or FalseHealthy children with normal cardiovascular function may tolerate lower hematocrit levels.

True *Compensate with increased CO if a **higher inspired [O2]** is provided to improve O2 delivery*## FootnoteSlide 67

Which of the following is the correct formula to calculate Maximum Allowable Blood Loss (MABL)?A. MABL = EBV × (Target Hct / Starting Hct)B. MABL = (EBV – Blood loss) / HematocritC. MABL = EBV × (Starting Hct – Target Hct) / Starting HctD. MABL = EBV × Target Hct

C. MABL = EBV × (Starting Hct – Target Hct) / Starting Hct## FootnoteSlide 67

Which of the following statements are true regarding intraoperative blood loss replacement? (Select all that apply-2)A. Blood loss can be replaced with 3 mL of crystalloid per 1 mL of blood lossB. Colloids are the first-line fluid for all pediatric surgeriesC. Packed red blood cells should be given in a 1:1 ratio for blood loss replacementD. Dextrose-containing solutions are ideal for fluid bolusesE. Crystalloid replacement is less efficient than PRBCs in restoring oxygen-carrying capacity

A. Blood loss can be replaced with 3 mL of crystalloid per 1 mL of blood lossC. Packed red blood cells should be given in a 1:1 ratio for blood loss replacement## FootnoteSlide 67

3-year-old child weighs 15 kg, starting hct 38%, desired hct = 25%, what is the MABL?

MABL = [(15 x 70) x (38-25)] / 38 = ?MABL = 360 mL## FootnoteSlide 68

Which of the following are goals of perioperative fluid management? (Select 3)A. Meet maintenance fluid requirementsB. Control intraoperative bleedingC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative lossesE. Maintain normoglycemiaF. Reduce postoperative nausea and vomiting

A. Meet maintenance fluid requirementsC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative losses## FootnoteSlide 59

What is the approximate hematocrit of packed red blood cells (PRBCs)?A. 30%B. 45%C. 60%D. 70%

C. 60%## FootnoteSlide 69

__ mL/kg of PRBCs will raise the hemoglobin level by 1 g/dL.A. 2B. 3C. 4D. 5

C. 4 mL/kg## FootnoteSlide 69

Which of the following are appropriate methods for warming small volumes of blood in pediatric patients? (Select 2)A. Draw into a syringe and warm by handB. Place under a forced-air warming blanketC. Warm using standard adult blood warmersD. Use a microwave for rapid warmingE. Allow the unit to reach room temperature over time

A. Draw into a syringe and warm by handB. Place under a forced-air warming blanket## FootnoteSlide 69

Which of the following is a contraindication to outpatient anesthesia in infants?A. Full-term infants over 2 months oldB. Infants born at 36 weeks gestation and now 61 weeks post-conceptual ageC. Infants born before 35 weeks gestation or under 60 weeks post-conceptual ageD. Infants with resolved GERD and no respiratory symptoms

C. Infants born before 35 weeks gestation or under 60 weeks post-conceptual age* At risk for postoperative apnea* Must stay overnight in hospital## FootnoteSlide 70

Postoperative discharge goals include ensuring that the patient is ventilating well, tolerating __ intake, and not experiencing significant __.A. IV; feverB. oral (PO); nausea or vomitingC. tube feeding; apneaD. glucose; hypotension

B. oral (PO); nausea or vomiting*The patient needs to be able to **take PO meds without n/v prior to d/c***| Postoperative goals are the same as for all surgeries## FootnoteSlide 70

Which of the following statements about postoperative apnea in premature infants are true? (Select 2)A. Infants born at 28 weeks have the highest risk of apneaB. Anemia increases the risk of apnea, regardless of ageC. The risk of apnea disappears entirely by 40 weeksD. Risk decreases as post-conceptual age approaches 60 weeksE. Infants born at 36 weeks have no risk of apnea

A. Infants born at 28 weeks have the highest risk of apneaD. Risk decreases as post-conceptual age approaches 60 weeks*Dr. M: that's why we want patients to stay overnight until they reach that 60 week post-conceptual age*## FootnoteSlide 71

Which of the following is NOT typically performed under outpatient anesthesia?A. ENT procedures B. Ophthalmology procedures (C. Urology procedures =D. CraniotomyE. Radiology procedures (e.g., CT or MRI under sedation)F. Dental procedures

D. Craniotomy## FootnoteSlide 70

Which of the following is NOT a contributing cause of perioperative hypothermia?A. Cold operating roomB. Anesthetic-induced vasodilationC. Infusion of room-temperature IV fluidsD. Use of warming blanketsE. Evaporative heat lossF. Cool irrigating solutionsG. Inspiration of cool/dry anesthetic gases

D. Use of warming blankets## FootnoteSlide 72

Which of the following are strategies to prevent hypothermia in neonates during surgery? (Select 3)A. Use of radiant heat lampsB. Applying cold IV fluids quicklyC. Over-body Bair-hugger warmerD. Keeping the head warmE. Using cool anesthetic gases

A. Use of radiant heat lampsC. Over-body Bair-hugger warmerD. Keeping the head warm## FootnoteSlide 72

Causes of Perioperative Cardiac Arrest in ChildrenCause1. Cardiac-related2. Respiratory-relatedCategoryA. HypovolemiaB. Myocardial ischemiaC. HyperkalemiaD. Sudden arrhythmiasE. LaryngospasmF. Inadequate oxygenationG. Difficult intubation

A. Hypovolemia → 1B. Myocardial ischemia→ 1C. Hyperkalemia→ 1D. Sudden arrhythmias→ 1E. Laryngospasm→ 2F. Inadequate oxygenation→ 2G. Difficult intubation→ 2*Dr. M: most prevalent in kids with congenital heart disease often during non-cardiac surgery*## FootnoteSlide 73

Which of the following are goals of perioperative fluid management? (Select 3)A. Meet maintenance fluid requirementsB. Control intraoperative bleedingC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative lossesE. Maintain normoglycemiaF. Reduce postoperative nausea and vomiting

A. Meet maintenance fluid requirementsC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative losses## FootnoteSlide 59

# True or FalseThe incidence of respiratory complications is not influenced by the experience level of the anesthesia provider.

FALSEIncidence of respiratory complications has been repeatedly reported to be **dependent on the experience level of the anesthesia provider**## FootnoteSlide 73

Match each patient type to the preferred extubation approach:Patient Scenario:A. Full stomach / RSIB. Difficult airwayC. Reactive airway diseaseD. Risk of needing emergent re-intubationExtubation Type:1. Deep extubation2. Awake extubation

A. Full stomach / RSI → 2 Awake extubationB. Difficult airway→ 2 Awake extubationC. Reactive airway disease→ 1Deep extubationD. Risk of needing emergent re-intubation→ 2 Awake extubation## FootnoteSlide 74

Which of the following influence the decision to perform an awake extubation? (Select a2)A. Preference and comfort of the providerB. Comfort and competency of the recovery room staffC. Patient’s insurance statusD. Operating room noise level

A. Preference and comfort of the providerB. Comfort and competency of the recovery room staff## FootnoteSlide 74

During which stage of anesthesia is extubation considered most risky due to heightened airway reflexes and potential for laryngospasm?A. Stage 1B. Stage 2C. Stage 3D. Recovery phase

B. Stage 2## FootnoteSlide 74

What is a helpful post-extubation positioning strategy for pediatics according to lecture?A. Supine with neck extendedB. Prone with head elevatedC. Lateral (side-lying) positionD. Trendelenburg position

C. Lateral (side-lying) position## FootnoteSlide 74

Which of the following circuits is recommended for transporting a patient to PACU?A. Bain circuitB. Jackson-Reese circuitC. Circle systemD. Venturi circuit

B. Jackson-Reese circuit## FootnoteSlide 75

Which of the following are essential monitoring tools during patient transport to the PACU? (Select 2)A. Precordial stethoscopeB. Pulse oximeterC. TourniquetD. Blood glucose meterE. ECG leads

A. Precordial stethoscopeB. Pulse oximeter## FootnoteSlide 75

Which of the following are essential emergency medications to have available during transport to the PACU? (Select 4)A. PropofolB. Succinylcholine (Succs)C. AtropineD. EpinephrineE. Midazolam

A. PropofolB. Succinylcholine (Succs)C. AtropineD. Epinephrine## FootnoteSlide 75

Which of the following best explains the increased risk of postoperative apnea in premature infants?A. Enhanced sensitivity to hyperoxiaB. Impaired ventilatory response to hypoxia and hypercarbiaC. Increased airway resistance due to narrow tracheaD. Overdevelopment of respiratory centers

**B. Impaired ventilatory response to hypoxia and hypercarbia***Dr. M: when the baby has respiratorydistress they can fatigue a lot faster leading to apnea apnea can lead to bradycardia and hypoxemia very easily.*## FootnoteSlide 76

Which of the following is used to stabilize respiratory rhythm in premature infants at risk for apnea? (Select 2)A. MorphineB. DexamethasoneC. CaffeineD. CPAPE. Midazolam

**C. Caffeine***Caffeine 20 mg/kg & maintenance therapy is ~ 5 mg/kg/day***D. CPAP**## FootnoteSlide 77

Which of the following are goals of perioperative fluid management? (Select 3)A. Meet maintenance fluid requirementsB. Control intraoperative bleedingC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative lossesE. Maintain normoglycemiaF. Reduce postoperative nausea and vomiting

A. Meet maintenance fluid requirementsC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative losses## FootnoteSlide 59

# True or FalsePostoperative apnea in premature infants typically resolves with maturation.

True## FootnoteSlide 77

Which of the following is the primary tool used to detect postoperative apnea in premature infants?A. Arterial blood gasB. Pulse oximetryC. Chest X-rayD. ECG monitoring

B. Pulse oximetry*< 60 weeks post-conceptual age should be admitted for 24-hour observation*## FootnoteSlide 77

Which of the following anesthetic strategies are recommended to reduce the risk of apnea in premature infants? (Select 3)A. Use of spinal or caudal anesthesia if appropriateB. High-dose opioids for prolonged analgesiaC. Non-opioid medications for pain controlD. TAP blocks (with caution regarding local anesthetic dosing)E. Routine use of general anesthesia with inhaled agents

A. Use of spinal or caudal anesthesia if appropriateC. Non-opioid medications for pain controlD. TAP blocks (with caution regarding local anesthetic dosing)*Dr. M: premature infants that are having episodes of apnea often called episodes of As and Bs apnea and bradycardia we want to do things to limit our opioid medicine so consider opioid sparing techniques*## FootnoteSlide 77

What is the estimated incidence of emergence agitation in the pediatric population?A. 1–10%B. 10–80%C. 50–90%D. <5%

B. 10–80%*No single cause*## FootnoteSlide 78

Which of the following is NOT considered an altered behavior in the PACU associated with emergence agitation or delirium?A. RestlessnessB. CryingC. MoaningD. BradycardiaE. IncoherenceF. Disorientation

D. Bradycardia***Agitation may be d/t: Pain, cold, full bladder, fear, anxiety, parental separation, etc***## FootnoteSlide78

Which of the following are characteristics of pediatric postoperative delirium? (Select 4)A. Inconsolable cryingB. DisorientationC. Following commandsD. Not responding to parentsE. No eye contact

A. Inconsolable cryingB. DisorientationD. Not responding to parentsE. No eye contact## FootnoteSlide 78

Which of the following age groups is most commonly associated with an increased risk of emergence delirium?A. NeonatesB. Infants under 6 monthsC. Children 2–9 years oldD. Adolescents 12–18 years old

C. Children 2–9 years old## FootnoteSlide 78

Which of the following factors may contribute to an increased risk of emergence delirium in pediatric patients? (Select all that apply-2)A. Recent upper respiratory infectionB. Length of surgeryC. Type of surgeryD. Anesthetic technique usedE. Use of regional anesthesia alone

**C. Type of surgery***Dr.M: a lot of ENT procedures***D. Anesthetic technique used***Dr.M: anesthetic gas is the highest risk factor where if you used tiva it would be a lower risk factor*## FootnoteSlide 79

Which of the following are appropriate treatment options for emergence delirium in pediatric patients? (Select 4)A. Anticholinergics like glycopyrrolateB. Alpha-2 agonistsC. Administration of propofolD. Effective pain managementE. Inhaled corticosteroidsF. Allowing time for resolution

B. **Alpha-2 agonists**C. Administration of **propofol**D. Effective **pain management**F. Allowing **time** for resolution## FootnoteSlide 79

Strict attention to the dose of ________ and ________ is essential when performing regional anesthesia in children.A. Propofol; ketamineB. Local anesthetic; epinephrineC. Fentanyl; dexmedetomidineD. Midazolam; nitrous oxide

B. Local anesthetic; epinephrine## FootnoteSlide 80

Which of the following are goals of perioperative fluid management? (Select 3)A. Meet maintenance fluid requirementsB. Control intraoperative bleedingC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative lossesE. Maintain normoglycemiaF. Reduce postoperative nausea and vomiting

A. Meet maintenance fluid requirementsC. Replace preoperative fluid deficitsD. Compensate for ongoing perioperative losses## FootnoteSlide 59

Which of the following statements is true regarding regional anesthesia in pediatric patients?A. Regional anesthesia is never performed under general anesthesia due to increased risk.B. Sensory level assessment of a block is easier under general anesthesia.C. The risk of injury may be reduced if the child is calm and not combative during placement.D. Accidental dural puncture is easily recognized and treated in anesthetized children.

C. The risk of injury may be reduced if the child is calm and not combative during placement.- Usually performed with the child under GA- Limited ability to properly assess the sensory level of the block under GA- Consequences of accidental dural puncture are more challenging to assess & treat## FootnoteSlide 80

Levels:L1S1S3L3Match the following:*Adults:*Conus MedullarisDural Sac Terminus*Infants*Conus MedullarisDural Sac Terminus

*Adults:*Conus Medullaris - L1Dural Sac Terminus - S1*Infants*Conus Medullaris - S1Dural Sac Terminus - S3## FootnoteSlide 81

What is the most commonly used regional anesthesia (RA) technique in pediatric anesthesia?A. SpinalB. EpiduralC. CaudalD. Femoral

C. Caudal*Adjunct to GA or solely for postop analgesia*## FootnoteSlide 82

The use of ____ is recommended to improve accuracy during caudal block placement.A. FluoroscopyB. Nerve stimulatorC. UltrasoundD. X-ray

C. Ultrasound## FootnoteSlide 82

Caudal anesthesia is administered with the patient in the __________ position with knees __________.A. Supine; extendedB. Prone; abductedC. Lateral; flexedD. Lithotomy; straight

C. Lateral; flexed## FootnoteSlide 82

Which anatomical landmarks are used to identify the sacral hiatus for caudal anesthesia placement?A. Anterior superior iliac spine and L3 spinous processB. Tip of the coccyx and sacral cornua on either side of the sacral hiatusC. Greater trochanter and posterior superior iliac spineD. Tuffier’s line and sacral promontory

B. Tip of the coccyx and sacral cornua on either side of the sacral hiatus*Forms an equilateral triangle*

Put the Following Steps in the Correct Order for Caudal Anesthesia Placement:A. Aspirate to check for blood or CSFB. Place 22-gauge needle bevel up at a 45° angle to the skinC. Inject local anestheticD. Advance needle until loss of resistance (LOR) is felt through the sacrococcygeal membraneE. Reduce needle angle and advance cephaladF. Use saline for LOR confirmation

B → D → E → F → A → C1. 22-gauge needle placed bevel up at 45° angle to the skin (B)2. Once LOR felt when sacrococcygeal membrane is punctured (D)3. Reduce the needle angle, and advance cephalad (E)4. Use saline for LOR (F)5. Aspirate (A)6. Inject LA (C)## FootnoteSlide 84

What volume of local anesthetic (LA) is typically used to achieve a T4–T6 dermatome level in pediatric caudal anesthesia?A. 0.5 mL/kgB. 1.0 mL/kgC. 1.2–1.5 mL/kgD. 2.5 mL/kg

C. 1.2–1.5 mL/kg## FootnoteSlide 85

What is the recommended maximum concentration of local anesthetic for caudal anesthesia in children?A. 1.0 mg/kgB. 1.5 mg/kgC. 2.0 mg/kgD. 2.5 mg/kg

D. 2.5 mg/kg## FootnoteSlide 85

Which factor most determines the choice of local anesthetic used in caudal blocks for children?A. Age of the childB. Hospital protocolC. Provider preferenceD. Cost of medication

C. Provider preference## FootnoteSlide 85

Approximately what volume of LA is used for lower procedures (e.g., below T10) in pediatric caudal anesthesia?A. 2 mL/kgB. 1.5 mL/kgC. 1.0 mL/kgD. 0.5 mL/kg

C. 1.0 mL/kg## FootnoteSlide 85

Which of the following are commonly used additives in pediatric caudal anesthesia (select 3)?A. Epinephrine (1:200,000)B. Clonidine (1–2 mcg/kg)C. FentanylD. MidazolamE. Naloxone

A. Epinephrine (1:200,000)B. Clonidine (1–2 mcg/kg)C. Fentanyl## FootnoteSlide 85