SUR 102 - Peds/Geriatrics
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VACTER syndrome - presence of 3 or more physical congenital anomalies
- V - vertebral defect
- A - anal malformation
- C - cardiac anomaly
- T - transesophageal fistula
- E - esophageal atresia
- R - renal anomaly
- L - limb defect
- C - coloboma (split iris) defect in the eye
- H - hearing impairment
- A - atresia choanae
- R - retardation
- G - genitourinary defects
- E - esophageal defects
most common surgically corrected childhood disease
frequency of malignant tumors in infants and children
minimal frequency when compared with occurrence rates for adults
leading cause of death in children
chronologic category - not compatible with life
chronologic category - in utero after 3 months' gestation
chronologic category - gestational age more than 24 weeks, birthweight >500 g, capable of sustaining life outside uterus
chronologic category - gestational age less than 37 weeks, birthweight 2500 g or less
chronologic category - gestational age less than 38 weeks, birthweight more than 2500 g
chronologic category - gestational age 38-40 weeks, birthweight >2500 g
chronologic category - gestational age extended by more than 8 weeks
chronologic category - first 28 days of extrauterine life
chronologic category - 28 days to 18 months
chronologic category - 18-30 months
chronologic category - 2-1/2 to 5 years
chronologic category - 6-12 years
chronologic category - 13-18 years
when is hypotension apparent in an infant?
not until 50% of circulating volume is lost
blood volume of neonate
blood volume of age 6 weeks-2 years
blood volume of age 2 years-puberty
newborn heart rate
- awake - 100-180
- asleep - 80-160
infant heart rate
- awake - 110-150
- asleep - 70-120
toddler heart rate
- awake - 110-130
- asleep - 70-100
preschool heart rate
- awake - 80-120
- asleep - 60-90
school age heart rate
- awake - 70-115
- asleep - 60-90
adolescent heart rate
- awake - 60-100
- asleep - 60-90
critical factors in selection of instrumentation, sutures, needles and equipment for peds surgery
size and weight
instruments used on delicate tissues of children
in peds surgery, what should hemostats have?
in peds surgery, what does mosquito hemostat clamp?
superficial vessel, but not major artery
in peds surgery, what are noncrushing vascular clamps used for?
occlusion of major vessels as well as can be placed across intestine
in peds surgery, where should instruments not being used be placed?
- return to Mayo stand or instrument table immediately after use
- never on patient, especially not on chest
what are frequently used in peds surgery to retract blood vessels and small structures to give greater visibility
umbilical tape or vessel loops
types of instruments used on adolescents
acute congenital anomaly characterized by esophageal obstruction, accumulation of secretions, gastric reflux, and respiratory complications
what is the goal of esophageal atresia?
to obtain end-to-end esophageal anastomosis
why is gastrostomy performed for esophageal atresia?
to establish conduit for feeding newborn less than 1200 g
what type of tube is placed during gastrostomy
when does anorectal malformation generally occur?
during 4th to 12th week of fetal development
how is imperforate anus classified?
as high or low in relation to levator muscles
single opening for urethra, rectum, and vagina
most common cause for abdominal surgical procedure in child aged 5-10 years
how can appendectomy be performed?
laparoscopy or open laparotomy
how is questionable diagnosis of appendicitis confirmed or ruled out?
with what condition is cryptorchidism associated?
operation performed for cryptorchidism
two-stage Torek operation
when is cryptorchidism usually repaired?
at age 5 or 6 years
treatment for congenital dislocated hip if diagnosed early in infancy
closed reduction with immobilization
treatment for congenital dislocated hip if diagnosed after child has begun to walk
open reduction with osteotomy to stabilize the joint
otherwise known as clubfoot
treatment for talipes varus during infancy
treatment for talipes varus in older, weightbearing child
wedge cast with turnbuckles
most common chronic condition of childhood
secretory otitis media
incision in tympanic membrane for drainage
what is commonly performed bilaterally in association with myringotomy?
cleft lip rules of 10
- 10 weeks of age
- 10 g hemoglobin
- 10 lbs body weight
fusion of two or more fingers or toes
most common congenital hand deformity
webbing between fingers
what does separation of webbed digits almost always necessitate?
occurs when passages between ventricles are blocked and dilated by accumulated CSF
how is hydrocephalus treated in utero?
cephalocentesis with insertion of ventriculoamniotic shunt to drain ventricles
how is hydrocephalus treated after birth?
implantation of shunt for transporting excess fluid from ventricles
funnel-shaped concave depression over lower end of sternum
what can result from extreme pectus excavatum during pubertal growth period?
procedures for pectus excavatum
- Nuss procedure - minimally invasive
- Ravitch repair - open
when is pulmonary ventilation established?
- during first breath at birth
- this causes increased left atrial force, which closes foramen ovale
when does ductus arteriosus close after birth?
- after 15 hours
- some neonates have delay of 1-3 weeks for complete closure
opening in septum between right and left atria, allowing oxygenated blood to shunt from left to right and return to lungs
atrial septal defect
2 ways atrial septal defect can be repaired
- closed with sutures
- if cannot be closed with sutures, patch graft is inserted
opening in membranous portion of septum between right and left ventricles
ventricular septal defect
repair of ventricular septal defect
- patients with small defects may not necessitate repair - 1/3 small defects close spontaneously by age 2
- patch graft is used to repair large defects
4 defects of tetralogy of Fallot
- large VSD
- stenosis or atresia of pulmonary valve
- hypertrophy of right ventricle
- displacement of aorta to the right
infants with tetralogy of Fallot
procedure in which aorta and pulmonary arteries are anatomically switched
why is Jantene procedure done?
infants with VSD or large PDA
absence of tricuspid valve between right atrium and ventricle, preventing normal blood flow through chambers of the heart
treatment for tricuspid atresia
Fontan procedure - performed at 3 or 4 years of age - direct anastomosis of pulmonary artery to right atrium
a balloon catheter is advancd into the right atrium, through foramen ovale and into left atrium, balloon inflated and pulled back, enlarging foramen ovale
most common cause of cardiac death in first week of life
hypoplastic left heart syndrome
what happens with hypoplastic left heart syndrome?
- left ventricle is severely underdeveloped and right ventricle is overloaded
- patient is in complete heart failure within 28 hours of life
treatment for hypoplastic left heart syndrome
immediate cardiac transplant
in postop peds care, how often is the patient's recovery evaluated?
at 5-min to 15-min intervals as patient emerges from anesthesia
who is responsible for the postop pediatric patient in PACU and for release criteria?
theories of aging
- wear-and-tear theory - body loses ability to keep pace
- genetic mutation theory - various agents damage DNA code
- viral theory - viruses use genetic materials to fool immune system
- environmental theory - environmental elements accelerate aging process
- physical factor theory - free radicals may cause premature aging
in physical factor theory, hormonal activities affecting organ systems
- decrease in estrogen production = increased risk for osteoporosis and heart disease
- decrease in thyroid activity decreases basal metabolic rate and increases weight gain
- decrease in efficiency of insulin production decreases efficiency of glucose metabolism
- decrease in testosterone production = decreased libido in men
how many geriatric patients have than one medical diagnosis capable of causing death?
more than 73%
- older adults are senile
- older adults do not engage in sexual behavior
- older adults always decline in health after surgical procedure
hearing defect of an older adult could be mistaken for?
where should hearing aids be during surgical procedure
if possible, patient should be allowed to wear it to the OR and possibly throughout the procedure
how many geriatric patients experience depression and alteration in self-image?
- between 10% and 65%
- physical decline may be rapid if psychological well-being is threatened
assessment of integumentary system
skin, fingernails and toenails, and all hair patterns of body, face and scalp
normal skin changes
- skin is often wrinkled as result of changes in connective tissue
- pigmentation and skin tags can be normal lesions in aging process
- hair patterns may be thinning or loss
chronic inflammatory disease characterized by fixation or fusion of vertebral joint
increased forward thoracic curvature
when assessing geriatric cardiopulmonary status, what is assessed?
- BP in sitting and lying positions
- respiratory efforts
- hemoglobin and hematocrit levels
multiple vaginal births can cause what?
uterine and bladder prolapse
at what temp are geriatric patients at risk for hypothermia?
when temp falls below 96.8 F (36 C)
why is anesthesia induction sometimes prolonged?
- because of COPD such as emphysema
- surgical procedures tend to be major and take longer
- increase in body fat is accompanied with aging process and most anesthetics are fat-soluble
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