Pediatrics- cleft lip repair

A 4-month old, 5 kg infant is scheduled for repair of cleft lip and palate.

1. What is an acceptable hemoglobin level in this age group?

2. When would you make this patient NPO?

3. Is premedication for separation from the parents necessary?

Sedation prior to parental separation is not necessary until after a child reaches about six months of age.

3. A nitrous oxide/oxygen/halothane anesthetic is planned, and the surgeon wants to use epinephrine 1:200,000 concentration. What do you tell her?

4. Will you extubate deep, or wait until the child is awake? Explain.

Electrical safety

Your patient requires defibrillation, but the line isolation monitor alarms when the defibrillator is activated.

1. Is it safe to use the defibrillator?

2. What would you do?

Ventilatory care- intensive care unit

You are consulted about a patient who is postoperative day number three, after laparotomy for blunt trauma. The patient is intubated, on mechanical ventilation. Most recent arterial blood gas on 100% FIO2 is: pH=7.50, paCO2 = 30 mmHg, paO2= 60 mmHg.

1. What are the possible causes of hypoxemia?

2. You impression is pulmonary edema due to increased pulmonary capillary permeability. Your advice?

Prophylaxis for allergic reactions

A patient presents for outpatient surgery, and has a history of allergy to a multitude of drugs. You choose to give prophylactic therapy in the hopes of preventing acute allergic reaction in the perioperative period. What will you use?

Prevention of allergic reaction may be treated with H1 blockers like diphenhydramine, H2 blockers like ranitidine or cimetidine, and corticosteroids, although the efficacy of doing so is not proved.