Pediatric anesthesia- airway emergencies
Following laser excision of laryngeal papillomas, a 2-year old child develops severe airway obstruction.
1. What is your assessment?
2. What is your treatment if this child is agitated?
3. What is your treatment if this child is quiet?
4. Would you use a topical vasoconstrictor?
5. What route of administration would you use?
As bleeding continues, the resident asks if a transfusion mismatch occurred.
1. What kinds of transfusion reactions can occur?
Febrile non-hemolytic reactions, allergic reactions, and hemolytic reactions can occur. Most are caused by the anti-A or anti-B antibodies during an incompatible transfusion.
1. You attempt to find out by doing what?
Stop the transfusion while you look for clinical manifestations of a transfusion reaction. For patients under general anesthesia, hypotension, diffuse bleeding, and hematuria may be the only signs, with the usual signs of fever, chills, chest or back pain, nausea, and flushing being masked.
2. What is your management if your suspicion is great?
Stop the transfusion, and remove blood tubing. Tell the blood bank, and send a patient and a blood donor specimen to them. Maintain blood pressure aggressively, with fluids and pressors if indicated. Maintain urine output with fluids and mannitol, then diuretics and dopamine if oliguria occurs. Watch for hyperkalemia, disseminated intravascular coagulation, and hemolysis. Tests for urine and plasma hemoglobin, direct antiglobulin, bilirubin, plasma haptoglobin, protime, prothrombin time, platelet count, and fibrinogen may be done.
3. What infections are possible through blood transfusions?
The risk of hepatitis C transmission is about 1:100 per unit, that of human immunodeficiency virus is about 1:250,000, and hepatitis B, bacteria, spirochetes, and parasites can also be transmitted.
Management of patient with suspected malignant hyperthermia
1. What general anesthetic technique would you choose for a patient who survived an episode of malignant hyperthermia? Explain.
2. What tests help establish a diagnosis of malignant hyperthermia?
3. When would you utilize these tests?