Pediatric Anesthesia Practice Questions

Q: Which inhalational agent is preferred for the induction of anesthesia in a child with a history of asthma?

Sevoflurane. ***Sevoflurane*** - **Sevoflurane** is preferred for asthmatic children due to its **less irritating nature** to the airway and potent **bronchodilating effects**. - It has a **pleasant odor** and a **rapid onset** of action, making it suitable for pediatric inhalational induction. *Halothane* - While **halothane** is a potent bronchodilator, its use has significantly declined due to concerns about **hepatotoxicity** (halothane hepatitis). - It also has a **slower onset** and offset compared to newer agents like sevoflurane. *Isoflurane* - **Isoflurane** is a **pungent** agent that can cause **airway irritation**, leading to coughing and bronchospasm, especially in children with reactive airways like asthma. - Although it is a bronchodilator, its irritant properties make it less suitable for asthmatic patients. *Desflurane* - **Desflurane** is highly **pungent** and a significant airway irritant, frequently causing **coughing, breath-holding, laryngospasm, and bronchospasm**. - This makes it particularly unsuitable for induction in patients with asthma or other reactive airway diseases.

Q: All of the following drugs increase the risk of postoperative nausea and vomiting after squint surgery in children except?

Propofol. ***Propofol*** - Propofol is known to have **antiemetic properties** and is often used to reduce the incidence of postoperative nausea and vomiting (PONV). - Its mechanism involves modulating **GABA-A receptors** and potentially other pathways that suppress emetic responses. *Halothane* - **Inhalational anesthetics** like halothane are a significant risk factor for PONV, particularly in children and following surgeries like squint repair. - They tend to increase PONV by directly stimulating the **chemoreceptor trigger zone** and altering gut motility. *Opioids* - Opioids, commonly used for postoperative pain control, are a well-known cause of **nausea and vomiting**. - They activate **opioid receptors** in the chemoreceptor trigger zone and the gastrointestinal tract, leading to emesis and delayed gastric emptying. *Nitrous Oxide* - The use of **nitrous oxide** as part of a general anesthetic regimen has been consistently associated with an increased risk of PONV. - It is believed to contribute to PONV by increasing the risk of **bowel distension** and stimulating neurotransmitter release involved in emesis.

Q: In pediatric epidural anaesthesia, what is the volume of local anaesthetic given to achieve a sacral dermatome block?

0.5 - 1 ml/kg. ***0.5 - 1 ml/kg*** - For a **sacral dermatome block** in pediatric epidural anesthesia, a volume of **0.5 to 1 ml/kg** of local anesthetic is commonly used. - This volume is generally sufficient to achieve effective analgesia in the desired sacral and lower lumbar dermatomes without causing excessive spread or systemic toxicity. *2 - 4 ml/kg* - This volume range is typically used for a **higher thoracic or lumbar block** in pediatric epidural anesthesia, aiming for a more extensive spread of local anesthetic. - Using this volume for a sacral block would likely result in an **unnecessarily high block** and increase the risk of side effects like hypotension or motor blockade. *5 - 10 ml/kg* - This volume range is **excessively high** for pediatric epidural anesthesia for any dermatomal level, even a sacral block. - Administering such large volumes significantly increases the risk of **systemic local anesthetic toxicity** and severe hemodynamic instability. *None of the options* - This option is incorrect because **0.5 - 1 ml/kg** is a standard and appropriate volume for a sacral dermatome block in children. - There is a correct option provided in the choices.

Q: A 6-year-old boy is taken for an ophthalmic examination under anesthesia. His father reports that the boy has lower limb weakness and that his elder brother died at 14 years of age. Which anesthetic drug should be avoided in this case?

Succinylcholine. ***Succinylcholine*** - The history of **lower limb weakness** and an elder brother's death at a young age suggests a **neuromuscular disorder** such as Duchenne muscular dystrophy. - In patients with undiagnosed or diagnosed muscular dystrophies, succinylcholine can trigger **rhabdomyolysis**, hyperkalemia, and cardiac arrest due to prolonged depolarization and potassium efflux from damaged muscle cells. *Pancuronium* - This is a **nondepolarizing neuromuscular blocker** with an intermediate duration of action. - While it prolongs neuromuscular blockade in patients with muscle weakness, it does not carry the same risk of **hyperkalemic cardiac arrest** as succinylcholine. *Atracurium* - This is a **nondepolarizing neuromuscular blocker** that undergoes Hofmann elimination and ester hydrolysis, making its elimination largely independent of renal or hepatic function. - It is often considered a **safer option in patients with neuromuscular disorders** because it does not cause potassium efflux or trigger malignant hyperthermia. *Dexacurium* - This is a **long-acting nondepolarizing neuromuscular blocker**. - While its effects might be prolonged in patients with muscle weakness, it does not pose the specific and life-threatening risk of **hyperkalemia** associated with succinylcholine in this patient population.

Q: Which circuit is specifically designed for anaesthesia in infants?

Ayres t piece. ***Ayres t piece*** - The **Ayres t piece (Jackson-Rees modification)** lacks a reservoir bag, which reduces **dead space** and resistance, making it ideal for infants with low tidal volumes. - Its simple design and **low resistance** minimize the work of breathing, crucial for neonates and infants. *Bains circuit* - The Bains circuit is a **modified Mapleson D system** often used in older children and adults. - It features a concentric design with a fresh gas flow lumen inside the expiratory limb, making it suitable for moderate to high fresh gas flows but less ideal for the very low tidal volumes of infants. *Magill circuit* - The Magill circuit is a **Mapleson A system**, most efficient for **spontaneous ventilation** in adults, requiring low fresh gas flows. - Its design with the APL valve near the patient leads to significant rebreathing if used with controlled ventilation or in infants due to their small tidal volumes. *Water's circuit* - The Water's circuit (also known as the **Mapleson E or F system**) is primarily used as an open-system mask for **spontaneous respiration**, often for induction or emergency situations. - It provides minimal control over ventilation and is generally not preferred for precise anesthesia management in any age group, especially not infants.

Q: Induction agent of choice in a child with cyanotic heart disease is

Ketamine. ***Ketamine*** - **Ketamine** is preferred in cyanotic heart disease because it generally maintains or even **increases systemic vascular resistance** and **blood pressure**, which helps maintain systemic-pulmonary shunting and reduces right-to-left shunting. - It also has a **sympathomimetic effect**, supporting myocardial contractility and heart rate, which is beneficial in patients with compromised cardiac function. *Thiopentone* - **Thiopentone** can cause **myocardial depression** and **vasodilation**, leading to a decrease in systemic vascular resistance. - This reduction in SVR can exacerbate **right-to-left shunting** in cyanotic heart disease, worsening hypoxemia. *Halothane* - **Halothane** is a potent **myocardial depressant** and causes significant **peripheral vasodilation**, leading to decreased blood pressure and systemic vascular resistance. - These effects can lead to a severe decrease in **pulmonary blood flow** and an increase in **right-to-left shunting**, worsening cyanosis and hypoxemia. *Midazolam* - **Midazolam** is a benzodiazepine primarily used for **sedation** and anxiolysis, not as a primary induction agent in critically ill children. - While it has minimal effects on cardiac output at typical doses, it lacks the favorable hemodynamic profile of ketamine for maintaining **organ perfusion** and preventing increased right-to-left shunting in cyanotic heart disease.

Q: In infants, the narrowest part of the larynx is at the cricoid level. In administering anesthesia, which of the following is NOT a potential complication of using a smaller size endotracheal tube?

Choosing a smaller size endotracheal tube. ***Choosing a smaller size endotracheal tube*** - This option incorrectly states that *choosing a smaller size endotracheal tube* is a complication. It is a decision or action, not a direct complication of the tube itself. - While an *appropriately* sized smaller tube can be beneficial, the act of *choosing* it isn't inherently a complication. *Trauma to the subglottic region* - Using an **overly *large* endotracheal tube** can cause trauma to the **subglottic region**, which is the narrowest part of an infant's airway. - Trauma can lead to **edema**, **ulceration**, or even **scarring**, potentially resulting in **subglottic stenosis**. *Increased risk of airway obstruction* - An **endotracheal tube (ETT) that is too *small*** for the child can lead to various issues, including an **increased risk of obstruction** due to secretions or kinking. - A tube that is too small also offers higher resistance to airflow, making adequate ventilation more challenging and potentially requiring higher pressures. *Choosing an inappropriate size endotracheal tube* - *Choosing an inappropriate size endotracheal tube*, whether too large or too small, is a **patient safety concern** that can lead to various complications. - An **incorrectly sized tube** can result in complications ranging from air leak and inadequate ventilation (if too small) to direct airway trauma and post-extubation stridor (if too large).

Q: The best inhalational agent of choice for induction of anesthesia in a six-year-old child who refuses IV access is –

Sevoflurane. ***Sevoflurane*** - **Sevoflurane** has a **low pungency** and a **rapid onset** due to its low blood/gas solubility, making it ideal for inhalational inductions in children who are often uncooperative with IV access. - Its pleasant odor and non-irritating properties minimize coughing and breath-holding, ensuring a smooth and quick induction. *Methoxyflurane* - **Methoxyflurane** is **nephrotoxic** and has a very slow onset, making it unsuitable for rapid inhalational induction, especially in children where kidney function can be more sensitive. - Due to its significant side effects and slow induction profile, it is rarely used today for general anesthesia. *Desflurane* - **Desflurane** has a very **pungent odor** and a high incidence of airway irritation, including coughing and breath-holding, which makes it a poor choice for gas induction, particularly in children. - Although it has a rapid onset due to very low blood/gas solubility, its irritating properties outweigh this benefit for pediatric inhalational induction. *Isoflurane* - **Isoflurane** is also highly **pungent** and associated with significant airway irritation, making it uncomfortable for inhaled induction and poorly tolerated by children. - It has a slower onset compared to sevoflurane and desflurane, further diminishing its suitability for uneventful inhalational induction in pediatric patients.

Question 1

Which inhalational agent is preferred for the induction of anesthesia in a child with a history of asthma?

Accepted Answer

Sevoflurane

Answer

Halothane

Answer

Isoflurane

Answer

Desflurane

Question 2

What is the primary reason for the preference of sevoflurane in inhalational induction for pediatric anesthesia?

Accepted Answer

It has a rapid onset and low blood-gas solubility.

Answer

It causes minimal airway irritation.

Answer

It has a sweet smell that is well-tolerated by children.

Answer

All of the above

Question 3

All of the following drugs increase the risk of postoperative nausea and vomiting after squint surgery in children except?

Accepted Answer

Propofol

Answer

Halothane

Answer

Nitrous Oxide

Answer

Opioids

Question 4

In pediatric epidural anaesthesia, what is the volume of local anaesthetic given to achieve a sacral dermatome block?

Accepted Answer

0.5 - 1 ml/kg

Answer

None of the options

Answer

2 - 4 ml/kg

Answer

5 - 10 ml/kg

Question 5

A 6-year-old boy is taken for an ophthalmic examination under anesthesia. His father reports that the boy has lower limb weakness and that his elder brother died at 14 years of age. Which anesthetic drug should be avoided in this case?

Accepted Answer

Succinylcholine

Answer

Pancuronium

Answer

Atracurium

Answer

Dexacurium

Question 6

Which circuit is specifically designed for anaesthesia in infants?

Accepted Answer

Ayres t piece

Answer

Bains circuit

Answer

Magill circuit

Answer

Water's circuit

Question 7

Induction agent of choice in a child with cyanotic heart disease is

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Halothane

Answer

Midazolam

Question 8

In infants, the narrowest part of the larynx is at the cricoid level. In administering anesthesia, which of the following is NOT a potential complication of using a smaller size endotracheal tube?

Accepted Answer

Choosing a smaller size endotracheal tube

Answer

Increased risk of airway obstruction

Answer

Trauma to the subglottic region

Answer

Choosing an inappropriate size endotracheal tube

Question 9

A one-year-old child, preterm, and low birth weight with delayed milestones is posted for elective hernia repair. Which of the following statements is true?

Accepted Answer

Wait for complete neurological evaluation

Answer

Avoidance of regional anesthesia

Answer

Avoidance of combination of inhalational and muscle relaxation

Answer

Inhalational agents are contraindicated in this scenario.

Question 10

The best inhalational agent of choice for induction of anesthesia in a six-year-old child who refuses IV access is –

Accepted Answer

Sevoflurane

Answer

Methoxyflurane

Answer

Desflurane

Answer

Isoflurane

Pediatric Anesthesia — MCQs

Pediatric Anesthesia — MCQs

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