Pediatric Anesthesiology
Induction Principles and Technics
Enjoy the QUIZ!

DIRECTIONS: Each of the questions or incomplete statements below is followed by four or five suggested answers or completions. Select the one that is BEST in each case and click in the box below that contains the letter corresponding to that answer or completion.

1. According to Dr. Gordon, when starting the inhalational induction of a healthy but anxious child

(A) a precordial stethoscope must be on the patient.
(B) all planned monitors must be applied to the patient.
(C) a pulse oximeter probe must be on the patient.
(D) an alert, vigilant anesthesiologist is a sufficient monitor.
(E) the patient's blood pressure must be taken.

2. A 3-year-old girl is scheduled for tonsillectomy. The child responds to the "try on your mask" test by screaming in fear as soon as she sees the mask. The most appropriate anesthetic induction plan is to now

(A) cancel the case; the child is too upset.
(B) consider preoperative pharmacologic sedation and prepare to do a rectal or IM induction.
(C) inject ketamine, 10 mg/kg, into a gluteus maximus muscle.
(D) locate two assistants to hold the child down and proceed with inhalational induction.
(E) tell the parents a rectal induction will now be necessary.

3. True facts about pediatric inhalational anesthetic induction include all of the following EXCEPT:

(A) Isoflurane inductions may be easily performed.
(B) Immediate 8% sevoflurane is well tolerated by ASA class I and II children.
(C) The child should be encouraged to take deep breaths during the initial phase of the induction.
(D) The induction may be performed with the child sitting up.
(E) A "steal" induction is a special type of inhalational induction.

4. True statements about rectal methohexital (Brevital) inductions include all of the following EXCEPT:

(A) The appropriate solution may be prepared by adding 5 ml of warm tap water to a 500 mg vial.
(B) If the child is not very sleepy 10 to 15 minutes after installation of the drug, an alternative induction plan should be considered.
(C) The induction dose is 30 mg/kg of a 10% solution.
(D) Rectal methohexital may provide a complete anesthetic for a brief painful procedure.
(E) After a standard rectal methohexital induction alone, a child will often sleep for about an hour.

5. Regarding ketamine and pediatric anesthesia, all of the following are true EXCEPT:

(A) A vial of 10% ketamine should be available as a back-up induction technic for the child without an IV who becomes uncooperative.
(B) 3 to 4 mg/kg of ketamine injected into a deltoid muscle is just not enough to regularly induce an anesthetic state.
(C) Ketamine is effective if given orally, intramuscularly or intravenously.
(D) Ketamine, 6 to 9 mg/kg, may unpredictably prolong recovery.
(E) Ketamine, 6 mg/kg IM, may be a complete anesthetic for a 5-minute procedure involving pin removal from an extremity.

Greg Gordon MD