Pediatric Anesthesiology
Preoperative Preparation of the Pediatric Patient
Enjoy the QUIZ!

Directions: For each of the following questions or incomplete statements, ONE or MORE of the answers or completions given is correct. Click below on button
A if only 1, 2, and 3 are correct,
B if only 1 and 3 are correct,
C if only 2 and 4 are correct,
D if only 4 is correct,
E if all are correct.

1. Which of the following preinduction drugs can be used in pediatric ambulatory patients without a significant delay in recovery?
  1. Nasal midazolam 0.2 mg/kg
  2. Intramuscular ketamine 2 mg/kg
  3. Rectal midazolam 1 mg/kg
  4. Intramuscular ketamine 10 mg/kg

2. Which of the following statements about preanesthetic medication of children with oral midazolam is/are true?
  1. Bioavailability is about 30%.
  2. Parent/child separation is optimum about 30-45 minutes after administration.
  3. More than 0.75 mg/kg may delay PACU discharge.
  4. SpO2 routinely decreases.

3. Important distinguishing features of pediatric (vs. adult) anesthesia include:
  1. Children are just small adults.
  2. Pediatric anesthesia is more clearly a family affair.
  3. The parents of a 7 year old child chould be the primary focus of the preoperative discussion of the induction.
  4. The art of anesthesia finds rich expression in pediatric anesthesia.

4. Good preparation of a 4 year old for an inhalational induction would include
  1. a warning that even though the gas smells bad, he need not cry.
  2. suggesting that the experience will be neat or fun.
  3. assure him that nothing will hurt him.
  4. explain simply, using appropriate positive suggestion, exactly what is about to happen.

5. Regarding stress and the preoperative patient, the following is(are) true:
  1. Telling the family what's going to happen helps alleviate stress.
  2. Young children are more afraid of "shots" than anything else.
  3. Two of the most important sources of stress are fear of the unknown and fear of separation from parents.
  4. A five year old child should not be allowed to help choose the induction technic.

6. Regarding errors in pediatric anesthesia management, the following is(are) true:
  1. The two top errors are "wrong choice" and "inadequate crisis management."
  2. The best way to confirm readiness on the part of the anesthesiologist is to use a checklist.
  3. The number one error in pediatric anesthesia management is inadequate ventilation.
  4. The number one error in pediatric anesthesia management is inadequate preparation.

7. The following is(are) true regarding premedication in pediatric anesthesia:
  1. Dr. Gordon believes that "parents are often the best premedication."
  2. Effective routes of administration for midazolam include rectal, oral and nasal.
  3. Dr Fred Barry feels that "the presence of parents during induction has virtually eliminated the need for sedative premedication."
  4. Anticholinergics are usually necessary.

8. Which of the following are important specific goals of preoperative preparation?
  1. Educate the patient and family.
  2. Obtain pertinent medical information.
  3. Decide what consultations and tests are needed.
  4. Obtain informed consent.

9. Which statement(s) about EMLA cream (a eutectic mixture of local anesthetics) is(are) true?
  1. The cream should be used on mucous membranes for topical anesthesia.
  2. Application to the skin approximately 15 minutes prior to the procedure is recommended.
  3. It should be applied in a thin layer over the skin.
  4. The cream should be covered by an occlusive dressing.

10. The following is(are) true regarding pediatric premedication:
  1. Rectal methohexital, 25-30 mg/kg, will very likely induce sleep within 10 minutes.
  2. Oral transmucosal fentanyl, 15-20 mcg/kg, may cause a significant drop in SpO2.
  3. Oral ketamine, 10 mg/kg, plus midazolam, 1 mg/kg, will often induce sleep.
  4. An oral mixture of midazolam, 0.4 mg/kg, plus ketamine, 4 mg/kg, produced 100% successful separation.

DIRECTIONS: Each question below is followed by four suggested answers or completions. Select the one that is best in each case and click on the button containing the corresponding letter.

11. When considering a choice of premedication for pediatric outpatients, which statement is MOST likely true?

(A) Sublingual midazolam 0.2-0.3 mg/kg is not as effective as 0.2 mg/kg intranasally.
(B) Oral ketamine 6 mg/kg can prolong the time to discharge due to sedation.
(C) Rectal methohexital 25-30 mg/kg does not prolong awakening in cases lasting less than 30 minutes.
(D) Fentanyl oralet 15-20 mcg/kg is not associated with an increased incidence of nausea and vomiting when compared to midazolam.

Greg Gordon MD