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Pediatric Potpourri

Leaders:

Jane Henderson, MD, FRCPC
Craig Reid, MD, FRCPC

Case 1:
Pain management in sickle cell disease.

A 14-year-old boy is admitted to hospital with a severe exacerbation of his pain. You are requested to assist with his pain management. Over the past year he has been admitted to hospital almost monthly.



Learning goals:



    
	
  1. To gain some insight into the variable nature and presentation of acute and chronic sickle cell pain.
	
  2. Develop an approach to the management of acute sickle cell pain.
	
  3. Develop a strategy to minimize the impact of longstanding sickle cell pain.






Case 2:

Anaesthesia for the severe asthmatic coming for adenotonsillectomy.




Learning goals:



    
	
  1. To learn the appropriate assessment and preparation of the asthmatic patient presenting for elective surgery.
	
  2. To develop a strategy for the safe management of anaesthesia (induction, airway management, maintenance, and
	emergence) in the asthmatic child.
	
  3. To learn the management of intra-operative bronchospasm.










Case 3:

Epidural morphine for post-operative analgesia in children.




Learning goals:



    
	
  1. To gain an understanding of the indications and efficacy of epidural analgesia in children.
	
  2. To identify the main side effects of epidural morphine and discuss the appropriate monitoring of these patients
	and treatment of side effects.








Case 4:

Hypotension in a Spina Bifida patient




A 9 year old boy with spina bifida presents with acute appendicitis. Just after surgery commences, you are settling
down to do some charting and you notice that the blood pressure is 70/30 and the heart rate is 140.




Learning goals:



    
	
  1. Learn the assessment of a patient with spina bifida.
	
  2. Decide on appropriate anaesthesia induction agents and learn whether succinylcholine can be used.
	
  3. Understand the etiology and management of hypotension and tachycardia in this case.














Case 5:

The Difficult Pediatric Airway




An emergency tonsillectomy has been booked in a 5 year old with Hunter’s syndrome. He has significant airway
obstruction at rest and has a history of sleep apnea. He has never had general anaesthesia but on assessment of
his airway you suspect that he may be difficult to manage.




Learning goals:



    
	
  1. Learn the features of Hunter’s syndrome
	
  2. Learn the management of a difficult airway in a pediatric patient for emergency surgery.
	
  3. Outline the perioperative anaesthetic plan for this case.












Case 6:

The Pediatric Trauma Victim




A 3 year old girl has just been admitted to the Emergency Room. She was in a MVA and on first assessment appears
to have at least a head injury and a fractured femur. She is presently unconscious, with a blood pressure of 60/28
and a heart rate of 160.



Learning goals:



    
	
  1. Learn how to assess and manage a case of trauma in a pediatric patient.
	
  2. Determine when it is appropriate to transfer this patient to the CT scan and/or to the OR.