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A 5 year-old female is having a craniectomy for resection of a posterior fossa
tumor. Which of the following would be MOST appropriate for intraoperative
management of this patient?

a) Temperature controlled to 34-36 degrees Celsius

b) Blood transfused to achieve goal hemoglobin 12 g/dL

c) Flexion of the neck until the chin reaches the chest

d) Continuous arterial blood pressure monitoring

e) Administration of ½ Normal saline during the case
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==Answer==
Answer d. In some cases, arterial cannulation may not be indicated (based on
patient, provider, and local practice factors); however, in general placement of an
arterial catheter is useful during the procedure for continuous blood pressure and
intermittent laboratory data assessment. Furthermore, postoperatively in the
ICU, an arterial cannula is very helpful in avoiding frequent phlebotomy sticks
for laboratory assessment. On the other hand, therapeutic hypothermia (A) and
hyponatremia fluids (E) are NOT indicated for this case and may be harmful.
There is considerable debate about the optimal hemoglobin level, but few
providers would transfuse up to a hemoglobin of 12 g/dL. Finally, extreme
flexion of the neck for prone cases such as this one may result in spinal cord
ischemia as well as decreased venous drainage from the cerebral vasculature
(with associated risk of intracranial hypertension).
==Notes==
<references />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
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