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A 3-year-old child with a history of mild reactive airway disease presents for
evaluation of recurrent low-grade fevers, fatigue, anorexia, irritability, and lower
extremity pain. Initial laboratory evaluation demonstrates leukocytosis (30,000
cells/μL), thrombocytopenia (50,000 cells/μL), and anemia (8 g/dL).
Appropriate anesthetic management for a diagnostic bone marrow biopsy and LP
in this child may include all of the following EXCEPT:

a) Consideration of premedication with midazolam in the preoperative area

b) Induction of general anesthesia with propofol

c) Administration of intravenous dexamethasone for nausea and bronchospasm
prophylaxis

d) Utilization of fentanyl for intra- and post-procedural analgesia

e) Utilization of a supraglottic airway device (such as a laryngeal mask airway)
throughout the operative procedure
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==Answer==
Answer c. The child in the vignette has signs and symptoms typical for a new
diagnosis of leukemia. The provision of systemic glucocorticoids prior to the
institution of chemotherapy may negatively impact the health of the child by
altering the risk-category of the leukemia as well as the subsequent
aggressiveness of the treatment regimen. While nausea and bronchospasm
prophylaxis may be of value, numerous alternatives to systemic steroids are
extant and should be considered (ondansetron, propofol, albuterol, avoidance of
tracheal intubation, etc.).
==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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