TYK316

Which of the following is the BEST induction plan for resection of a known pheochromocytoma in a child?

a) IM ketamine, IV placement, propofol, rocuronium

b) PO midazolam, inhalational induction, lidocaine, fentanyl, propofol, rocuronium

c) PO midazolam, IV placement, lidocaine, fentanyl, pancuronium

d) PO clonidine, inhalational induction, rocuronium

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Answer

Answer b. Agents that cause catecholamine release (ketamine, ephedrine), inhibit catecholamine reuptake (droperidol), cause tachycardia (pancuronium, desflurane) or sensitize the myocardium to cardiac dysrhythmia (succinylcholine, halothane) are best avoided. Because laryngoscopy is a known precipitant of catecholamine surge a surgical level of anesthesia should be achieved prior to attempts at laryngoscopy; answer B ensures this depth of anesthesia better than answer D.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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