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S5 - Principles III - Test 4 > Anesthesia for Infants & Neonates > Flashcards

Anesthesia for Infants & Neonates Flashcards

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1
Q

weights for:

low birth weight

very low birth weight

extremely low birth weight

A

LBW- < 2500 g

VLBW - < 1500 g

ELBW: < 1000 g

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2
Q

when is surfactant production complete

A

36 weeks gestation

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3
Q

why do preemies have increased alveolar surface tension

A

low surfactant

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4
Q

when does incidence of apnea significantly decrease

A

55 weeks postconceptual age

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5
Q

why do hypovolemia and hypotension occur quickly in infants?

A
  • small absolute blood volume
  • poorly developed autoregulation
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6
Q

when do pain receptors begin developing?

A

19 weeks gestation

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7
Q

current trend for pain management in preemies

A

anesthesia and analgesia with postop pain management regardless of gestational age

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8
Q

risk factors for IVH in preemies

A
  • fetal distress
  • low APGARs
  • acidosis
  • hypercapnia
  • PPV
  • vasopressors
  • rapid changes in cerebral blood flow
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9
Q

how do preemies generate heat?

what is this process dependent on?

A

nonshivering thermogenesis

dependent on brown fat stores

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10
Q

most effective method of temp warming in preemies

A

forced hot air warming

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11
Q

why do preemies have decreased renal function

A

less nephrons

smaller glomerular size

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12
Q

drug metabolism in preemies

A

may be affected by immature hepatic function

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13
Q

when might thrombocytopenia be seen in preemies

A

sepsis
DIC
NEC

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14
Q

why are preemies at risk for both hypo and hyper glycemia?

A

hypo: decreased glycogen and body fat
hyper: decreased insulin prodction + glucose infusions

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15
Q

considerations for IVF in preemies

A

glucose infusions should be given via pump (and monitor levels intraoperatively)

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16
Q

current trend in anesthesia for babies

A

low volatile with opioids or regional when possible

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17
Q

common anesthetic used in neonates

A

high dose opioid with relaxation and post-op ventilation

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18
Q

why do bebes have major venous access issues

A

small vessels
dehydration
3rd space losses
overused, thrombotic veins

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19
Q

where is a preductal vs postductal SaO2 monitored:

A

preductal - R hand

postductal - any other extremity

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20
Q

historical use of pre and postductal sats

A

trend shunting

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21
Q

consult needed in a patient with choanal atresia

A

cardiology

(part of CHARGE syndrome - may have heart disease)

22
Q

airway considerations for laryngeal web

A

never proceed with elective surgery without ENT available for emergent trach

23
Q

airway considerations for subglottic stenosis

A

smaller than expected ETT needed

24
Q

poiseuille’s law applied to infant airways

A

small decrease in airway in diameter = larger increase in airway resistance

25
Q

why is a cardiology consult needed in pts with TE fistula?

A

frequently assoc. with VACTERL syndrome - congenital heart diseases

26
Q

how is ETT placement confirmed for TEF? why?

A

fiberoptic - have to place ETT below fistula and above carina

27
Q

why is a congenital diaphragmatic hernia (CDH) a huge emergency

A

inability to oxygenate with mediastinal shift

28
Q

ventilation considerations for congenital diaphragmatic hernia

A

may need alternative ventilation techniques - oscillators, jet ventilation

29
Q

therapies for a congenital diaphragmatic hernia

A
  • ventilation (oschillator, HFJV)
  • pulmonary vasodilators (prostaglandins, nitrates, NO)
  • ECMO
  • surgical repair when stable
30
Q

pulmonary complications congenital diaphragmatic hernia pts are at risk for and why

A

pneumothorax

require high PIPS

31
Q

idk how to word this but babies with intestinal obstrictions can have lots of other anomalies

A

:(

32
Q

3 things intestinal obstruction babies are prone to

A

hypothermia
hypoglycemia
hyperglycemia

33
Q

airway plan for pt with intestinal obstruction

A

RSI

often come to OR already intubated

probable post-op ventialtion

34
Q

complications of intestinal obstructions

A
  • sepsis
  • relative hypovolemia
  • anemia
  • HD instability/need for pressors
35
Q

preop labs to draw and correct in pts with pyloric stenosis

A
  • hypokalemia
  • hypochloremia
  • metabolic alkalosis
36
Q

airway plan for pyloric stenosis pts

A

clear stomach with warmed NS lavage before true RSI

(don’t want to ventilate at all)

37
Q

preop consult needed for imperforate anus

A

CV evaluation with echo

38
Q

complications of NEC

A
  • acidosis
  • hypotension
  • anemia
  • coagulation dysfunction
39
Q

why do NEC babies have huge fluid and blood product needs

A

huge 3rd space loss and anemia

40
Q

preop treatment for omphalocele and gastroschisis

A

silo

41
Q

complications of a volvulus

A

hypotension
hypovolemia
electrolyte imbalances

42
Q

*RSI for basically all the tummy things*

A

intestinal obstructions
pyloric stenosis
imperforate anus (consider)
NEC
volvulus

43
Q

what is Hirschprung disease

A

absence of parasympathetic ganglionic cells = nonperistaltic segment of colon

44
Q

can you use NMBs throughout a hirschprung repair? why or why not?

A

no - nerve monitoring

45
Q

what conceptual age must be admitted for apnea monitoring postop

A

< 55 weeks

46
Q

is a PDA a cyanotic or noncyanotic shunt?

A

non-cyanotic, left-right shunt

47
Q

specific monitoring to consider in PDA pts

A

pre and post ductal monitoring

48
Q

disorder in babies that can cause right to left shunt

A

PPHN (persistent pulmonary HTN of the newborn)

49
Q

anestheticc technique of choice for PDA ligation

A

high opioid, relaxant, postop ventilation

50
Q

common laser surgery in neonates

A

ROP -retinopathy of prematurity

S5 - Principles III - Test 4 (7 decks)

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