Anesthesia for Infants & Neonates Flashcards
weights for:
low birth weight
very low birth weight
extremely low birth weight
LBW- < 2500 g
VLBW - < 1500 g
ELBW: < 1000 g
when is surfactant production complete
36 weeks gestation
why do preemies have increased alveolar surface tension
low surfactant
when does incidence of apnea significantly decrease
55 weeks postconceptual age
why do hypovolemia and hypotension occur quickly in infants?
- small absolute blood volume
- poorly developed autoregulation
when do pain receptors begin developing?
19 weeks gestation
current trend for pain management in preemies
anesthesia and analgesia with postop pain management regardless of gestational age
risk factors for IVH in preemies
- fetal distress
- low APGARs
- acidosis
- hypercapnia
- PPV
- vasopressors
- rapid changes in cerebral blood flow
how do preemies generate heat?
what is this process dependent on?
nonshivering thermogenesis
dependent on brown fat stores
most effective method of temp warming in preemies
forced hot air warming
why do preemies have decreased renal function
less nephrons
smaller glomerular size
drug metabolism in preemies
may be affected by immature hepatic function
when might thrombocytopenia be seen in preemies
sepsis
DIC
NEC
why are preemies at risk for both hypo and hyper glycemia?
hypo: decreased glycogen and body fat
hyper: decreased insulin prodction + glucose infusions
considerations for IVF in preemies
glucose infusions should be given via pump (and monitor levels intraoperatively)
current trend in anesthesia for babies
low volatile with opioids or regional when possible
common anesthetic used in neonates
high dose opioid with relaxation and post-op ventilation
why do bebes have major venous access issues
small vessels
dehydration
3rd space losses
overused, thrombotic veins
where is a preductal vs postductal SaO2 monitored:
preductal - R hand
postductal - any other extremity
historical use of pre and postductal sats
trend shunting
consult needed in a patient with choanal atresia
cardiology
(part of CHARGE syndrome - may have heart disease)
airway considerations for laryngeal web
never proceed with elective surgery without ENT available for emergent trach
airway considerations for subglottic stenosis
smaller than expected ETT needed
poiseuille’s law applied to infant airways
small decrease in airway in diameter = larger increase in airway resistance
