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NEONATAL ANESTHESIA > Anesthetic Drugs In Neonates > Flashcards

Anesthetic Drugs In Neonates Flashcards

1
Q

Factors affecting metabolism of drugs (4)

A
  1. Larger volume of distribution - increase dose for water soluble medications
  2. Decreased protein binding - increase free drug levels leading to increase activity and toxicity
  3. Decreased body fat percentage - decrease amount of fat and muscle mass leading to greater levels of drugs that are primarily distributed to muscle and fat
  4. Immature renal and hepatic function - increase blood levels from normal dose
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2
Q

Helpful in decreasing secretions and response to vagal stimulation on intubation

A

Anticholinergics:

Atropine
Glycopyrrolate

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3
Q

Atropine dose in neonates

  1. IV
  2. IM
A
  1. IV 10 mcg/kg or 0.01 mg/kg

2. IM 20 mcg/kg or 0.02 mg/kg

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4
Q

Caution should be exercised if neonates have other associated congenital abnormalities particularly _____________ due to possible increase in IOP

A

Narrow angle glaucoma

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5
Q

An anticholinergic which is a synthetic quaternary ammonium, has longer duration than atropine, less central effects because of decreased penetration of BBB

A

Glycopyrrolate

No sedative effects

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6
Q

Clearance of midazolam is _________ in neonates and premature infants

A

LOWER

Hence caution has to be exercised
May cause hypotension if combined with opioids

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7
Q

THIOPENTAL

  1. Dose
  2. Clearance
  3. Duration
  4. Hemodynamic effects
  5. Contraindication
A
  1. Dose - 2 to 4 mg/kg (larger doses required due to large volume of distribution)
  2. Clearance - Reduced
  3. Duration - Longer than anticipated
  4. Hemodynamic effects - can cause HYPOTENSION in volume depleted neonates
  5. Contraindication - Neonates with CHD due to effect on myocardial function
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8
Q

Most commonly used IV induction agent in the United states

A

PROPOFOL

Phenol derivative sedative/hypnotic
Maintain adequate hemodynamics in neonate

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9
Q

KETAMINE, an NMDA antagonist

  1. Induction dose IV/IM
  2. Indication
  3. Side effects
A
  1. Induction dose
    IV 2 mg/kg
    IM 4-7 mg/kg
  2. Indication - neonates with cardiovascular instability or with CHD
  3. Side effects - increase oral secretions
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10
Q

DEXMEDETOMEDINE, an alpha 2 receptor agonist

A
  • Dose for sedation same as adult: 0.2-0.6 mcg/kg/hr
  • Has not been FDA approved for use in neonatal population
  • Adjunct to general anesthesia
  • Effective for sedation of term and preterm undergoing mech vent
  • Reduce required dise of midazolam and fentanyl
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11
Q

FENTANYL, a synthetic opioid

A
  1. Dose 2-4 mcg/kg/hr can maintain hemodynamic stability
  2. Adverse reactions:
    - hypotension (if with benzodiazepine)
    - respiratory depression (continuous infusion > boluses)
    - chest wall and glottic rigidity (1-2 mcg/kg)
    - desaturation
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12
Q

MORPHINE

A
  1. Decreased clearance - dosing should occur on a 4-6 hour basis
  2. Postoperative pain contril in ICU
  3. Metabolites: M3G and M6G
    M6G - respiratory depression
    Sensitivity to M6G increases with age due to increased maturation of neuronal receptors
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13
Q

REMIFENTANIL

A
  1. Ultra short acting - half life 10 mins
  2. Metabolized by: NONSPECIFIC ESTERASE
  3. Used for maintenance of anesthesia with avoidance of volatile anesthesia
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14
Q

METHADONE

A
  1. Long acting opioid
  2. Used in managing OPIOID TOLERANCE/WITHDRAWAL
  3. Avoid use in patients with prolonged QT interval
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15
Q

Only depolarizing muscle relaxant; has the most rapid onset time

A

SUCCINYLCHOLINE

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16
Q

SUCCINYLCHOLINE DOSE

A
  1. Neonates and infants
    IV 3 mg/kg
    onset 30-45 sec
    duration 5-10 mins

Larger dose compared to children (2mg/kg) due to neonates and infants’ larger ECF volume and larger volume of distribution

  1. IM 4 mg/kg
    onset 3-4 mins
    duration 20 mins
17
Q

Second dose of succinylcholine may lead to

A

Vagally mediated bradycardia or sinus arrest

  • Pretreat with Atropine
18
Q

Routine use of succinylcholine has been a concern in these particular group of patients

A

Boys younger than 8 years old

  • hyperkalemia with cardiac arrest in such children with unrecognized muscular dystrophy
19
Q

Hyperkalemia caused by succinylcholine can be recognized by

A

PEAKED T WAVES (2-3 mins after drug administration)

  • interferes with cardiac conduction leading to bradycardia or cardiac arrest
20
Q

Treatment of hyperkalemia caused by succinylcholine

A
  1. IV Calcium chloride - 10mg/kg
  2. Sodium Bicarbonate
  3. Hyperventilation
  4. Epinephrine - stimulates Na-K pump; also for refractory hypotension (5-10 mcg/kg)
  5. Magnesium - antagonize effects of hyperkalemia, only employed in the setting of digoxin toxicity
21
Q

Albumin binds _____ drugs

a. Acidic
b. Basic

22
Q

a1-acid glycoprotein binds _____ drugs

a. Acidic
b. Basic

NEONATAL ANESTHESIA (5 decks)

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