Berstein #3 Flashcards
What is Congenital diaphragmatic Hernia?
- Gut herniates into thorax
- Left side most common
- 50% mortality
Congenital Diaphragmatic Hernia presentation?
- Hypoxia
- Scaphoid abd
- Pulm HTN
What causes death in Congenital Diaphragmatic Hernia?
respiratory insuffiency
Congenital Diaphragmatic Hernia treatment.
- Sedation
- Paralysis
- Moderate hyperventilation
- ECMO
- Nitric oxide
Congenital Diaphragmatic Hernia anesthesia concerns.
- ↓ gastric distension
- Low O2 delivery
- Pressure limited vent
- R pneumothorax
- Awake intubation
- No nitrous oxide
- Peak pressure <30
What would cause peak pressure to rise in Congenital Diaphragmatic Hernia?
Right side pneumpthorax
Why no nitrous in Congenital Diaphragmatic Hernia
Bowel distension = more hypoxia
most common Tracheoesophogeal Fistula?
- 3B
- ends in blind pouch
- Lower esophagus connects to trachea
Signs of Tracheoesophogeal Fistula.
- Gastric distension w/ respiration
- Feeding leads to choking/cough/cyanosis
anesthesia concerns with Tracheoesophogeal Fistula
- Copious secretions
- No positive pressure ventilation
- awake intubation
- Dehydrated
- do not extend neck post repair
complications Tracheoesophogeal Fistula
- Pneumonia
- Atelectasis
- SubQ emphysema
- RLN injury
- esophageal stricture
- Anastomotic leak
Tracheoesophogeal Fistula principle cause of death
- Pulm complications
- Associated anomalies
- Anastomotic leak
In a patient with CDH, what should the peak inspiratory pressure be (cmH20):
30
Which is not a manifestation of CDH
Lab tests
what is Hypoplastic Left Heart Syndrome
Left side of hear fails to develop fully
3 causes of Hypoplastic Left Heart Syndrome
- Mitral stenosis/atresia
- Aortic stenosis/atresia
- Hypoplastic aortic arch
- all duct dependent
What is the goal pf surgery for Hypoplastic Left Heart Syndrome?
- Single ventricle circulation
- Pulm blood flow is passive from vena cava
What is done during norwood stage 1
- Neonatal period
- Aortic arch arise from pulm trunk
- Pulm valve become aortic valve
- BT shunt
What is a BT shunt?
Shunt from subclavian to pulmonary artery
What is done during norwood stage 2
- BT shunt disconnected
- Glenn shunt created
What is a glenn shunt
SVC to pulmonary artery
What happens in norwood stage 3 (fontan)?
-Both SVC and IVC are connected to pulmonary artery
How to increase PVR?
- PEEP
- High airway pressure
- Atelectasis
- Low FiO2
- acidosis
- ↑ HCT
- sympathetic stimulation
- Surgery
- Vasoconstrictors
How to decrease PVR
- No peep
- low airway pressure
- Lung expansion to FRC
- ↑ FiO2
- Alkalosis
- ↓ HCT
- Blunt stress response
- Nitric oxide
- Vasodilators
