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P&P 3 > Ex 2 Peds 1 > Flashcards

Ex 2 Peds 1 Flashcards

1
Q

Neonatal period

A

first 28 days outside uterus (“extrauterine life”)

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2
Q

Neonatal anesthesia

A

anesthesia only in this timeframe if urgent or life threatening

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3
Q

Which is more resistant: full term or preterm infants?

A

More resistant: full term

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4
Q

highest rate of adverse events intraop/postop

A

Neonates + infants < 12 months old

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5
Q

Preterm infants are more prone to developing

A

respiratory complications

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6
Q

Neonate - Age

A

0-1 month (28 days)

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7
Q

Infant - Age

A

1-12 months

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8
Q

Toddler - Age

A

1-3 years

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9
Q

Child - Age

A

4-12 years

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10
Q

Adolescent - Age

A

13-19 years

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11
Q

Highest mortality in pediatric anesthesia is associated with

A

cardiac arrest, medication related, CVS

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12
Q

Over half of all anesthesia related cardiac arrests were among what age group

A

infants < 1 y/o

*1/3 of arrests were ASA I-II

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13
Q

What occurs 2x as often in pediatric anesthesia (vs adults)?

A

Bronchospasm
Laryngospasm
Aspiration

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14
Q

Bradycardia is associated with

A

inadequate ventilation or impending catastrophe

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15
Q

Organogenesis takes place within

A

8 weeks of conception

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16
Q

Preterm infant

A

born before 37 weeks gestation

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17
Q

Postmature infant

A

born after 42 weeks gestation

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18
Q

Low birth weight infant

A

born weighing < 2500 g

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19
Q

What may indicate potential anesthetic implications/problems during perinatal history eval?

A

Problems during pregnancy: maternal drug abuse, infxn, eclampsia, diabetes
or during/after delivery: fetal distress, meconium aspiration, prematurity, postdelivery intubation

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20
Q

functional unit of placenta

A

chorionic villus

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21
Q

Fetal circulation is characterized by

A

high PVR + low systemic circulatory resistance

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22
Q

Why does fetal circulation have high PVR?

A

uninflated atelectatic lungs + hypoxic vasoconstriction

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23
Q

Why does fetal circulation have low systemic circulatory resistance?

A

High flow + low impedence of the placental vessels

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24
Q

Intracardiac shunts

A

Foramen ovale (atrial septum; RA to LA)

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25
Q

Extra cardiac shunts

A

Ductus arteriosus (RV-pulm artery to aorta) + ductus venosus (liver to inf. Vena cava)

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26
Q

Highest rates of AEs intra/postop

A

Neonates + infants (< 12m)

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27
Q

Risk of pediatric anesthesia most often d/t

A

Inadequate ventilation + unexplained CVS events

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28
Q

Occurs 2x as frequently in peds vs adults

A

Bronchospasm, laryngospasm, aspiration

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29
Q

Bradycardia in pediatrics

A

Sentinel sign of inadequate ventilation or impending catastrophe
10x as often in infants vs 4 year old

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30
Q

Organogenesis

A

Within 8 weeks of conception

1st trimester stress may cause abnormal organogenesis

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31
Q

Stress during 2nd trimester may result in

A

Abnormal functional development of organs

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32
Q

Stress during 3rd trimester may result in

A

Smaller organs or reduced muscle/fat mass

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33
Q

Thin layer of cells that separate maternal + fetal blood in placenta

A

Syncytial trophocytes

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34
Q

Cord blood is comprised of

A

2 umbilical arteries + 1 umbilical vein

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35
Q

What is getting bypassed in fetal circulation + how?

A

Lungs bypassed d/t Increased PVR via:

  • Foramen ovale (RA to LA)
  • Ductus Arteriosus (PA to Aorta)
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36
Q

Route of blood returning to mom from fetus

A

LV –> aorta –> common iliac artery –> umbilical arteries

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37
Q

PDA connects

A

aorta + PA

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38
Q

PFO connects

A

RA + LA

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39
Q

Ductus Venosus connects

A

sinusoids of liver to inferior vena cava

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40
Q

Fetal circulation of blood through the lungs is limited by

A

hypoxic pulmonary vasoconstriction (increased resistance in lungs d/t decreased O2)

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41
Q

Fetal circulation is characterized by

A

3 shunts: DV, DA, FO
High PVR
Low SVR

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42
Q

During birth, the first breath (while placenta still attached) causes what to occur?

A
  • pulmonary alveoli open up*
  • Decreased pressure in pulmonary tissue
  • Decreased pressure in RH (blood rushes to fill alveolar capillaries)
  • LH pressure increases (increased blood from Pulm veins)
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43
Q

Transitional Circulation

A

Occurs at birth d/t cessation of placental blood flow

  • decreases PVR
  • increases SVR
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44
Q

Transitional circulation: PVR decreases d/t

A

asphyxia, lung expansion, pulmonary vasodilation d/t presence of oxygen (+ no longer receiving prostaglandins from placenta - which keeps DA open)

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45
Q

When placenta is cut off, what significant events occur?

A

2 events:

  1. fetal asphyxia (decreased PVR)
  2. increased pressure in aorta + SVR
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46
Q

Why does the foramen ovale close?

A

LA > RA

d/t pulmonary vascular dilation

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47
Q

When does foramen ovale close?

A

At birth

*permenantly closes 2-3 months

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48
Q

Why does the ductus arteriosus close?

A

OXYGEN
*exposure to oxygenated blood
+ SVR > PVR

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49
Q

When does the ductus arteriosus close?

A

1-8 days

  • anatomic closure 1-4 months
  • premies: may take longer to close
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50
Q

When does the ductus venosus close?

A

1-3 after birth

  • mechanism unknown; muscular constriction
  • portal venous pressure increases
  • results in all vena cava blood = deoxygenated
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51
Q

Risk factors for prolonged transitional circulation

A 
Prematurity
Acidosis
Infection
Pulmonary Disease
Hypothermia
Hypercarbia
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52
Q

Flip Flop

A

Revert back to fetal circulation

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53
Q

Flip Flop is d/t

A

Hypoxia, Hypercapnia, anesthesia induced changes in peripheral or pulmonary vascular tone

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54
Q

Mechanism of flip flop

A

Hypoxia (via any mechanism) causes pulmonary vasoconstriction (increased PVR) = R to L shunt (PDA or PFO)

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55
Q

Tx: Flip flop

A

Hyperventilation

*increased PA pressure will return to normal d/t decreased PaCO2

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56
Q

When would RA > LA in a baby?

A

pHTN

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57
Q

Anesthetic goals of baby at risk for transitional circulation/flip flop

A
  • keep infant warm
  • maintain normal arterial O2 + CO2 tensions
  • minimal anesthetic induced myocardial depression
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58
Q

PPHN

A

Persistent Pulmonary HTN of the Newborn

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59
Q

Persistent fetal circulation

A

PPHN

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60
Q

PPHN: characteristics

A 
Sustained elevation of PVR
R to L shunt (PFO/PDA)
*vicious cycle*
RV + CO decreased
May be d/t Bronchopulmonary Dysplasia  or CV disease
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61
Q

Risk of PPHN

A

RV dysfunction + RV hypertrophy (cor pulmonale)

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62
Q

PPHN Tx

A 
Pulmonary Vasodilators
- NO
-Sildenafil
-Milrinone
-Bonsentan
-Prostanoids
Ventilation strategies: high frequency ventilation or exogenous surfactant administration
Avoidance of Hypoxemia, acidosis
Normal Hematocrit
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63
Q

Prostanoids

A

Iloprost, Prostacyclin, or treprostinil

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64
Q

Why does a normal hematocrit help treat PPHN?

A

To ensure adequate oxygen carrying capacity while avoiding polycythemia (hyperviscosity can increase PVR)

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65
Q

CV System: immature components

A
  • myocardium
  • contractile components
  • baroreceptor reflex
  • sympathetic NS
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66
Q

Cardiac output is solely dependent on

A

heart rate

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67
Q

Autonomic innervation is predominately controlled by the

A

parasympathetic nervous system

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68
Q

What may occur with suctioning + laryngoscopy?

A

bradycardia

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69
Q

Immature baroreceptor reflex may lead to _____ ; Tx =

A

inability to compensate for HOTN

Tx: atropine or epi if refractory

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70
Q

ventilation with high peak pressures in neonate may result in

A

LV dysfunction + overload of RV

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71
Q

Neonates have a poor sensitivity to

A

volume loading

-may develop CHF d/t stiff LV compressing RV (decreasing CO)

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72
Q

Preterm Neonate: Vital Signs

A

HR: 120-180
SBP: 45-60
DBP: 30

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73
Q

Term Neonate: Vital Signs

A

HR: 100-180
SBP: 55-70
DBP: 40

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74
Q

1 Year old: Vital Signs

A

HR: 100-140
SBP: 70-100
DBP: 60

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75
Q

2 Year old: Vital Signs

A

HR: 84-115
SBP: 75-110
DBP: 70

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76
Q

5 Year old: Vital Signs

A

HR: 80-100
SBP: 80-120
DBP: 70

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77
Q

HOTN in anesthetized newborn

A

SBP < 60 mmHg

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78
Q

EBV: Premature

A

90-100 mL/kg

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79
Q

EBV: Neonate (< 1 month)

A

80-90 mL/kg

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80
Q

EBV: Infant (3 months-3 years)

A

75-80 mL/kg

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81
Q

EBV: Children > 6 y/o

A

65-70 mL/kg

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82
Q

Newborns blood volume is dependent on

A

time of cord clamping (transfusion from placenta)

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83
Q

Intravascular volume of newborn changes how

A
  • Decreases 25% in immediate postnatal period (loss of intravascular fluid)
  • blood volume increases over next 2 months, peaks at 2 months old
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84
Q

HOTN in anesthetized 1 year old

A

SBP < 70 mmHg

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85
Q

HOTN in anesthetized older child

A

SBP 70 mmHg + (age x 2)

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86
Q

Why is the cardiac output of a neonate higher than that of an adult?

A

Necessary to meet higher metabolic oxygen consumption demands

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87
Q

Newborn cardiac output

A

180-240 mL/kg

2-3x adults CO: 70mL/kg

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88
Q

Predominant hemoglobin in babies

A

fetal hemoglobin

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89
Q

Normal Hemoglobin at birth

A

18-20 g/dL

90
Q

Normal Hct: Full term baby

A

55%

91
Q

Normal Hct: 3 months old

A

30%

92
Q

Normal Hct: 6 months old

A

35%

93
Q

At what age in babies does the Hgb hit lowest point?

A

3 months old - decline in Hgb reaches nadir

“physiological anemia”

94
Q

Type of cell that secretes surfactant

A

Type II pneumocytes

95
Q

When does fetus begin to produce surfactant? Peak surfactant production?

A

Begins: 22-26 weeks gestation
Peaks: 35-36 weeks gestation

96
Q

Why would a baby not have enough surfactant?

A

Premature neonate: absence of surfactant = stiff, noncompliant alveoli

97
Q

What mechanism describes surfactant effect on lungs?

A

Law of Laplace
P=2T/R
Surfactant decreases surface tension within the alveoli to decrease alveolar collapse

98
Q

Treatment for infantile respiratory distress syndrome

A

Synthetic surfactant
Continuous positive airway pressure
Mechanical ventilation
*steroids if preterm labor before 26w

99
Q

Narrowest portion of neonate airway

A

Cricoid Cartilage

beyond vocal cords aka glottis

100
Q

Which law explains why pediatric airway anatomy is at higher risk for problems?

A

Poiseuilles Law

  • small changes in radius can significantly increase resistance to airflow
  • resistance is inversely proportional to radius^4 (laminar) or radius^5 (turbulent)
101
Q

Biggest difference between adult + pediatric airway anatomy

A
  • Shallow vallecula
  • larynx directed towards nasopharynx (nasal breathing); C2-C4
  • large arytenoids, tongue, occiput
  • Subglottic regon = small, conical shaped
  • cricoid lumen = ellipsoid, not round
  • Cricoid cartilage lined w/ pseudostratified epithelium (easily injured = edema, stridor)
  • should roll = best
102
Q

Best position for infant intubation

A

Headrest + shoulder roll

  1. glabella + chin plane horizontally aligned
  2. neck: wide/open
  3. external auditory meatus + substernal notch plane horizontally aligned
103
Q

Best position for toddler intubation

A

Simple head extension

104
Q

Infants are obligate nose breathers until

A

3 months

105
Q

Airway obstruction risks in infants

A

choanal atresia, nasal secretions

106
Q

failure of development of the posterior opening between nasal cavity + nasopharynx

A

choanal atresia

107
Q

Alveoli increase in size and number until

A

child is 8 years old

108
Q

Breathing mechanics in children

A
  • pliable chest wall = paradoxical breathing
  • horizontal rib orientation
  • decreased FRC
  • belly breathing
109
Q

Muscle fibers involved in respiratory mechanics + their importance

A

Type I - resistant to fatigue, slow twitch
Type II - susceptible to fatigue, fast twitch
**neonates have more Type II, not enough Type I. At risk for respiratory failure d/t reduced reserve

110
Q

FRC in infant vs adult

A

25mL/kg in infant
45mL/kg in adult
*less effective reserve d/t increased metabolism + O2 consumption rates

111
Q

Postop monitoring required for

A

infants < 45-55 weeks postconception

*24h observation in hospital

112
Q

over-inflation of lung

A

Hering breur reflex
-pulmonary stretch receptors present in smooth muscle of airways respond to excessive stretching of lung during large inspiration

113
Q

Maturation of Nervous system in infant

A

PNS: myelination begins in motor roots then sensory
CNS: myelination in sensory system precedes that of motor systems
*incomplete myelination

114
Q

incomplete myelination can be seen in which CNS responses in infants?

A

Moro + Palmar Grasp Reflex

115
Q

Myelination is not complete until what age?

A

3 years old

116
Q

Moro Reflex

A

Response to sudden loss of support, when infant feels as if it is falling:

  1. spreading out arms (abduction)
  2. unspreading the arms (adduction)
  3. Crying
    * present in newborns until 3-4months
117
Q

Palmar Grasp Reflex

A

Object placed in infants hand, palm of child stroked, fingers close reflexively
-object is grasped

118
Q

Which muscles are more easily depolarized in infants?

A

Immature
d/t prolonged opening of ion channels.
*risk of diaphragm - susceptible (fewer Type I fibers)

119
Q

Which NMBs are effective in infants? Why?

A

increased ECF + ____
(NMBS = highly H2O soluble)

  1. increased sensitivity to NDMR
    = normal dose
    *Prolonged DOA (immature clearance)
  2. normal sensitivity to Sux
    = increased dose
120
Q

Sux dose

A

2mg/kg IV

4mg/kg IM

121
Q

Postop apnea Tx

A

Caffeine 10mg/kg IV

122
Q

Risk of pain in neonate

A

HTN + immature cerebral autoregulatory response + fragile cerebral vasculature
=risk of intracerebral hemorrhage +pHTN

123
Q

most damage from anesthesia occurs when?

A

during maturation periods when synaptogenesis rapidly occurs
*in utero: post 20 weeks

124
Q

Infants/Kids: Conus medularis terminates between

A

L2 and L3

Age 8: L1

125
Q

Nerves within spinal cord mature until completion at age

A

6-7

126
Q

Dural sac ends between _____ in kids?

A

Between S2-S3 until 6 years old

127
Q

Brain size in infants

A

2x size by 6m old

3x size by 1y/o

128
Q

Maturation of cerebral cortex + brainstem is nearly complete by what age

A

1 y/o

129
Q

Anterior fontanelle closes by

A

2 y/o

130
Q

Posterior fontanelle closes at

A

4 months

131
Q

Blood brain barrier in infants

A

immature until 1 y/o

Higher permeability

132
Q

What should be avoided in neonates d/t their BBB immaturity?

A

Hypertonic solutions

-can damage cerebral vessels, prone to intracranial bleeding (+ hypoxia, hypercarbia, hypo- or hyperglycemia, swings in BP)

133
Q

Primary fuel for brain

A

Glucose

134
Q

major source of morbidity in infants

A

hypoglycemia

135
Q

s/s hypoglycemia in infants

A

jitteriness, cyanosis, lethargy, hypotonia, apnea, HOTN, bradycardia, convulsions, brain injury

136
Q

Why are neonates at higher risk for hypoglycemia?

A

Decreased stores of glycogen

137
Q

CBF in premature infant

A

40mL/100g/minute

138
Q

CBF in older children

A

adult level

100mL/100g/minute

139
Q

Loss of cerebral autoregulation may occur in infants due to?

A
  • hypoxia
  • severe hypercapnia > 80 mmHg
  • BBB disruption (head trauma, hemorrhage, cerebral ischemia)
  • after admin of IAs or vasodilators (SNP)
140
Q

Bradycarda in infant, Tx focuses on

A

1st hypoxia

-treat laryngospasm, post-extubation croup, bronchospasm, aspiration, inadequate O2, pneumothorax

141
Q

Drugs that may cause bradycardia in infants

A

Sux, anticholinesterases, IAs

142
Q

Neurogenic causes of bradycardia in infants

A

Oculocardiac reflex

143
Q

Metabolic causes of bradycardia in infants

A

Hypoglycemia, anemia, hypothermia, acidosis

144
Q

Infancy: Autonomic Nervous System

A

PNS > SNS

145
Q

SNS in infants develops when?

A

4-6 months old

146
Q

Infants: renal system considerations

A

“obligate sodium losers”

  • unable to conserve sodium
  • cannot fully respond to aldosterone
  • decreased GFR + concentration ability
147
Q

When are infants kidneys developed?

A

70% mature by 1 month

Adult level by 1 year old

148
Q

Infants have low GFR due to?

A
  • decreased systemic arterial pressure
  • increased renal vascular resistance
  • decreased permeability of the glomerular capillaries
149
Q

infant PO requirement

A

150mL fluids/kg/day

150
Q

Infants cannot reduce urine output below

A

1mL/kg/hr

151
Q

What may occur if hypoglycemia in preterm neonates is not treated?

A

Neurologic damage

152
Q

Increased risk of hypoglycemia if infants are

A
  • premature
  • SGA
  • infants of diabetic mothers
153
Q

Which other electrolyte may be off in babies?

A

Calcium

*risk of hypocalcemia

154
Q

Hypocalcemia is common in infants who are

A
  • premature
  • SGA
  • asphyxiated
  • offspring of diabetic moms
  • offspring of mothers who received transfusions with citrated blood or FFP
155
Q

Explain the process of glycogen synthesis in the infant

A

Fetal liver synthesizes glycogen

  • w/in first 48h of life, 98% of stored glycogen is released from liver
  • glycogen levels not restored until 3weeks old
  • SGA/preterm = susceptible to hypoglycemia
156
Q

Fetal hepatic system - effect on Rx

A

Immature Phase II liver enzymes

-Rx metabolized by P450 = prolonged elimination half life

157
Q

Fetal hepatic system - why is jaundice seen?

A

Decreased glucuronyl transferase activity

enzyme responsible for breakdown of bilirubin

158
Q

Fetal hepatic system - effect on protein and drugs

A

-lower total protein
*albumin + alpha-1-acid glycoprotein (binds Rx) decreased
= decreased protein binding of Rx
= higher free drug concentration

159
Q

When does the ability to coordinate swallowing with breathing take place?

A

4-5 months old

160
Q

Upper intestinal abnormalities in infants present as

A

vomiting + regurgitation

161
Q

Lower intestinal abnormalities in infants present as

A

Distention + failure to pass meconium

162
Q

Why are neonates/infants at higher risk for hypothermia?

A
  • Large surface area
  • poor insulation
  • small mass
  • inability to shiver
163
Q

What does cold stress cause in neonates/infants?

A

Increased O2 consumption + metabolic acidosis

164
Q

In infants who cannot shiver, how do they stay warm?

A

Non-shivering thermogenesis (NST)

  • increases heat production by 100%
  • brown fat metabolism: high density of mitochondria, activated by norepi: acts on brown fat to uncouple oxidative phosphorylation
165
Q

Majority of heat loss in babies is due to

A

Radiant Heat Loss

-transfer of heat to environment

166
Q

Counteract radiant heat loss how?

A
  • Preheat OR to 26 C
  • Double shelled isolette during transport
  • wrap neonate in warm blanket
  • head = 60% total heat loss
167
Q

What type of heat loss is due to a cold operating table?

A

Conductive

*also warm irrigation, blankets, bair hugger

168
Q

What type of heat loss is due to air currents?

A

convection

169
Q

What type of heat loss is due to wet clothing, liquid from body cavities/resp tract?

A

Evaporative

*vaporization of liquid from body to air

170
Q

What is the most effective means of warming children?

A

Hot air blankets

171
Q

Premature fluid compartment volumes: TBW, ECF, ICF

A

TBW: 80-90%
ECF: 50-60%
ICF: 60%

172
Q

Infant fluid compartment volumes: TBW, ECF, ICF

A

TBW: 75%
ECF: 40%
ICF: 35%

173
Q

Child fluid compartment volumes: TBW, ECF, ICF

A

TBW: 65-70%
ECF: 30%
ICF: 40%

174
Q

Adult fluid compartment volumes: TBW, ECF, ICF

A

TBW: 55-60%
ECF: 20%
ICF: 40%

175
Q

Volume of distribution equation

A

Dose of drug/plasma concentration

176
Q

Lipid soluble drugs in infants = _____ plasma concentration

A

higher

177
Q

Water soluble drugs in infants = ______ plasma concentration

A

lower

178
Q

Pharmacokinetics - infants cardiac output effects this how?

A

Higher CO = faster drug delivery + removal

179
Q

Albumin binds to ____ Rx

A

acidic

180
Q

AAG binds to _____ Rx

A

Basic

181
Q

Highly protein bound drug

A

Lidocaine

182
Q

Highly protein bound drugs will have what effect in infants?

A

greater free fraction of drug, potentially greater pharmacological effect…. narrow therapeutic index (high risk of toxicity) –> reduce the dose!

183
Q

Water soluble drugs

A

NMBDs

184
Q

How is acetaminophen, chloramphenicol, and sulfonamides metabolized in neonates?

A

Reduced enzyme activity …
Neonates lack the capacity to effectively conjugate bilirubin (decreased glucuronyl transferase activity)
*same enzyme needed to metabolize these Rx

185
Q

Drugs with prolonged half lives in neonates/infants

A 
bupivacaine (25 hrs)
mepivacaine (8.5 hrs)
diazepam (100 hours)
indomethacin (15-20 hours)
meperidine (22 hours)
phenytoin (21 hrs)
186
Q

Which drugs may be effected in infants due to their immature enzyme activity?

A

LA, sux, atracurium, cisatracurium, esmolol

187
Q

oral/rectal drug administration relies on ______ for absorption

A

passive diffusion

188
Q

Rectal administration of drugs: superior rectal veins empties into

A

portal system

189
Q

Rectal administration of drugs: middle/inferior rectal veins empties into

A

IVC (systemic circulation)

190
Q

oral drugs degree of ionization depends on

A

gastric/intestinal pH levels

191
Q

Oral drugs degree of ionization depends on gastric/intestinal pH levels. Acidic drugs are ____

A
  • non-ionized

- favored absorption in stomach

192
Q

Oral drugs degree of ionization depends on gastric/intestinal pH levels. Basic drugs are ____

A

absorbed in the intestines

193
Q

Upper 1/3 of rectum - superior rectal veins

Which Rx avoid this area?

A

Avoid opioids + midazolam

*acetaminophen okay to give there

194
Q

Rapid equilibrium of IAs in infants d/t

A
  • increased ventilation (relative to FRC)
  • increased cardiac output
  • decreased solubility of IA
195
Q

Neonates have _____ MAC but ____ at ___ days

A

lower MAC but peaks at 30 days

196
Q

intracardiac shunts will cause what during induction (inhaled)?

A

prolonged time (R to L shunt)

197
Q

FA/FI ratio is affected by

A

delivered IA concentration, IA blood-gas coefficient, alveolar ventilation, cardiac output, distribution to vessel rich (heart, brain, liver, kidneys)

198
Q

Why may IV agents have a prolonged DOA in infants?

A

decreased muscle/fat (therefore less redistribution)

199
Q

Highly ionized, low lipophilicity, limited ability to cross BBB

A

Neuromuscular blocking drugs

200
Q

Which NMBD are infants more resilient to?

A

Sux

*only used in emergencies < 12 y/o d/t severe hyperkalemia risk in undx myopathies

201
Q

Important rule of NMBD

A

ALWAYS reverse

202
Q

Which system in infants is inhibited by anesthesia?

A

RAAS - renin angiotensin

203
Q

Neonate maintain urine osmolality between

A

200-400 mOsm/L

204
Q

Neonate specific gravity should be maintained

A

1.006-1.012

205
Q

Neonate normal serum osmolality

A

270-280 mOsm/kg

206
Q

Neonate on TPN - what fluids to give?

A

continue or infuse dextrose solution + monitor BG

207
Q

NPO requirements - breast milk

A

4 hours

208
Q

NPO requirements - clear liquids

A

2 hours

209
Q

NPO requirements - formula

A

6 hours

210
Q

Preterm + SGA neonates glucose requirement

A

8-10 mg/kg/min to prevent hypoglycemia

211
Q

If preterm or SGA neonate becomes hypoglycemic intraop, Tx?

A

D5 or D10 solution followed by 10-15% Dextrose solution titrated to serum BG > 40 mg/dL

212
Q

electrolyte abnormality d/t excess water loss in infants

A

hypernatremia

213
Q

electrolyte abnormality d/t respiratory alkalosis/aggressive diuresis

A

hypokalemia

214
Q

Hyperglycemia in neonate/infants intraop may lead to

A

intraventricular hemorrhage, osmotic diuresis, dehydration, release of insulin –> hypoglycemia

215
Q

How to estimate blood loss from neonate/infant

A

1gm sponge weight = 1 mL blood loss

216
Q

Which should be transfused at higher Hgb levels: neonate, infant, child?

A

Neonate

217
Q

Most common cause of cardiac arrest in noncardiac procedures

A

hyperkalemia

218
Q

What will reduce the risk of hyperkalemia d/t blood transfusion in neonate/infant?

A

Fresh ( < 1 week old)
Washed blood
Radiated
pRBC NOT whole blood

219
Q

Which patient population should receive irradiated blood?

A

Immunocompromised patients

220
Q

Electrolyte abnormality seen in blood transfusions

A

hypocalcemia
d/t citrate in blood
= CV instability

P&P 3 (9 decks)

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