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Anesthesia Principles 2 > Exam 1 - Pediatrics > Flashcards

Exam 1 - Pediatrics Flashcards

1
Q

less than 37 weeks gestation or less than 2500 grams

A

premature

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2
Q

0-1 month

A

Neonate

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3
Q

1 month - 1 year

A

Infant

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4
Q

1 year to 3 years

A

Toddler

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5
Q

4 to 6 years

A

Small Child

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6
Q

6 to 12 years

A

Big Child

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7
Q

13 to 18 years

A

Adolescents

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8
Q

What are the differences in a pediatric airway (as compared to an adult airway)?

A

Pediatric airway:
- Large tongue and occiput
- Larynx is higher than it is in the adult: C2 to C4 instead of C3 to C6
- Epiglottis is Omega-shaped (U) and stiff
- Narrowest point of the peds airway = cricoid cartilage

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9
Q

Pediatric respiratory physiology

A
  • airway resistance is greater
  • immature CNS
  • infants <60 weeks PCA: SpO2 monitoring overnight after general and neuraxial anesthesia
  • the neonate’s chest wall is very compliant due to a lack of calcification of the ribs
  • alveolar compliance is low
  • higher risk of apnea in the preterm neonate <60 weeks PCA
  • increased oxygen consumption
  • early breathing fatigue (due to abundance of type 2 fibers)
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10
Q

What law describes resistance during laminar flow?

A

Poiseuille’s law

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11
Q

Trisomy 21 - special considerations

A
  • atlanto-ccipital instability
  • chronic upper respiratory infections
  • large tongue or small oral cavity
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12
Q

Pediatric cardiovascular differences

A
  • oxygen consumption is twice that of an adults (7mL/kg/min versus 3.5 mL/kg/min)
  • C.O. is HEART RATE dependent
  • increased susceptibility to myocardial depression by inhaled drugs
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13
Q

Fetal hemoglobin has a _________ affinity for oxygen than adult hemoglobin

A

higher

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14
Q

Pediatric body composition

A
  • larger total body water %
  • neonate is unable to conserve sodium

They are little bags of water, with a big ol’ head

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15
Q

Estimated Blood Volume: Premature

A

90-100 mL/kg

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16
Q

Estimated Blood Volume: Newborn (term)

A

80-90 mL/kg

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17
Q

Estimated Blood Volume: Infants

A

75-80 mL/kg

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18
Q

Estimated Blood Volume: School age children

A

75 mL/kg

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19
Q

Estimated Blood Volume: Adult

A

65-70 mL/kg

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20
Q

Thermoregulation in the pediatric patient

A
  • thermoregulation is compromised because of a lack of the ability to shiver
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21
Q

How do pediatrics accomplish non-shivering thermogenesis?

A

They metabolize brown fat

(Heat producing energy is derived from brown adipose tissue)

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22
Q

Spinal cord in the pediatric patient ends at _____

A

L3

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23
Q

Pediatric Nervous System

A
  • spinal cord ends at L3
  • fontanelles are not fused
  • the blood-brain barrier is incomplete
  • myelination begins during the fetal period and extends progressively (Myelination of nerve cells is not complete until 2-3 years of age)
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24
Q

Pediatric Hypoglycemia:

An infant requires ______(mg/kg/min) of glucose and a neonate requires ______ (mg/kg/min)

A

3 to 4 mg/kg/min; 5 to 6 mg/kg/min

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25
Q

How many mL/hr does a 2 kg neonate require? (D5% = 50 mg/mL)

A
  • A 2 kg neonate requires 5 mg/kg/min which equals 10 mg/min
  • 10 mg/min = 600 mg/hr
  • 600 mg/hr divided by 50 mg/mL = 12 mL/hr

Answer: 12 mL/hr

26
Q

Pediatrics have _________ (increased or decreased) total body water as compared to adults

A

increased

27
Q

CNS effects of opioids and barbiturates may be prolonged in the pediatric patient because of ___________________.

A

the immature blood-brain barrier

28
Q

True or False. Pediatrics are very sensitive to opioid respiration depression

A

True

29
Q

MAC (minimum alveolar, concentration) is higher in infants from ____ to _____ (ages), peaking at ________ (age).

A

one to six months; 3 months

30
Q

Pediatrics have a ______ (larger or smaller) volume of distribution

A

larger

31
Q

The dose of succinylcholine in children must be ________ due to the larger volume of distribution.

A

increased (more per kg)

32
Q

Succinylcholine is often avoided in kids unless clinically indicated for a rapid sequence induction because of ______

A

reported cases of unanticipated cardiac arrest

(Boys with undiagnosed Duchenne’s muscular dystrophy—it can precipitate untreatable hyperkalemia.)

33
Q

Fluid replacement for third spacing: Minor Surgery

A

2-4 mL/kg/hr

Ex. herniorrhaphy, clubfoot

34
Q

Fluid replacement for third spacing: Moderate Surgery

A

4-8 mL/kg/hr

Ex. pyloromytotomy

35
Q

Fluid replacement for third spacing: Extensive Surgery

A

8-10 mL/kg/hr

Ex. Bowel resection, NEC

36
Q

Estimated Blood Volume (EBV) equation

A

EBV = body weight (kg) x average blood volume (mL/kg)

37
Q

Allowable blood loss equation

A

EBV x (starting HCT - Target HCT) / starting HCT

38
Q

What is your initial fluid bolus for mild to moderate hypotension in pediatrics? What solution?

A

10-20 mL/kg ; often 5% albumin or LR

39
Q

Fasting Guidelines: Heavy Meal

A

8 hours before any anesthetic

(Heavy meal = a meal that includes any fatty foods)

40
Q

Fasting Guidelines: Light Meal

A

6 hours before any anesthetic

(Light meal = toast and clear liquids)

41
Q

Fasting Guidelines: Formula and Non-human milk

A

6 hours before any anesthetic

42
Q

Fasting Guidelines: Breast milk

A

4 hours before any anesthetic

43
Q

Fasting Guidelines: Clear Liquids

A

2 hours before any anesthetic

44
Q

Formula for estimating weight in kilograms based on age:

A

(age x 2) + 9

Formula is for aged 2-9 years (age is in unit years)

45
Q

ETT Size (uncuffed) for a Preemie <2.5 kg

A

2.5-3

46
Q

ETT Size (uncuffed) for a Term Newborn

A

3-3.5

47
Q

ETT Size (uncuffed) for a 3 month to 1 year old

A

3.5-4

48
Q

ETT Size (uncuffed & cuffed) for a 2-year-old

A

4.5 (uncuffed)
4.0 (cuffed)

49
Q

Formula for estimating ETT size (age >4 yr)

A

(age in years/4) + 4

Good for uncuffed tube size
Generally reduce by 0.5 to 1 size for cuffed ETT

50
Q

Formula for estimating ETT depth (age >4 yr)

A

3 times the ETT size

OR

Age + 10 cm

51
Q

What is included in a basic room set up for a pediatric patient

A
  1. Set the OR room to 80 degrees
  2. Put an under-body Bair hugger on the bed.
  3. Set out 3 lead EKG, NIBP, Pulse Ox, precordial stethoscope.
  4. Pediatric tonsil tip suction
  5. Paper tape for eyes. Cloth tape available for ETT especially if the ETT is going to remain after the procedure (Transport to NICU, PICU).
  6. MAC 1 and 2, Miller 1 and 2 blades. Miller 0 if less than 8 kg., ETT of several sizes (one bigger and one smaller than calculated to be needed), oral airways, and skin temp probe.
  7. IVF– less than one year old use Buritrol.
    - Greater than 1 year old use a micro drip set. Preferred fluid is usually non-glucose containing isotonic fluid.
    - Most at Vidant will use NS and perhaps add Dextrose but ask as this guideline has many practitioner dependent preferences and patient condition variables.
  8. Several IV catheters 22 and 24 gauge with tourniquet, alcohol wipe, 2x2’s, tape, Tegaderm, “T” piece extension set.
  9. Emergency and induction drugs
52
Q

What are the 3 main emergency drugs you should have set up for a pediatric case?

A
  1. Epinephrine 10 mcg/mL
  2. Atropine 0.4 mg/mL conc.
  3. Succinylcholine 20 mg/mL
53
Q

What is the emergency drug setup and dosaging for Epinephrine for a pediatric patient?

A

Epinephrine 10 mcg/mL
- Epinephrine 1 mcg/mL if less than 10 kg
- Dose 2-10 mcg/kg (vasopressor)
- Dose 30mcg/kg (arrest)

54
Q

What is the emergency drug setup and dosaging for Atropine for a pediatric patient?

A

Atropine 0.4 mg/mL concentration
- Dose 0.02- 0.04 mg/kg IM
- Dose 0.02 mg/kg IV

55
Q

What is the emergency drug setup and dosaging for Succinylcholine for a pediatric patient?

A

Succinylcholine 20 mg/mL
- Dose 4 mg/kg IM
- Dose 2 mg/kg IV

56
Q

Explain the steps of a basic inhalation induction

A
  1. To room, onto bed. Put on pulse ox and coax child to breath in mask with 70% nitrous 30% oxygen.
  2. Gradually add Sevoflurane up to 8%.
  3. Once the patient is unresponsive/minimally responsive, lay flat on the bed. Place precordial, NIBP, and EKG leads (in that order).
  4. One team member looks for an IV while you manage the airway. Once you have taken over respirations completely for the patient, shut off nitrous and go to 100% oxygen, turn Sevo down to 4-6%.
  5. Once IV established, give fentanyl and propofol.
  6. Establish airway. Listen for bilateral breath sounds. Listen for a leak at ETT/glottic opening at 20 cm H2O.
  7. Tape ETT. Listen again.
57
Q

How are diaphragmatic and intercostal muscles different in the pediatric population?

A

Fewer type I muscles; easily fatigued

58
Q

How much fluid should an 8 kg infant get in the first hour of a laparoscopic inguinal hernia repair?

A
  • Maintenance: 4 mL/kg up to 10 kg = 32 mL/hr
  • 3rd spacing: 2-4 mL/kg/hr = 16-32 mL/hr
  • 1st hour: 48-64 mL/hr
59
Q

What is a reasonable estimation for the weight of a two year old?

A

Equation for 2-9 yr olds: (age x 2) + 9

(2x2) + 9 = 13 kg

60
Q

In general, how do you calculate the 4:2:1 rule for fluid replacement?

A
  • 4 mL/kg for the first 10 kg
  • 2 mL/kg for 10 kg to 20 kg
  • 1 mL/kg for every kg over 20 kg

Anesthesia Principles 2 (4 decks)

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