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principles 3 > exam 3 > Flashcards

exam 3 Flashcards

1
Q

what is the leading cause of cancer deaths in the US

A

bronchogenic cancer

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2
Q

COPD patients are __x more likely to get lung cancer

A

4x

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3
Q

___% needing resections are disqualified due to poor pulmonary function

A

40%

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4
Q

biggest risk factor for lung cancer

A

smoking

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5
Q

Consider __-week delay if coronary bypass needed

A

6-week

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6
Q

true or false

radiographic airway evaluation for mediastinal masses
is very important

A

true

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7
Q

neuroendocrine tumors cause

A

carcinoid syndrome

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8
Q

______calcemia occurs in up to 25% of lung cancer patients

A

HYPER

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9
Q

symptoms of HYPERcalcemia

A

polyuria
polydipsia
confusing
vomiting
abd cramping
bradycardia

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10
Q

Paradoxical breathing
Tympanic chest percussion
Rhonchi
Wheezing

A

COPD symptoms

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11
Q

Jugular vein distention
Peripheral edema
Split S2
Rales

A

cor pulmonale

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12
Q

CXR looks at

A

Evaluation for airway infringement*

Tracheal shift*

CHF

PTX

PA enlargement (signs of increased PulmVR)

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13
Q

Tall R in V1

A

RVH

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14
Q

Biphasic P in V1

A

R atrial hypertrophy

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15
Q

Pathologic Q waves + LVH

A

increased risk of ischemia/infarction

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16
Q

EKG

A

tall R
biphasic P
ST depression
BBB
T inversion
Pathologic Q wave
LVH

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17
Q

Best INITIAL tool for pulmonary HTN

A

echo

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18
Q

room air COPD

> ___ = poor function

A

> 45

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19
Q

spO2 < ___ = increased risk of postop complications

A

<90%

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20
Q

albumin < ____ = 2.5x risk

A

<3.6

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21
Q

BUN > ___

A

> 2

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22
Q

Pulm Function Tests

“Significant improvement” = ___% increase in FEV1 after bronchodilators

A

12%

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23
Q

true or false

NO single test is a good predictor or lung function

A

true

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24
Q

increased risk

PPO FEV1 & DLCO <___%

VO2 max <___-___

A

<40%

VO2 < 10-15*

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25
Q

Maximum volume of O2 utilization

A

vo2 max

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26
Q

vo2 max

Ability to climb 5 flights of stairs = >___

Inability to climb 1 flight = <____

A

> 20 for 5 flights

<10 for 0 flights

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27
Q

forced expiratory volume/1 second

A

FEV1

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28
Q

diffusion in the lung of carbon monoxide

A

DLCO

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29
Q

mortality for smokers with lung cancer

A

1.5% mortality

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30
Q

pack-year index***

packs/____ x ______

A

packs/day x years

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31
Q

pack year index

> ___ = increased complications over “moderate” smokers

A

> 20

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32
Q

cessation of smoking

<___ weeks has NO difference in outcomes

A

<4

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33
Q

best option for cessation of smoking

A

8 weeks

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34
Q

which lead EKG for dysrhythmias

A

Lead II

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35
Q

which lead EKG for ischemia

A

V5

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36
Q

which side should the aline be on

A

dependent

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37
Q

CVP should be inserted on*

A

NON-dependent, operative side

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38
Q

trachea

___-___ cm long

A

11-12

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39
Q

trachea begins

A

C6 (cricoid cartilage)

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40
Q

trachea bifurcates

A

T5 (stermomanubrial joint)

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41
Q

which bronchus is WIDER and has LESS of an angle

A

R mainstem bronchus
(20 degrees)

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42
Q

which bronchus is NARROWER and has STEEPER angle

A

L mainstem bronchus
(45 degrees)

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43
Q

3 lobes

A

R lung

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44
Q

*Orifice of R upper lobe:
__-__cm from carina

can be a major problem for double lumen tube

A

1-2cm

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45
Q

Orifice of L upper lobe:
__ cm from carina

A

5 cm

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46
Q

sitting up

zone 1

A

clavicle/apices

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47
Q

sitting up

zone 2

A

axillary

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48
Q

sitting up

zone 3

A

lower ribs/base

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49
Q

if you are LAYING down, on the L side, where is zone 3

A

mostly L lung

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50
Q

true or false
normal, sitting person

perfusion AND ventilation BOTH increase from apex to base

they are both HIGHEST at BASE

A

true

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51
Q

BASE is more compliant

most tidal breathing is here

A

true

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52
Q

lateral + awake

perfusion AND ventilation are higher/better in the _____________ lung

A

dependent

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53
Q

lateral + awake has NO change in V/Q

A

true

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54
Q

diaphargm is displaced

A

cephalad

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55
Q

lateral + anesthetized, spontaneous ventilation

which lung has better VENTILATION

A

NON-dependent
(better compliance)

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56
Q

lateral + anesthetized, spontaneous ventilation

which lung has better PERFUSION

A

dependent
(more gravity)

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57
Q

lateral + anesthetized, spontaneous ventilation

net result

A

V/Q mismatch

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58
Q

lateral + anesthetized + NMB, mechanical ventilation, chest closed

which lung has better VENTILATION

A

non-dependent

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59
Q

lateral + anesthetized + NMB, mechanical ventilation, chest closed

net result

A

GREATER V/Q mismatch

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60
Q

lateral + anesthetized + NMB, mechanical ventilation, chest closed

treatment

A

PEEP

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61
Q

lateral + anesthetized + NMB, chest open

net result

A

GREATEST V/Q mismatch

(large increase in ventilation for NON dependent lung)

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62
Q

lateral + anesthetized + chest open

mediastinum shifts ___________ due to
LOSS of negative intrathoracic pressure

A

downward

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63
Q

lateral + anesthetized + chest open

what is something that is a hypothetical situation that we do NOT want to occur (patient should be paralyzed)

A

“paradoxical” respiration

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64
Q

“paradoxical” respiration

what occurs during INSPIRATION

A

air FROM the open-chest non-dependent lung
moves into the
dependent lung

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65
Q

“paradoxical” respiration

what occurs during EXPIRATION

A

air moves FROM the dependent lung
to the
open-chest non-dependent lung

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66
Q

“paradoxical” respiration

air movement, net result

A

Vt moves back-and-forth between the lungs

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67
Q

treatment for “paradoxical” respiration

A

mechanical ventilation
PEEP

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68
Q

“paradoxical” respiration

net result
physiologic ________ in _____________ lung

A

physiologic SHUNT in DEPENDENT lung

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69
Q

which lung is better PERFUSED

A

dependent

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70
Q

which lung is better VENTILATED

A

non-dependent

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71
Q

PERFUSION without ventilation

A

SHUNT

dependent lung

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72
Q

VENTILATION without perfusion

A

DEAD space

NON-dependent lung

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73
Q

What is the worst V/Q mismatch?

A

Lateral + Anesthetized; Paralyzed; Chest Open

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74
Q

one-lung ventilation

we STOP ventilation to the _____-____________ lung

A

non-dependent is STOPPED

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75
Q

Non-dependent lung (which now has NO ventilation)

diverts/forces perfusion to dependent lung,

and DECREASES the shunt effect

A

hypoxic pulmonary vasoconstriction (HPV)

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76
Q

HPV

net result

A

less V/Q mismatch

less shunt

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77
Q

which lung is clamped

A

non-dependent = operative

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78
Q

what lumen tube is most often used

A

L

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79
Q

true or false

It does NOT matter what side the tube is in

it matters what lumen is clamped

A

true

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80
Q

sizing for females

A

35, 37

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81
Q

sizing for males

A

39, 41

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82
Q

what is sizing based on

A

height

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83
Q

external french range

A

26, 28, 35, 37, 39, 41

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84
Q

internal diameter
____-____mm

A

3.4-6.6 mm

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85
Q

DLT have large ______ diameter

A

outer

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86
Q

which lumen is BLUE

A

bronchial

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87
Q

which lumen is WHITE

A

tracheal

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88
Q

which lumen has the STYLET

A

bronchial

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89
Q

what type of blade

A

MAC

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90
Q

insert the DLT with an __________ curve

A

anterior

“shotgun”/over & under

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91
Q

once the DLT is through the vocal cords, turn it ____ degrees

A

turn it 90 degrees

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92
Q

advance DLT until resistance

females: ___ cm

A

27 cm

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93
Q

advance DLT until resistance

males: ___ cm

A

29 cm

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94
Q

true or false

inflate cuff
do F/O scope
position lateral
reverify with F/O

A

true

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95
Q

Up to ___% of DLTs are mal-positioned when verified by auscultation only

A

80%

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96
Q

absent/weak R breath sounds

A

tube is too shallow, occluding the distal trachea

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97
Q

where do you clamp

A

high, at the adapter

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98
Q

L DLT tube

R middle lobectomy, which side is clamped

A

tracheal (L) side

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99
Q

L DLT

L middle lobectomy, which side is clamped

A

bronchial (L) side

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100
Q

CONTRAindications for L DLT

A

distorted L main bronchus

compression of L main bronchus due to aortic aneurysm

L-sided:
pneumoectomy,
sleeve resection,
single lung transplant

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101
Q

*what is the most common DLT complication

A

malpositioning

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102
Q

Catheter with inflatable balloon to block operative lung bronchus

A

bronchial blockers

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103
Q

indications for bronchial blocker

A

difficult airways
ETT change risky
some children
infections/cysts/bullae

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104
Q

which lung would become shunt flow during OLV

this would be withOUT HPV kicking in

A

non-dependent=operative

a 40% shunt would result normally, without HPV

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105
Q

HPV occurs within

A

seconds

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106
Q

HPV improves SaO2 during ___-___% lung hypoxia: the usual condition present with OLV

A

20-80%

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107
Q

AVOID

______capnia with HPV
______thermia

A

HYPOcapnia
HYPOthermia

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108
Q

AVOID

> ____ MAC

A

> 1.5 MAC

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109
Q

which NMB agents are best for OLV

A

intermediate

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110
Q

true or false

regional sympathectomy does NOT effect HPV

A

true

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111
Q

Vt __-__ is ideal

A

6-8

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112
Q

limit PIP ___-___

A

20-25

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113
Q

it is BETTER to be HYPERcapnic

<___

A

< 60

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114
Q

use _________-limiting ventilation mode

A

pressure-limiting

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115
Q

true or false

R lung is larger than L, so hypoxemia will be WORSE in R-side procedures

A

true

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116
Q

The degree of drop when shifting to OLV is proportionate to perfusion of the ____-___________ lung:

A

non-dependent

The greater the initial drop in EtCO2 = the greater the chance of hypoxia during OLV!

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117
Q

what is most common cause of hypoxia

A

tube malposition

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118
Q

**if patient is hypoxic, which lung should be given PEEP 1st

A

NON-dependent = operative lung

start at 2 PEEP

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119
Q

unclamping, use PIP of ___-___ to re-inflate

A

30-40

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120
Q

which drugs are good to reinflate lung

A

nitriC oxide
prostacyclin

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121
Q

__________* to non-dependent lung + nitric to dependent lung = 100% increase in PaO2

A

Almitrine

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122
Q

promotes HPV in non-dependent lung

Carotid body chemoreceptor agonist

A

almitrine

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123
Q

mediastinal tumors

A

HTN
HYPERcalcemia
cushings
myasthenia
etc.

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124
Q

true or false

mediastinal mass surgery is very dangerous

A

true

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125
Q

Venous distention of thorax and neck

Redness/edema of face, neck, torso, airway, conjunctiva

SOB

Headache

Confusion

A

SUPERIOR Vena Cava Syndrome

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126
Q

place peripheral IVs in ______ extremities

A

lower

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127
Q

radiation ______ surgery

A

before

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128
Q

*MAJOR goal of mediastinal mass surgery

A

maintain SPONT ventilation

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129
Q

best choice for intubation

mediastinal mass surgery

A

awake F/O

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130
Q

what helps minimize turbulence

A

helium/O2 mixture

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131
Q

mediastinoscopy

you can knick something very easily!!!

A

true

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132
Q

which arm should be monitored due to pressure on innominate artery

A

R arm

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133
Q

For COPD patients with bullae

A

bullectomy

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134
Q

best anesthesia for bullectomy

A

low Vt
high RR
100% O2
PIP < 20

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135
Q

highest risk for complications
post-thoracotomy

> ___ years
FEV1 DLCO <___%
ASA status > or = ___
____ min surgery time

A

> 80 years old
FEV1 DLCO < 40%
ASA 3
80 min surgery time

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136
Q

highest risk factors for
acute lung injury

A

R pneumonectomy
overhydration*
high PIP
preop ETOH abuse

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137
Q

Chest tube drainage should NOT exceed

A

< 500 ml/day

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138
Q

____ ml/day = surgical exploration

A

200 ml/day

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139
Q

treatment for supraventricular dysrhythmias

A

beta blockers

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140
Q

which artery can lead to spinal cord injury

A

radicular

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141
Q

3 ABSOLUTE CONTRAindications to laparoscopic proceudres

A

diaphragmatic hernia*
CHF*
peritonitis*

ileus
intraperitoneal hemorrhage
severe cardiopulm disease?
bowel obstruction?

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142
Q

when does the uterus interfere

A

23rd week

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143
Q

we want a slightly _________ state for mother

A

alkalotic

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144
Q

___ degree L uterine displacement

A

30 degree

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145
Q

pregnancy

limit intraperitoneal pressures to < or = ____

A

12

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146
Q

what are the 4 potential causes of major physiologic changes during pregnancy

A

creation of pneumoperitoneum

Potential for systemic absorption of CO2

Initial trendelenburg position

Reverse trendelenburg position

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147
Q

best gas to use

A

CO2

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148
Q

HYPERcarbia leads to _____________ acidosis

A

respiratory

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149
Q

insufflate at a pressure <___ (3L)

A

<19

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150
Q

once distended, maintain pressure at ___

A

12 maintenance

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151
Q

> ___% of complications occur during entry and insertion of trocars

A

> 50%

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152
Q

___-___% of injuries from the beginning of the case are NOT diagnosed intraop, resulting in
mortality of 3.5-5%

A

30-50%

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153
Q

true or false

we canNOT control the volume of CO2 absorbed

A

true

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154
Q

pneumoperiteneum

INCREASED:
___
___
___
____
____
____

A

SVR,
MAP,
HR

CVP (initially, then decreased)

CBF
ICP

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155
Q

pneumoperiteneum

DECREASED:
_________ ________
___
___
___
___
___
_________ __________
______ __________
____ __________

A

venous return
SV
CVP

CI, initially

UOP
GFR
creatinine clearance

pulm compliance
lung volumes

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156
Q

what can help the decrease in SV

A

periop hydration

change patient position (put in t-burg)

compression stockings

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157
Q

bradycardia can occur with INITIAL insufflation

who is MOST at risk*

A

young, healthy patients

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158
Q

best treatment for bradycardia

A

stop insufflation

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159
Q

**_________ myocardial filling pressures INITIALLY, followed by sustained __________ in preload (decreased venous return)

A

Increased initially, followed by decrease

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160
Q

avoid _____ventilation
with pneumoperiteneum

A

avoid HYPOventilation/hypercarbia

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161
Q

true or false

pneumoperitenum

hypoxemia is NOT normally seen with healthy patients

A

true

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162
Q

best PEEP and Vt for laparoscopic **

A

5-8

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163
Q

how do we help the respiratory acidosis that occurs with laparoscopic procedures

A

increasing RR (this increases Mv)

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164
Q

max CO2 absorption pressure

A

10

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165
Q

PaCO2 reaches plateau ___ min after start of insufflation

A

40 min

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166
Q

rate of absorption
is determined by (3)

A

tissue solubility
blood flow
diffusion pressure

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167
Q

PaCO2
Increased absorption with _____peritoneal

A

extra

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168
Q

EtCO2 ACCURATELY predicts changes in PaCO2 with (2)

A

HEALTHY

mechanically ventilated patients

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169
Q

sick, pulm, cardiac patients need to check PaCo2 how

A

with aline (since EtCO2 is NOT accurate)

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170
Q

___-___ degrees t-burg for decreased risk with small/bowel

A

10-20 degrees

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171
Q

what can occur with t-burg

A

R mainstem intubation

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172
Q

Combined with pneumoperitoneal pressure, the trendelenburg position increased ICP ___% over baseline

A

150%

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173
Q

durant position

A

L lateral tilt

we want to avoid air bubble going to RV outflow

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174
Q

reverse t burg

A

head UP tilt

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175
Q

t burg

A

head DOWN tilt

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176
Q

reverse tburg

decreased:

A

venous return
LVEDV
EF (only in SICK)

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177
Q

reverse tburg

EF is _____________

A

maintained = healthy
decreased = sick

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178
Q

we like _______carbia for laparoscopic

A

normocarbia (35-45)

179
Q

major concern for laparascopic

A

must PREVENT HYPERcarbia

180
Q

premedicate with

A

anxiolytic

181
Q

use _____% oxygen

A

100%

182
Q

best anesthetic option for laparoscopic procedure

A

regional + GA

183
Q

true or false

STOP ventilation during insertion of Veress needle

A

true

184
Q

there is an INCREASED risk of PONV during laparoscopy

A

true (48%)

185
Q

treatment for opioid spasm

A

glucagon

186
Q

Deferred pain to SHOULDERS related to irritation of the

A

diaphragm

187
Q

when does shoulder pain occur

A

1st day postop

188
Q

why does bradycardia occur

A

due to vagal stimulation/stretching

189
Q

what can occur during laparoscopic procedure (CV)

A

bradycardia
asystole
arrythmias
PEA

190
Q

signs of CO2 emboli**

A

HYPOtension
JVD
tachy
mill-wheel

short increase in EtCO2, followed by decrease

hypoxemia
cyanosis

191
Q

treatment for CO2 emboli*

A

stop insufflation
release pneumo
L side down (durant)
HYPERventilate
increase CVP (volume)
CVL (aspirate)

192
Q

signs of lung rupture or PTX or pneumomediastinum

A

increase in pressure
hypoxemia
severe CV compromise
HYPOtension
SQ emphysema

193
Q

there is LESS pulm dysfunction, but it can still occur

A

true

194
Q

Diaphragmatic dysfunction may last up to ___ hr

A

24 hr

195
Q

treatment for SQ emphysema

give ____% O2

A

100%

196
Q

lithotomy w/ steep trendelenburg

A

pelvis, robotic

197
Q

steep trendelenburg

A

prostatectomy, robotic

198
Q

robotics

limit fluid to ___-___ L of crystalloid

A

1-2 L

better to use colloids

199
Q

average age for radical prostatectomy

A

60 years

200
Q

patient positioning for thoracoscopy

A

lateral decubitus

201
Q

true or false

avoid LA with laparocopic, robotic

A

true

202
Q

VATS requires

A

OLV

203
Q

Uses no pneumoperitoneum; no gas, purely mechanical

A

Gasless laparoscopy

204
Q

gasless lap

lifts abd wall ___-___ cm, with only __-__ IAP

A

10-15 cm

1-4 IAP

205
Q

best indication for gas-less

A

ASA III-IV

206
Q

true or false

GA is NOT preferred with hysteroscopy

A

true

207
Q

what can cause TURP syndrome

A

resectoscope

208
Q

best option of fluid for resectoscope

A

saline

209
Q

what 2 things do we want to avoid with resectoscope (TURP)

A

HYPERvolemia
HYPOnatremia (HYPOosmolarity)

210
Q

true or false

Must have a sodium level baseline*

A

true

211
Q

HYPERvolemia
HYPOnatremia (HYPOosmolarity)

this causes

A

cerebral edema, which leads to TURP syndrome

212
Q

turp syndrome

symptoms

A

HTN (both diastolic and sys)
BRADYcardia
CNS changes
N/V
headache
agitation
lethargy
cardiac arrest

213
Q

AVOID GA with resectoscope**

A

true

cannot assess patient for TURP!

214
Q

EKG changes with TURP

A

nodal/junctional
ST changes
U wave
widening of QRS

215
Q

resectoscope

average rate of absorption is ___ ml/min (>__ L/hr)

A

20 ml/MIN

> 1 L/hr

216
Q

best anesthetic with resectoscope

A

regional

217
Q

try to limit surgical time to
< __ hr

A

< 1 hr

can occur within 15 min!

218
Q

2 best drugs for TURP

A

saline
furosemide (lasix)

219
Q

glycine deficits/absorption of ____ml

lead to decrease in Na of ____

A

500ml

Na decrease of 2.5

220
Q

organogenesis occurs

A

1st 8 weeks

221
Q

rapid growth

A

2nd trimester

222
Q

preterm

A

<37 weeks

223
Q

term

A

37-42 weeks

224
Q

post-term

A

> 42 weeks

225
Q

what is gestational age assessed by (4)

A

crown-rump length
1st trimester
ultrasound
1st day of LMP

226
Q

Combination of physical and neuro characteristics to estimate gestational AGE

this is MORE accurate

A

dubowitz score

227
Q

true or false

Gestational age is INDEPENDENT of weight

A

true

228
Q

what type of age should be used

A

“corrected” gestational age

229
Q

how long should “corrected” gestational age be used for

A

until 2 years old

230
Q

current age of viability

A

22, 23-24 weeks

231
Q

when are AIRWAYS formed

A

16th week

232
Q

when are PULM VASCULATURE formed

A

16th week
(complete at late adolescence)

233
Q

when are ALVEOLI formed

A

up to 8 years of age

234
Q

3 stages of lung embryology

A

1) glandular
2) canalicular
3) alveolar

235
Q

glandular stage

A

7-16 weeks

236
Q

canalicular stage

A

16-24 weeks

237
Q

alveolar stage

A

24 weeks to term

238
Q

segmental airways, vessels, cartilage differentiation in the trachea and bronchi

A

glandular

239
Q

Formation of gas exchange surface and beginning of surfactant production

Type II pneumocytes

A

canalicular

240
Q

surface area grows quickly, membrane thins, surfactant levels in amniotic fluid becoming indicator of lung maturity

A

alveolar

241
Q

Heart tube formed, connects to arterial and venous systems

Aorta divides

A

3rd week

242
Q

Fetal circulation in place

A

7th week

243
Q

Bronchial arteries develop between __-___ weeks

A

9-12

244
Q

fetal circulation is _________

A

PARALLEL (2 at once)

245
Q

bypass the LIVER

A

ductus VENOSUS

246
Q

bypass the LUNGS

RA to LA

A

patent foramen ovale (PFO)

247
Q

bypass the PULM ARTERIES

RV to AORTA

A

patent ductus ARTERIOSUS (PDA)

248
Q

R sided pressure is high because pulm pressure is high; there is a whole between RA and LA, so there is no blood flow to the lungs

A

PFO

249
Q

RV to aorta

A

PDA

250
Q

2 unoxygenated

A

arteries

251
Q

1 oxygenated

A

vein

252
Q

1st critical event

A

1st gasp

253
Q

1st gasp leads to***
_________ pulm blood flow
_________ pulm O2
_________ SVR

_________ pulmVR

A

INCREASE in blood flow, O2, SVR

DECREASE in pulmVR

254
Q

true or false
normal, physiologic R to L shunting occurs for several hours after birth

A

true

255
Q

LOW level of Type __
for infants

A

1

256
Q

elastic recoil is _______ at infancy

A

LOWEST

257
Q

big determinant of static lung volume

A

elastic recoil

258
Q

Total lung capacity (TLC)

A

low

259
Q

FRC

A

SIMILAR to other ages per kg

however, LOW elastic recoil makes it go to 10% of predicted

260
Q

**Reason for rapid desaturation in infants with airway loss

A

disproportionately low O2 reserve

(TLC, FRC, low elastic recoil)

261
Q

Closing volume is NOT able to be measured in children < ___ years of age

A

<5 years

262
Q

airway dynamics

HIGH resistance =
even higher =

A

High resistance = newborns
even higher = premies

263
Q

resistance DECREASES in peripheral airways (>___th) generation
around 5 years of age

A

> 12th generation

264
Q

*Reason for severe respiratory impairment in very young children with only minimal airway inflammation (bronchiolitis)

A

high resistance

265
Q

tracheal compliance

___x higher in infants

A

2x (but higher risk of collapse)

266
Q

pulm

increased

A

PaCO2
Vt
RR

267
Q

lung inflation
leads to
induced apnea (positive pressure extubation)

A

hering breuer reflex

268
Q

periodic breathing

___-___ second pause
normal!

A

5-10 second

269
Q

treatment for apnea

A

increase central ventilation drive (theophylline)

chest wall stabilization (PEEP)

tactile stimulation

270
Q

**Apnea of ___________ has huge GA implications

A

prematurity

271
Q

***when is the highest risk post-conceptual age for apnea

A

< 55 weeks

(normal preterm babies)

272
Q

infant O2 consumption is >___x higher than adults

A

2x

273
Q

compensation for increased O2 consumption

A

increased RR

274
Q

PaO2 __________ in neonates**

A

DECREASES

(consumption increases)

275
Q

why does PaO2 decrease

A

L shift

276
Q

babies have _______ affinity for O2

A

HIGHER (less to the tissues)

277
Q

newborn HR

A

120

278
Q

1 month HR

A

160

279
Q

adolescent HR

A

75

280
Q

SYSTOLIC BP

6 weeks - 1 year

A

99

281
Q

SYSTOLIC BP

1 year - 6 year

A

minimal change

282
Q

CO

> ___-___x higher

A

> 2-3x higher

283
Q

best measurement for CO

A

echo (doppler)

284
Q

PR interval
QRS duration

A

increase with age

285
Q

QRS axis is ___ at birth, rotates ___ during 1st month

A

QRS R = birth

rotates L

286
Q

at birth, GFR is <___% of adults

A

< 30%

287
Q

when is GFR normal

A

2 years old

288
Q

infants have a normal, physiologic __________

A

acidosis

(bicarb is poorly reserved)

289
Q

true or false

infants have NORMAL BUN

A

true

290
Q

Biliary tract completed at ____th week gestation

A

10th

291
Q

premies are at risk of _____glycemia

A

HYPOglycemia

292
Q

jaundice is normal

A

true

293
Q

encephalopathy due to increased bilirubin

A

kernicterus

294
Q

cause of cholestatic jaundice

A

long-term TPN

295
Q

GI tract “migrates and rotates” into abdominal position: __-__ weeks gestation

A

5-7 weeks

296
Q

Duodenal motility maturation: ___-___ weeks’ gestation

A

29-32 weeks

297
Q

Peristaltic waves absent in infant’s lower esophagus
cause

A

“spitting”

298
Q

what can lead to inadequate swallowing

A

CNS damage

299
Q

___% of newborns have reflux for several days

A

40%

300
Q

should be passed in the 1st ___ hours

A

48 hours

301
Q

3 symptoms of meconium aspiration

A

pneumonia
PTX
persistent pulm HTN

302
Q

if a baby has increased insulin levels at birth, that can lead to

A

rapid HYPOglycemia

303
Q

Maintain glucose at > ___-___ in newborns

A

40-45

304
Q

symptoms of HYPERglycemia (2)

A

cerebral bleeding
infection

305
Q

symptoms of HYPOglycemia (3)

A

jittery
lethargic
seizures

(may have NO symptoms!)

306
Q

initial blood volume

___ mL/kg = immediate clamping

A

80

307
Q

initial blood volume

premies: ___ mL/kg

A

90

308
Q

newborn Hgb

A

14-20

309
Q

3 month old Hgb

A

10

310
Q

who has the greatest decrease in Hgb

A

premies at 2 months

311
Q

3 month- 2 year old Hgb

A

12

312
Q

true or false

anemia is NORMAL

A

true

313
Q

as baby ages, they have a ___ shift of oxyhgb

A

R

314
Q

Hct >___% is polycythemia

A

> 65%

315
Q

vitamin K dependent factors

A

2, 7, 9, 10

316
Q

true or false

Decreasing perinatal mortality has NOT led to a decrease in cerebral palsy

A

true

317
Q

predictors of CP

A

LBW
congenital anom
low placental weight
fetal position
asphyxia

318
Q

what can lead to handicapping?

A

malnutrition until the age of 2 years

this leads to impaired myelination

319
Q

always assess by ___________ age

A

conceptual

320
Q

What must be considered with motor deficits? (3)

A

drug interactions
hepatic/renal function
enzyme induction

321
Q

drug dosing for infants

A

the SAME

more sensitive + larger Vd

322
Q

key point for safe drug dosing**

A

titrate to effect!

323
Q

metabolism
CP450 system

A

decreased

324
Q

2 diseases that cause decreased metabolism

A

cystic fibrosis
celiac’s

325
Q

elim 1/2 life

A

increases

326
Q

drug clearance

A

prolonged

327
Q

infants have an ___________ risk of toxicity

A

INCREASED

328
Q

renal blood flow: ___-___% of CO

adult:

A

peds: 5-6% of CO

adults: 15-25%

329
Q

true or false

creatinine is NOT a useful indicator

A

true

330
Q

what must be considered when dosing infants

A

renal function

331
Q

true or false

we can still USE unapproved drugs

A

true

332
Q

neurons are genetically programmed to “commit suicide” if they fail to make synaptic connections on time

A

apoptosis

333
Q

“anesthesia induced neuroapoptosis”

anesthetics cause
___________ death for good neurons

___________ death for weak neurons

A

abnormal = good

inhibited = weaker neurons

334
Q

2 receptors involved**

A

N-methyl-D-aspartate (NMDA) glutamate

y-aminobutyric acid (GABA)A

335
Q

NMDA antagonists (3)

A

ketamine
nitrous
ETOH

336
Q

GABA antagonists (3)

A

benzos
inhalational agents
propofol

337
Q

who is MOST at risk for brain issues with anesthetics (2)
with LENGTHYYYY procedures (> 3 hrs)

A

children < 3

pregnant in 3rd trimester

338
Q

the rate of equilibrium of alveolar to inspired anesthetic partial pressures [FA/FI]

A

wash-in

339
Q

wash-in is ______ ______ in neonates

A

more RAPID

340
Q

why is wash-in more rapid in neonates

A

higher ventilation/FRC ratio

lower tissue/blood solubility

lower blood/gas solubility

341
Q

lethal dose (LD50) is ___________ in neonates

A

very DECREASED

342
Q

caution with centrally acting meds in children < __ year of age

A

< 1

343
Q

EXTREMEEE caution with centrally acting meds in children < __ weeks post-conceptual

A

<48 weeks

344
Q

volatiles

___________ cerebral blood flow

___________ CMRO2

A

increase blood flow

decrease CMRO2

345
Q

best to use <___ MAC with mild HYPERventilation

A

<1 MAC

346
Q

2 best volatiles

A

sevo
iso

347
Q

true or false

BIS monitoring is not reliable in children

A

true

348
Q

Overall, __________ margin of safety in children

A

decreased

349
Q

** for every 1 MAC, there is a ___% DECREASE in SYSTOLIC for children

A

30%

350
Q

hypoxia,
_______cardia,
dysrhythmias

lead to the death spiral

A

BRADYcardia

351
Q

Hepatic metabolism reaches adult levels by ___ years old

A

2 years old

352
Q

2 volatiles used for induction

A

sevo
halo

353
Q

2 options for induction with sevo

sevo + ___-___% nitrous
sevo + ____% O2

A

sevo + 50-70% nitrous

sevo + 100% O2

354
Q

biggest factor in emergence

A

NOT reducing agent in timely manner

355
Q

true or false

NO difference for solubility, laryngospasm, vomiting between agents

A

true

356
Q

what causes the worst emergence delirium

A

SEVO
des

357
Q

risk factor for emergence delirium

A

< 6 years

358
Q

best drug for emergence delirium

A

dexmedetomidine

359
Q

What is the primary determinant of IV anesthetic agents duration of action?

A

re-distribution

360
Q

**2 huge NEONATAL factors for redistribution

A

body maturation

BBB maturation

361
Q

propofol

________ doses create good intubating conditions after inhalation induction

A

smaller

362
Q

seen in children after prolonged propofol sedation
> 48 hours
>70 mcg/kg/hr

A

Propofol Infusion Syndrome (PRIS)

363
Q

symptoms of
Propofol Infusion Syndrome (PRIS)

A

Refractory BRADYcardia
Metabolic acidosis
HYPERkalemia
Rhabdomyolysis
CV instability, refractory CV arrest

364
Q

3 different routes for ketamine

A

PO
nasal
rectal

365
Q

ketamine increases

A

HR
SBP
PA pressure

366
Q

3 indications for ketamine

A

HYPOvolemia (trauma)

cyanotic R to L shunt

asthma/wheezing

367
Q

ketamine

SVR is ____________

A

maintained

368
Q

true or false

ketamine

maintains spont vent
neonates tolerate very well

A

true

369
Q

3 indications for etomidate

A

TBIs, CV compromised
HYPOvolemia
cardiomyopathy

370
Q

true or false

etomidate
must give steroids for stress coverage, especially for CRITICALLY ILL CHILDREN

A

true

371
Q

80% of children < ___ will have BRADYCARDIAAAA after Sch

A

80% under < 10

372
Q

what should you pre-treat with for Sch

A

vagolytic
(atropine)

373
Q

2 major CONTRAindications with Sch

A

MH

hyperkalemia

(upper/lower motor neuron disease)
neuromuscular disorders (duchenne’s MD)

374
Q

true or false

defibrillation is NOT helpful for Sch

A

true

375
Q

true or false
Sch

fasciculation is NOT seen in infants

A

true

376
Q

best RSI alternative to Sch

A

high dose roc (with sugg)

377
Q

what type of metabolism for atracurium

A

hoffmann elimination

(NO plasma cholinesterase involved)

378
Q

atracurium

___-___x the ED95

A

2-3x ED95

379
Q

atracurium

intubating conditions ___min

A

2 min

380
Q

atracurium

duration ___ min

A

20 min

381
Q

atracurium

children generally require _______

A

MORE

382
Q

atracurium

children recover _________ than adults

A

recover FASTER

383
Q

indications for atracurium

A

hepatic/liver dysfunction**

continuous infusions

384
Q

atracurium metabolite

A

laudanosine

385
Q

true or false

atracurium

laudanosine can be ELEVATED in children with HEPATIC impairment

A

true

386
Q

what does laudanosine cause

A

excitation, seizures

NO NMB properties

387
Q

nimbex is ___x as potent

A

3x

slower onset
duration the same

388
Q

nimbex

__________ recovery in children

A

FASTER

due to LARGER Vd

389
Q

major advantage of Vec**

A

NO CV effects, even with large doses!

390
Q

major DISadvantage of Vec**

A

metabolized by LIVER

391
Q

roc

neonates are ______ sensitive with marked variability in duration of action

A

MORE

392
Q

roc

why are neonates more sensitive

A

due to reduced clearance and P450 substrates

393
Q

true or false

roc can be given IM

A

true

394
Q

dose of roc for IM

A

1.8mg/kg

395
Q

roc

how long does IM intubating conditions take

A

up to 4 min

396
Q

pancuronium

__________ effects

A

vagolytic effects

there is NO histamine

397
Q

what is the only NMB that has some histamine (minimal)

A

nimbex

398
Q

PANC
indications/USES/GOOD FOR

A

cardiac surgery

high-risk infants/neonates

frequently used in NICU

399
Q

PANC
true or false

Very predictable recovery in neonates, infants, and young children compared to vec and roc

A

true

400
Q

even with a slight residual NM blockade, you can have ________ and ___________

A

hypoxia
HYPERcarbia

401
Q

___________ elimination ½-life of NMBs

A

longer

402
Q

babies have less of type __ fibers

A

less type I

403
Q

true or false

observe preop clinical conditions and aim for “back to baseline” at emergence

A

true

404
Q

4 things to assess for with antagonizing of NMB*

A

facial nerve
hip/arm flexing
leg lift
abd muscle tone

405
Q

_____ infants before attempting antagonism

A

WARM

406
Q

what drug do you give 1st BEFORE neostigmine

A

anticholinergic (robinul)

MUST wait for HR to increase

407
Q

who is sugg approved for

A

> 2 and higher

408
Q

who can sugg be used with

A

everyone

409
Q

morphine**

who has RAPID/FAST clearance

A

children

410
Q

morphine**

who has REDUCED/slower clearance

A

infants

411
Q

opioids

what is the BIGGEST respiratory depressant

A

morphine

412
Q

morphine

neonatal brain has ___x uptake of adult

this is due to:

A

3x

due to the immature BBB

413
Q

AVOID morphine with < __ year old

A

< 1 year old

414
Q

best drug for decreasing shivering

A

meperidine

415
Q

meperidine

what is the elimination 1/2 life for NEONATES

A

3.3-60 hrs (huge variation!)

416
Q

what metabolite with meperidine

A

normeperidine

417
Q

what can normeperidine cause

A

seizures

418
Q

true or false

many peds centers have REMOVED meperidine from their formularies

A

true

419
Q

Most common opioid for peds GA

A

fentanyl

420
Q

true or false

fentanyl
HUGE doses are tolerated well by premies/neonates for cardiac procedures

A

true

however, only give if you are NOT planning on extubating at the end of the case!

421
Q

true or false

fentanyl
Dynamics VARIABLE in all peds age groups, especially premies

Titrate to effect!

A

true

422
Q

___________ + _________ profound hypotension, especially in neonates

A

fentanyl + versed

423
Q

fentanyl

what can occur in neonates

A

increased vagal tone

bradycardia

DECREASED CO

424
Q

fentanyl
what route can be used with BMT for GA

A

nasal

425
Q

what opioid has a very brief 1/2 life (<10 min)

A

remifentanil

426
Q

for creating ideal intubating conditions, when Sch should be avoided
use _____________ + __________

A

remifentanil + propofol

427
Q

Indication

Prevention of withdrawal symptoms when weaning from opioid infusions

A

methadone

428
Q

true or false

methadone has elim variation in children

A

true

429
Q

true or false

ketorolac (NSAID)
has NO respiratory depression

A

true

430
Q
A
431
Q

what is current evidence with T&A

A

OKAY to use ketorolac

432
Q

CONTRAindications for ketorolac

A

ortho (especially spinal)

GI/renal/allergy

433
Q

Most common benzo for peds

A

midazolam

434
Q

midazolam

CONTRAindications (3) as

A

OSA

neuro patients (VP shunt issue)

increased ICP

Opioids

435
Q

indications (2) for zofran

A

strabismus repair (eye)

ENT

436
Q

4 indications for precedex

A

sedation, maintaining spontaneous ventilation

opioid-sparing

emergence delirium

ETT tolerance for weaning from vent

437
Q

4 indications for atropine

A

decrease secretions (common for infants)

pre-treat Sch

block oculocardiac reflex

prevent/treat bradycardia

438
Q

which form of atropine is given to infants < 6 months old

A

IM

439
Q

atropine

IM
BEFORE
inhalational induction

for < 6 months old

A

true

(infrequent now with sevo)

440
Q

true or false

atropine CROSSES the BBB

A

true

441
Q

glycopyrollate

has MINIMAL BBB penetration
(mimimal CNS effects)

A

true

442
Q

true or false

physostigmine is NOT for NMB blocker

A

true

instead, it is used for central cholinergic syndrome and delirium

443
Q

narcan

brief 1/2 life, need to be monitored

neonates/children often need _______ doses

A

LARGE

444
Q

3 side effects of narcan

A

HTN
dysrhythmias
pulm edema

principles 3 (4 decks)

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