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Nur 943 OB > Exam 3 CHD 1-3 > Flashcards

Exam 3 CHD 1-3 Flashcards

1
Q

What is the most common form of congenital pathology?

A

Congenital Heart Disease (0.3-1.2% of live births)

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2
Q

What is the most common cardiac defect?

A

Bicuspid Aortic Valve (30% of all Congenital Heart Diseases, 1% of all life births)

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3
Q

What is the second most common cardiac defect?

A

VSD

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4
Q

What is the third most common cardiac defect?

A

ASD

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5
Q

What kind of lesion accounts for about 6% of all Congenital Heart Disease cases? And what disease is the one that predominates these types of lesions?

A

Cyanotic. Tetralogy of Fallot predominates.

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6
Q

What are some of the most common congenital heart diseases that people are surviving to adulthood with?

A 
Bicuspid Aortic Valve
Coarctation of the Aorta
Pulmonic Valve Stenosis
Ostium Secundum ASD
VSD
PDA
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7
Q

Chromosomal abnormalities are associated with ____% of congenital CV lesions. What are these (4)?

A

10%

Trisomy 21 (Down Syndrome)
Trisomy 13 (Patau Syndrome)
Trisomy 18 ( Edwards Syndrome)
Turner's Syndrome
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8
Q

Congenital Hear Diseases due to a defect in chromosome 22 are groups as “Catch 22” disorders. What does CATCH 22 Stand for?

A 
C- Cardiac Defects
A- Abnormal Facies
T- Thymic Hypoplasia
C- Cleft Palate
H- Hypocalcemia
22- The chromosome defect associated with these features.
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9
Q

What are the L to R shunt lesions?

A 
Atrial Septal Defects
Ventricular Septal Defects
Atrioventricular Canal Defects
Patent Ductus Arteriosus
Aortopulmonary Window
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10
Q

What are the R to L shunt lesions?

A

Tetralogy of Fallot
Ebstein’s Anomaly
Pulmonary Stenosis in conjunction with atrial or ventricular septal defects (high PVR causes R to L Shunt)
Eisenmenger’s Syndrome

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11
Q

What is the Transposition Physiology lesion?

A

Dextro-Transposition of the Great Arteries

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12
Q

What are the One-Ventricle Lesions?

A

Hypoplastic Left Heart Syndrome
Tricuspid Atresia
Double Inlet Left Ventricle

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13
Q

What are the Two-Ventricle Lesions?

A

Truncus Arteriosus
Tetralogy of Fallot with Pulmonary Atresia
Severe Neonatal Aortic Stenosis

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14
Q

Left Ventricular Obstructive Lesions

A 
Mitral Stenosis (Valvular, Cor Triatriatum)
Aortic Stenosis (Valvular, Subvalvular (Subarotic Membrane) Supravalvular (Williams-Beuren Syndrome)
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15
Q

Coarctation Lesions

A

Shone’s syndrome (mitral stenosis, aortic stenosis, coarctation)

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16
Q

Mixing of Systemic and Pulmonary Venous Blood with Series Circulation

A

Partial anomalous pulmonary Venous Return (PAPVR)

Total anomalous pulmonary Venous Return (TAPVR)

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17
Q

Tables GALORE

List the Lesions that cause Outflow Tract Obstruction

A

LV- Coarctation of the Aorta and Aortic Stenosis

RV- Pulmonic Valve Stenosis

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18
Q

Lesions causing L to R Shunting

A 
VSD
PDA
ASD
Endocardial cushion defect
Partial anomalous pulm. ven. return
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19
Q

Lesions causing R to L shunting

A 
TOF
Pulm. Atresia
Tricuspid Atresia
Transposition of the Great Arteries
Truncus Arteriosus
Single Ventricle
Double - Outlet RV
Total Anomalous Pulm. Ven. Return
Hypoplastic Left Heart
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20
Q

Volume overload Lesions

A 
ASD
VSD
AV Septal Defect
PDA
Truncus Arteriosus
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21
Q

Obstruction to Systemic Blood Flow

A

Aortic Stenosis
Coarctation of the Aorta
Interrupted Aortic Arch
Hypoplastic LH syndrome

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22
Q

Obstruction to Pulmonary Blood Flow

A

Pulmonary Stenosis
ToF
Pulmonary Atresia

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23
Q

Parallel Circulation

A

D- Transposition of the Great Arteries

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24
Q

Single Ventricle Lesions

A

Tricuspid Atresia
Double Inlet LV
Unbalanced AV Septal Defect

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25
Q

Intrinsic Myocardial Disorders

A

Cardiomyopathy

Myocarditis

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26
Q

What are the Cyanotic Defects?

A

TOF
Transposition of the Great Vessels
Hypoplastic Left Heart
Hypoplastic Right Heart

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27
Q

What are the acyanotic defects?

A

All the other ones that are not (TOF,TGV,HLH,HRH)

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28
Q

What are the 5 differences in Fetal and Adult Circulation?

A
  1. Placenta is the organ of respiration
  2. Fetal Circulation is parallel; adult is in series
  3. R-L shunting occurs across FO and DA
  4. PVR is high in fetus (lungs collapsed and full of fluid)
  5. SVR is low in fetal circulation (placenta is a large, low resistance vascular bed).
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29
Q

Acyanotic CHD is characterized by which type of shunt?

A

L to R Shunt

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30
Q

Pathophysiology of Acyanotic CHD (or L-R shunt)

A

Increased Pulmonary Blood Flow —> Increased PVR—> Intimal Hyperplasia and Vascular Remodeling

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31
Q

What is the end result of L-R Shunt (or Acyanotic CHD)

A

Pulmonary HTN, RVH, and CHF

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32
Q

Atrial Septal Defect (ASD) accounts for 1/3 of CHD in adults, it is 2-3x more frequent in _____

A

females

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33
Q

List the types of ASD

A 
Patent Foramen Ovale
Ostium Secundum
Ostium Primum
Sinus Venosus (near SVC or IVC junction)
Coronary Sinus
Common Atrium
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34
Q

Physiologic consequences of all ASDs are the same. Direction and Magnitude of shunt depends on __________&___________.

A

Size of Defect and Ventricular Compliance

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35
Q

Defect of ______ diameter has little to no effect.

A

<0.5cm

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36
Q

Defect of _____ diameter has large and significant effects.

A

> 2 cm

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37
Q

When pulmonary blood flow is ____x systemic blood flow, ASD should be closed.

A

1.5x

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38
Q

Symptoms of a large ASD includes:

A 
Dyspnea on Exertion
SVTs
RHF
Paradoxical Embolism
Recurrent Pulmonary Infections
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39
Q

Anesthetic considerations with surgical repair of ASD

A

GA with invasive monitoring

Access to CPB and ability to treat potential heart block

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40
Q

Anesthetic considerations with percutaneous (endovascular) repair of ASD

A

Deep Sedation or GA

Noninvasive or minimal monitoring

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41
Q

For surgical correction of ASD, extubation should occur (early or late)

A

Early- Most extubated in OR or early ICU. Use small doses of opioids or Remifentanil/Propofol Gtts.

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42
Q

Which type of Ventricular Septal Defect (VSD) is the most common (70-80%), known as conoventricular, perimembranous or infracristal, is associated with valvular aneurysms or insufficiency and located lower in septum, just below crista terminalis.

A

Type 2

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43
Q

What type of VSD is known as endocardial cushion, inlet or canal-type, accounts for 5% of VSDs, is a AV canal defect, and located below mitral and tricuspid valves.

A

Type 3

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44
Q

What type of VSD accounts for 10-20% of VSDs, known as “muscular”, associated with multiple lesions, located deep in muscular portion of septum and can have single to multiple perforations.

A

Type 4

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45
Q

Which type of VSD is known as conal, sub-arterial, supracristal outlet, subpulmonic or infundibular, account for 5% of VSDs, located high in the interventricular septum (just below the pulmonic valve above the crista terminalis), and is associated with aortic insufficiency.

A

Type 1

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46
Q

Which type of VSD typically occurs with Down Syndrome?

A

Type 3

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47
Q

What is the most common type of VSD and the incidence %.

A

Type 2, account for 70-80% of all VSDs

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48
Q

What PVR:SVR ratio is indicative for small VSD?

A

Qp:Qs 1.4:1 or less

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49
Q

What PVR:SVR ratio is indicative for moderately restrictive VSD?

A

Qp:Qs 1.4:1-2.2:1

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50
Q

What type of shunt is known as a restrictive shunt?

What Sx are associated with this type?

A

Small (1.4:1 or less) “the amount of the shunt is restricted by the size of the defect”. No Sx

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51
Q

What PVR:SVR ratio is associated with a nonrestrictive VSD?

A

Qp:Qs 2.2:1 or greater.

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52
Q

What Sx progression is associated with Moderatly to nonrestrictive VSD?

A

Equalization of RV and LV pressures —> Volume and Pressure Overload of Pulmonary System (Pulm HTN).
End Result: L-R Shunt becomes a R-L shunt which leads to hypoxia as blood bypasses the lungs.

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53
Q

Can surgical correction be performed in Pt with Nonrestrictive VSD?

A

None—Will cause RH failure. So best to correct early before disease progression.

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54
Q

What heart sound is associated with VSDs?

A

Holosystolic Murmur heard best at the Left Sternal Border.

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55
Q

What tests can help determine the severity of VSDs?

A

CXR- May show cardiomegaly
EKG- May show enlarged cardiac silhouette.
Echo- used to evaluate most to evaluate presence, directionality & severity of VSD

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56
Q

Anesthetic management concerns with VSD

A

Small (restricted) defect (<1.4:1) can be closed percutaneously.
Most undergo surgical closure

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57
Q

Post-surgical complications with VSD correction

A 
A-V block
V-Tach
CHF
Pulmonary HTN
Inotropic support may be needed
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58
Q

Atrioventricular Septal Defect (AVSD) is what type of VSD?

A

Type 3

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59
Q

AV Canal Defect, or Endocardial Cushion Defect is other names for

A

Atrioventricular Septal Defect (AVSD)

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60
Q

What are the two common types of AVSDs

A

Partial and Complete

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61
Q

Describe the two common types of AVSDs

A

Partial- Primum ASD with cleft in anterior MV leaflet

Complete- Large septal defect with atrial and ventricular components, common AV valve.

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62
Q

What 3 disorders are associated with AVSDs?

A

Trisomy 21
Tetralogy of Fallot
DiGeorge Syndrome

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63
Q

What type of shunt with AVSDs?

A

L to R shunt

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64
Q

AVSD is (cyanotic/acyanotic) disorder?

A

Acyanotic

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65
Q

What hemodynamic changes are associated with AVSDs?

A

AV valve regurgitation and Shunting (L to R)

Can result in Eisenmengers Syndrome (L to R –> R to L cyanotic shunting).

66
Q

Anesthetic Management with AVSD

A

Small defect w/o Mitral Regurg- Inhalation Induction
IV Induction use Ketamine 1-2mg/kg, Fentanyl 5-10mcg/kg, Rocuronium 1mg/kg
Maintenance-Volatile agents and narcotics
Emergence- Will probably require Postop Ventilation.

67
Q

More Anesthetic Management with AVSD

A 
Inotropes may be needed
Postop Pulmonary HTN may occur
TEE helpful in assessing repair
Heart Block may occur postop
Associated with Trisomy 21- So all anesthetic management needs for Down Syndrome
68
Q

Disorder where blood flows from the Aorta to the Pulmonary Artery (L to R Shunt)

A

Patent Ductus Arteriosus (PDA)

69
Q

Amount of shunt in PDA depends on:

A

Size of ductus, pressure difference between aorta & PA, & ratio between PVR & SVR

70
Q

Sx with mild moderate shunting with PDA:

A

asymptomatic

71
Q

Sx with large PDA shunt:

A

Ventricular hypertrophy & pulmonary hypertension

Leads to- Heart failure, failure to thrive, aneurysmal dilatation of ductus, Eisenmenger syndrome

72
Q

AVSDs are more common among

A

Down Syndrome (Trisomy 21)

73
Q

PDAs are more common among

A

Preterm Infants

74
Q

What is the 1st line Treatment for PDA?

A

Indomethacin (cyclooxygenase inhibitor, decreases the production of prostaglandins) (Prostaglandins keep the ductus open)

75
Q

Infants with PDA, who fail to respond to Indomethacin Tx, will require:

A

Surgical closure

76
Q

Preop requirement with surgical correction of PDA

A

Crossmatched blood available
Antibiotics
Vitamin K

77
Q

What are the perioperative risks associated with PDA repair?

A

Difficulty ventilating/desaturation; accidental extubation; tearing PDA; recurrent laryngeal nerve damage; phrenic nerve paralysis; chylothorax; ligation of aorta or PA; endocarditis; paradoxical air embolism

78
Q

Standard monitoring for PDA repair

A

2 pulse ox (1 right hand, 1 on lower ext)

1 BP cuffs (1 right arm, 1 on lower ext)

79
Q

Anesthetic management considerations with PDA repair

A

Have dedicated IV for fluids and drugs (Duh)
High-dose opioids are good option (30-50mcg/kg)
Muscle Relaxation
ETT with small air leak
Avoid Decreasing PVR, Myocardial Contractility and SVR
Use Dopamine to maintain BP

80
Q

Rule of Thumb with determining where to keep MAP for infants

A

Keep MAP equal to Gestational Age

81
Q

PDA repair induction agents

A

Ketamine 1-2mg/kg, Rocuronium 1mg/kg, fentanyl 2-5mcg/kg

or Sevo+N2O/O2 Inhalation induction

82
Q

Maintenance agent for PDA repair

A

Sevo or ISO

83
Q

Emergence from PDA repair

A

Older patient with isolated PDA may be extubated awake in OR. Most others and especially neonates will be kept on vent. postop.

84
Q

What is the major left-sided obstructive lesion occurring at valvular, subvalvular, supravalvular or a combination of these locations?

A

Aortic Stenosis

85
Q

Aortic Stenosis is frequently due to _________

A

Bicuspid Aortic Valve

86
Q

Aortic Stenosis is often _____ until adulthood

A

asymptomatic

87
Q

A mean aortic valve gradient of ___ mmHg is considered mild.

A

20

88
Q

A mean aortic valve gradient of ___mmHg is considered severe.

A

40

89
Q

Infants with severe aortic stenosis (which is usually subvalvular) will have these problems

A

Feeding Difficulties
Poor Growth
Heart Failure

90
Q

Supravalvular Aortic Stenosis is associated with

A

Round forehead, prominent facial bones, pursed upper lip and Williams syndrome

91
Q

Both Subvalvular and Supravalvular Lesions have a high risk of

A

Sudden Death under Anesthesia

92
Q

Patho of Aortic Stenosis

A

O2 Supply/Demand Imbalances, LV Hypertrophy and LV Failure.
Impaired coronary blood flow d/t low CPP and increased workload on LV —> ischemia

93
Q

The ____ ventricle is more sensitive to afterload than the ____ ventricle.

A

The RIGHT ventricle is more sensitive to afterload then the LEFT ventricle.

94
Q

What are the 4 types of Pulmonic Stenosis?

A

Valvular Pulmonary Stenosis
Supravalvular Pulmonary Stenosis
Subvalvular (infundibular) Pulmonary Stenosis
Branch Peripheral Pulmonary Stenosis

95
Q

Pulmonary artery just above pulmonary valve is narrowed. Associated with ASD, VSD, PDA, and ToF.

A

What is Supravalvular Pulmonary Stenosis?

96
Q

Valve leaflets art thickened and/or narrowed. Usually occurs in isolation of other congenital issues.

A

What is Valvular Pulmonary Stenosis?

97
Q

Right or Left Pulmonary Artery (or both) is narrowed

A

What is Branch Peripheral Pulmonic Stenosis?

98
Q

Muscle under valve area is thickened, narrowing tract from the RV. Associated with VSD.

A

What is Subvalvular (infundibular) Pulmonary Stenosis?

99
Q

_______ Gradient is used for classification of Pulmonary Stenosis Classification, rather than Mean Gradient.

A

Peak Gradient

100
Q

Peak Gradient that is associated with Mild Pulmonic Stenosis.

A

<36

101
Q

Peak Gradient that is associated with Severe Pulmonic Stenosis?

A

> 64

102
Q

List the Signs Sx of Pulmonic Stenosis and what will heard on auscultation and seen on ECG.

A

Sx- Right sided HF Sx (Dyspnea, JVD, Peripheral Edema and Asities)
Auscultation- Systolic Ejection Murmur at 2nd ICS
ECG- Right Ventricular Hypertrophy

103
Q

Anesthetic Management of Pulmonic Stenosis

A

CPB or Valvuloplasty

Avoid Increases in RV O2 Requirements

104
Q

Narrowing of the Aorta, close to the Ductus Arteriosus

A

What is Coarctation of the Aorta?

105
Q

What are the 3 forms of Coarctation of the Aorta

A

Preductal
Juxtaductal
Postductal

106
Q

Coarctation of the Aorta is more common in (Males or Females)?

A

Males

107
Q

What is the most common (NEONATAL) form of Coarctation of the Aorta?

A

Preductal

108
Q

What is the most common form of Coarctation of the Aorta? (Silly but yet in the slides)

A

Postductal

109
Q

What type of Coarctation of the Aorta is associated with minimal collateral blood flow below coarctation and requires prostaglandin to maintain PDA?

A

Preductal

110
Q

What types of CoA does have collateral blood flow below the coarctation?

A

Juxtaductal and Postductal

111
Q

CoA accounts for ___% of all CHDs.

A

5% (so stupid)

112
Q

Which group has the most adverse outcomes of CoA?

Neonatal or >1 year

A

Neonatal

113
Q

Coa= Few Collaterals, poor LV function, weak femoral pulses, and progressive acidosis? (neonatal or > 1 year)

A

Neonatal

114
Q

All forms of CoA have adverse effects, list them all:

A 
Systolic HTN
CHF
Aortic Dissection
Premature CAD
Intracerebral Hemorrhage (aneurysm rupture)
115
Q

Sx/Signs of CoA

A

Headache, Dizziness, Palpitation, Epistaxis
On exam: BP changes between upper and lower ext, widened pulse pressure, and diminished femoral pulse.
Newborn: selective cyanosis of lower extremities but with pink upper extremities and face.

116
Q

CoA- Auscultation, BP, ECG, and CXR findings

A

Murmur along LEFT STERNAL BORDER
Different BP in Right Arm and Left Leg
LVH on ECG
Notching in posterior part of ribs (d/t increased collateral BF in the intercostal arteries) on CXR
Possibly see “Reversed E sign” on CXR (from coarctation and post stenotic dilatation)

117
Q

Definitive Dx for Coa

A

Ultrasound, CT, MRI

118
Q

Discuss Repair strategies with Coa

A

Done in infancy or early childhood before HTN develops- (if done after HTN, it may continue)
Repair can be done Percutaneously or Surgically
Percutaneously: Balloon Dilatation and Stent placement
Surgically: Patch or end to end Anastomosis
No CPB, but High Aortic Cross Clamp- managing 2 circulations.

119
Q

Coa- IV access needs?

A

One for IV induction drugs

One for Prostaglandin E1

120
Q

Surgical Approach for CoA?

A

Left Thoracotomy

121
Q

Infants are cooled to a temp of ____ C to reduced spinal cord injury in CoA repair.

A

34-35 C

122
Q

Most common Nerve Injury with CoA?

A

Left Laryngeal Nerve- Presents with Horseness or Stridor

123
Q

Phrenic nerve injury is not as common during COA repair, but if occurs, can mean ______ may be needed.

A

Ventilatory support

124
Q

CoA Induction for Neonate

A

Fentanyl 2-5mcg/kg IV, Roc 0.6-1 mg/kg IV
Low dose Isoflurane (0.3-0.5% if tolerates)
(Maintain HR, Preload, & Contractility to maintain CO)
Avoid Increases/Decreases in SVR and Avoid Myocardial Depression

125
Q

Maintenance of Neonate for CoA (Fentanyl dose and what to do with prostaglandin).

A

Fentanyl 10-20mcg/kg, volatile agent, continue prostaglandin.

126
Q

Emergence considerations with CoA
Keep SBP < ______
Consider ____ and _____ if cardiac function compromised.
Will require postop _____ . ______ tubes will be in place.

A

SBP < 120
dopamine and milrinone
ventilation
chest

127
Q

Older children with CoA are (sicker/not as sick) as the neonate

A

not as sick- but will require same vascular lines and same precautions to protect spinal cord during CoA repair.

128
Q

CoA- Treat postop HTN with

A

Nitroprusside and B-Blockers

129
Q

Use cuffed tube with older children b/c extubation occurs______, compared to the neonate.

A

early

130
Q

ToF, Truncus Arteriosus, Tricuspid Atresia, Hypoplastic Left Heart Syndrome, Anomalous Pulmonary Venous Connection and Eisenmenger syndrome are what types of CHD?

A

Cyanotic

131
Q

Major characteristic of Cyanotic CHDs? (shunt direction and outcomes)

A

Right to Left Shunt–> Decreased pulmonary blood flow and hypoxia.

132
Q

Severity of hypoxemia is determined by

A

pulmonary to systemic blood flow (Qp:Qs<1)

133
Q

Associated problems with cyanotic CHDs

A

Erythrocytosis and Hyperviscosity
May have abnormal coag studies
HF, Pulm. HTN, Dysrhythmias, Dec lung compliance, altered response to hypoxia and hypercarbia, renal insufficiency.

134
Q

What is the Most Common CYANOTIC Lesion?

A

Tetralogy of Fallot (ToF) accounts for 6-11% of all CHDs

135
Q

What are the 4 features of ToF?

A
  1. Perimembranous VSD
  2. Aorta Overriding VSD
  3. RVOTO
  4. RVH
136
Q

What are the 5 features of Pentrology of Fallot?

A
  1. Perimembranous VSD
  2. Aorta Overriding VSD
  3. RVOTO (aka pulmonary stenosis)
  4. RVH
  5. ASD
137
Q

4 major defects of To4 (same as the features, but worded better from another slide)

A
  1. Pulmonary Stenosis (RVOTO)
  2. RVH
  3. Overriding Aorta
  4. VSD
138
Q

Spell or Episodes associated with ToF

A

Tet Spells (Hypercyanotic Episodes)

139
Q

Classic presentation of Tet Spells (Hypercyanotic Episodes)

A

Cyanosis, Hyperpnea, Possible LOC, Stroke, Seizures, or even Death.

140
Q

Tet Spells (Hypercyanotic Episodes) occur ding periods of _____

A

Stress (crying, feeding, exercise, surgical stress, and anesthesia.

141
Q

Proposed mechanism of Tet Spells

A

Spasm of the infundibular portion of the RVOT along with peripheral vasodilation and hyperventilation.

142
Q

Susceptible period for Tet Spells?

A

2-3 months, however, can occur anytime during 1st year of life.

143
Q

Squatting causes what during Tet Spells

A

Increased Peripheral Vascular Resistance and Decreased R to L Shunting.

144
Q

Management of Tet Spells:

A 
Phenylephrine 100mcg/ml, initial dose 0.5-1.0mcg/kg
100% O2
IV Fluid Bolus
Sedation/Analgesia
NaHCO3
Vasoconstrictors
Beta-blockers
145
Q

Additional Management of Cyanotic Spell (as from the chart)

A 
Moist O2 Inhalation
Knee Chest
Morphine Sulphate 0.1-0.2mg/kg. IM/IV
IV Propanolol 0.5mg/kg
NaHCo3 (0.02mg/kg)
Phenylephrine 0.02mg/kg
Ketamine 1-3mg/kg IV
Gen. Anesthesia
Emergency Surgical Intervention
146
Q

Surgical Management for ToF

A

Trend is early repair

Initial palliation surgery sometimes performed- Appoach is Thoracotomy, but can be sternotomy…with no CPB.

147
Q

Anesthetic Goals for TOF

A

Maintain intravascular volume and SVR.

Avoid Increased PVR, especially from acidosis and excessive AW pressures. Ketamine is often used.

148
Q

Postoperative Course for ToF

A

Potential for pulmonary reguritation
PFO sometimes left open as a “pop-up” valve to reduce RV pressures
RBBB is common

149
Q

The palliative surgical Tx for ToF is the

A

Systemic to Pulmonary Shunt (Modified Blalock-Taussig Shunt)

150
Q

Explain the Systemic - to - Pulmonary Shunt (Modified Blalock-Taussig Shunt)

A

Shunt from subclavian artery to branch pulmonary artery

151
Q

What is always a risk during induction for these kids?

A

Hypercyanotic Spell During Induction

152
Q

With TOF, avoid muscle relaxants that causes _____ release.

A

Histamine

153
Q

TOF Tx- Place arterial line NOT ON THE SIDE where ________.

A

Shunt will be placed. Subclavian Artery will be clamped and pressure tracing will be lost.

154
Q

Avoid _____ during ToF repair

A

Hypercarbia (This increases PVR and increases the R to L shunt)

155
Q

Too much inotrope in ToF can worsen _____ postop.

A

RVOTO

156
Q

_______ and ________ may precipitate Junctional Tachycardia

A

Pyrexia and Excessive Beta Adrenergic Stimulation

157
Q

Best Inhalation Induction Agent with ToF?

A

Sevo

158
Q

Best IV Induction Agent with ToF?

A

Ketamine 1-2mg/kg, Fentanyl 10mcg/kg, Roc 1mg/kg

159
Q

Maintenance during ToF correction?

A

Iso or Sevo, Maintain Preload, HR, Contractility, and Treat Hypercyanotic Spells.

160
Q

ToF surgery will probably need what postop?

A

Postop Ventilation.

Nur 943 OB (11 decks)

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