Exam 3 - Review Flashcards
fasting clear liquids
2 hours
fasting breast milk
4 hours
fasting infant formula
6 hours
fasting solid (fatty or fried foods)
8 hours
0–6 months age specific anxiety
Maximum stress for parent Minimum stress for infants—not old enough to be frightened of strangers
6 months–4 years age specific anxiety
Maximum fear of separation Not able to understand processes and explanations Significant postoperative emotional upset and behavior regression Begins to have magical thinking Cognitive development and increased temper tantrums
4–8 years age specific anxiety
Begins to understand processes and explanations Fear of separation remains Concerned about body integrity
8 years–adolescence age specific anxiety
Tolerates separation well Understands processes and explanations May interpret everything literally May fear waking up during surgery or not waking up at all
Adolescence age specific anxiety
Independent Issues regarding self-esteem and body image Developing sexual characteristics and fear loss of dignity Fear of unknown
if a child has a history of squatting what might there be a concern for?
asthma cardiovascular problems
Sickle cell disease needs
hydration, possible transfusion
The major objectives of pre-anesthetic medication are to
(1) allay anxiety (2) block autonomic (vagal) reflexes (3) reduce airway secretions (4) produce amnesia (5) provide prophylaxis against pulmonary aspiration of gastric contents (6) facilitate the induction of anesthesia (7) if necessary, provide analgesia.
premedication decrease the stress response to anesthesia by preventing what
cardiac arrhythmia
Factors to consider when selecting a drug or a combination of drugs for premedication include: 6 things
childs age idea body weight drug history and allergic status underlying medical or surgical conditions and how they might affect the response to premedication or how the premedication might alter anesthetic induction parent and child expectation the childs emotional maturity personality, anxiety level, cooperation, and physiologic and phychological status.
diazepam oral dose rectal dose
0.1-0.5mg/kg 1mg/kg
midazolam oral dose nasal dose rectal dose intramuscular dose
0.25-0.75mg/kg 0.2mg/kg 0.5-1mg/kg 0.1-0.15mg/kg
lorazepam oral dose
0.025-0.05mg/kg
ketamine oral dose nasal rectal IM
3-6mg/kg 3mg/kg 6-10mg/kg 2-10mg/kg
benzodiazepines - as premedication- why do we use preservative free for nasal administration
due to fears of neurotoxicity
recommended doses of anticholinergics are
atropine 0.01-0.02mg/kg scopolamine 0.005-0.010mg/kg glyco 0.01mg/kg
why is atropine more commony used
blocks the vagus more effectively
when is scopolamine better
sedative, antisialagogue and amnestic
when is glycopyrrolate better to be used
sialorrhea associated with ketamine
if a child is seated on a parents or anesthesiologist lap during induction what is strongly recommended
this should be undertaken when the child is wearing diapers or sitting on a thick blanket
how do you engage the child and help make them feel less vulnerable during induction
have the child pick out a favorite lip balm have them seated on the or table distract them by telling them to blow up the balloon and taking deeper and deeper breaths.
airway obstruction during anesthesia is due to
loss of muscle tone in the pharyngeal and laryngeal structures rather than apposition of the tongue to the posterior wall
extension of the head at the atlantooccipital joint with anterior displacement of the cervical spine sniffing position improves hypo pharyngeal airway potency but does not necessarily change the position of
the tongue
what is the most effective means to improve airway latency and ventilation in children undergoing adentonsillectomy
jaw thrust
what is the concern with laryngospasm in children
life threatening complications
what are the factors associated with laryngospasm
Age: greater in infants than older children and adults; the risk decreases with increasing age Recent URTI (<2 weeks) History of reactive airway disease Exposure to second-hand smokeAirway anomalies Airway surgery Airway devices (tracheal tubes, LMA) Stimulating the glottis during a light plane of anesthesia Secretions in the oropharynx (e.g., blood, excess saliva, gastric juice) Inhaled anesthesia (desflurane and isoflurane) Inexperienced anesthesia provider
if its a short or long pediatric case can you use regular rubing
no! just because its a short case you should never use regular tubing.
If positive pressure ventilation, 100% oxygen, and jaw thrust maneuver fail to break the laryngospasm, further intervention should be undertaken before desaturation and bradycardia develop. Appropriate treatment would include in the following order
IV or IM atropine (0.02 mg/kg), IV propofol (1 mg/kg), and IV or IM succinylcholine (1 to 2 mg/kg IV or 4 to 5 mg/kg IM).
For third-space losses,
the replacement volume is based on the severity of the losses: 1 to 2 mL/kg/hr for minor surgery, 2 to 5 mL/kg/hr for moderate surgery, and 6 to 10 mL/kg/hr for major surgery and large third-space losses.
how much balanced salt solution should be administered to a child for every 1 ml of fluid lost.
Initial blood loss may be replaced with balanced salt solution at a rate of 3 mL of solution for every 1 mL of blood loss.
parental anxiety may be most extreme with children what age?
<12 mos
the fear of death is greatest in :
teenagers/ adolescent (13-19 yr o)
in peds, the larynx has a higher position in
the neck.
the narrowest portion of the larynx in ped patients
the cricoid cartilage (as opposed to the VC’s in adults)
Full term neonates require higher or lower concentrations of volatiles than infants 1-6 mos of age do?
lower *younger the greater their metabolic rate
MAC in preterm neonates increases or decreases with decreasing gestational age?
decreases
MAC steadily increases until what age:
2-3 mos
After 3 mos, MAC steadily
declines with age *there is a slight increase at puberty
Neonates and infants require more succinylcholine on a ______ basis than do older children to produce similar degrees of neuromusculuar blockade b/c of :
-more sux per kilogram basis -the increased ECF volume and larger volume distribution
sux is limited to cases requiring
RSI and tx of laryngospasm b/c of risks for bradycardia and MH
uptake of inhaled anesthetics is more rapid in infants than older children or adults b/c of the infants
high alveolar ventilation relative to FRC
Protein binding of many drugs in decreased in infants which can result in
high circulating concentrations of UNBOUND and pharmacologically active drugs
as a group, low gestation age NB’s have immaturity of all organ systems and represent the most vulnerable of all peds patients with the highest
morbidity and mortality
surfactant is produced by
Type 2 pneumocytes
surfactant does
reduces alveolar surface tension -helps maintain alveolar stabiltiy
RDS is apparent within
minutes of birth
during anesthesia, arterial O2 saturation should be maintained near pts
pre-op levels *100% before = 100% during
goal HCT to optimize systemic O2 delivery
40% (but you might see something like 45%)
excessive hydration should be avoided; so use colloids over crystalloids. whats the replacement ratio?
3:1
Bronchopulmonary dysplasia (BPD) is a form of
chronic lung disease of infancy
the canalicular phase of lung development is at how many weeks?
24-26 weeks
BPD is a clinical dx defined as
-O2 dependence at 36 weeks post conceptual age or -O2 requirement to maintain PaO2 > 50mmHG beyond 28 days of life in infants with birth weights of less than 1500g
BPD tx is to maintain oxygenation of: why? prevents and promotes what?
PaO2 > 55 mmHG and O2 sat >94% prevents cor pulmonale (RHF) and promote growth of lung tissue and remodeling of pulmonary vascular bed
IN children w/a hx of mechanical ventilation, an ET one to one half size smaller than that predicted for age should be use because:
subglottic stenosis may be present
in the preterm newborn, airway hyperreactivity is likely. what plane of anesthesia must be established before airway instrumentation?
deep plane
in the preterm newborn, fluids should be administered judiciously to avoid
pulmonary edema
This dx is a congenital or acquired condition of excessive flaccidy of the laryngeal structures; specifically the epiglottis and arytenoids
Laryngomalacia
Laryngomalacia is associated with
-excessive flaccidy of the laryngeal structures -epiglottis -arytenoids
Cause of Laryngomalacia
-lack of neural control of laryngeal muscles or - from pressure on the laryngeal cartilage which leads to inadequate laryngeal rigidity and thus structural collapse during inspiration and exhalation
Bronchomalacia is seen in infants who had a prolonged stay
in the NICU
Key Difference b/w Laryngomalacia and Bronchomalacia:
-Laryngomalacia: congential -Bronchomalacia: NICU exposure
the cartilage of the major airways is weak, and when infants with this condition bear down, the airways can become partially/completely compressed. This is known as
bronchomalacia **generally associated with BPD
Retinopathy of prematurity (ROP) is a vasoproliferative retinopathy that occurs almost exclusively in
preterm infants in whom retinal vasculogenesis is incomplete
Most cited cause of ROP is exposure to
elevated tension of oxygen -injuring the developing retinal capillaries
Two phases of ROP:
phase 1 : oxygen toxicity to immature retina causes an arrest of normal vascularization phase 2: increased metabolic demand of the growing retina is met w/relative hypoxia caused by the paucity of blood vessels
ROP is classified into 5 stages of severity. What are the mildest and most severe forms?
stage 1 - mildest. a clear demarcation b/w vascular and avascular portions of the retina. stage 5 - most severe. complete retina detachment
TX for ROP
transscleral cryotherapy and laser photocoagulation
Cause for the most anxiety*** in children age 1-5yrs
Shy temperament
Just as RDS is a result of immaturity of the pulmonary system, apnea of prematurity (AOP) is a result of immaturity of the respiratory control centers in the newborn
brainstem
primary AOP (apnea of prematurity) versus central AOP. difference?
Primary - respiratory Central - neurological
the mainstay of drug therapy for AOP
Methylxanthines
Various forms of methylxanthines used include
aminophylline, caffeine, and caffeine citrate
Postanesthetic apnea is seen mostly in infants born
preterm (where preterm birth is defined as birth at <37 weeks of gestation)
one of the most significant risk factors for postanesthetic apnea
a hematocrit of less than 30%
the most common metabolic problem occurring in newborn infants ***
Hypoglycemia is
Many neonates whose serum glucose levels are at or just below the lower limits of the normal range are
asymptomatic