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Nur 943 OB > FINAL 1 > Flashcards

FINAL 1 Flashcards

1
Q

Ex-Premature infants are infants born:

A

<37 weeks gestation and <60 weeks postconceptional age.

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2
Q

These premature infants will need _____ hours post-op monitoring for apnea and desaturation

A

12-24

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3
Q

3 Factors that Increase the risk of postop apnea

A

<60 weeks post-conceptual age
Anemia (Hgb < 12)
Secondary Diagnoses (like intraventricular hemorrhage)

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4
Q

Do you want to give opioids to ex-premature infants?

A

nope

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5
Q

Caffeine ____mg/kg IV given intraoperatively can reduce the frequency of apnea

A

10mg/kg

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6
Q

These infants at risk of post-op apnea can be discharged _____ hours after free from apnea

A

12 hours

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7
Q

Does reginal anesthesia increase risk of post-op apnea?

A

No- so, they will not require extended monitoring, only ones under sedation or GA.

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8
Q

Abnormality of Tricuspid Valve where septal and often posterior leaflets are displaced into the RV

A

Ebstein’s Anomaly

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9
Q

Ebstein’s Anomaly (if occurs in isolation) is considered what type of lesion?

A

Acyanotic. But most will have a ASD or PFO and blood will be shunted R to L, causing cyanosis.

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10
Q

Ebsteins Anomaly can have ____ outflow tract obstruction

A

RV

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11
Q

Ebstein’s Anomaly- Tricuspid valve is usually _____ but may be _____

A

Regurgitant, Stenotic.

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12
Q

Result of Ebstein’s Anomaly

A

RA is Dilated and RV is atrialized with reduced RV cavity

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13
Q

Sx of Ebstein’s Anomaly in Neonates:

A

Presents as systemic venous congestion and cyanosis which worsens AFTER ductus arteriosus closes, which leads to decreased pulmonary blood flow

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14
Q

Ebstein’s Anomaly- Anterior valve leaflet is ____ and ___-like, with chordal attachments to the ____ free wall

A

elongated, sail-like.

Chordal attachments to RV free wall

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15
Q

Older children are diagnosed with Ebsteins Anomaly bc/ ________ is found

A

incidental murmur

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16
Q

Adolescents and adults with Ebsteins Anomaly will have

A

SVT causing CHF, worsening cyanosis and occasional syncope.

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17
Q

Patients with Ebsteins Anomaly are at risk for (4 items)

A

Paradoxical Embolization
Brain Abscess
CHF
Sudden Death

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18
Q

Classic Signs/Sx of Ebstein’s Anomaly

A

Cyanosis-depends on degree of R-L shunt
Systolic Murmur- (Left Lower Sternal Border)
Hepatomegaly (d/t hepatic congestion from CHF)
ECG=Tall, broad P waves, possible 1st degree AVB
PST and VT
20% have W-P-W
Echo=Cardiomegaly, R heart can compress lungs and become “restrictive” heart disease.

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19
Q

Treatment for Ebsteins’s Anomaly

A

Controversial- may do tricuspid valve repair, Fontan procedure or transplant.

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20
Q

Treatment of EA in older patients

A

Prevent associated complication like infective endocarditis, CHF and SVT.
Repair or replace the tricuspid valve and repair the ASD

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21
Q

Complications of EA repair

A

3rd degree AVB
SVT
Residual Tricuspid Regurg
Prosthetic Valve Dysfunction

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22
Q

EA- may be a _____ effect of IV anesthetics

A

delayed. d/t pooling and dilution of blood in the RA

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23
Q

3 Major Hazards with anesthetic management of EA.

A

Depressed RV function and forward flow
Hypoxia d/t increased R-L shunt
SVTs

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24
Q

Anesthetic goals with EA management (ventilation and cardiac)

A

Minimize mechanical and metabolic affects of ventilation

Maintain RV contractility

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25
Q

What is the most common chromosomal disorder?

A

Down Syndrome (Trisomy 21)

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26
Q

3 most common cardiac anomalies with Down Syndrome

A

Complete AV canal defect
VSD
ASD
(Others include TOF and PDA)

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27
Q

All of the cardiac anomalies with Down Syndrome have the propensity for

A

increased pulmonary blood flow (Pulm. HTN)

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28
Q

1 of the most common clinical features with DS

A

Hypotonia (weak muscle tone) can affect patency of airway.

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29
Q

Issues with DS that adds to risk of upper aw obstruction

A

Large Tongue
Short Neck
Crowded Midface
Laryngomalcia (congenital softening of the tissues of the larynx, above the vocal cords).

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30
Q

DS Pts have increased incidence of subglottic and tracheal ______. So ETT size may need to be ____

A

Stenosis

Smaller

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31
Q

DS Pts need cervical xrays to assess_____

A

Ligamentous Laxity of Atlantoaxial Joint (Atlanto-Axial Instability)

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32
Q

DS: Postpone the case I atlantodens interval is _____ on cervical x-ray

A

> 5mm

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33
Q

Normal Alantodens interval for Adult and Child

A

Adult < 3mm

Child<4.5mm (<5mm on next slide)

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34
Q

DS: Keep head and neck in _____ position

A

neutral

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35
Q

What do you know about C1?

A

“Atlas”
Ring shaped
Does not have a body

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36
Q

What do you know about C2?

A

“Axis”

Has fused remnants of the atlas body called the “Odontoid Process” or “Dens”

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37
Q

What is the Alantodens interval (ADI)?

A

Distance between the odontoid process and the posterior order of the anterior arch of the atlas.

38
Q 
Downs Syndrome Chart
\_\_\_\_ birth weight
\_\_\_\_\_ stature
Congenital \_\_\_\_ Disease
\_\_\_\_\_ susceptibility to pulmonary HTN
\_\_\_\_\_\_ Sensitivity
High arched narrow \_\_\_\_\_
\_\_\_\_\_glossia
\_\_\_\_\_gnathia
Subglottic \_\_\_\_\_
Postextubation \_\_\_\_\_
Upper airway \_\_\_\_\_\_\_- Sleep Apnea
A 
Low birth weight
Short stature
Congenital Heart Disease
Increased susceptibility to pulmonary HTN
Atropine Sensitivity
High arched narrow palate
Macroglossia
Micrognathia
Subglottic Stenosis
Postextubation stridor
Upper airway obstruction- Sleep Apnea
39
Q 
More DS Chart
Dental \_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_ obstruction
Gastroesophageal \_\_\_\_
H\_\_\_\_\_\_\_ Disease
Mental \_\_\_\_\_\_\_
Ep\_\_\_\_\_y
St\_\_\_\_\_\_s
\_\_\_\_\_tonia
\_\_\_\_\_\_extensibility or flexibility
D\_\_\_\_\_\_ pelvis
Alantoaxial \_\_\_\_\_\_\_\_
Neonatal poly\_\_\_\_\_\_
Low circulating levels of \_\_\_\_\_\_\_\_\_\_\_
Hypothyroidism
A 
Dental Abnormalities
Duodenal obstruction
Gastroesophageal reflux
Hirschprung Disease
Mental Retardation
Epilepsy
Strabismus
Hypotonia
Hyperextensibility or flexibility
Dysplastic pelvis
Alantoaxial subluxation
Neonatal polycythemia
Low circulating levels of catecholamine
Hypothyroidism
40
Q

In utero, abdomen swells with fluid and is resorbed by birth leaving wrinkled abdomen.

A

Prune Belly Syndrome

41
Q

Prune belly associated with _____hydramnios and urethral ________

A

Oligohydramnios

Urethral Obstruction

42
Q

Prune Belly Syndrome occurs mostly with ______(m/f?)

A

Males

43
Q

Is Prune Belly associated with other defects?

A

Yes
50% Orthopedic involvement
30% GI involvement
10% Congenital Heart Disease and Chromosomal defects

44
Q

Describe patho of Prune Belly Syndrome as it leads to aspiration pneumonia.

A

Abdominal overdistention in utero leads to
Weak rectus abdominis which interferes with infants ability to EXHALE FORCEFULLY. Leading to
inability to cough and clear secretions, leading to
Aspiration Pneumonia

45
Q

What is a frequent GI problem with Prune Belly Syndrome.

A

Constipation. Will often need stool softeners.

46
Q

Prune Belly associated with Trisomy ____, and contradictory to previous knowledge, is now associated with 60-80% _____(m/f?)

A

18

Females

47
Q

Discuss the 3 types of Prune Belly Syndrome Classifications

A

Type 1: Severe Renal Disease, or pulmonary hypoplasia or both. Incompatible with survival
Type 2 Neonatal Emergencies with severe uropathy and UTI. Requires multiple surgeries
Type 3 Minimal problems as newborn
Pro to infections in later childhood

48
Q

Which type of PBS is associated with neonatal emergencies with severe uropathy and UTI. Will required several surgeries

A

Type 2

49
Q

Which type of PBS is associated with minimal problems as a newborn but prone to infections later in childhood

A

Type 3

50
Q

Which type of PBS is associated with severe renal disease, or pulmonary hypoplasia or both and incompatible with survival?

A

Type 1

51
Q 
Anesthetic management of PBS
Avoid preop \_\_\_\_\_\_\_\_
Use H2 \_\_\_\_\_\_\_ and sodium \_\_\_\_\_\_
\_\_\_\_\_ intubation or \_\_\_
Avoid \_\_\_\_\_\_ relaxants
Minimal \_\_\_\_\_\_
Avoid drugs requiring \_\_\_\_\_ excretion
Controlled \_\_\_\_\_\_\_
Maintenance - inhalation or IV
\_\_\_\_\_\_ extubation
Reginal anesthesia may be \_\_\_\_\_\_
A 
Avoid preop sedation
Use H2 antagonist and sodium citrate
Awake intubation or RSI
Avoid muscle relaxants
Minimal opioids
Avoid drugs requiring renal excretion
Controlled ventilation
Maintenance - inhalation or IV
Awake extubation
Reginal anesthesia may be preferred
52
Q

Pierre Robin is characterized by (3 things (R.A.G))

A

Retrognathia (posterior position of the mandible)
Airway Obstruction
Glossoptosis (tongue falling to back of throat)

53
Q

Sequence (not syndrome) of fixed fetal position in the uterus inhibiting mandibular growth leading to small mandible and subsequent airway obstruction.

A

Pierre Robin

54
Q

Pierre Robin is often associated with ______ syndrome

A

Stickler

55
Q

Stickler syndrome characteristics (3 things)

A

Micrognathia
Poor Vision
Collagen disorder with hyperflexible Joints

56
Q

PR also associated with

A

velocardiofacial syndrome
fetal alcohol syndrome
bilateral hemifacial microsomia

57
Q

PR will always have some sort of ______ obstruction and may need to have _____ or _____ position to relieve.

A

airway

lateral or prone position

58
Q

PR often have _____ and ______ difficulties (GI)

A

reflux and feeding difficulties

59
Q

Surgical management options for Pierre-Robin (3 options)

A

Tongue-lip adhesion
Mandibular distraction
Tracheostomy

60
Q

Tongue Lip adhesion involves

A

Suturing the inferior portion of the tongue to the lower lip. Relieves AW obstruction and improves feeding. Will need several days postop ventilation. Left intact until child is about a year old

61
Q

Mandibular distraction is performed in infants ____ months old

A

< 6

62
Q

Tracheostomy for PR takes an average of ____ years for decannulation

A

3

63
Q

Pierre Robin are usually difficult mask ventilation and intubation. What techniques should you be prepared to employ? (4)

A

LMA
Nasal Intubation
Video Laryngoscopy
Suture (o-silk) placed at base of tongue to displace tongue anteriorly

64
Q

Tongue-lip adhesion or mandibular distraction will require _____ intubation, _____induction with ____ventilation.

A

nasal
inhalation
spontaneous

65
Q

Tongue-lip adhesion will require postop_____, then to ICU, but extubate back in the _____

A

ventilation

OR- so that you can readily reintubate if needed

66
Q

Mandibular distraction will have difficulty with ______ ventilation because of the distractors

A

mask- distractors prevent effective mask ventilation

67
Q

Cleft lip is usually repaired at age_____

Cleft palate is usually repaired at age ____

A

3-6 months

9-18 months

68
Q

Technique used to repair hard/soft palates. Usually done before _____ year old

A

Palatoplasty

1 year old

69
Q

Technique used to repair/treat incompetent velopharyngeal sphincter that allows inappropriate nasal air to escape during speech. Done between ___ and ____ years of age

A

Pharyngoplasty

5-15 years of age

70
Q

Clefting AW management is usually straightforward.

Factors that predict difficult laryngoscopic view (2)

A

Blilateral Clefts

Retronathia

71
Q

GA with clefting- remain ______ breathing until trachea is secure

A

spontaneous

72
Q

Beware using _____ in patients with cleft repair because potential for disruption of repair.

A

LMA

73
Q

This type of ETT is preferred for patients with a cleft.

A

Oral RAE

74
Q

Due to the fixed length of the Oral RAE, there is an increased risk of _________ intubation

A

mainstem

75
Q

For Palate surgery keep MAP ________

A

50-60 to reduce risk of bleeding

76
Q

Palate surgery- surgeon infiltrates palate with epinephrine. What is a safemaximal dose?

A

10mcg/kg for infiltration

77
Q

Palate correction surgery is long so

A

positioning and padding is critical.

Protect infant’s chest and extremities

78
Q

Main concern postop for palate repair?

Confirm removal of _____

A

Postop airway obstruction

Throat pack

79
Q

Palate repair has risk for tongue, palate and pharyngeal ______. If this occurs, best to:

A

edema

reintubate and mechanically ventilate for a few days until edema subsides

80
Q

Rectal dose of Acetaminophen

A

20-40mg/kg initially

followed by 20mg/kg Q6H

81
Q

Oral dose of Acetaminophen

A

10-15mg/kg Q 4-6 hours

82
Q

Morphine dose IV

A

0.02mg/kg IV q 3-4 hours

83
Q

Reginal technique used for cleft palate repair pain control. What nerve does this block and what sensory does this nerve provide?

A

Bilateral Infraorbital nerve block
Maxillary division of trigeminal nerve that exits infraorbital foramen and supplies sensory to the upper lip, choana, maxillary sinus and part of the nasal septum

84
Q

Craniofacial defect characterized by poorly developed supraorbital ridges, aplastic/hypoplastic zygomas, ear deformities, hearing loss, cleft palate (in 1/3), mandibular and midface hypoplasia

A

Treacher Collins Syndrome

85
Q

Another name for Treacher Collins Syndrome

A

Mandibulofacial dysostosis

86
Q

TC is associated with mutation on chromosome ____

A

5

87
Q

AW is always a concern with TC and obstruction depends on (3 things)

A

Degree of Maxillary and mandibular hypoplasia
Choanal Atresia
Glossoptosis

88
Q

TC: trach may be needed for those at risk for

A

OSA and SIDS

89
Q

TC may be difficult to mask or intubate.

Techniques used for success?

A

Bullard Laryngoscopy
LMA
Glidescope
Sedation and fiberoptic intubation

90
Q

TC- make sure you protect the patient’s ____

A

Eyes- d/t zygomatic hypoplasia

91
Q

TC can be accompanied by congenital cardiac defects so

A

use antibiotic prophylaxis to prevent subacute endocarditis.

Nur 943 OB (11 decks)

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