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Peds Anesthesia - Summer 2013 > First Lecture by Dr Albert > Flashcards

First Lecture by Dr Albert Flashcards

1
Q

Why is surface area a special concern in pediatric anesthesia?

A

Because it parallels metabolic rate

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2
Q

What are some physiologic differences between adults and children?

A
  • Head size
  • Airway/respiratory
  • Cardiovascular
  • Temp regulation
  • liver
  • Kidney
  • Fluids and electrolytes
  • pharmokinetics
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3
Q

What is different about the pediatric head/neck?

A

large head compared to adult
weak neck muscles
short neck

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4
Q

What is different about the airway of the pediatric pt?

A
  • narrow nasal path
  • small mouth
  • large tongue
  • narrow/floppy epiglottis (omega shaped)
  • epiglottis is higher (c3-c4 vs c4-c5 in adult)
  • sloping cords
  • funnel shaped
  • Narrow cricoid ring
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5
Q

What are some differences with the pediatric rids?

A
  • They are more horizontal and less mechanical (don’t expand as well as adults)
  • Cage is more cartilage and more pliable
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6
Q

Peds have a higher amount of Type II muscles vs Type I muscles in the chest. What is the difference?

A

Type I muscles are for endurance and Type II will fatigue quickly when stressed.

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7
Q

How many arteries and veins are in the umbilical cord?

A

2 arteries and 1 vein

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8
Q

What is different about fetal hemoglobin?

A

Has a higher affinity for O2 (low 2,3 DPG), therefore it does not release oxygen at the tissue level well.

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9
Q

How is the fetal heart different than an adult?

A

Fetal heart is 30% contractile mass vs 60% in adults - lower contractile mass results in lower compliance.

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10
Q

How do infants increase cardiac output?

A

by increasing HEART RATE

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11
Q

In the newborn, what variable does not change, HR, SV or CO?

A

Stroke volume - newborns have low cardiac mass –> lower compliance –> Frank-Starling mechanism is not functional. To increase CO in infants, you must increase HR.

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12
Q

What are some efferent responses to cold in an infant?

A
  • Behavioral (unable to do this like pulling up blankets)
  • Vasoconstriction (not highly effective)
  • nonshivering thermogenesis
  • shivering
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13
Q

What is brown fat? When does it develop and when is it gone?

A

Brown fat helps keep babies warm and can double their metabolic heat production.
- develops ~ 26-30 wks and is gone by 2 yrs.

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14
Q

What’s the afferent input for warm/cold sensation?

A

A-delta fibers (most cold fibers)

C (most warm fibers)

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15
Q

How is hypovolemia manifested in newborns?

A

hypotension without tachycardia

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16
Q

The pediatric pt’s major mechanism for heat production is?

A

NONSHIVERING THERMOGENESIS (per Valley review)

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17
Q

An appropriate blood pressure for a term neonate would be?

A

65/40

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18
Q

why can’t newborns shiver?

A

maybe due to immaturity of musculoskeletal systems.

Maybe due to small muscle mass - shivering would be ineffective.

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19
Q

What is the maximum amount of heat loss prevented by vasoconstriction?

A

25-50% - this could take hours to reach this amount of heat loss.

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20
Q

What are the 4 major routes of heat loss/transfer?

A

Radiation (39%)
Convection (37%)
Evaporation (21%) - increased with surg prep
Conduction (3%)

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21
Q

What are some anesthesia effects on heat loss?

A
  • Lower threshold - more loss of temp before body attempts to compensate
  • vasoconstriction begins @ 34-35 C vs 36.7C
  • Nonshivering thermogenesis inhibited
  • Post anesthesia shivering not applicaple in infants
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22
Q

How much can 1 unit of PRBC or 1 Liter of fluids at room temp decrease your body temp?

A

0.25 degrees C

23
Q

What are some intraoperative strategies to maintain body heat?

A
  • heat and humidify gases
  • Cutaneous heating like lamps, water blanket, forced air blanket, raise room temp
  • Warm IV fluids (prevents loss of heat)
24
Q

when is an infant’s liver function usually functional? Mature?

A

Functional - 1-2 wks (postnatal)
Mature - 6-12 months

*enzyme function r/t postnatal age NOT gestational age

25
Q

What are the 3 steps to Phase I liver function?

A

Oxidation
Reduction
Hydrolysis

26
Q

In phase I liver function - what does hydrolysis do to drugs?

A

turns fat soluble drugs to water soluble so they can be eliminated

27
Q

After birth, when do the kidneys start functioning well?

A

Day 5 shows improved renal function. By 1 month kidneys are approximately 70% mature.
Most have mature kidneys by 3 months but could take up to 2 yrs

28
Q

Do infants have a larger or smaller amount of body fluid?

A

Larger amount - Approx 80% vs 60% in adults

29
Q

Since infants have an increased metabolic rate, does that mean they metabolize water quicker, too?

A

Yes. They also have an increased risk of metabolism

30
Q

What is a normal K+ level in newborns?

A

5 to 6.5 vs 3.5 to 5 in adults

31
Q

If an infant’s K+ is 3 to 3.5 with GI loss, is this a problem?

A

yes. would need rehydration and replacement of electrolytes prior to surgery

32
Q

Do infants have good gastrointestinal uptake of drugs?

A

No. Enzyme levels mature over first 3 months of life.

33
Q

For inhalation agents, put the groups that have the highest to lowest MAC. (Adult, children or newborns)

A

Newborns&raquo_space; child > adults

34
Q

Why do newborns have a higher uptake of inhalation agents?

A
  • increased HR
  • Decreased FRC and increase Vt
  • Increased tissue perfusion
35
Q

Know how to calculate fluids using the 4:2:1

A

0-10 kg - 4 ml/kg/hr
11-20kg - 2ml/kg/hr + 40 ml
>20kg - 1ml/kg/hr + 60

36
Q

What is the approx. blood volume of a premature infant?

A

100ml/kg

37
Q

What is the approx. blood vol of 0-2 yr old

A

80ml/kg

38
Q

What is the approx. blood vol of 2-16 yr old?

A

70 ml/kg

39
Q

What is the formula for Allowable blood loss in children?

A

Kg x EBV x Hct initial - Hct Allowable / 100

40
Q

How fast should you give fluid deficit to a pt?

A

1/2 deficit in first hr

1/4 deficit in 2nd and 3rd hrs

41
Q

How much and when should you give fluids to replace 3rd space loss?

A

2-10ml/kg depending on the procedure and give over 2nd and 3rd hrs.

42
Q

How much should you replace blood loss with crystalloids?

A

3:1. As you approach 70% of allowable blood loss, consider replacing 25% of blood loss with PRBC

43
Q

How much urine output should you expect on an infant in surgery?

A

1-2ml/kg/hr

44
Q

What is the best way to monitor cardiovascular stability?

A

Urine output

45
Q

What are the 3 types of dehydration?

A

Isotonic
Hypotonic
Hypertonic

46
Q

What is the most common type of dehydration?

A

Isotonic - can be caused by pyloric obstruction, upper and lower bowel loss, peritonitis, starvation

47
Q

What are some causes of hypotonic dehydration?

A

Fever
Diarrhea
starvation

48
Q

What are some causes of hypertonic dehydration?

A

burns
sweating
diarrhea

49
Q

What is the most common cause of metabolic alkalosis in an infant?

A

Pyloric Stenosis

50
Q

Is Pyloric stenosis usually an emergency?

A

No, rarely

51
Q

What should be done for a child before they have surgical repair of pyloric stenosis?

A

correction of fluid balance, k+ level, and metabolic abnormalities

52
Q

Why do kids with pyloric stenosis develop metabolic alkalosis?

A

from vomiting - leads to loss of H+, Cl and H2O.

53
Q

What other electrolyte can be abnormal from emesis?

A

K+

Peds Anesthesia - Summer 2013 (14 decks)

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