Hall Ch7 Flashcards
Cricoid cartilage is at what cervical level in a newborn?
C4
Cricoid cartilage is at what cervical level in adults?
C6
Cricoid cartilage is at what cervical level in a 6 yr old?
C5
First sign of a high spinal in a patient under 5 yrs old
Hypoxia. Hypotension is rare in patients under age 5, this hemodynamic stability allows chance to start IV after spinal anesthesia is given.
Percentage of total body weight is water in term newborns
75%
Percentage of total body weight is water in premature newborns
80-85%
Anesthetic management for pt who is lethargic and no urine output for last 3 hrs and brought to OR for pylorus stenosis surgery
Postpone surgery until fluid resuscitated
Most common type of tracheoesophageal fistula
Esophageal atresia with lower segment of esophagus communicating with back of trachea
Volatile agent that sensitizes myocardium to catecholamines and causes dysthymias with inhalational induction
Halothane
Risk of retinopathy of prematurity is negligible after what post conceptual age?
44 weeks
Stage four of anesthesia
Respiratory paralysis, associated with respiratory and cardiovascular arrest
First stage of anesthesia
Analgesia. Responsive to verbal stimulation, intact lid and airway reflexes.
Rate of oxygen consumption in neonate
6 mL/kg/min
Previously healthy 5 yr old is in recovery room after GA, urine is dark brown, what does the pt need to be evaluated for?
Malignant hyperthermia
ETT leak for infant should be
15-25 cm H2O
Premature infant with congenital diaphragmatic hernia suddenly desaturates and bradys down after awake tracheal intubation, what’s next step?
Consider tension pneumo and place chest tube
Tube depth for 1 kg newborn
7 cm
Tube depth for 2 kg newborn
8 cm
Tube depth for 3 kg newborn
9 cm
Tube depth for typical 3.5 kg term newborn
10 cm
Equation to estimate tube depth for children > 3 yrs old
Age/2 + 12
Or
Tube size * 3
Omphalocele, imperforate anus, congenital diaphragmatic hernia, meningomyelocele and a tracheoesophageal fistula should have preop eval of what?
Eval of heart with echocardiogram
Compared to adult dose, infant dose of succinylcholine should be?
Increased because of greater volume of distribution. 2 mg/kg instead of 1 mg/kg
MCC of neonatal bradycardia
Hypoxemia
What is the energy level for initial shock of defibrillator for children
2 J/kg, increasing to 4 J/kg for subsequent shocks
Spinal cord of adults extend to what vertebral level
L1-L2
Spinal cord of newborns extend to what vertebral level
L3
MC initial symptom of esophageal atresia and TE fistula
Regurgitation and coughing with first feeding
Beckwith-Wiedemann syndrome
Omphalocele, macrosomia, macroglossia, hypoglycemia, polycythemia, large fontanelles
Estimated blood volume of healthy full term neonate
80-90 mL/kg
Estimated blood volume of premature neonate
90-100 mL/kg
Estimated blood volume of healthy 3-12 month old infant
75-80 mL/kg
Pulmonary vascular resistance in newborns decreases to adult levels by what age?
2-3 months
Patient after pyloric stenosis surgery can have CNS depression of ventilation because?
CSF alkalosis caused by metabolic alkalosis caused by emesis, worsened by intraop hyperventilation
MAC for isoflurane and halothane is greatest at what age?
3 months old
How much crystalloid should be administered in first 24 hrs after a burn injury?
4 mL/kg for each percent of body burned. Eg. 50% burn of 40 kg pt equals 4x40x50 = 8000 mL
Preferred induction of GA in patient with cerebral palsy and severe GERD
Rapid sequence induction with succinylcholine. No reports of succinylcholine-induced hyperkalemia with cerebral palsy
Fluid resuscitation for a patient with hypokalemia and is anuric for last few hrs
Isotonic crystalloid solution WITHOUT potassium, then add potassium once there is urine output
Preterm infant making twitching movements
Hypocalcemia, preterm infants have very limited reserves. Dose would be 100-200 mg/kg of calcium gluconate every 6-8 hrs
Why shouldn’t beta blockers be used to treat severe hypertension after phenylephrine is used by surgeons for sinus surgery
The severe peripheral vascular resistance shifts blood from periphery to increase preload. Beta blockers may lead to severe pulmonary edema and cardiac arrest. If beta blockers causes CHF to develop, consider using high dose glucagon (5-10 mg)
The usual dose of bupivacaine for spinal anesthesia for infants usually lasts how long?
About 80 min
GFR in newborns compared to adults
Lower
Procedures with low incidence of PONV in children
Brief procedure with minimal pain
Incidence of apnea and bradycardia spells in infants decrease significantly after what postconceptual age?
60 weeks
Epidural technique with loss of resistance with air should be avoided in kids because?
Risk of venous air embolism
Factors related to increased chance of SIDS (sudden infant death syndrome)
Low birth weight, maternal smoking, maternal cocaine use, low socioeconomic status, African-Americans, sleeping in prone position
Chemo drug that inhibits plasma cholinesterases
Cyclophosphamide
Chemo drug that is usually associated with pulmonary fibrosis
Bleomycin
