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SEE/NCE Boards Core Concepts > High Yield Pediatric Anesthesia Review > Flashcards

High Yield Pediatric Anesthesia Review Flashcards

1
Q

What is unique with the pediatric CO?

A

Heart rate dependent CO

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2
Q

Chest wall compliance in pediatric?

A

Greater chest wall compliance

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3
Q

What is the body water content in pediatric

A

Higher Total body water content

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4
Q

In pediatric patient ratio of BSA to body weight

A

Increase BSA to body weight

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5
Q

Nasal passages of the pediatric is

A

Narrower

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6
Q

Risk of morbidity in pediatric anesthesia is

A

INVERSELY Proportional to age

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7
Q

Lung volume changes in pediatric

A

Reduce FRC, reduced lung compliance

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8
Q

HR, BP and RR in the pediatric patients

A

Increase HR
REDUCED BP
Increased RR

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9
Q

How is the LV in the pediatric patient?

A

Noncompliant LV

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10
Q

Resistance to airflow is greater or lower in the pediatric patient?

A

Greater

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11
Q

Epiglottis in the pediatric patients

A

Longer

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12
Q

Head and tongue in the pediatric patients?

A

Larger head and tongue

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13
Q

Cannulation of IV in the pediatric patients is

A

Difficult for both venous and arterial

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14
Q

Larynx in the pediatric patients 2 characteristics?

A

Anterior and cephalad

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15
Q

Trachea and neck of the pediatric patients

A

Shorter trachea and neck

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16
Q

Protein binding for pediatric patients

A

Decreased protein binding for drug binding in blood

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17
Q

Induction and recovery in the pediatric patients?

A

More rapid induction and recovery from inhaled anesthetics.

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18
Q

MAC in pediatric patients is

A

Increased

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19
Q

Volume of distribution for water soluble drugs in pediatric patients?

A

RELATIVELY LARGER VOLUME OF DISTRIBUTION for water soluble drugs

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20
Q

NMJ for Pediatric patients

A

Immature NMJ

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21
Q

Hepatic bio-transformation for the pediatric patients?

A

Immature liver/hepatic biotransformation

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22
Q

0-1 months is a

A

Neonate

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23
Q

1-12 months is a

A

infant

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24
Q

12-24 months is a

A

toddler

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25
Q

2 -12 years is a

A

Young children

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26
Q

Neonate and infants ventilate (more/less) efficiently and why?

A

Less efficiently and thats because their ribs are more horizontal and they have BIG ABDOMEN (protuberant )

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27
Q

Airways of pediatric are ________

A

fewer and smaller

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28
Q

Alveoli are ______ in pediatric leading to e ______Lung compliance; ______airway resistance and ______ WOB

A

Fewer; Reduced lung complaince,

Increased airway resistance and increased WOB

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29
Q

Cartilaginous ribcage in pediatric does what to chest wall compliance ?

A

Increase chest wall compliance that promotes collapse during inspiration and a LOW RV at expiration.

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30
Q

LOW RV predispose what in pediatric patients?

A

Limited O2 reserve during apneic episodes

Predispose them to hypoxemia and ATELECTASIS

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31
Q

2 things that can both cause depression in respiration in PEDIATRIC ?

A

Hypoxia and HYPERCAPNIA

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32
Q

RR is ______ in neonates and reach adult values by ______

A

INCREASED

ADOLESCENT (it decreases)

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33
Q

2 VALUES that remains constant THROUGHOUT DEVELOPMENT?

A

TV and DEAD space per KG

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34
Q

GLOTTIS for Neonates and infants is at

A

C4

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35
Q

Narrowest point of the airway in children younger than 5

A

Cricoid cartilate

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36
Q

Narrowest point of the airway in ADULTS

A

Glottis

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37
Q

CO is very sensitive to changes in ______for the pediatric patient?

A

HR

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38
Q

3 major things that can trigger bradycardia and profound reduction in CO?

A

Activation of PNS
Anesthetic overdose
Hypoxia

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39
Q

Bradycardia in the pediatric patients lead to

A

Hypotension
Asystole
Intraoperative death.

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40
Q

2 immature in the infants causing more prone to adverse events

A

SNS and baroreceptor reflexes are immature.

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41
Q

PEDIATRIC RESPONSE To exogenous catecholamies

A

Blunted response to exogenous catecholamines.

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42
Q

Pediatric heart and VA

A

Immature heart more sensitive to depression by VA and to opioid-induced bradycardia.

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43
Q

VASCULAR TREE is less able to ______In pediatric patients

A

Less able to respond to hypovolemia with compensatory vasoconstriction.

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44
Q

Intravascular volume depletion in neonates and infants may manifest as

A

Hypotension without tachycardia.

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45
Q

Normal BP for 12 months old`

A

95/65

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46
Q

Normal BP for 3yo

A

100/70

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47
Q

Normal BP for 12 years

A

110/60

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48
Q

Neonate BP

A

65/40

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49
Q

RR normal in neonate

A

40

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50
Q

RR normal in 12 months old

A

30

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51
Q

RR normal in 3 years old

A

25

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52
Q

Pediatric kidney function approaches to normal by

A

6 months to as late as 2 years old

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53
Q

Premature neonates renal problems include

A 
decrease CrCl
Impaired sodium retention
Impaired glucose excretion
Impaired bicarb reabsorption
Reducing dilution and concentrating ability
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54
Q

Neonates and GI problems

A

Increase incidence of GERD

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55
Q

Neonate conjugation

A

Liver conjugates drugs and other molecules.

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56
Q

What predispose neonates to hypoglycemia?

A

They have REDUCED glycogen stores.

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57
Q

Neonates are more predisposed to hypoglycemia because they have a reduced glycogen stores, what can offset this tendency?

A

Their IMPAIRED GLUCOSE EXCRETION

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58
Q

What are the neonates at the greatest risk for HYPOGLYCeMIA>?

A

PREMATURE
Small for gestational age
Receiving hyperalimentation
Born to mothers with diabetes.

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59
Q

Pediatric pt weight calculation based on age

A

(Agex2) + 9

60
Q

Neonates TBW vs ADULT

A

70-75% vs 50-60%

61
Q

Vd for most IV drugs for neonates, infants and young children is

A

DISPROPORTIONATELY GREATER

62
Q

What prolongs drug duration of action for neonates? 2 examples

A

Decreased muscle mass prolongs some drugs duration of action by delaying redistribution to muscle.
Fentany, THIOPENTAL

63
Q

Neonate, infants and young children have a _________ alveolar ventilation and ________ FRC compared with aldults

A

Greater ; reduced

64
Q

Minute Ventilation-to-FRC ratio in children?

65
Q

The greater minute ventilation to FRC ratio in children leads to what kind of changes?

A

Greater blood flow to vessel-rich organ contributes to a rapid increase in ALVEOLAR ANESTHETIC CONCENTRATION and SPEED INHALATION INDUCTION

66
Q

What is responsible for the rapid increase in alveolar anesthetic concentration and speed of induction seen in PEDIATRIC patients?

A

The Greater Minute ventilation to FRC ratio is responsible .

67
Q

MAC of halogenated agents adults vs neonate

A

Greater in infants than adults.

68
Q

BP sensitivity and VA in neonates

A

Neonates and infants are more sensitive to volatile agents because of immature compensatory mechanisms and GREATER sensitivity of the neonate and infant myocardium to myocardial depressants.

69
Q

Emergence delirium is faster after use of

A

Sevoflurane

70
Q

Some clinicians switch to ISOFLURANE after induction with SEVOFLURANE, why?

A

Agitation and delirium upon emergence seen with sevoflurane.

71
Q

Preferred agent for inhaled induction in pediatric anesthesia

A

Sevoflurane

72
Q

Why do children require larger doses of propofol?

A

Because of a larger volume of distribution compared with adults.

73
Q

Propofol elimination half life and plasma clerance for children?

A

Shorter elimination half life , HIGHER Plasma clearance.

74
Q

Propofol in critically ill patients?

A

Propofol is not recommended for prolonged sedation in critically ill patients because of an association with GREATER mortality than other agents.

75
Q

What is more common in children than adults with propofol>

A

PROPOFOL infusion syndrome

76
Q

PROPOFOL INFUSION SYNDROME symptoms ae

A 
Rhabdomyolysis
Metabolic acidosis
Hemodynamic instability 
Hepatomegaly
Multiorgan failure.
77
Q

Morphine sulfate , particularly in repeated doses in neonates?

A

Use in caution because HEPATIC conjugation is reduced and renal clearance of morphine metabolites is decreased.

78
Q

Clearance of opioids in children

A

Sufentanil, Alfentanil, remifentanil, and fentanyl clerance may be greater in children

79
Q

Ketamine and neonates

A

Higher doses than adults

80
Q

Midazolam clearance and neonates

A

Reduces in neonates compared with older children.

81
Q

Onset of Muscle relaxants in pediatric patients

A

Faster onset because of SHORTER circulation times.

82
Q

Fastest onset MR for both adults and children

A

Succinylcholine 1-1.5mg/kg

83
Q

Infants and doses of succinylcholine

A

Require larger doses of succinylcholine -3 mg/kg because of the LARGER VOLUME OF DISTRIBUTION.

84
Q

Exclusion of succinylcholine and possibly cisatracurium, infants require

A

Significant smaller muscle relaxant doses than older children.

85
Q

Rapid intubation can be achieved with a dose that _____the ED95

86
Q

Why do you see a variable response to ND MR with neonates?

A

Because of an immature NMJ, tending to increase sensitivity (not yet proven) and a LARGE Extracellular compartment reducing drug concentration.

87
Q

Duration of action of NDNMB in pediatric is _____Why>

A

Prolonged; because of immature neonatal hepatic function.

88
Q

Infant ED 95 for succinylcholine (mg/kg)

89
Q

Infant ED95 for cisatracurium

90
Q

Infant ED95 for rocuronium

91
Q

Infant ED95 for vecuronium

92
Q

Pancuronium infant ED 95

93
Q

Pancuronium child ED95

94
Q

Child ED95 for vecuronium

95
Q

Child ED95 For Rocuronium

96
Q

When a child experiences cardiac arrest after succinylcholine administration, Immediate treatment for ____should be instituted

A

Hyperkalemia

97
Q

Succinylcholine and children

A

Succinylcholine routinely avoided

98
Q

Why is succinylcholine avoided in children?

A

Because of undiagnosed muscular dystrophy

99
Q

Children getting succinylcholine should

A

Children may have profound bradycardia, and sinus node arrest after the first dose of succinylcholine without atropine pre-treatment.

100
Q

Indications for succinylcholine in a child is only if

A

Full stomach and laryngospasm that does not respond to PPV

101
Q

Succinylcholine may be used for rapid muscle relaxation before IV access,(with inhaled inudction in patients with full stomachs”) IM dose is

102
Q

Atropine dosing for administering IM succinylcholine ____why?

A

0.02 mg/kg ; to reduce the likelihood of bradycardia.

103
Q

Drug of choice for routine intubation in the pediatric patients and why?

A

rocuronium 0.6 mg/kg; because it has the fastest onset of NDNMB agents.

104
Q

Larger doses of rocuronium and implications

A

Larger doses of rocuronium 0.9-1.2 mg/kg may be used for RSI but a prolonged duration (up to 90 min) may follow.

105
Q

What is the only NMBA that has been adequately studied for IM administration

A

Rocuronium 1- 1.5 mg/kg requires 3-4 min to onset

106
Q

Young infants, particularly in short procedures, because these drugs consistently display short to intermediate duration , NMB agents

A

Atracurium and Cisatracurium

107
Q

Peri-operative Risk of cardiac arrest for pediatric is

A

1.4 in 10000

108
Q

Peri-operative Risk of cardiac arrest for pediatric, OVERALL mortality is

109
Q

33% of pediatric patients who had a cardiac arrest had ASA PS

110
Q

Greatest risk of anesthesia-related arrests ____% Who is at the greatest risk?

A

Infants 55%

younger than 1 month greatest risk

111
Q

Most cardiac arrest with pediatric occurred during

A

Induction of anesthesia

112
Q

3 things that preceded arrests with Pediatric patients?

A

Bradycardia
Hypotension
Low SPO2

113
Q

Most common mechanism of cardiac arrest in pediatric is

A

Drug (medication) related

114
Q

When a CV mechanism could be identified in pediatric patients , it was most often related to

A

Hemorrhage
Transfusion
Inappropriate fluid therapy.

115
Q

Respiratory mechanism for pediatric included : (leading to adverse outcomes)

A
  1. Laryngospasm
  2. Airway obstruction
  3. Difficult intubation
116
Q

Equipment-related mechanism with pediatric most common

A

Attempt with CVC insertion including pneumo, hemothorax, and cardiac tamponade.

117
Q

What place a child at an increased risk for perioperative PULMONARY complications

A

A viral infection 2- 4 weeks before GA.

118
Q

Pulmonary complications common with pediatric

A

Wheezing
Laryngospasm
Hypoxemia
Atelectasis

119
Q

Murmur in children and implications

A

Innocent murmurs may occur in about 30% of normal children.

120
Q

Pediatric are more prone to

A

Dehydration

121
Q

Breast milk up to ___before induction

122
Q

Light meal up to ___before induction

123
Q

Clear fluid up to ___before induction

124
Q

Children with uncontrollable separation anxiety, should be given a sedative such as

A

midazolam 0.3-0.5 mg/kg

125
Q

Maximum midazolam for pediatric

126
Q

Preferred midazolam route for pediatric is

127
Q

What is given orally,IM OR rectally to decrease the likelihood of bradycardia during induction?

A

Atropine , 0.05mg/kg rectally or IM, orally

128
Q

Give atropine when?

A

During induction, or shortly after

129
Q

Provide an inexpensive means to monitoring heart rate , heart sounds and airway patency

A

PRECORDIAL STETHOSCOPE

130
Q

Neonate, where should the Pulse oximeter probe be placed

A

RIGHT HAND or EARLOBE to measure preductal oxygen saturation

131
Q

FLOW THROUGH analyzers are usually

A

Less accurate in patients weighing less than 10 kg

132
Q

CO2 and pediatric patients

A

Inspired CO2 can appear falsely elevated, and the expired CO2 can be falsely low.

133
Q

Temperature monitoring and pediatric patients

A

Greater risk for malignant hyperthermia and intraoperative hypothermia and hyperthermia

134
Q

Risk of hypothermia is prevented how in the pediatric patients?

A

Maintain a warm OR environment 26C or higher, warming and humidifying inspired gases, using a warm blanket and warming lights, and warming all IV fluids.

135
Q

Best arterial cannulation for neonates and why?

A

RIGHT RADIAL artery , because its preductal location mirrors the OXYGEN CONTENT of the carotid and retinal arteries

136
Q

Critically ill neonates may retain an

A

Umbilication artery catheter

137
Q

What is an important indicator of the adequacy of intravascular volume and CO? In pediatrics

A

Urine output

138
Q

What pediatric population is more prone to Hypoglycemia?

A

Premature
SMALL FOR Gestational age
Neonates receiving hyperalimentation
Mother with diabetes

139
Q

GA is usually induced by what ways in pediatric?

A

IV or inhalational

140
Q

IM ketamine and pediatric

A

Reserved for combative children

141
Q

Preferred when the patient comes to the OR (Pediatric)

A

IV induction

142
Q

When is awake/sedated awake intubation with topical anesthesia indicated ?

A

Emergency procedures in neonates and small infant and they are critically ill or a potential difficult airway is present.

143
Q

IV induction sequence for pediatric

A

Same, propofol, NDNMB (if giving succinylcholine, ATROPINE MUST BE GIVEN)

144
Q

Inhlational induction –>Explain steps

A

If without IV, mixture of N2O (70%) and O2 (30%). Sevoflurane can be added to the anesthetic gas mixture in 0.5% increments. After adequate depth of anesthesia, an IV Line is placed and a muscle relaxant is administered to facilitate intubation. Pts typically pass through an excitement stage during which any stimulation can induce LARYNGOSPASM> Steady application of 10 cm of PEEP will usually overcome laryngospasm.

145
Q

Inhalation induction what can overcome laryngospasm?

A

10cm of PEEP

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