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Anesthesia based on Nebuchanedzzer II > ITE Peds 2 > Flashcards

ITE Peds 2 Flashcards

1
Q

Pt with Tetralogy of fallot becomes hypoxic and cyanotic during inhalational induction. What is the likely cause and treatment?

A

Tet spell

  • d/t R to L shunting
  • d/t increased and worsening PVR and blood is shunted through VSD

Phenylephrine

  • increase SVR -> increases pulmonary blood flow -> decreases R to L shunt -> improves end organ perfusion pressures
  • Reflex bradycardia reduces hypercontractility and limits RVOT
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2
Q

4 cardiac lesions of TOF

A
  1. VSD
  2. Overriding aorta (aorta sits on top of VSD)
  3. Infundibular pulmonic stenosis
  4. RVH -> RVOT
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3
Q

Isoproterenol is a ______. and causes cardiac muscle _____, and vascular smooth muscle ______

A

nonselective beta-agonist

  • cardiac m contraction
  • sm relaxation

*worsens TET spell

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4
Q

Milrinone is a ______. Causes cardiac muscle _____ and vascular smooth muscle ____

A

phosphodiesterase type 3 inhibitor

  • cardiac m contraction
  • sm relaxation and decreases SVR.

*worsens TET spell

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5
Q

Goals of anesthetic management of TOF (3)

A
  1. maintaining SVR
  2. reducing HR and contractility
  3. ensuring adequate oxygenation and normocarbia
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6
Q

Management of post op obstructions in pts following cleft palate and lip repairs

A

positional changes
- proning

Avoid nasal or oral airways - damage the surgical repair

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7
Q

Which pain medication is NOT recommended for children following T&A?

A

Codeine

  • shown to inc pain post op
  • FDA black box warning in children following T&A if they are rapid metabolizers
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8
Q

Codeine is and inactive medication that becomes ____ after CYP __ metabolism. It has a wide polymorphism in metabolic pathway (some metabolize it rapidly, and others do not metabolize it at all)

A

morphine

CYP 2D6

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9
Q

Why are pain control response more predictable with morphine and oxycodone vs codeine?

A

Morphine and oxy are active and do not require metabolism for activation

Codeine is inactive and requires CYP2D6 metabolism

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10
Q

Why is pulmonary edema a possible complication of post-tonsillectomy procedures?

A

Airway obstruction is relieved by tonsillectomy ->
increase negative inspiratory pressure ->
Increases pulmonary venous return and blood volume

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11
Q

Cardiomyopathy from repeated transfusions is most likely found in pts d/t ____ and _____

A

iron overload and hemosiderosis

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12
Q

Thalassemias are a variety of hemolytic anemia disorders in which the ratio of ____ to ____ units is unequal.

A

alpha to beta globin units

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13
Q

A pt with longstanding ostium primum defect (ASD) presents with dyspnea, SOB at baseline, and dec exercise tolerance indicates that the pt has _____, and is at risk for arrhhythmias.

A

pulmonary HTN

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14
Q

Permissive hypercapnia is not ideal for pts with pulmonary HTN bc it ______

A

increases pulmonary vascular resistance and worsens pulm HTN

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15
Q

Benzodiazepines act (Centrally/Peripherally) to potentiate GABA, which activates chloride channels and hyperpolarize the membranes, thus having muscle-relaxing properties

A

centrally

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16
Q

GABA is an (excitatory/inhibitory) neurotransmitter that controls the state of chloride ion channels

A

inhibitory

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17
Q

Infants have a more (cephalad/caudad) larynx than adults at C __ level

A

cephalad, C3,4

as the infant grows, the neck lengthens and moves caudal C5,6

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18
Q

How do the vocal cords differ in infants vs adults?

A

Adults
- perpendicular vocal cords to trachea

Infants

  • angled vocal cords
  • anterior insertion is lower than posterior insertion
19
Q

Why is nitrous oxide contraindicated in pts with air filled cavities like emphysema?

A

Nitrous oxide is poorly dissolved in blood and will ppt out into air filled cavities and expand the cavity

20
Q

Induction of anesthesia for pts with congenital emphysema includes _______ and ______

A

spontaneous ventilation

minimal peak inspiratory pressure

*Avoid nitrous oxide

21
Q

Myelination of nerve fibers in the pediatric population is (accelerated/delayed) compared to adults, which leads to faster onset time and shortened duration.

A

delayed

- easier intraneural penetration of LA

22
Q

(higher/lower) cognitive function in children leads to increased preoperative anxiety

A

higher

23
Q

Pts with myelomeningocele often have associated ____ defects.
Neuraxial anesthesia is contraindicated d/t potential _____ and _____.

A

arnold-chiari malformation 80%

herniation of cerebellar tonsils and hydrocephalus

24
Q

Neural tube defects include (3), in order of worsening severity

A
  1. spina bifida occulta
  2. meningocele
  3. myelomeningocele
25
Q

NTD occurs during the ___ week of embryonic development, during neural tube pore closure, prevention with _____ supplementation is important.

A

3rd
- before most women realize they are pregnant

Folate

26
Q

Hypothermia in neonates and infants if left uncorrected, can result in ______, from nonshivering thermogenesis and metabolism of brown fat.

A

metabolic acidosis

27
Q

How does metabolic acidosis arise in infants after prolonged hypothermia?

A

Skin and core temp difference ->
Hypothalamus stimulates release of norepi ->
Norepi binds receptors on brown fat cells ->
Activates breakdown of fatty acids ->
Consumes oxygen and glucose ->
Promotes ketone production ->
metabolic acidosis

28
Q

Examples of Active humidifiers

A

Nebulizers

Vaporizers

29
Q

Maximum allowable blood loss equation

A

EBV x (pt starting Hct - min acceptable hct) / Pt’s starting Hct

30
Q

What is the minimum acceptable hct lvl in children?

A

20%

31
Q

Neonatal myasthenia gravis usually resolves w/in ___ weeks, after maternal antibodies (anti-AChR) that were transferred across the placenta are metabolized

A

2-4 weeks

32
Q

Neonatal myasthenia gravis (decreased muscle tone, feeding/respiratory difficulties) occurs in __% of babies born to mother with myasthenia gravis

A

20%

33
Q

Treatment of neonatal myasthenia gravis

A

Same as adult MG

- anticholinesterases or acetylcholinesterase inhibitors

34
Q

Pts with myasthenia gravis response to succinylcholine and nondepolarizing NMB agents

A

resistance to succinylcholine

sensitivity to nondepolarizing NMB agents

35
Q

Marfan syndrome can have (obstructive/restrictive) pulmonary defects

A

both

obstructive

  • pneumothorax
  • emphysema

restrictive

  • pes excavatum: restrictive lung disease
  • kyphoscoliosis
36
Q

Hydralazine is an arteriolar (vasodilator/vasoconstrictor) and can cause significant reflex tachycardia

A

vasodilator

37
Q

Nitric oxide, epoprostenol, and sildenafil have all been shown to (increase/reduce) pulmonary HTN in children

A

reduce

38
Q

Sildenafil is a _____, and can help with pulmonary vasodilation cause by endogenous nitric oxide

A

PDE5 inhibitor

39
Q

Pt with TOF becomes hypotensive after induction, how does applying pressure to abdomen help combat decreased systemic vascular resistance?

A

During induction, the pt has worsening R to L shunt.

Applying pressure increases preload and increases afterload and improves shunt conditions

*shoulda induced with ketamine, not propofol

40
Q

Nitrous oxide causes an (increase/decrease) in pulmonary vascular resistance. In pts with VSD, this causes a _ to _ shunt

A

increase

R to L

41
Q

What does VACTERL stand for?

A

congenital anomalies

Vertebral defects
Anal atresia
Tracheoesophageal fistula with
Esophageal atresia
Radial dysplasia
Limb abnormalities
42
Q

Most common type of tracheoesophageal fistula

A

type IIIb

  • upper esophagus ends in blind pouch
  • lower esophagus connects to trachea
43
Q

Down syndrome abnormalities of concern to anesthesiologists (6)

A
  1. short neck
  2. atlantooccipital instability
  3. irregular dentition
  4. mental retardation
  5. hypotonia
  6. large tongue
  7. 40% congenital heart disease
44
Q

Down syndrome abnormalities of concern to anesthesiologists (6)

A
  1. short neck
  2. atlantooccipital instability
  3. irregular dentition
  4. mental retardation
  5. hypotonia
  6. large tongue

Anesthesia based on Nebuchanedzzer II (38 decks)

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