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Pediatric Anesthesia Lecture 1 > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

What is transition?

A

The change from fetal to extra-uterine life

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2
Q

Pre-term is?

A

Prior to 37 weeks gestational age

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3
Q

Neonate is?

A

1 - 28 days of life

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4
Q

Infant is?

A

28 days to 1 year of life

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5
Q

Child is?

A

> 1 year of life

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6
Q

Puberty is?

A

Age 13 or 14 years of age (teens)

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7
Q

When is the most significant part of transition?

A

Within the first 24 - 72 hours after birth

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8
Q

Which way does fetal Hgb shift the oxyhemoglobin dissociation curve? What does this mean?

A

Left = increased O2 loading in the lungs/placenta, decreased O2 unloading at tissues

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9
Q

What is the Hgb of a full term neonate?

A

18-20 g/dL

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10
Q

What happens at 4 weeks fetal lung development?

A

Primitive lung buds develop from foregut

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11
Q

What happens at 16 weeks fetal lung development?

A

Branching of bronchial tree complete 28 divisions (no further formation of cartilaginous airways)

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12
Q

What happens at 24 weeks fetal lung development?

A

Primitive alveoli (succulent) and type II cells present; surfactant possible

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13
Q

At how many weeks is survival possible with artificial ventilation of a preterm baby?

A

24 weeks

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14
Q

What happens at 28-30 weeks fetal lung development?

A

Capillary network surrounds succules

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15
Q

At how many weeks can a preterm baby survive WITHOUT support?

A

28-30 weeks

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16
Q

What happens at 36 - 40 weeks fetal lung development?

A

True alveoli present, roughly 2 million at birth

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17
Q

What happens to lung development from birth to 3 mos?

A

PaO2 rises as R to L mechanical shunts close

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18
Q

How many alveoli are present at 6 years of life?

A

350 million

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19
Q

When does “Guppy breathing” start in uterine?

A

30 weeks gestation

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20
Q

What has been proven to lead to fetal lambs NOT breathing?

A

Diaphragm denervation, NOT chemoreceptors

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21
Q

What is the current view on how rhythmic breathing starts in fetal lambs?

A

Clamping of the umbilical cord and increasing O2 tensions

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22
Q

At birth what are baby’s blood gases (in general)?

A

Acidotic, low PaO2 and high PaCO2

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23
Q

At 24 hours what are baby’s blood gases (in general)?

A

Normalized pH, PaO2, and PaCO2

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24
Q

What is the primary event of the respiratory system transition at birth? What happens to alveoli?

A

Initiation of ventilation —> alveoli go from fluid-filled to air-filled

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25
Q

What happens as a result of increased PO2 and decreased CO2 at birth?

A

DECREASE pulmonary vascular resistance —> pulmonary blood flow increases allowing gas exchange to occur

26
Q

What pressure to infants need to generate to inflate lungs

A

-70 cm H2O

27
Q

What is infant FRC?

A

Approximately 25-30 ml/kg

28
Q

Why don’t infants lungs collapse all of the time?

A

Terminate expiratory phase of breathing BEFORE reaching their true FRC —> creates intrinsic PEEP and a higher FRC

29
Q

**What should be done to prevent neonate lung collapse during artificial ventilation and anesthesia?

A

Add PEEP of 5 cm H2O

30
Q

When is respiratory control normal and better developed i infants?

A

At 3-4 weeks

31
Q

What depresses a neonate’s response to CO2?

A

Hypoxia

32
Q

What abolishes a neonate’s initial hyperpneic Response?

A

Hypothermia and low levels of anesthetic gases

33
Q

How is apnea defined for infants?

A

Respiratory pauses exceeding 20 seconds or those accompanied by bradycardia or cyanosis

34
Q

What does hypoxia cause in babies?

A

Profound bradycardia

35
Q

What percent of infant diaphragm muscle fibers are Type I fatigue-resistant? Adults?

A

25% in infants; 55% in adults

36
Q

What is the O2 consumption rate of an infant?

A

6 mL/kg

37
Q

Where does gas exchange occur in the fetus?

A

Placenta

38
Q

What are the 3 intracardiac shunts of the fetus? Purpose?

A
  1. Ductus Venosus; 2. Ductus Arteriosus; Foramen Ovale —> to minimize blood flow to lungs while maximizing flow/O2 delivery to organ systems
39
Q

Is fetal circulation parallel or series? What about transitional circulation?

A

Fetal circulation = parallel; transitional = series

40
Q

What 2 things happen at birth that reverse shunts?

A
  1. Cut umbilical cord - INCREASES SVR; 2. Onset of breathing = DECREASES PVR
41
Q

Why are babies born blue?

A

In utero PVR is high and SVR is low

42
Q

Why do babies “pink up” after birth?

A

SVR is high and PVR is low —> shunts close

43
Q

What is persistent pulmonary hypertension of the Newborn (PPHN)?

A

Persistence of fetal shunting beyond the normal transition period in the absence of structural heart defect

44
Q

What is etiology of PPHN?

A

hypoxia and acidosis

45
Q

What is treatment for PPHN (5)?

A

Hyperventilation; pulmonary vasodilators; minimal handling; avoid stress; adequate ventilation and oxygenation

46
Q

What is adequate tidal volume for baby to 10/12 years of age?

A

10 mL/kg

47
Q

What is major function of fetal renal system?

A

Urine contributes to formation of amniotic fluid

48
Q

What are the characteristics of fetal kidney (2)?

A

Low renal blood flow and low GFR

49
Q

When are all nephrons developed?

A

By 34 weeks

50
Q

Why is a neonate considered an “obligate sodium loser?”

A

Because immature tubules do not completely reabsorbed NA under the stimulus of aldosterone

51
Q

What must newborns IVF have in it?

A

Sodium, because they cannot conserve Na and will continue to produce dilute urine to the point of dehydration

52
Q

What is the lowest acceptable Hgb and Hct for a neonate?

A

Hgb = 10 or more; Hct = 35% or more

53
Q

What are the 2 stages of heat loss?

A
  1. Transfer of heat from body core to skin.surface (internal temperature gradient); 2. Dissipation of heat from skin surface to environment (external heat gradient)
54
Q

How to prevent conduction heat loss in babies?

A

Warm blankets, heating mattress, Bair hugger

55
Q

How to prevent convection heat loss in babies?

A

Reduce air movement across body survace

56
Q

How to prevent radiation heat loss in babies?

A

Warm OR; radiant heat lamps

57
Q

How to regent evaporation heat loss in babies?

A

Cover exposed body cavities; heat and humidify inspired gases

58
Q

How is heat proction and thermal regulation achieved in infants (3)?

A
  1. Voluntary muscle activity; 2. Involuntary muscle activity; 3. Non-shivering thermogenesis
59
Q

What is non-shivering thermogenesis?

A

Metabolism of brown fat -> prevents babies from shivering

60
Q

When does brown fat develop? Where is it located?

A

Between 26-30 weeks gestation; located in the mediastinum, between the scapulae, around the adrenals and in the axilla

Pediatric Anesthesia Lecture 1 (1 decks)

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