Lifespan Flashcards
02 consumption, alveolar ventilation, RR, TV in kids vs adults
V02: 6mL/kg/min kids | 3.5mL/kg/min adults
Alveolar ventilation: 130mL/kg/min kids | 60mL/kg/min adults
RR: 35/min kids | 15/min adults
TV: 6mL/kg kids AND adults - this is the only thing that is the same
APGAR
HR: 2=>100, 1=<100, 0=absent
Resp effort: 2=normal+cry, 1=slow irregular 0= absent
Muscle tone: 2=active, 1=some flex, 0=limp
Reflex irritability: 2=cough+cry, 1=grimace, 0=none
Color: 2=pink, 1=pink+blue, 0=pale/blue
Considerations for post-tonsillectomy bleeding
-Typically either 24hrs after surgery (usually 6 hrs) or 5-10 days out.
- RSI with cricoid pressure
- Awake extubation, ideally lateral
- fluid resuscitation may be needed
-pre-02 in lateral, head-down position
Most common comorbidity seen in pediatrics
Obesity
Neonatal resuscitation
Epi 1:10,000
10-30mcg/kg
IV or tracheal
Normal VS newborn
BP: 70/40
HR: 140
RR: 40-60
Normal VS 1 year old
BP: 95/60
HR: 120
RR: 40
Normal VS 3 year old
BP: 100/65
HR: 100
RR: 30
Key neonatal respiratory differences compared to adults
Neonates have
- ↑ 02 consumption to support demand
- ↑ alveolar ventilation to ↑ supply
- slight ↓ FRC, reflects reduced reserve
Differences between muscle fibers in the diaphragm
- Type I = slow twitch = endurance
- Type II = fast twitch = speed
Neonatal diaphragm is only 25% Type I, so they poop out super fast. Adults have 55% Type I.
Premies only have 10% Type I !
(SMALLER number of Type I fibers puts infant at risk for resp fatigue, distress, failure)
Pulmonary mechanical differences in neonates
Compared to adults neonates have:
- ↓ lung compliance
- ↑ chest wall compliance, rib cage is flimsier, less supportive
↓ : FRC, VC, TLC
↑ : RV, CC
No change: TV
How does hypoxemia affect the neonate?
Respiratory control doesn’t mature until 42-44 weeks.
→ before maturation: hypoxemia depresses ventilation further.
→ after maturation: hypoxemia stimulates ventilation.
Sensible transfusion triggers in the neonate
Hgb <13g/dL in child with severe cardiopulmonary disease
Hgb <10g/dL in child presenting for major surgery or moderate cardiopulmonary disease
Dose: 10-15cc/kg
EBV babies
Premie: 100cc/kg
Neonate: 90cc/kg
Infant: 80cc/kg
>1 year: 70cc/kg
How neonates handle water
Neonates do a poor job conserving water, so they are intolerant of fluid restriction, but also can’t excrete large volumes, so too much is bad, also they have high insensible losses.
Also obligate sodium losers first few days of life, but it gets better after that
TBW
Premie: 85%
Term: 75%
Adult: 60%
In premie and term neonate, ECF>ICF, which is different than all other groups. Diuresis after birth fixes this
Shortcut for fluid maintenance
If >20kg, hourly is weight in kg +40
TEF
Type C most common (upper esophagus ends in blind pouch, and lower esophagus communicates with distal trachea)
VACTERL association common (vertebral defects, imperforate anus, cardiac abnormalities, TEF, esophageal atresia, renal dysplasia, limb anomalies)
-head up, frequent suctioning, awake intubation or inhalation induction wth SV (PPV is baaaad)
Hemodynamic anesthesia goals of R → L shunt
-Maintain SVR ↓ PVR Hyperoxia Hyperventilation Avoid lung hyperinflation
Most common congenital cardiac abnormality
VSD (infants and children)
Adults = bicuspid aortic valve
Perioperative “Tet spell” mgmt
100% Fi02
Volume, phenylephrine
↓ SNS stim to improve RVOT obstruction (deepen, esmolol)
Knee chest position
Diastolic and systolic changes in the elderly
Actually systolic function is unchanged
Diastolic function declines with age
Most significant risk factor for pediatric cardiac arrest
Heart disease - kids with cardiac issues 50% more likely
Which shunts are cyanotic?
4 “T”s = R → L shunts
Tetralogy Fallot
Transposition great arteries
Tricuspid valve abnormality (Ebstein’s anomaly)
Trucks arteriosus
Total anomalous pulmonary venous connection
Most common acyanotic shunt
VSD
