Lifespan

Question 1

02 consumption, alveolar ventilation, RR, TV in kids vs adults

Answer 1

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

Question 2

APGAR

Answer 2

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

Question 3

Considerations for post-tonsillectomy bleeding

Answer 3

-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

Question 4

Most common comorbidity seen in pediatrics

Answer 4

Obesity

Question 5

Neonatal resuscitation

Answer 5

Epi 1:10,000

10-30mcg/kg

IV or tracheal

Question 6

Normal VS newborn

Answer 6

BP: 70/40
HR: 140
RR: 40-60

Question 7

Normal VS 1 year old

Answer 7

BP: 95/60
HR: 120
RR: 40

Question 8

Normal VS 3 year old

Answer 8

BP: 100/65
HR: 100
RR: 30

Question 9

Key neonatal respiratory differences compared to adults

Answer 9

Neonates have

• ↑ 02 consumption to support demand
• ↑ alveolar ventilation to ↑ supply
• slight ↓ FRC, reflects reduced reserve

Question 10

Differences between muscle fibers in the diaphragm

Answer 10

• 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)

Question 11

Pulmonary mechanical differences in neonates

Answer 11

Compared to adults neonates have:

• ↓ lung compliance
• ↑ chest wall compliance, rib cage is flimsier, less supportive

↓ : FRC, VC, TLC
↑ : RV, CC

No change: TV

Question 12

How does hypoxemia affect the neonate?

Answer 12

Respiratory control doesn’t mature until 42-44 weeks.

→ before maturation: hypoxemia depresses ventilation further.
→ after maturation: hypoxemia stimulates ventilation.

Question 13

Sensible transfusion triggers in the neonate

Answer 13

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

Question 14

EBV babies

Answer 14

Premie: 100cc/kg
Neonate: 90cc/kg
Infant: 80cc/kg
>1 year: 70cc/kg

Question 15

How neonates handle water

Answer 15

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

Question 16

TBW

Answer 16

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

Question 17

Shortcut for fluid maintenance

Answer 17

If >20kg, hourly is weight in kg +40

Question 18

TEF

Answer 18

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)

Question 19

Hemodynamic anesthesia goals of R → L shunt

Answer 19

-Maintain SVR
↓ PVR
   Hyperoxia
   Hyperventilation
   Avoid lung hyperinflation

Question 20

Most common congenital cardiac abnormality

Answer 20

VSD (infants and children)

Adults = bicuspid aortic valve

Question 21

Perioperative “Tet spell” mgmt

Answer 21

100% Fi02
Volume, phenylephrine
↓ SNS stim to improve RVOT obstruction (deepen, esmolol)
Knee chest position

Question 22

Diastolic and systolic changes in the elderly

Answer 22

Actually systolic function is unchanged

Diastolic function declines with age

Question 23

Most significant risk factor for pediatric cardiac arrest

Answer 23

Heart disease - kids with cardiac issues 50% more likely

Question 24

Which shunts are cyanotic?

Answer 24

4 “T”s = R → L shunts

Tetralogy Fallot
Transposition great arteries
Tricuspid valve abnormality (Ebstein’s anomaly)
Trucks arteriosus
Total anomalous pulmonary venous connection

Question 25

Most common acyanotic shunt

Answer 25

VSD