Memory Master overview select. Flashcards
When do liver enzyme become completely functional in the neonate?
One month of age
What are the angles of the left and right bronchi in a child less than three years of age?
Left 55
Right 25 to 70
What factors contribute to the decreased functional residual capacity in the neonate and infant during general anesthesia?
- Comopliant chest wall
- poorly compliant lungs.
What is the distance from the teeth to midtrachea in the newborn, In six month to 1 year, Two year old, three year old, and 4 year year old?
Newborn = 10 6 month to 1 year =11 2 yr =12 3 yr =13 -14 4 yr = 15 5yr = 15 -16
Describe the physiologiical anemia of the neonate and pediatric patient?
Full term =
-Normal hemoglobin levels 14 -20 until 9th to 12 week and then bottom out to 10 - 11 and then in the 3 month the levels stop dropping and at 2 years of age the level begin to climb to normal adult.
Compare the physiological anemia in the preterm neonate?
Decrease of hemoglobin is greater and earlier with the low being 8 for hemoglobin by week 4-8 and at 1 year the preterm and full term are comparable.
Below what hemoglobin concentration is anemia sufficient to jeopardize oxygen carrying capacity in the neonate? Infant older than three months.
New born = 13
3 month old =10
During the preoperative evaluation of a 6 month old surgical candidate you note physiologic anemia. What is a likely cause for the physiologic anemia?
Premature infant
What is the normal heart rate of the term infant?
120 - 180
List two way the physiology of the cardiovascular system of the neonate differs form that of the adult?
- Cardiac output is heart rate dependent
- Left ventricular compliance is decreased
At what age is basal metabolic rate normally the highest?
6 -12 months old
Where is brown fat located?
- Interscapular space
- around large blood vessels
- around the neck
- behind the sternum
- around the kidneys and adrenals
What contral non shivering thermogenesis in infants?
Autonomic nervous system
Non shivering thermogenesis a crucial heat generating mechanism in the neonate and infant as you know. At approximately what age does non shivering thermogenesis cease to be clinically significant?
2 years of age
At what rate do infants consume oxygen?
7 ml/kg/min
How much faster does infants consume oxygen than adults?
twice as fast
Blood shunts through what two structures in the neonate with persistent fetal circulation?
- Ductus arteriosus
- Foramen ovale
What is a patent ductus arteriosus? When does the ductus arteriosus normally close
Few hours to a few days
What is the probable problem if the pediatric patient has a systolic and diastolic murmur?
Patent ductus arteriosus
Identify the best site to obtain arterial blood gases from in the neonate?
Radial artery
Identify 4 factors that may cause a neonate infant to return to fetal circulation?
- Hypoxia
- acidosis
- pneumonia
- hypothermia
List three condition that increase right to left shunt?
- Acidosis
- hypercarbia
- hypotension
List three congenital anomalies associated with prune belly syndrome?
- cryptorchidis
- club feet
- genitourinary tract abnormalities
Name four condition in which the patient presents with a large tongue. What is the concern if the patient has a large tonguue?
- Down’s syndrom
- Pierre Robin syndrome
- Acromegaly
- Hypothyroidism
Treacher Collins syndrome is associated with cleft palate as you know indicating a difficult airway. What congenital heart diseases is associated with Treacher Collins syndrome?
Ventricular Septal Defect
At what age is cleft Palate usually repaired?
12 - 18 month
List 7 anomalies often co existent with myelomeningocele.
-club foot hydrocephalus dislocation of hips exsstrophy of bladder exstrophy of bladder prolapsed uterus Klippel feil syndrome congenital cardiac defects
What is Arnold Chiari Malformation?
Elongated cerebellar vermis that herniates through the foramen magnam
What are four symptoms of Arnold Chiari malformation?
-Difficulty swallowing
recurrent aspiration
stridor
apneic episode
In addition to cleft palate and ventriculoseptal defects, what other condition are associated with Treacher collins syndrome?
Malar hypoplasia colobomas (Notching of the lower eyelids macrostomia (Large moutn malocclusion small oral cavity
Chidren with long standing obstructive sleep apnea show what anatomic changes in the heart?
Pulmonary artery hypertension
Right ventricualr hypertrophy develop
Children of what ages get croup (Laryngotracheobronchitis)?
Croup wuually occurs in children aged 2 or less
List three treatments for postintubation laryngeal edema?
Coo humidified mist with O2
Aerosolized racemic epinephrine 0.05mL/kg of 2.25
Intravenous dexamethasone
What is the pathogenesis of post intubation croups?
Glottic tracheal edema
Identify 6 risk factors for post intubation croup?
Early childhood repeated intubation attempts large endotracheal tube prolonged surgery head and neck procedures excessive movement of the endotracheal tube
What is the appropriate treatment for post intubation croup?
- Nebulized racemic epinephrine
- Intravenous dexamethasone
Children of what ages get epiglottitis?
1 to 7 years (greater frequency with children less than 3 years)
List four anesthesia consideration for the patient with congenital diaphragmatic hernia?
-Ketamine 0.5 mg/kg or fentanyl 1-3 mcg/kg
-avoid nitrous oxide
-Gently attempt to reexpand the lungs under direct vision using pressure no greater the 30 cm H2O after repair
Anticipate the need for postoperatice support of ventilation
The newborn has undergone a pyloromyotomy. What might you be concerned about in the postoperative period?
Respiratory depression and hypo ventilation in the recovery room because of persistent metabolic or cerebrospinal fluid alkolosis.
What is the average amount of blood lost (in mL/kg) during tonsillectomy?
4 mL/kg
Should extubation be performed while the patient is awake or asleep after a tonsillectomy? Why?
An awake extubation is preferred by most anesthetists because risk of aspiration is reduced.
Identify ten factors associated with postintubation laryngeal edam.
- age younger than 4 year
- tight fit in endotracheal tuve
- traumatic or repeated intubation
- prolonged intubation
- high pressure low volume cuff
- patient bucking or coughing during intubation
- head repositioning while intubated
- history of infections or postintubation croup
- upper respiratory infection
- Trisomy
What is the most common cause for liver transplantation in children?
Cholestatic liver disease secondary biliary atresia
What are three major concerns related to anesthetizing the Down’s patient?
- intubation may difficult to large tongue, short neck, small mouth, and subglottic stenosis
- neck flexion during laryngoscopy and intubation may result in atlanto occipital dislocation because of congenitally weak ligaments
- Congenital hear disease is present in 40% of patient
What are four pathophysiological feature associated with Down’s syndrome, in addition to difficult airway, atlanto occipital instabiliity and congenital heart defects?
- Irregular dentition
- Mental retardation
- hypotonia
- tracheoesophageal fistual
- chronic pulmonary infection
- seizures
Where should PCO2 be maintained during intracranial surgery in children?
20 - 25 mm Hg
State two reasons why neonates require more succinylcholine on a mg/kg basis than adults?
- Larger volume of ditribution for succinylcholine that adults 40 - 50 %
- Neuromuscular junction is immature
Maximum dose of bupivacaine for a pediatric patient?
- 1 mL/kg
- up to 25 cc can be used
Is elimination of amide local anesthetics shortened or prolonged in the neonate compared with the adult.
- Prolonged in the neonate by 2 - 3 times
- (approaches adult levels at 6 month)
Which local anesthetic is not metabolized in neonates?
Mepivicaine
State 3 reason why the uptake of anesthetic drugs is typically faster in children than in adults?
- Child’s higher alveolar ventilation per weight account largely for this effect
- Increased cardiac output wiht greater distribution to the vessel risk groups
- Anesthetic agents appear to be less blood solube in children thatn in adults.
Give the two most important reasons why children are induced faster than adults with inhalational agents?
- Smaller functional residual capacity per unit of body
- Greater blood flow to the brain
Which fluid is most appropriate for a normal six month old?
D5 lactated ringer’s
What is the best criteria for determining premedication dosages in kids?
body weight of child
