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Peds Anesthesia - Summer 2013 > Memory Master overview select. > Flashcards

Memory Master overview select. Flashcards

1
Q

When do liver enzyme become completely functional in the neonate?

A

One month of age

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2
Q

What are the angles of the left and right bronchi in a child less than three years of age?

A

Left 55

Right 25 to 70

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3
Q

What factors contribute to the decreased functional residual capacity in the neonate and infant during general anesthesia?

A
  • Comopliant chest wall

- poorly compliant lungs.

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4
Q

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?

A 
Newborn = 10
6 month to 1 year =11
2 yr =12
3 yr =13 -14
4 yr = 15
5yr = 15 -16
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5
Q

Describe the physiologiical anemia of the neonate and pediatric patient?

A

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.

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6
Q

Compare the physiological anemia in the preterm neonate?

A

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.

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7
Q

Below what hemoglobin concentration is anemia sufficient to jeopardize oxygen carrying capacity in the neonate? Infant older than three months.

A

New born = 13

3 month old =10

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8
Q

During the preoperative evaluation of a 6 month old surgical candidate you note physiologic anemia. What is a likely cause for the physiologic anemia?

A

Premature infant

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9
Q

What is the normal heart rate of the term infant?

A

120 - 180

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10
Q

List two way the physiology of the cardiovascular system of the neonate differs form that of the adult?

A
  • Cardiac output is heart rate dependent

- Left ventricular compliance is decreased

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11
Q

At what age is basal metabolic rate normally the highest?

A

6 -12 months old

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12
Q

Where is brown fat located?

A
  • Interscapular space
  • around large blood vessels
  • around the neck
  • behind the sternum
  • around the kidneys and adrenals
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13
Q

What contral non shivering thermogenesis in infants?

A

Autonomic nervous system

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14
Q

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?

A

2 years of age

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15
Q

At what rate do infants consume oxygen?

A

7 ml/kg/min

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16
Q

How much faster does infants consume oxygen than adults?

A

twice as fast

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17
Q

Blood shunts through what two structures in the neonate with persistent fetal circulation?

A
  • Ductus arteriosus

- Foramen ovale

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18
Q

What is a patent ductus arteriosus? When does the ductus arteriosus normally close

A

Few hours to a few days

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19
Q

What is the probable problem if the pediatric patient has a systolic and diastolic murmur?

A

Patent ductus arteriosus

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20
Q

Identify the best site to obtain arterial blood gases from in the neonate?

A

Radial artery

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21
Q

Identify 4 factors that may cause a neonate infant to return to fetal circulation?

A
  • Hypoxia
  • acidosis
  • pneumonia
  • hypothermia
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22
Q

List three condition that increase right to left shunt?

A
  • Acidosis
  • hypercarbia
  • hypotension
23
Q

List three congenital anomalies associated with prune belly syndrome?

A
  • cryptorchidis
  • club feet
  • genitourinary tract abnormalities
24
Q

Name four condition in which the patient presents with a large tongue. What is the concern if the patient has a large tonguue?

A
  • Down’s syndrom
  • Pierre Robin syndrome
  • Acromegaly
  • Hypothyroidism
25
Q

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?

A

Ventricular Septal Defect

26
Q

At what age is cleft Palate usually repaired?

A

12 - 18 month

27
Q

List 7 anomalies often co existent with myelomeningocele.

A 
-club foot
hydrocephalus
dislocation of hips exsstrophy of bladder
exstrophy of bladder
prolapsed uterus
Klippel feil syndrome
congenital cardiac defects
28
Q

What is Arnold Chiari Malformation?

A

Elongated cerebellar vermis that herniates through the foramen magnam

29
Q

What are four symptoms of Arnold Chiari malformation?

A

-Difficulty swallowing
recurrent aspiration
stridor
apneic episode

30
Q

In addition to cleft palate and ventriculoseptal defects, what other condition are associated with Treacher collins syndrome?

A 
Malar hypoplasia 
colobomas (Notching of the lower eyelids
macrostomia (Large moutn
malocclusion
small oral cavity
31
Q

Chidren with long standing obstructive sleep apnea show what anatomic changes in the heart?

A

Pulmonary artery hypertension

Right ventricualr hypertrophy develop

32
Q

Children of what ages get croup (Laryngotracheobronchitis)?

A

Croup wuually occurs in children aged 2 or less

33
Q

List three treatments for postintubation laryngeal edema?

A

Coo humidified mist with O2
Aerosolized racemic epinephrine 0.05mL/kg of 2.25
Intravenous dexamethasone

34
Q

What is the pathogenesis of post intubation croups?

A

Glottic tracheal edema

35
Q

Identify 6 risk factors for post intubation croup?

A 
Early childhood
repeated intubation attempts
large endotracheal tube
prolonged surgery 
head and neck procedures
excessive movement of the endotracheal tube
36
Q

What is the appropriate treatment for post intubation croup?

A
  • Nebulized racemic epinephrine

- Intravenous dexamethasone

37
Q

Children of what ages get epiglottitis?

A

1 to 7 years (greater frequency with children less than 3 years)

38
Q

List four anesthesia consideration for the patient with congenital diaphragmatic hernia?

A

-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

39
Q

The newborn has undergone a pyloromyotomy. What might you be concerned about in the postoperative period?

A

Respiratory depression and hypo ventilation in the recovery room because of persistent metabolic or cerebrospinal fluid alkolosis.

40
Q

What is the average amount of blood lost (in mL/kg) during tonsillectomy?

A

4 mL/kg

41
Q

Should extubation be performed while the patient is awake or asleep after a tonsillectomy? Why?

A

An awake extubation is preferred by most anesthetists because risk of aspiration is reduced.

42
Q

Identify ten factors associated with postintubation laryngeal edam.

A
  • 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
43
Q

What is the most common cause for liver transplantation in children?

A

Cholestatic liver disease secondary biliary atresia

44
Q

What are three major concerns related to anesthetizing the Down’s patient?

A
  • 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
45
Q

What are four pathophysiological feature associated with Down’s syndrome, in addition to difficult airway, atlanto occipital instabiliity and congenital heart defects?

A
  • Irregular dentition
  • Mental retardation
  • hypotonia
  • tracheoesophageal fistual
  • chronic pulmonary infection
  • seizures
46
Q

Where should PCO2 be maintained during intracranial surgery in children?

A

20 - 25 mm Hg

47
Q

State two reasons why neonates require more succinylcholine on a mg/kg basis than adults?

A
  • Larger volume of ditribution for succinylcholine that adults 40 - 50 %
  • Neuromuscular junction is immature
48
Q

Maximum dose of bupivacaine for a pediatric patient?

A
  • 1 mL/kg

- up to 25 cc can be used

49
Q

Is elimination of amide local anesthetics shortened or prolonged in the neonate compared with the adult.

A
  • Prolonged in the neonate by 2 - 3 times

- (approaches adult levels at 6 month)

50
Q

Which local anesthetic is not metabolized in neonates?

A

Mepivicaine

51
Q

State 3 reason why the uptake of anesthetic drugs is typically faster in children than in adults?

A
  • 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.
52
Q

Give the two most important reasons why children are induced faster than adults with inhalational agents?

A
  • Smaller functional residual capacity per unit of body

- Greater blood flow to the brain

53
Q

Which fluid is most appropriate for a normal six month old?

A

D5 lactated ringer’s

54
Q

What is the best criteria for determining premedication dosages in kids?

A

body weight of child

Peds Anesthesia - Summer 2013 (14 decks)

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