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Advanced Principles II > Neonatal > Flashcards

Neonatal Flashcards

1
Q

How long are infants obligate nose breathers?

A

Up to about 5 months

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2
Q

What is the epiglottis shape of a neonate/infant?

A

Omega shaped
Stiff
difficult to displaced during laryngoscopy

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3
Q

How do pediatric tongues differ from adult tongues?

A

Take up a greater volume of the mouth, which makes obstruction more likely and displacement difficult during laryngoscopy

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4
Q

How are pediatric vocal cords positioned?

A

At an anterior slant
Easy to get the tube stuck in the anterior commissure

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5
Q

If you encounter resistance beyond the vocal cords, this is likely due to:

A

the cricoid cartilage

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6
Q

What is the narrowest region of the pediatric airway?

A

Narrowest fixed: Cricoid
Narrowest Dynamic: vocal cords

The vocal cords are technically narrower, but they’re also distensible, so they can get bigger. The cricoid can’t/

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7
Q

What is the narrowest region of the pediatric airway?

A

Narrowest fixed: Cricoid
Narrowest Dynamic: vocal cords

The vocal cords are technically narrower, but they’re also distensible, so they can get bigger. The cricoid can’t/

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8
Q

What is the oxygen consumption in an adult? An infant?

A

Adult: 3 ml/kg/min
Infant: 6 ml/kg/min

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9
Q

Which is altered in neonates: alveolar ventilation or tidal volume?

A

Alveolar ventilation. Their tidal volume is the same as adults (6ml/kg)

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10
Q

Do neonates have a smaller FRC?

A

No, the volume is technically the same, but oxygen consumption is so much higher that the FRC is rapidly exhausted

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11
Q

What is the rate of alveolar ventilation in a neonate?

A

130 ml/kg/min

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12
Q

What is the rate of alveolar ventilation in an adult?

A

60 ml/kg/min

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13
Q

What are Type I muscle fibers?

A

Slow-twitch muscles that are built for ENDURANCE - resistant to fatigue

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14
Q

What are Type II Muscle fibers?

A

Fast-twitch muscles that are built for SPEED - they tire easily

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15
Q

What percentage of adult diaphragm muscles are type I?

A

55%

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16
Q

What percentage of neonatal diaphragm muscles are type I?

A

25% - they tire out faster

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17
Q

The risk of apnea in neonates is inversely proportional to:

A

gestational and Post-Conceptual Age (PCA)

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18
Q

What preterm infants should be admitted postoperatively for apnea monitoring?

A

< 44 Weeks PCA

All patients <66 weeks PCA should be kept for monitoring

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19
Q

Besides caffeine, what can be used to reduce the incidence of apnea in postop neonates?

A

Theophylline, but it has more toxicity risks

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20
Q

Is neonatal lung compliance higher or lower than adults?

A

Lung compliance is lower, because there are fewer alveoli

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21
Q

Is neonatal chest wall compliance higher or lower than adults?

A

Higher. The chest wall is flimsy.

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22
Q

Is closing capacity increased or decreased in neonates?

A

Increased. Closing capacity overlaps with tidal breathing

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23
Q

What mechanisms help support neonatal FRC?

A
  1. Sustained tonic activity of inspiratory muscles
  2. Narrowing of the glottis during expiration
  3. Shorter expiratory time coupled with a faster respiratory rate results in PEEP

ALL OF THESE ARE ABOLISHED WITH GENERAL ANESTHESIA

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24
Q

In the newborn, hypoxemia causes:

A

Apnea
Respiratory drive is not fully developed until about 42-44 weeks PCA

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25
Q

What is the P50 of HgbF?

A
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26
Q

What is the composition of HgbF?

A

2 Alpha chains and 2 gamma chains

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27
Q

Why does Hgb F have a higher affinity for oxygen?

A

The binding site for 2,3-DPG is on the beta chain, which Hgb F doesn’t have. So it can’t bind 2,3-DPG

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28
Q

How long does it take for Hgb F to completely replace Hgb A?

A

6 months

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29
Q

What is the transfusion trigger in a child < 4 months with cardiopulmonary disease?

A

13 g/dl

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30
Q

What is the transfusion trigger in a child < 4 months presenting for surgery?

A

10 g/dl

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31
Q

What is the transfusion dose for neonates?

A

10-15 ml/kg

32
Q

A 10ml/kg transfusion should raise Hgb how much?

A

1-2 g/dl

33
Q

What is the transfusion trigger in a child > 4 months?

A

Since most of their Hgb F has been replaced, it’s the same as for everyone else:

> 10 no transfusion
6-9 maybe
< 6 definitely

34
Q

What are the indications for FFP?

A
  1. Emergency reversal of warfarin
  2. Correction of coagulopathic bleeding with elevated PT/PTT
  3. Correction of coagulopathic bleeding if > 1 blood volume has been replaced and coags are not easily attainable
35
Q

What is the dose of FFP in a child?

A

Same as for blood
10-20 ml/kg

36
Q

Massive Transfusion is associated with:

A
  1. Alkalosis (citrate is metabolized to bicarb in the liver)
  2. Hypothermia
  3. Hyperglycemia (stored blood has added dextrose)
  4. Hypocalcemia
  5. Hyperkalemia (from hemolysis)
37
Q

What is the calculation for MABL?

A
38
Q

What is a normal Hgb in a neonate?

A

14-20

39
Q

What is the EBV of a term neonate?

A

80-90 ml/kg

40
Q

What is the EBV in a preterm infant?

A

90-100 ml/kg

41
Q

Does the newborn kidney tend to excrete or retain sodium?

A

Excrete
It lacks developed concentrating mechanisms

42
Q

Why do neonates have high insensible water loss?

A

Their BSA to body weight ratio is four times higher than for adults, plus they have thin skin

43
Q

Do neonates tend to excrete or reabsorb glucose?

A

Excrete

44
Q

When does the renal tubule develop full concentrating abilities?

A

~ 2 years

45
Q

When does GFR increase to adult levels?

A

8-24 months

46
Q

Compared to adults, what three kidney functions are lower in the neonate?

A
  1. GFR
  2. Renal Perfusion Pressure
  3. Concentrating & Diluting ability
47
Q

TBW % for a premature neonate is about:

A

85% of body weight

48
Q

TBW % for a term infant is about:

A

75%

49
Q

TBW % for a child and adult is about:

A

60%

50
Q

On a cellular level, why are neonates so sensitive to water loss?

A

Almost all of their TBW is extracellular, so there’s less intracellular fluid to pull from

51
Q

Neonates need higher dose of _____ soluble drugs

A

Water, because they have a higher % water

52
Q

Will neonates have higher or lower free fractions of protein bound drugs?

A

Higher, because they have less albumin and alpha 1 glycoproteins for drugs to bind to. This means they are at greater risk of toxicity

53
Q

Will propofol have a longer or shorter duration of action in the neonate?

A

Longer, because the duration of action is usually limited by redistribution, but in neonates there’s less fat to redistribute into, so it remains in the plasma longer

54
Q

When does hepatic clearance of drugs reach adult levels?

A

About 1 year

55
Q

Why can’t neonates conjugate bilirubin?

A

Reduced Glucuronyl Transferase. This means they also can’t metabolize tylenol

56
Q

When does GFR reach adult levels?

A

8-24 mos

57
Q

When does renal tubular concentrating ability reach adult levels?

A

2 years

58
Q

Are neonates more or less sensitive to sedatives and hypnotics?

A

Generally more sensitive, because they have a poorly developed BBB

59
Q

Is a neonatal MAC higher or lower than an infant MAC?

A

Lower (BBB)
EXCEPT WITH SEVO

60
Q

Is a premature MAC higher or lower than a neonatal MAC?

A

Lower (BBB)
EXCEPT WITH SEVO

61
Q

What is a normal Sevo MAC in neonates?

A

3.2%

62
Q

What is the CO of a newborn?

A

200ml/kg/min

63
Q

Should the dose of a water soluble drug increase or decrease in neonates?

A

Increase

64
Q

Should the dose of a lipid soluble drug increase or decrease in neonates?

A

Decrease

65
Q

Is the dose for succinylcholine higher or lower in neonates?

A

Higher! They have increased volume of extracellular fluid and their receptors are just as sensitive as adult receptors

66
Q

Is the dose for nondepolarizing NMBAs higher or lower in neonates?

A

Its the same, BECAUSE:
their neuromuscular junction is MORE sensitive to nondepolarizers and EQUALLY sensitive to succinylcholine

67
Q

Are NMBAs lipid or water soluble?

A

VERY WATER SOLUBLE
This is why they don’t cross barriers well

68
Q

What is the duration of action of succinylcholine in a neonate?

A

The same as in an adult

69
Q

When is bradycardia from succinylcholine most likely to occur?

A

It may occur after the first dose, but its more likely to occur with subsequent doses

70
Q

What is the IM dose for succinylcholine in the neonate and infant?

A

5 mg/kg

71
Q

What is the IM dose for succinylcholine in the child?

A

4 mg/kg

72
Q

Which nondepolarizer can be given IM?

A

ONLY ROC

73
Q

What is the IM dose of Rocuronium for children?

A

1.8 mg/kg

74
Q

What is the IM dose of Rocuronium for infants?

A

1 mg/kg
“One for less than one”

75
Q

How long does it take for IM rocuronium to work?

A

3-4 minutes!

76
Q

What are good indicators or readiness for extubation in a neonate?

A

ToF > 90%
MIF < - 25cmH2O

77
Q

For every gas EXCEPT sevo, when does MAC peak?

A

2-3 months

Advanced Principles II (5 decks)

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