Neonatal A&P 4 Flashcards
Infants and children at risk for developing hypoglycemia include
prematurity
less than 48 hours of age
small for gestational age
newborns of diabetic mothers
children with diabetes who received insulin on the day of surgery
children who receive glucose-based parenteral nutrition
Treatment of hypoglycemia in the infant or child includes
IV 10% dextrose at 2 ml/kg
If seizures are present in the setting of hypoglycemia, then
the dose is doubled to 4 mL/kg and then an infusion of 8 mg/kg/min of d10 is titrated
A 2 week old neonate will be expected to demonstrate all of the following EXCEPT a/an:
a. increased free fraction of highly protein bound drugs
b. faster circulation time
c. large volume of distribution for water-soluble drugs
d. shorter duration of action for lipid-soluble drugs
d. shorter duration of action for lipid soluble drugs
Describe the hepatic and renal function of the neonate
immature so it alters the pharmacokinetics and pharmacodynamics of drugs
Is MAC lower or higher in the infant?
higher
Describe the blood brain barrier of the infant.
immature
Describe cardiac output of the infant
higher
Describe the volume of distribution of drugs in the neonate.
volume of distribution of water-soluble drugs is higher
What is plasma protein concentration like for neonates?
lower
Neonates require higher doses of _____________ to achieve a given plasma concentration
water-soluble drugs
For drugs that are highly protein bound, the neonate will
experience increased free drug levels and have a higher risk of toxicity because they have lower concentrations of albumin and alpha-1 acid glycoprotein
In the neonate, drugs that require fat for redistribution and termination of effect
will have a longer duration of action
The neonate cannot conjugate bilirubin due to a reduction in _______________. this is the same enzyme that metabolizes _____________
glucuronyl transferase; acetaminophen
What is the MAC value for the neonate (0-30 days):
lower than the infant
What is the MAC value for the premature?
lower than the neonate
What is the MAC value for the 1-6 month old infant?
MAC is higher than the adult
What is the MAC value for the 2-3 month infant?
MAC peaks at its highest level
The MAC requirement pattern for __________ is different
sevoflurane
What is the MAC requirement of sevoflurane for 0 days to 6 months
MAC is higher (3.2%)
What is the MAC requirement for sevoflurane for 6 months to 12 years.
MAC is lower but still higher than the adult (2.5%)
Anesthetic considerations for the administration of neuromuscular blockers in the neonate include:
a. avoidance of succinylcholine
b. a longer duration of action of succinylcholine
c. larger dose of succinylcholine
d. a larger dose of succinylcholine and nondepolarizing neuromuscular blockers
c. a larger dose of succinylcholine
What neuromuscular drugs can be administered intramuscularly?
succinylcholine and rocuronium
What is the recommended dose of succinylcholine in the neonate?
2 mg/kg
Why do neonates need a higher dose of succinylcholine?
increased ECF
normal sensitivity to succinylcholine
What is the duration of succinylcholine in the neonate?
same as the adult
What is the dose of nondepolarizers for neonates?
combination of an increased ECF and increased sensitivity is assumed to be a wash so dose stays the same
What is the duration of action of nondepolarizers in the neonate?
immature metabolic and clearance mechanisms may prolong the duration of action
What are subjective signs of adequate recovery of NMBDs?
grimacing
elbow and hip flexion
bringing the news to the chest
Objective data suggests recovery from neuromuscular blockade includes a
TOF ratio >90% & a maximum inspiratory force less than 25 cmH2O
The FDA black box warning on succinylcholine warns of
hyperkalemia associated with undiagnosed muscular dystrophy in children under 8 years old
Although a head lift >5 seconds is appropriate for an adult, a neonate
does not have the muscle strength to raise his head
What is the dose of edrophonium for reversal?
1 mg/kg and is associated with less muscarinic side effects
Which NMDBs are useful in the neonates?
Atracurium and cisatricurium due to their organ-independent elimination
Concerns with using pancuronium in the neonate include
stronger vagolytic effect and may cause HTN which an increase EBL and lead to intracerebral hemorrhage
Pancuronium and vecuronium dosing is
0.1-0.15 mg/kg
What is the onset of IM dose of rocuronium?
3-4 minutes
What is the IM dose of rocuronium for children <1 year of age?
1 mg/kg
What is the IM dose of rocuronium for children >1 year of age?
1.8 mg/kg
The IM dose of succinylcholine for neonates and infants is
5 mg/kg
The IM dose of succinylcholine for older children is
4 mg/kg
When compared to administration into peripheral skeletal muscle _______________- administration of succinylcholine likely has the fastest onset
intralingual administration via the submental approach
In children less than 5 years of age, succinylcholine can cause _______ and _____________________ can be used as pretreatment
bradycardia or asystole; atropine (0.02 mg/kg IV)
