Neonatal emergencies 2 Flashcards
Which condition is MOST closely associated with gastroschisis?
a. prematurity
b. congenital heart disease
c. Beckwith-Weidemann syndrome
d. trisomy 21
a. prematurity
Defects in the abdominal wall of the infant include
omphalocele and gastroschisis
Which is more common omphalocele or gastroschisis?
ompalocele
Omphalocele is associated with
trisomy 21, cardiac defects, & Beckwith Wiedemann syndrome
Ompalocele includes ____________________–whereas gastroschisis does not
a covering over the abdominal viscera; does not include a covering over the abdominal viscera
The patient with gastroschisis is
sicker and at a higher risk of fluid and heat loss
Anesthetic considerations for omphalocele and gastroschisis include
monitoring thoracic and abdominal pressure along with meticulous attention to fluid balance and body temperature
Omphalocele is caused by
failure of gut migration from the yolk sac into the abdomen
Gastroschisis is caused by
occlusion of the omphalomesenteric artery during gestation
With gastroschisis, abdominal contents are
placed in a bag after delivery to minimize water and heat loss
Where should SpO2 be measured with gastroschisis and omphalocele?
lower extremity to monitor for impaired venous return
One should expect ____________ with anesthetic management of gastroschisis and omphalocele.
significant fluid and electrolyte shifts
What is a late finding in the patient with untreated pyloric stenosis?
a. hyponatremia
b. hyperkalemia
c. metabolic acidosis
d. alkaline urine
c. metabolic acidosis
Pyloric stenosis occurs when
hypertrophy of the pyloric muscle creates a mechanical obstruction at the gastric outlet
With pyloric stenosis, one can palpate
an olive-shaped mass just below the xiphoid process
The infant with pyloric stenosis presents with
non-bilious projectile vomiting leading to dehydration with hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis + compensatory respiratory acidosis
Pyloric stenosis is a ________________________ so pyloromyotomy should be
medical (not surgical) emergency; postponed until the fluid, electrolyte, and acid-base status are optimized
With pyloric stenosis, one should anticipate a
full stomach; empty the stomach before induction, intubate either awake or with RSI, and extubate awake