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NEONATAL ANESTHESIA > NEONATE Others > Flashcards

NEONATE Others Flashcards

1
Q

TRANSFUSION TRIGGERS

A

Hemoglobin <10 g/dL - major surgery or newborn with moderate cardiopulmonary disease

Hemoglobin <13 g/dL - newborn with severe cardiopulmonary disease

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2
Q

PLATELETS should be kept above ___ /uL for invasive procedures

A

> 50,000/uL

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3
Q

Hemoglobin in transfused blood is

Hemoglobin A or Hemoglobin F?

A

HEMOGLOBIN A

Better release of oxygen at tissue level

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4
Q

Rare but potentially deadly complication of RBC transfusion where transfused lymphocytes in the donor blood attack the recepient none marrow

A

TRANSFUSION-ASSOCIATED GRAFT VERSUS HOST DISEASE

Causes: 
Fever
Pancytopenia 
Diarrhea 
Hepatitis

Prevention:
GAMMA IRRADIATION OF CELLULAR BLOOD

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5
Q

This is used for transfusion in premature neonates to

  1. Reduce cytomegalic virus transmission
  2. Decrease risk of alloimmunization
  3. Decrease febrile hemolytic transfusion reactions

There are also decrease in retinopathy of prematurity, bronchopulmonary dysplasia and length of hospital stay

A

LEUKOCYTE REDUCTION by FILTRATION

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6
Q

Most frequent surgical procedures in the FIRST MONTH of life (6)

A
  1. Exlap for necrotizing enterocolitis
  2. Correction of pyloric stenosis
  3. Patent ductus arteriosus ligation
  4. Shunt procedure for hydrocephalus
  5. Central venous catheter placement
  6. Inguinal hernia repair
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7
Q

Newborns have ______ hemoglobin levels than infant or child

A

HIGHER - 15-18 g/dL

> 20 g/dL polycythemia

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8
Q

At risk for hypoglycemia

A
  1. Stressed preterm or SGA or VLBW
  2. With diabetic mothers
  3. Who have not been receiving either enteral or parenteral feeds
  4. Septic
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9
Q

Glucose level

  1. Full term
  2. Preterm
A
  1. Full term 60-80 mg/dL

2. Preterm 10 mg/dL below the full term glucose level (50-70 mg/dL

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10
Q

Hypoglycemia or gloves levels less than ___ warrant therapy with additional dextrose

A

< 45 mg/dL

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11
Q

Unexplained thrombocytopenia can be an early sign of _____

A

Sepsis

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12
Q

PT and PTT are ______ in newborns

A

10% longer

PT approach adult levels in the 1st week
PTT approach adult levels within the 1st month of life

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13
Q

Prevention of early vitamin K deficiency bleeding of the newborn

A

IM vitamin K administration after birth

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14
Q

NIBP

  1. Cuff size
  2. Cycle
A
  1. Size 1/2 or 2/3 of the length of the upper arm

2. Should not be routinely cycled excessively more than every 3 mins - at risk for venous stasis

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15
Q

Lipid emulsion dose for LAST

A

1.5 ml/kg bolus which may be repeated followed by continuous infusion of 0.25 ml/kg/min

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16
Q

EMLA

A

Mixture of lidocaine 2.5% and prilocaine 2.5%

Applied under an occlusive bandage for 45-60 mins

17
Q

High or total spinal anesthesia in infants will present as _________

A

APNEA or falling oxygen saturation instead of hypotension due to lack of sympathetic tone in infants

18
Q

Landmarks for caudal epidural block

A
  1. Coccyx
  2. Two safral cornua
  3. Posterior superior iliac spines
19
Q

Evidence of intravascular injection during caudal block

A
  1. Peak T waves
  2. Increase in HR
  3. Increase in BP
20
Q

Primary mechanism the newborn has to respond to heat loss

A

NONSHIVERING THERMOGENESIS

21
Q

Administering _______ at dose ________ prophylactically to infants at risk of postoperative apnea to ensure adequate serum levels may prevent the need for prolonged periods of postoperative ventilatory support

A

CAFFEINE 10 mg/kg

Caffeine and theophylline - increase central respiratory drive and lowering the threshold of response to hypercarbis and stimulating contractility in the diaphragm

22
Q

The most common cited cause of ROP (retinopathy of prematurity)

A

HYPEROXIA

Other causes: hypoxemia, hypotension, sepsis, intraventricular hemorrhage and other stresses

23
Q

Surgical procedures performed in the FIRST WEEK of life (6)

A
  1. CDH
  2. Omphalocele
  3. Gastroschisis
  4. TEF
  5. Intestinal obstruction
  6. Myelomeningocele
24
Q

Multimodal treatment of pulmonary HPN as preoperative preparation for patients with CDH (congenital diaphragmatic hernia) include:

A
  1. Nitric oxide
  2. Sildenafil - PDE-5 inhibitor
  3. Milrinone - PDE-3 inhibitor
  4. Epoprostenol or iloprost - PGI2 inhibitor
  5. Bosentan - endothelin inhibitor
  6. Imantibin - PDGF inhibitor
25
Q

Anesthetic technique for repair of CDH

A
  1. Infants who will remain intubated: Inhalation agents and narcotics
  2. Small defect with little to no respiratory distress: Regional or neuraxial analgesia in anticipation of extubation
  3. Muscle relaxant to facilitate abdominal closure
  4. Avoid nitric oxide if abdominal closure could be difficult
26
Q

During ___ to ___ week of fetal life, the abdominal contents are extruded into na extraembryonic coelem and gutnreturns to the abdominal cavity at 10th week

A

5th to 10th week

27
Q

Omphalocele or Gastroschisis

Failure of part of or all the intestinal contents to return to abdominal cavity

Covered with a membrane called amnion

Umbilical cord is found at the APEX of the sac

A

OMPHALOCELE

Amnion - protects the abdominal contents from infection and loss of ECF

28
Q

Omphalocele or Gastroschisis

Develops later in life, after intestinal contents have returned to the abd cavity

Results from interruption of the omphalomesenteric artery which results in ischemia and atrophy of the various layers of abd wall

No sac; abd viscera may be found outside the periotoneal cavity

Umbilical cord is found at one side of the intestinal contents

A

GASTROSCHISIS

29
Q

Omphalocele or gastroschisis

High incidence of associated congenital anomalies

A

OMPHALOCELE

30
Q

Beckwith-Wiedemann syndrome (5)

A
  1. Mental retardation
  2. Hypoglycemia
  3. Congenital heart disease
  4. Large tongue
  5. Omphalocele
31
Q

The most common upper gastrointestinal obstruction in the newborn is ________

A

PYLORIC STENOSIS

32
Q

Most common congenital primary neural tube defect

A

MYELOMENINGOCELE

Failure of neural tube closure during 4th week of gestation

33
Q

Most common airway problem in infants and young children is ________

A

Upper airway obstruction due to LARYNGOMALACIA

Supraglottic structures converge on the glortic opening during inspiration preventing air entry

Characterized by

  1. Suprasternal and supraclavicular retractions
  2. Paradoxical collapse of chest wall or sternum
  3. Exaggerated diaphragmatic excursions

Treatment: POSITIVE AIRWAY PRESSURE
Resolve with age and without treatment

34
Q

Single most effective strategy available to minimize heat loss in children who undergo surgery lasting for 1 hour

A

Forced air warmers

35
Q

In children, heat loss follows the order:

A
  1. Radiation 39%
  2. Evaporation 24%
  3. Conduction 3%
36
Q

Core temperature

A

Mid-esophagus usinh esophageal temp probe

NEONATAL ANESTHESIA (5 decks)

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