NEONATES MUST KNOW Flashcards
Calculate the minute volume of a newborn who weighs 3 Kg and has respiratory rate of 40 breaths per minute?
(Was on the SEE)
MV = RR x TV
Tidal volume for the adult is the same as in the infant, 7ml/kg
First calculate the TV which is 3kg x 7ml = 21
MV= 21 x 40 = 840 ml/min
Deadspace in the neonate
2-2.5 ml/kg
Intracardiac Right to Left shunt disorders are (RL-TEPPET)
Tetralofy of Fallot Ebstein anomaly Pulmonary atresia Pulmonary Stenosis with atrial or ventricular defects Eisenmenger syndrome. Tricuspid atresia
Right to left shunt is associated with cyanosis/ vs acyanosis
Cyanosis
Intracardiac LEFT to RIGHT shunt disorders are (LR-AVAPA) think Lactated Ringer’s AVAPA
ASA VSD AV Canal defects PDA Aortopulmonary Defects
Which intracardiac shunt is associated with outflow tract obstruction?
Right to left shunt (RL-TEPE)
Left to right shunt is associated with
CHF (no cyanosis) (too much pulmonary blood flow)
Left to right shunt is associated with _________ pulmonary blood flow
HIGH pulmonary blood flow.
Right to Left shunt is associated with ________pulmonary blood flow
LOW pulmonary blood flow.
Cyanosis defects include
Tetralogy
Ebstein anomaly
The primary pathways by which heat is lost in the neonate are via.
radiation (39%) and convection (34%). Evaporation accounts for about 24% of neonatal heat loss and conduction accounts for 3%.
What route of administration of midazolam would be least recommended for a five year-old patient?
IM (because it can cause sterile abscess)
What is the Intranasal fentanyl dose can be used as a premedication agent for pediatric surgery?
1-2 mcg/kg
The administration of intravenous caffeine can reduce the risk of apnea for premature infant. What is the dose?
10 mg/kg
What is the lower limit of autoregulation of cerebral blood flow in children of all ages?
60
What is the most common significant airway problem in pediatric anesthesia?
Laryngomalacia
What happens with laryngomalacia and what is the treatment?
In laryngomalacia, the upper airway structures collapse during inspiration. Treatment is focused on positive airway pressure.
What is the most common form of neural tube defect?
Myelomeningocele
Myelomeningocele can be prevented in mother take what?
Folic acid.
Succinylcholine is metabolized by
pseudocholinesterase in the plasma OR PLASMA CHOLINESTERASE
In obese pediatric patients, the initial dose of rocuronium and morphine should be based on
ideal body weight.
Propofol and remifentanil should be based on
lean body weight.
Over 80 percent of patients with a myelomeningocele will also develop
Hydrocephalus
Over 80 percent of patients with a myelomeningocele will also develop
Hydrocephalus (so with correction surgery they may also get a shunt placement
Following removal of the amnion of an omphalocele, large amounts of fluid may exude. This fluid constitutes extracellular fluid and should be replaced with a
balanced salt solution.
Principal concerns during the surgical repair of an omphalocele or gastroschisis are
fluid management and adequate ventilation.
Bradycardia for infants (<1 yr of age) is and for
100 bpm;
Bradycardia for young children 1 to 5 years of age is
80 bpm;
Bradycardia for children >5 years of age is
60 bpm.
What is an appropriate rectal dose of acetaminophen for a pediatric patient for postoperative analgesia?
20-30 mg/kg
The baseline mean heart rate ranges between
110 and 160 beats per minute in the normal fetus.
Neonate Ketamine IV dosing
2mg/kg
Neonate Ketamine IM dosing
5-10 mg/kg
Emergence delirium in children between the ages of 2 and 6 years is most common with
Sevoflurane
Which APGAR score reflects some flexion of extremities, grimace, heart rate >100 bpm, completely pink color, and crying?
8
According to the APGAR scoring method, this patient would receive the following points: some flexion of extremities (1), grimace (1), >100 heart rate bpm (2), completely pink (2), and crying (2).
What Can be a sign of Hypoxia in the fetus?
Meconium aspiration during the third trimester can be an indicator of fetal hypoxia.
Which local anesthetic would be least appropriate for use in an epidural for a patient undergoing a cesarean section?
Bupivacaine is no longer used for obstetric epidurals because of the higher risk for local anesthetic systemic toxicity. Ropivacaine 0.5% can also be used as a substitute for bupivacaine as it has a lower risk for toxicity.
The induction dose of propofol in infants between 1-6 months of age is
3 mg/kg.
The induction dose of propofol For children 1-12 yo.
1.3-1.6 mg/kg.
Hyperglycemia in the parturient can produce _____ in the fetus soon after delivery.
Hypoglycemia
What is the most common cause of upper GI obstruction in the newborn?
Pyloric stenosis
What substance is responsible for promoting the continued patency of the ductus arteriosus?
prostaglandins
The oral dose of dexmedetomidine for pediatric patients is
2-4 mcg/kg
Common oral agents include 3 and dosing for each ?
acetaminophen 10-15 mg/kg, ibuprofen 5-10 mg/kg, and hydrocodone 0.1 mg/kg.
The most common causes of desaturation in otherwise healthy children in the post-anesthesia care unit are hypoventilation and
airway obstruction
Children who have had recent upper respiratory tract infections should not undergo elective anesthesia for at least
4 weeks
Uncuffed ET tubes can seal effectively up to about
8 years old
The alveoli and pulmonary vasculature are not mature enough to produce acceptable gas exchange until about _____ weeks gestation.
24-26 weeks
Ametop consists of
Tetracaine 4%
ELA-max is 4% liposomal lidocaine
Synera is a combination of lidocaine and tetracaine.
During what period following general anesthesia are premature neonates most likely to exhibit apnea and bradycardia?
4-6 hours
Which nondepolarizing muscle relaxant has an intermediate duration in adults, but is considered a long-acting agent in neonates?
vecuronium
Which of the following is an expected characteristic of persistent pulmonary hypertension of the newborn?
Hypoxia
n children with difficult IV access, what is the intubating dose for IM succinylcholine (mg/kg)?
4mg/kg
Which of the following explains why pediatric patients tend to desaturate more quickly than adults?
they have a higher alveolar ventilation to FRC ratio
The potency of rocuronium is inversely related to
Age
What would be an appropriate preoperative intranasal dose of midazolam for a 10 kilogram pediatric patient?
1mg The pediatric dose of intranasal midazolam is 0.1-0.2 mg/kg. For this patient, the range would be 1-2 mg.
You would expect that an oral dose of dexmedetomidine would produce sedation in a pediatric patient in about
30-60 minutes
You are contemplating using ketamine in suppository form for induction of anesthesia. What would be an appropriate dose?
5mg/kg
You are preparing to anesthetize a pediatric patient with Down syndrome. You know that airway management would most likely be complicated by
Macroglossia. Same as Apert and crouton disease
Warfarin should not be used past ___weeks gestation
36
Anticoagulation is a concern for parturients presenting with mechanical prosthetic valves. Current anticoagulation options for pregnancy per the American College of Cardiology are as follows:
- Warfarin should be continued until week 36; Convert to unfractionated heparin or low molecular-weight heparin at that point
- Use low molecular-weight heparin for entire pregnancy
- Use low molecular weight heparin or unfractionated heparin from 6 to 12 weeks and also after week 36; use warfarin from 12 to 36 weeks.
What is the most rapidly growing tumor of the anterior mediastinum in children?
Lymphoblastic T cell lymphoma
Which of the following monitors would you anticipate to be most appropriate for an infant undergoing exploratory laparotomy for necrotizing enterocolitis?
Arterial line
Are all typically repaired within the first week following delivery. GOCHTIM
Gastroschisis Omphalocele Congenital diaphragmatic Hernia, Intestinal obstruction, and Tracheoesophageal fistula,
Myelomeningocele
Maternally administered meperidine can produce what in fetus?
decreased beat-to-beat variability and tachycardia in the fetus.
You are preparing to administer ketamine orally to a 33 pound three year-old. Which of the following doses would be appropriate?
5-6 mg/kg
Newborn exhibits meconium staining. After suctioning the airway, bradycardia develops. What intervention should be done next?
Apply PPV
You are preparing to perform a deep extubation on a pediatric patient. You know that this generally requires a MAC of
1.5-2.0
The neonatal response to hypoxia is typically a short period of _____ followed by _____.
hyperventilation, hypoventilation
In 2013, the FDA issued a black box warning against the use of codeine for postoperative pain for children undergoing _____.
tonsillectomy and adenoidectomy
In former premature infants, the incidence of apnea increases with (2)
Anemia
decreased postconceptual age
You plan to administer acetaminophen to a pediatric patient as part of the postoperative analgesia plan. You know that the maximum dose is _____ in a 24 hour period.
100MG/KG
Premature infant level of glottis
C3
The first sign of a total spinal in a neonate is
Apnea
The primary means a newborn infant has to respond to hypothermia is
Increase release of norepinephrine
The most common surgical procedure in former premature infants is
Hernia repair
What is the primary anesthetic concern for patients with Emery-Dreifuss syndrome?
Conduction
What is the conduction in which intracardiac left to right and right to left shunts are equal?
Dextro-transposition of the great arteries
