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Pathophys II > Pathophys final review part 4 > Flashcards

Pathophys final review part 4 Flashcards

1
Q

Infants are at risk for postoperative apnea up to

A

60 weeks postconceptual age

-type of anesthetic is not a risk factor

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2
Q

Postconceptual age is

A

age in weeks plus gestational age

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3
Q

A vagotomy is

A

an operation when one or more branches of the vagus nerve are cut
this is done to treat patients with excessive gastric acid production & peptic ulcer disease

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4
Q

If a patient is vomiting, we may see

A

metabolic alkalosis

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5
Q

If a patient is having diarrhea, we may see

A

metabolic acidosis

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6
Q

Gastroschisis is

A

herniated viscera exposed to air

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7
Q

Omphalocele is

A

herniated viscera covered in a membranous sac & is often associated with other congenital anomalies

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8
Q

The BTT shunt is

A

a systemic to pulmonary shunt
it commonly involves connecting the subclavian artery to the pulmonary artery
risks include shunt blockage (possibly from low flow states), infection, and excessive flow to the lungs

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9
Q

The infant’s retina continues to develop until

A

44 weeks post-conceptual age

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10
Q

Known factors to increase pulmonary vascular tone include

A 
hypoxemia & use of <30% fiO2
hypercarbia/acidosis
hypothermia
atelectasis
transmitted positive pressure & PEEP
stress response/stimulation/light anesthesia
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11
Q

Known factors to decrease pulmonary vascular tone include

A

increasing inspired oxygen to 100%
hyperventilation
potent inhalation agents reduce SVR more than PVR
nitric oxide

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12
Q

Chronic Fontan complications include

A

dysrhythmias
protein losing enteropathy
thrombosis

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13
Q

The PDA can be kept open with

A

prostaglandins

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14
Q

HLHS is a term used to

A

describe a spectrum of defects with the common denominator being under development of the heart’s left side
-aorta, aortic valve, LV, & MV

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15
Q

Describe the Norwood with shunt

A

connection between systemic to pulmonary circulation
anticipate oxygen saturation 75-80%
RV ejects into the systemic circulation

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16
Q

Describe the Bidirectional Glenn

A

requires low PVR & blood flow is passive
expected arterial oxygen saturation is 75-85%
direct anastomosis between the SVC & pulmonary artery branch

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17
Q

Describe the Fontan procedure

A

the inferior vena cava is connected to the pulmonary vasculature
allows for passive blood flow from the IVC to lungs while bypassing the heart
completes the separation of the pulmonary & systemic circulations
expected arterial oxygen saturation is 88-93%

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18
Q

TOF includes

A

VSD, RVOT, RVH, & overriding aorta

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19
Q

_____ may be used to treat pulmonary hypertension

A

Nitric oxide

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20
Q

The patent ductus arteriosus can be closed

A

medically via indomethacin or ibuprofen or surgical therapy

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21
Q

Describe where preductal and postductal measurement takes places

A

preductal- right arm

postductal- lower limb

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22
Q

Necrotizing enterocolitis anesthetic management includes

A

aspiration risk may necessitate RSI
inhalation agents poorly tolerated–> narcotic technique & avoid nitrous oxide
vasopressors required typically
large fluid loss & blood loss

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23
Q

Inguinal hernia repair, be prepared to see

A

laryngospasm when the surgeon pulls on the hernia sac if there is inadequate depth of anesthesia

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24
Q

Infants with _____ type hernia are more likely to have concurrent birth defects including CHD & chromosomal abnormalities

A

Bochdalek-type

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25
Q

CDH is a potentially lethal anomaly due to

A

pHTN, pulmonary hypoplasia, & associated cardiac or congenital defects

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26
Q

Anesthetic management for CDH repair includes

A 
avoid mask ventilation
place NG tube
Pre & post ductal monitoring
reactive pulmonary vasculature
give paralysis and narcotics while avoiding nitrous oxide
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27
Q

Omphalocele is typically

A

associated with genetic, cardiac, urologic, & metabolic abnormalities

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28
Q

High intra-abdominal pressures >_____ are poorly tolerated with omphalocele & gastrochisis

A

20

c

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29
Q

Criteria for aborting primary closure of omphalocele & gastrochisis includes

A

end-tidal CO2 >50
max ventilatory pressure >35
intra-gastric pressure & intravesical pressure >20

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30
Q

Describe VATER & VACTERL

A

vertebral abnormalities, imperforated anus, congenital heart disease, tracheo-esophageal fistula, renal abnormalities, and limb abnormalities
associated with tracheoesophageal fistula

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31
Q

When inducing a neonate for tracheoesophageal repair,

A

maintain spontaneous ventilation
place ETT between fistula & carina
avoid nitrous

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32
Q

Crohn’s disease vs. ulcerative colitis.

A

Crohn’s disease will affect anywhere in the tract
UC targets the colon
both have an autoimmune component

33
Q

Gastrin stimulates

A

parietal cells to release HCl

gastrin is released from G cells

34
Q

Cholecystokinin is released from

A

I cells as a result of protein, fat, & acid

35
Q

Proton pump inhibitors work by

A

inhibiting the parietal cell H+/K+ exchanger ATPase pump

PPIs are more effective than H2 antagonists

36
Q

H2 receptor antagonists work by

A

selective, reversible inhibition of H2 receptor mediated secretion of H+ ions

37
Q

Sympathetic response of the GI tract

A

will cause decrease gastric motility

38
Q

Water absorption occurs in

A

small intestine (ileum)

39
Q

Risk factors for apnea include

A

low birth weight, anemia, hypothermia, sepsis, neurological abnormalities, & type of surgical procedure
apnea is inversely related to postconceptual age

40
Q

For retinopathy of prematurity, the anesthesia saturation goal is

A

90-94%

41
Q

Normoglycemia for infants is

A

45-90 mg/dL

42
Q

Four routes of heat loss in the infant include

A

radiation (39%), >convention> evaporation> conduction

43
Q

At birth the liver is

A

somewhat incomplete
cytochrome P450 reaches ~50% adult values at birth
phase II are impaired until 1 year

44
Q

The ductus arteriosus remains patent in utero due to

A

hypoxia, mild acidosis, & placental prostaglandins

45
Q

Describe blue vs. pink lesions.

A

pink lesions- L to R shunts- connects arterial and venous circulation resulting in increased pulmonary blood flow
blue lesions- R to L shunts- venous blood is ejected systemically; there is decreased pulmonary blood flow & patients are cyanotic

46
Q

Eisenmenger’s syndrome is

A

when the shunt reverses direction when the PVR is high enough

47
Q

Coarctation presents with

A

upper extremity hypertension

decreased lower extremity pulses & LVH

48
Q

The Ross procedure is where

A

the diseased aortic root is resected the patient’s own pulmonary valve root is excised & implanted into the aortic position

advantages: free from long-term anticoagulation & the valve grows as the patient grows
disadvantage: single valve disease is treated with 2 valve procedure

49
Q

Describe class vs. modified BTS

A

classic- subclavian artery is divided & directly anastomosed to the ipsilateral pulmonary artery
modified- synthetic shunt between the subclavian artery & PA; hypotension leads to sluggish flow & possibly thrombosis

50
Q

SBE prophylaxis dose is

A

50 mg/kg of cefazolin

doxycycline if allergy exists

51
Q

TET spell is a

A

acute dynamic increase in the pulmonary outflow tract obstruction that may result in a cyanotic episode due to right to left shunting

52
Q

Intraoperative treatment of a TET spell includes

A 
100% oxygen
knees to chest
fluid bolus
hyperventilation
sedation
esmolol
phenylephrine
53
Q

Anesthetic considerations for the elderly include

A

decrease induction agents by 50%

54
Q

Two major structural effects in blood vessels of the elderly include

A

stiffening & atherosclerosis

55
Q

Additional CV considerations for the elderly include

A

systolic function is abnormal (increases) and diastolic does not so see widened pulse pressure
increased incidence of dysrhythmias
Decreased sensitivity to beta-adrenergic modulation***

56
Q

The most common complication and leading cause of death in the postoperative period for the elderly is

A

myocardial infarction

57
Q

The respiratory system of the elderly has

A

FRC increases with age
closing volume exceeds FRC in supine position at 45 and exceeds FRC in upright position at 65
more prone to respiratory failure
reduced oxygen exchange at alveolar level
more prone to atelectasis because increased tendency for airways to close
residual volume increases

58
Q

Elderly individuals have an

A

increased risk of aspiration**

due to decreased ability to clear secretions & attenuated protective cough mechanisms

59
Q

The aging kidney is

A

more susceptible to injury

60
Q

Hepatic function in the elderly

A

decreased metabolism
prolonged half-life
phase 1 drug metabolism is variable
phase 2 drug metabolism is not significantly affected
serum albumin decreases while alpha 1 acid glycoprotein increases

61
Q

A major risk factor for CV disease is

A

diabetes

62
Q

____ is more pronounced and lasts longer in the elderly

A

hypothermia

63
Q

Frailty is

A

an independent predictor of in-hospital mortality

a state of reduced physiologic reserve

64
Q

Diminishing cognitive performance over any time interval is

A

predictive of an earlier death

65
Q

______ is the norm in the elderly patient

A

polypharmacy

66
Q

Drug dosages in the elderly should be adjusted for

A

smaller lean body mass

67
Q

The ideal induction agent for the elderly is

A

etomidate

68
Q

Primary risk of opioids in the elderly is

A

respiratory depression

-reduce dose

69
Q

_____ is not recommended in the elderly

A

meperidine

70
Q

The NMBD of choice in the elderly is

A

cisatricurium

71
Q

Poor functional status is a risk factor for

A

SSI & postoperative complications

72
Q

Additional drugs that should be avoided in the elderly include

A 
metoclopramide
meperidine
NSAIDs
transdermal fentanyl 
agonist-antagonist opioids
methadone
73
Q

______ has worse outcomes than ______ surgery in the elderly.

A

emergent; elective

74
Q

The most common postoperative complications for the elderly include

A

cardiac, pulmonary or neurologic complications

75
Q

Increased number of clinical risk factors leads to

A

increased risk of surgical procedure & overall poor outcomes

76
Q

The two most important factors for perioperative outcomes include:

A

surgical risk of the procedure

number of defined clinical risk factors in patient

77
Q

____ is common after major surgery

A

delirium

78
Q

The leading cause of morbidity is

A

pulmonary insufficiency or infection

Pathophys II (43 decks)

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