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peds and general adults Anesthesia > Pedi Board Facts > Flashcards

Pedi Board Facts Flashcards

1
Q

Placenta not allow insult and glucagon pass through?

A
  • no, placenta is impervious to insulin and glucagon
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2
Q

Contraindications of cricoid pressure?

A
  • 2 layers of cervical level: trachea, esophagus and cervical spine
  • no cricoid if:
    + trachea: tracheal ring fracture, sharp foreign body in trachea
    + esophagus: zenker diverticulum, sharp foreign body
    + spine: sharp foreign body (knife?), unstable c spine
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3
Q

If child has swallow coin, how do you know if coin is in esophagus or trachea?

A
  • if in esophagus XRAY will appear flat

- if in trachea, X-RAY will appear rotated 90 degrees will not be flat

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4
Q

Cerebral perfusion and CO2, O2

A
  • In neonatal, goal PO2 70-90 mmHg
  • PO2 > 100 mmHg harmful to lungs and cerebral perfusion (hyperoxia- cerebral vasoconstriction)
  • PCO2 low -> cerebral vasoconstriction
  • PO2 low -> cerebral vasodilation
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5
Q

Pt is allergic to penicillin what is alternative?

A
  • clindamycin 20mg/kg
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6
Q

Pulses paradoxus

A
  • pulses paradoxus seen as late finding in cardiac tamponade ( hypotension, jugular vein distention, pulsus paradoxus)
  • pulsus paradoxus = drop in systolic BP > 12 mmHg during inspiration caused by reduced LV stroke volume due to increased filling pressure of right heart during inspiration
  • not sensitive nor specific
  • beck’s triad for cardiac tamponade - Low pressure in the arteries (hypotension)
    Bulging (distended) neck veins.
    Muffled heart sounds.
  • dyspnea is the earliest and most sensitive symptom of cardiac tamponade
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7
Q

Separation anxiety when?

A
  • 6-12 months old -> give versed starting at this age group
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8
Q

How much fluid to give to prevent PONV?

A
  • crystalloid 30ml/kg is sufficient to prevent PONV
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9
Q

Going to higher altitude, percent concentration of volatile anesthetics going up or down?

A
  • higher altitude, percent concentration of isoflurane delivery goes up compared to sea level
    + partial pressure DOES NOT change w altitude
    + output of vaporizer is the partial pressure not the percent concentration ( which is labeled on dial)
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10
Q

MEPs motor evokes potentials

A
  • MEPs can be measured by direct transcranial stimulation of motor cortex or by spinal cord stimulation
  • MEPs: neurogenic or epidural MEPs
  • with spinal cord stimulation, neurogenic MEPs measured the conduction vua dorsal columns in a retrograde fashion —- MEPs is actually sensory in nature
  • with epidural MEPs the recording electrodes in lower lumbar epidural space- they monitor conduction via corticospinal tract - not monitor motor conduction
  • the CMAPs compound muscle action potentials generated after transcranial stimulation then transmitted via motor tract conduction in anterior horn of spinal cord
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11
Q

Mechanical dead space?

A

Mechanical dead space exists only where fresh and exhaled gases are mixed ie distant to the Y piece

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12
Q

MAC of isoflurane peak at what age?

A
  • MAC of isoflurane peaks at 1-6 months of age
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13
Q

MAC of sevoflurance peaks at what age?

A
  • MAC of sevoflurance peaks at full term new borns
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14
Q

Steroids prolong or shorten NMB?

A
  • steroids prolongs muscle weakness from NMB
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15
Q

QT prolong syndrome - drugs that can trigger prolongation, Torsades se point

A
  • succinylcholine (due to autonomic effect and Potassium release)
  • ketamine
  • atropine
  • glycopyrrolate
  • droperidol
  • zofran
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16
Q

Iodine skin prep leads to thyroid suppression

A

Yes

17
Q

Decadron bad side effects?

A
  • avascular necrosis of femoral head with corticosteroid use in ALL acute lymphoblastic leukemia
  • higher dose of decadron 0.5 mg/kg use has been associated with increased postoperative bleeding in tonsillectomy
18
Q

MAC of volatile agents in neonates?

A
  • listed in order of most potent to least potent

+ isoflurane (1.6) > sevoflurance (3.3) > desflurance (9) > N2O (104)

19
Q

Closing capacity of infants, children compared to adolescents?

A
  • infants, children have HIGHER closing capacity compared to adolescents -> atelectesis, airway collapses during normal respiration
  • closing volume is lung volume at which terminal airways begins to collapse
20
Q

Ventilation and perfusion of lung in infants/children vs adults?

A
  • different in children vs adult in ventilation V and perfusion P
  • in adults, due to gravity, V and P are preferred to DEPENDENT lung regions
  • in infants & small children, V is greater in NON DEPENDENT, P is evenly distributed throughout lung
21
Q

Inspiratory stridor?

A
  • inspiratory stridor = supraglottis or glottis obstruction
  • biphasic stridor = glottis obstruction
  • expiratory stridor = distal trachea or mainstem bronchi obstruction
22
Q

When sympathetic nervous starting to mature?

A
  • ~ 6 months old
23
Q

Craniopharyngioma need stress dose steroid?

A
  • yes
  • craniopharyngioma -> ACTH deficiency -> stress dose corticosteroid perioperatively
  • also see hypothyroidism due to mass effect
  • surgery by transcranial approach
24
Q

Beck with wiedenmann

A
  • hypoglycemia hyperinsulinemia

- omphalocele

25
Q

Hyponatremia in subarachnoid hemorrhage kid?

A
  • cerebral salt wasting

- can also occur in brain tumors

26
Q

Conn dz?

A
  • conn dz = primary hyperaldosteronism
  • hyper Na, hypoK, metabolic alkalosis

-

27
Q

Which factor deficiency the treatment is FFP?

A
  • factor V deficiency

- factor XI deficiency

28
Q

Female Duchene muscular dystrophy prompt to what?

A
  • female carriers of duchene muscular dystrophy may have
    + underlying cardiomyopathy that can result in cardiac failure intraoperative
    + rhadomyolysis, hyerK arrest w volatile anesthetics or succinylcholine
29
Q

Pt w myotonic congenita has sustained muscle contractions intraoperative, treatment?

A
  • sodium channel blocker procainamide
30
Q

Mitochondrial myopathies pt what fluid should be used?

A
  • mitochondrial myopathies cause inefficient oxygen use and ATP generation so use d5% NS for fluid
  • avoid LR due to lactate of LR
  • want d5% to supply energy
  • avoid prolonged propofol infusion
31
Q

Which syndromes is the airway management worse with age?

Which syndrome is airway get better with age?

A
  • worse with age: Treacher Collin, CHARGE syndromes

- better with age: Pierre Robin sequence

32
Q

When Physiologic anemia in full term neonate vs preterm neonates?

A
  • full term neonates 9-12 weeks 10-11 g/dL

- preterm neonates 5-8 weeks 7-8 g/dL

33
Q

When babies double weight? Triple weight?

A
  • most babies double weight by 4 months, triple weight by 1 year
34
Q

Best induction agent for Tetralogy of Fallot?

A
  • ketamine as it maintains SVR
35
Q

Charcot Marie tooth dz which drugs to avoid?

A
  • Charcot Marie tooth dz is neuropathy dz effecting motor and sensory neurons
  • avoid N2O, Serotonin reuptake inhibitors like Prozac, Zoloft, Paxil, Luvox - these drugs are neurotoxic to Charcot Marie tooth pts

-

36
Q

Pt for repair of complex thumb/ index finger syndactyly. What’s preop testing needs to be done?

A
  • Apert or Potter syndromes- syndactyly

- need to rule out QT prolong syndrome -> EKG needed

37
Q

Which syndromes becomes more and more difficult to intubate as one gets older?

A
  • treacher Collins

- goldenhar

38
Q

Anatomy of CNS in a newborn?

A

L3 S3
- L3 conus medullaris

  • S3 dural sac

peds and general adults Anesthesia (3 decks)

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