Pedia Anes Flashcards by Frankie Aguinot

respiratory anatomy of neonates

. Large occiput, head In the “sniffing” position
. Obligate nose breathers
. Narrow nares
. Large tongue in proportion to oral cavity
. Anterior and cephalad larynx (C3-C4 compared
to adults’ C6)
. Epiglottis is omega-shaped and longer
. Cricoid ring is the narrowest portion of airway compared to epiglottis in adult

How well did you know this?

Not at all

Perfectly

pentington’s formuala for ID of ET

<6 yo
>6 yo

<6 years old = age/3 + 3.5
I
>6 years old = age/4 + 4

How well did you know this?

Not at all

Perfectly

0.1 mm difference in the size of ET in pedia can cause

80% decrease of oxygen saturation due to tracheal stenosis/trauma

How well did you know this?

Not at all

Perfectly

why is pentington’s formula used

to prevent tracheal stenosis or any trauma in the airway of children

How well did you know this?

Not at all

Perfectly

acronym for laryngoscope

BURP

backward, upward, right position

How well did you know this?

Not at all

Perfectly

length of ETT in pedia

12 + (age yo/2)

How well did you know this?

Not at all

Perfectly

match airway devices

neonates, toddlers, older children, adolescents, adults

red, yellow, green, blue, black white

neonates BLUE
toddlers BLACK
children WHITE
adolescents GREEN
adults YELLOW

Blue Black WGY

How well did you know this?

Not at all

Perfectly

sedated children desaturate (slower/faster) than adults

sedated children desaturate FASTER than adults

How well did you know this?

Not at all

Perfectly

PHYSIOLOGIC ANEMIA OF NEONATES

age, level and preterm

.Occur in infants up to 3 months
. Can be as low as 8-10 gm/dL at 8-12 months
. Varies inversely w/ gestational age (more
rapid in preterm infants)

How well did you know this?

Not at all

Perfectly

why is there physiologic anemia in neonates

Decrease erythropoietic activity
Decrease RBC survival time (70 days
in neonate compared to 120 days in
adult)
Increase plasma volume

How well did you know this?

Not at all

Perfectly

blood volume in preterm infant

90-100 ml/kg

How well did you know this?

Not at all

Perfectly

blood volume in term infant

80-90 mL/kg body wt

How well did you know this?

Not at all

Perfectly

blood volume Infant 3mos to 1 yr.

70-80 mL/kg body wt.

How well did you know this?

Not at all

Perfectly

blood volume >1 yr old

70 mL/kg body wt.

How well did you know this?

Not at all

Perfectly

HCT for

premature
newborn
3 months

premature 35
newborn 35
3 months 25

How well did you know this?

Not at all

Perfectly

neonates with congenital cardiac anomalies, HCT should be (lower/higher) due to…

neonates with congenital cardiac anomalies, HCT should be HGHER due to compensation in producing a lot of erythrocytes

How well did you know this?

Not at all

Perfectly

equation for allowable blood loss

ABL =[ (start Hct-Max Hct)xEBV]/start Hct

How well did you know this?

Not at all

Perfectly

fasting < 6 yo

breast milk
formula
clear fluids

breast milk 3-4 hours
formula 6 hours
clear fluids 2 hours

How well did you know this?

Not at all

Perfectly

fasting > 6 yo

breast milk
formula
clear fluids

breast milk 4 hours
formula 6-8 hours
clear fluids 2 hours

How well did you know this?

Not at all

Perfectly

why is SV fixed in pedia?

fixed by non-compliant and underdeveloped left ventricle

How well did you know this?

Not at all

Perfectly

in pedia maintain (low/high) level of catecholamine store

in pedia maintain LOW level of catecholamine store

How well did you know this?

Not at all

Perfectly

pedia heart is sensitive to

to calcium-channel blocking properties of volatile anesthetics and opioidinduced
bradycardia

How well did you know this?

Not at all

Perfectly

HR should not be less than (x) and in infant

normal sinus rhythm is up to (y)

HR should not be <100/min and in infant
normal sinus rhythm is up to 200/min (range
100-170/min)

what is range for neonates HR

range 100-170/min

what is considered cardiac arrest in pedia

HR of <85/min in neonate and 60/min is | considered CARDIAC ARREST

what is HALLMARK OF HYPOVOLEMIA

HYPOTENSION | WITHOUT TACHYCARDIA

Greater heart loss in pedia is attributed to

. Thin skin . Low fat content . Higher surface relative to weight

Major mechanism of heat production in pedia

. Non-shivering thermogenesis by metabolism of brown fat | . Shunting of hepatic, oxidative prosphorylation to the thermogenic proton leak.

hypothermia in pedia predisposes to

. metabolic acidosis . increase oxygen uptake . right to left shunting . respiratory depression and hypoventilation . depressed conscious state and delay awakening or emergences from anesthesia . dysrhythmia and cardiac depression

main goals of preop evaluation in pedia

.To establish whether a child is fir or unfit for surgery . To look for presence of any disease or to further evaluate for any congenital anomaly which could affect the cause of anesthesia . To decide which anesthetic regimen is optimal for the child . To establish a good rapport with the child and allay any anxiety

RECOGNITION AND MANAGEMENT OF DIFFICULT | PEDIATRIC AIRWAY

1. Congenital 2. Structural 3. Inflammatory 4. Neoplastic

AIRWAY ANOMALY THAT REPRESENTS ADDITIONAL | PROBLEMS IN INFANTS (2)

. Pierre-Robin Sequence . Treacher Collin’s Syndrome or Mandibulofacial Dysistosis

describe Pierre-Robin Sequence

``` . Micrognathia/Retrognathia . Airway distress in 1st 24 hours . Glossoptosis . Cleft Palate in 50% . Improves with age ```

Treacher Collin’s Syndrome or | Mandibulofacial Dysistosis description

. Absent cheekbone . Downward slanting eyes . Micrognathia . Malformed or absent ear

structural anomalies that represents additional problems in infants (6)

1. Aspirated Foreign Body 2. Trauma 3. Tracheal Stenosis 4. Post-Intubation Edema 5. Temporomandibular Joint Ankylosis 6. Post burn contractures

inflammatory anomalies that represents additional problems in infants (5)

1. Croup 2. Epiglottitis 3. Papillomatosis 4. Retropharyngeal Abscess 5. Peritonsillar Abscess

when do you not intubate

bird facies

NEONATAL EMERGENCIES 1st week of life (5)

``` . Congenital Diaphragmatic Hernia . Tracheoesophageal Fistula . Omphalocele and Gastroschisis . Intestinal Obstruction . Meningomyelocele ```

NEONATAL EMERGENCIES 2nd week and later (3)

. Necrotizing Enterocolitis . Hernia . Duodenal Atresia

Inhalational Anesthesia may be difficult in neonate due to | the ff:

1. Combine effect of volatile anesthetic and immature ventilator drive predispose infant to hypoventilation 2. Hypoventilation increases alveolar CO2 and displace O2 3. Anesthetic agent decreases FRC

net effect of inhalation anesthesia difficulty

INFANT DESATURATION

Imperforate Anus – emergency surgical management is | needed to avoid further abdominal obstruction (2 steps)

1. Double barrel sigmoid colostomy of birth 2. PSARP – postero sagittal anorectoplasty – later in life

Failure of gut migration from yolk sac into abdomen GASTROSCHISIS OMPHALOCELE

OMPHALOCELE

Within umbilical cord GASTROSCHISIS OMPHALOCELE

OMPHALOCELE

Assoc. w/ Beckwith- Wiedemann syndrome macroglossia, gigantism, hypoglycemia GASTROSCHISIS OMPHALOCELE

OMPHALOCELE

Congenital Heart Dse GASTROSCHISIS OMPHALOCELE

OMPHALOCELE

Exstrophy of Bladder GASTROSCHISIS OMPHALOCELE

OMPHALOCELE

Occlusion of omphalomesenteric artery GASTROSCHISIS OMPHALOCELE

GASTROSCHISIS

Periumbilical GASTROSCHISIS OMPHALOCELE

GASTROSCHISIS

exposed gut inflammation, edema, dilation and foreshortened GASTROSCHISIS OMPHALOCELE

GASTROSCHISIS

Maintenance Fluid: <10kg:

<10kg: 4mL/kg

Maintenance Fluid: 10-20kg

10-20kg: 40mL + 2mL/kg for the 2nd 10kg. 10-20kg: 40mL + 2mL/kg(x-10)

Maintenance Fluid: >20kg

>20kg: 60mL + 1mL/kg for anything more than 20kg. >20kg: 60mL + 1mL/kg(x-20)

Replacement Fluid: Abdominal Surgery

Abdominal Surgery: 5-10ml/kg

Replacement Fluid: Head and Neck

Head and Neck: 2-5mL/kg depending on extent of | bleeding

Brainscape's Knowledge GenomeTM

Pedia Anes Flashcards

Brainscape's Knowledge Genome^TM