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Anes Final > Pedia Anes > Flashcards

Pedia Anes Flashcards

1
Q

respiratory anatomy of neonates

A

. 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

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2
Q

pentington’s formuala for ID of ET

<6 yo
>6 yo

A

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

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3
Q

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

A

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

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4
Q

why is pentington’s formula used

A

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

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5
Q

acronym for laryngoscope

A

BURP

backward, upward, right position

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6
Q

length of ETT in pedia

A

12 + (age yo/2)

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7
Q

match airway devices

neonates, toddlers, older children, adolescents, adults

red, yellow, green, blue, black white

A 
neonates BLUE
toddlers BLACK
children WHITE
adolescents GREEN
adults YELLOW

Blue Black WGY

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8
Q

sedated children desaturate (slower/faster) than adults

A

sedated children desaturate FASTER than adults

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9
Q

PHYSIOLOGIC ANEMIA OF NEONATES

age, level and preterm

A

.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)

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10
Q

why is there physiologic anemia in neonates

A
  1. Decrease erythropoietic activity
  2. Decrease RBC survival time (70 days
    in neonate compared to 120 days in
    adult)
  3. Increase plasma volume
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11
Q

blood volume in preterm infant

A

90-100 ml/kg

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12
Q

blood volume in term infant

A

80-90 mL/kg body wt

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13
Q

blood volume Infant 3mos to 1 yr.

A

70-80 mL/kg body wt.

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14
Q

blood volume >1 yr old

A

70 mL/kg body wt.

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15
Q

HCT for

premature
newborn
3 months

A

premature 35
newborn 35
3 months 25

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16
Q

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

A

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

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17
Q

equation for allowable blood loss

A

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

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18
Q

fasting < 6 yo

breast milk
formula
clear fluids

A

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

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19
Q

fasting > 6 yo

breast milk
formula
clear fluids

A

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

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20
Q

why is SV fixed in pedia?

A

fixed by non-compliant and underdeveloped left ventricle

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21
Q

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

A

in pedia maintain LOW level of catecholamine store

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22
Q

pedia heart is sensitive to

A

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

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23
Q

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

normal sinus rhythm is up to (y)

A

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

24
Q

what is range for neonates HR

A

range 100-170/min

25
Q

what is considered cardiac arrest in pedia

A

HR of <85/min in neonate and 60/min is

considered CARDIAC ARREST

26
Q

what is HALLMARK OF HYPOVOLEMIA

A

HYPOTENSION

WITHOUT TACHYCARDIA

27
Q

Greater heart loss in pedia is attributed to

A

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

28
Q

Major mechanism of heat production in pedia

A

. Non-shivering thermogenesis by metabolism of brown fat

. Shunting of hepatic, oxidative prosphorylation to the thermogenic proton leak.

29
Q

hypothermia in pedia predisposes to

A

. 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

30
Q

main goals of preop evaluation in pedia

A

.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

31
Q

RECOGNITION AND MANAGEMENT OF DIFFICULT

PEDIATRIC AIRWAY

A
  1. Congenital
  2. Structural
  3. Inflammatory
  4. Neoplastic
32
Q

AIRWAY ANOMALY THAT REPRESENTS ADDITIONAL

PROBLEMS IN INFANTS (2)

A

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

33
Q

describe Pierre-Robin Sequence

A 
. Micrognathia/Retrognathia
. Airway distress in 1st 24 hours
. Glossoptosis
. Cleft Palate in 50%
. Improves with age
34
Q

Treacher Collin’s Syndrome or

Mandibulofacial Dysistosis description

A

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

35
Q

structural anomalies that represents additional problems in infants (6)

A
  1. Aspirated Foreign Body
  2. Trauma
  3. Tracheal Stenosis
  4. Post-Intubation Edema
  5. Temporomandibular Joint Ankylosis
  6. Post burn contractures
36
Q

inflammatory anomalies that represents additional problems in infants (5)

A
  1. Croup
  2. Epiglottitis
  3. Papillomatosis
  4. Retropharyngeal Abscess
  5. Peritonsillar Abscess
37
Q

when do you not intubate

A

bird facies

38
Q

NEONATAL EMERGENCIES 1st week of life (5)

A 
. Congenital Diaphragmatic Hernia
. Tracheoesophageal Fistula
. Omphalocele and Gastroschisis
. Intestinal Obstruction
. Meningomyelocele
39
Q

NEONATAL EMERGENCIES 2nd week and later (3)

A

. Necrotizing Enterocolitis
. Hernia
. Duodenal Atresia

40
Q

Inhalational Anesthesia may be difficult in neonate due to

the ff:

A
  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
41
Q

net effect of inhalation anesthesia difficulty

A

INFANT DESATURATION

42
Q

Imperforate Anus – emergency surgical management is

needed to avoid further abdominal obstruction (2 steps)

A
  1. Double barrel sigmoid colostomy of birth
  2. PSARP – postero sagittal anorectoplasty –
    later in life
43
Q

Failure of gut migration
from yolk sac into
abdomen

GASTROSCHISIS
OMPHALOCELE

A

OMPHALOCELE

44
Q

Within umbilical cord

GASTROSCHISIS
OMPHALOCELE

A

OMPHALOCELE

45
Q

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

GASTROSCHISIS
OMPHALOCELE

A

OMPHALOCELE

46
Q

Congenital Heart Dse

GASTROSCHISIS
OMPHALOCELE

A

OMPHALOCELE

47
Q

Exstrophy of Bladder

GASTROSCHISIS
OMPHALOCELE

A

OMPHALOCELE

48
Q

Occlusion of
omphalomesenteric artery

GASTROSCHISIS
OMPHALOCELE

A

GASTROSCHISIS

49
Q

Periumbilical

GASTROSCHISIS
OMPHALOCELE

A

GASTROSCHISIS

50
Q

exposed gut inflammation, edema, dilation and foreshortened

GASTROSCHISIS
OMPHALOCELE

A

GASTROSCHISIS

51
Q

Maintenance Fluid:

<10kg:

A

<10kg: 4mL/kg

52
Q

Maintenance Fluid:

10-20kg

A

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

10-20kg: 40mL + 2mL/kg(x-10)

53
Q

Maintenance Fluid:

> 20kg

A

> 20kg: 60mL + 1mL/kg for anything more than 20kg.

> 20kg: 60mL + 1mL/kg(x-20)

54
Q

Replacement Fluid:

Abdominal Surgery

A

Abdominal Surgery: 5-10ml/kg

55
Q

Replacement Fluid:

Head and Neck

A

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

bleeding

Anes Final (3 decks)

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