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
what is considered cardiac arrest in pedia
HR of <85/min in neonate and 60/min is | considered CARDIAC ARREST
26
what is HALLMARK OF HYPOVOLEMIA
HYPOTENSION | WITHOUT TACHYCARDIA
27
Greater heart loss in pedia is attributed to
. Thin skin . Low fat content . Higher surface relative to weight
28
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.
29
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
30
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
31
RECOGNITION AND MANAGEMENT OF DIFFICULT | PEDIATRIC AIRWAY
1. Congenital 2. Structural 3. Inflammatory 4. Neoplastic
32
AIRWAY ANOMALY THAT REPRESENTS ADDITIONAL | PROBLEMS IN INFANTS (2)
. Pierre-Robin Sequence . Treacher Collin’s Syndrome or Mandibulofacial Dysistosis
33
describe Pierre-Robin Sequence
``` . Micrognathia/Retrognathia . Airway distress in 1st 24 hours . Glossoptosis . Cleft Palate in 50% . Improves with age ```
34
Treacher Collin’s Syndrome or | Mandibulofacial Dysistosis description
. Absent cheekbone . Downward slanting eyes . Micrognathia . Malformed or absent ear
35
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
36
inflammatory anomalies that represents additional problems in infants (5)
1. Croup 2. Epiglottitis 3. Papillomatosis 4. Retropharyngeal Abscess 5. Peritonsillar Abscess
37
when do you not intubate
bird facies
38
NEONATAL EMERGENCIES 1st week of life (5)
``` . Congenital Diaphragmatic Hernia . Tracheoesophageal Fistula . Omphalocele and Gastroschisis . Intestinal Obstruction . Meningomyelocele ```
39
NEONATAL EMERGENCIES 2nd week and later (3)
. Necrotizing Enterocolitis . Hernia . Duodenal Atresia
40
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
41
net effect of inhalation anesthesia difficulty
INFANT DESATURATION
42
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
43
Failure of gut migration from yolk sac into abdomen GASTROSCHISIS OMPHALOCELE
OMPHALOCELE
44
Within umbilical cord GASTROSCHISIS OMPHALOCELE
OMPHALOCELE
45
Assoc. w/ Beckwith- Wiedemann syndrome macroglossia, gigantism, hypoglycemia GASTROSCHISIS OMPHALOCELE
OMPHALOCELE
46
Congenital Heart Dse GASTROSCHISIS OMPHALOCELE
OMPHALOCELE
47
Exstrophy of Bladder GASTROSCHISIS OMPHALOCELE
OMPHALOCELE
48
Occlusion of omphalomesenteric artery GASTROSCHISIS OMPHALOCELE
GASTROSCHISIS
49
Periumbilical GASTROSCHISIS OMPHALOCELE
GASTROSCHISIS
50
exposed gut inflammation, edema, dilation and foreshortened GASTROSCHISIS OMPHALOCELE
GASTROSCHISIS
51
Maintenance Fluid: <10kg:
<10kg: 4mL/kg
52
Maintenance Fluid: 10-20kg
10-20kg: 40mL + 2mL/kg for the 2nd 10kg. 10-20kg: 40mL + 2mL/kg(x-10)
53
Maintenance Fluid: >20kg
>20kg: 60mL + 1mL/kg for anything more than 20kg. >20kg: 60mL + 1mL/kg(x-20)
54
Replacement Fluid: Abdominal Surgery
Abdominal Surgery: 5-10ml/kg
55
Replacement Fluid: Head and Neck
Head and Neck: 2-5mL/kg depending on extent of | bleeding