Pediatric Flashcards
In what ways is the premature infant different from the full term neonate?
Premature infants have immature organ systems. Prematurity brings with it a host of complications including anemia, apnea, bradycardia, temperature instability, multi system organ complications, intraventricular hemorrhage, and death. Variability in complications related to prematurity are enormous and worsen with lower birth weight and earlier gestational age
The ratio of minute ventilation to FRC is 2 to 3 times higher in the newborn. What is the clinical significance of this?
The decrease in FRC relative to minute ventilation means that there is less oxygen reserve. Expect a more rapid drop in oxygen levels during periods of apnea or hypoventilation. The ratio of minute ventilation to FRC also explains the more rapid inhalation induction and faster emergence in the newborn versus the adult.
What is the normal heart rate range of the term infant? What are the normal heart rate changes through childhood development?
HR of the term infant to three months old is 100-150
3 to 6 months: HR is 90-120
6 to 12 months: 80-120
1 to 3 years: 70-110
3 to 6 years: 65-110
from 6 to 12 years: HR 60-95 greater than 12 years: 55 to 85
What is the caloric need in relation to BSA for a full term infant? At what age does caloric need in relation to BSA peak and how does this compare to adult caloric need/m^2 per hour
the caloric intake in relation to BSA of a full term infant is about 30 K Cal per meter squared per hour.
It increases to about 50 K Cal per meter squared per hour by two years of age, and then decreases gradually to the adult level of 35 to 40K cals/m^2/hour
List 14 factors that contribute to persistent pulmonary hypertension of the newborn
1) premature birth
2) pulmonary disease
3) hypoxemia
4) hypercarbia
5) congenital heart disease
6) sepsis
7) acidosis
8) hypothermia
9) meconium aspiration
10) polycythemia
11) congenital diaphragmatic hernia
12) severe hypotension
13) high altitude
14) prolonged stress
list 5 congenital defects in which there is a simple left to right shunt
1) atrial septal defects 2) ventricular septal defects 3) atrioventricular canal defects 4) patent ductus arteriosus 5) aortopulmonary window
a key to managing patients with shunting lesions is to balance pulmonary and vascular resistance to alter shunt flow. What 11 factors decrease pulmonary vascular resistance and will increase left to right flow?
100 percent 02 hypocarbia alkalosis normothermia hypothermia low mean airway pressure or spontaneous ventilation avoiding catecholamine release medications increased SVR sympathetic stimulation A1 agonists
A key to managing patients with shunting lesions is to balance pulmonary and vascular resistance to alter shunt flow. What 11 factors increased pulmonary vascular resistance and will decrease left to right flow?
hypoxia hypercarbia acidosis hypothermia high mean airway pressures catecholamine release medications (phenylephrine, nitrous, ketamine) decreased SVR B2 agonists neuraxial anesthesia deep general anesthesia
What comorbidities may be associated with Down syndrome and should be taken into consideration when formulating your anesthetic plan?
1) difficult mask airway 2) atlantoaxial instability 3) congenital heart defects 4) macroglossia 5) cognitive impairment 6) hypotonia 7) tracheoesophageal fistula 8) chronic pulmonary infections/post intubation croup 9) gastrointestinal anomalies (including GERD)
What endotracheal tube size is needed for the pediatric patient with epiglottitis?
endotracheal intubation is performed orally with a stylet and tube one or two sizes smaller than usual. Visualization of the classic cherry red epiglottis under direct laryngoscopy confirms a diagnosis
list nine anesthesia considerations for the patient with congenital diaphragmatic hernia
1) place a nasogastric tube 2) do not apply positive ventilation via mask 3) intubate with controlled ventilation 4) use an opioid and nondepolarizing muscle relaxant once chest is open 5) avoid nitrous oxide 6) do not attempt to re expand the lung- excessive positive airway pressure can damage the contralateral lung 7) monitor PaCO2 and SaO2 8) use 100% oxygen 9) anticipate the need for post operative support of ventilation
list three actions that should be taken to manage a patient with pyloric stenosis
perioperative management of the patient with pyloric stenosis includes 1) empty the stomach 2) use rapid sequence induction or awake intubation 3) extubate awake
What are the anesthesia related considerations in caring for an infant with retinopathy of prematurity?
limit 02 supplementation to all neonates with or without retinopathy of prematurity. Retinal vessels will develop normally in the intrauterine environment where O2 tension is 25 to 50; however an infant born preterm PaO2 ranges from 55 to 85 with or without oxygen supplementation; therefore exposure to supplemental oxygen should be limited. The risk of ROP is inversely proportional to birth weight and is associated with neonatal oxygen exposure, apnea, blood transfusion, sepsis. Challenges include limiting hypoxemia while avoiding hypoxemia
How is succinylcholine currently used in the pediatric population? what prompted this change?
FDA has relabeled succinylcholine as an emergency airway rescue drug in children less than eight years old due to the increased risk of severe hyperkalemia
What 4 medications have a prophylactic effect in preventing agitation and treating acute episodes of emergence delirium in the pediatric patient?
propofol, fentanyl dexmedetomidine, and pre operative analgesics have a prophylactic effect in preventing agitation and treating acute episodes of emergence delirium in the pediatric patient
