Pediatric

Question 1

How are pediatric airways different than adults?

Answer 1

1) Larger tongue (oral airway helpful)
2) Pharynx smaller
3) Epiglottis is larger and floppier
4) Larynx more ANTERIOR and SUPERIOR

Question 2

Narrowest portion of pedi airway?

Answer 2

Cricoid cartilage

Question 3

How to calculate ETT size?

Answer 3

(Age/4) + 4

Subtract 0.5 if CUFFED

Question 4

In terms of cardiac physiology, what component is fixed in kids?

Answer 4

*Stroke volume is FIXED

If you want to increase CO, you can ONLY increase the heart rate

Question 5

What are triggers for vagal reactions and subsequent bradycardia in children?

What can you use to pretreat?

Answer 5

Abdominal insufflation 
Anal manipulation
ET tube placement
Hypoxia
Volatile anesthetics

Tx: glycopyrrolate (anti-ACh)

Question 6

What pulmonary components are different in kids?

Answer 6

• Smaller diameter of airways = more resistance and less flow
• Increased chest wall compliance = increased airway collapse and **DECREASED FRC
• Diaphragm + intercostals are Type II fibers until 2 yo –> this means an increased work of breathing will cause earlier respiratory fatigue and failure

Question 7

What lung volume component is important to consider in kids?

Answer 7

DECREASED FRC (doesn’t take long to desat + they have high O2 consumption rates)

Question 8

How is liver physiology affected in kids?

Answer 8

• Increased blood flow to liver = increased drug delivery
• Impaired liver conjugation until 1 yo (**prolonged T1/2 of benzo’s, morphine)
• Decreased drug binding b/c decreased albumin levels

Question 9

Rules of NPO?

Answer 9

8-6-4-2 rule

8 hrs = full meal (fats, meats)
6 hrs = light solids (FORMULA, toast, tea)
4 hrs = BREAST MILK
2 hrs = Clears (water, apple juice, jello)

Question 10

Estimated blood volumes for:

• Premature?
• Term infant?
• 3-12 months?
• Child > 1 yo?
• Adult female?
• Adult male?

Answer 10

Premature: 100-120 mL/kg
Term: 90 mL/kg
3-12 months: 80 mL/kg
Child > 1 yo: 70 mL/kg
Adult female: 60 mL/kg
Adult male: 50 mL/kg

Question 11

Formula for allowable blood loss (ABL)?

Answer 11

EBV x [(Hct start - Hct target) / Hct start]

Question 12

What is the rate of fluid loss into the open abdomen (3rd spacing)?

Answer 12

10 mL/kg/hr

Question 13

How much crystalloid, colloid, and PRBC do you need to replace 1 mL of blood loss?

Answer 13

3 mL crystalloid per 1 mL blood loss
1 mL colloid per 1 mL blood loss
1 mL PRBC per 1 mL blood loss

Question 14

Maintenance fluid resuscitation formula?

Answer 14

4-2-1 rule
4ml/kg/hr for first 10kg
2ml/kg/hr for second 10kg
1ml/kg/hr for each additional kg

Question 15

Easy way to calculate maintenance fluid requirements?

Answer 15

If OVER 20kg –> Weight + 40 = mL/hr

Question 16

List and describe the 4 types of heat transfer to the environment?

Answer 16

1) Radiation: all surfaces radiate head and absorb heat
2) Convection: still air over skin serves as insulator - if this layer is disturbed, heat loss will increase
3) Evaporation: from skin and open wounds
4) Conduction: heat loss proportional to temp differences b/w 2 adjacent surfaces

Question 17

During 1st hour of surgery, what is the most important contributor to heat loss?

Answer 17

Redistribution of blood –> vasodilation from anesthetic agents cause blood to travel peripherally resulting in heat transfer to environment

Question 18

What precautions are taken when MH is suspected?

Answer 18

Flush system with 10L/min O2 for 10-30 minutes pre-op
Replace etCO2 absorbant
Perform complete TIVA

Question 19

Risk factors for MH?

Answer 19

All volatile agents (NOT nitrous oxide)
Succinylcholine
Fam Hx
MSK disorders

Question 20

S/S of MH?

Answer 20

Increasing etCO2 w/ constant ventilation
Tachycardia
Increasing temperature (late sign)
Tachypnea
Arrhythmias
Masseter muscle spasm

Question 21

Tx of MH?

Answer 21

Stop anesthesia and surgery
Call for help
Hyperventilate with 100% O2 (emergency O2 tank and BVM off back of machine)
Dantrolene (bolus 2.5mg/kg IV)
Aggressive cooling
Treat hyperkalemia (NO calcium! Use HCO3)