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Anesthesiology > Pediatric > Flashcards

Pediatric Flashcards

1
Q

Perinatal history?

A

APGAR score (Appearance, Pulse, Grimace, Activity, Respiration), O2 requirement, birthweight, current weight, maternal DM/HTN.

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2
Q

Premature at how many weeks?

A

37

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3
Q

NPO guidlines for kids

A

No clear liquids for 2 hours prior to surgery
No breast milk 4 hours prior to surgery
No solids or cow’s milk 6 hours prior to surgery
No heavy/fatty meals 8 hours prior to surgery.

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4
Q

Implications of URI for anesthesia?

A

Nasal blockage could cause respiratory distress.
URI’s increase risk for laryngospasm, bronchospasm, and desaturations.
Kids are at increased risk for 4-6 weeks after URI.

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5
Q

Anatomic differences between peds and adults?

A

a. Head is larger
b. Larynx is more anterior/higher than in adult so requires less head tilt to open the airway
c. Epiglottis is long and floppy so a straight blade is more appropriate
d. Smaller diameter of the airway
e. Large tongue in relation to jaw size
f. Infants are obligate nasal breathers until 5 months old
g. Short trachea and neck
h. Narrowest point in the pediatric airway is the cricoid cartilage

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6
Q

At what spinal level is the Larynx in an infant and adult?

A

Infant at C1, 6 months at C3, adults C5

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7
Q

Until what age are infants obligate nasal breathers?

A

5months

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8
Q

What blade is more appropriate for a child?

A

Miller blade/straight blade because epiglottis is long and floppy

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9
Q

What is the narrowest point in the pediatric airway

A

cricoid cartilage

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10
Q

Pediatric CO is relation to adult?

A

Increased CO with increased HR but fixed SV. Can respond to stress by increasing HR.

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11
Q

What is infant heart more sensitive to?

A

Calcium channel blocking properties of volatile anesthetics and opioid induced bradycardia.

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12
Q

What does hypotension without tachycardia mean in an infant? Why does it happen?

A

Intravascular fluid depletion.

Vascular tree is less able to respond to hypovolemia with vasocontriction.

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13
Q

What respiratory values are increased in children relative to adults? What is decreased? What stays the same per kilo?

A

Increased minute volume ventilation. Increased RR. so Increased O2 use.
Decreased: FRC.
The same: TV and dead space.

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14
Q

Why is the FRC decreased in children?

A

FRC is decreased because they have a smaller number and smaller size of alveoli which causes decreased lung compliance while chest wall is very compliant ( rib cage is more cartilaginous)

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15
Q

What is work of breathing in kid compared to adult?

A

Work of breathing is 3X that of adult because of decreased FRC and increased O2 use means. More easily desat, more easily hypoxia/hypercapnia because poorly developed ventilator drive.

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16
Q

Why do kids display a blunted response to exogenous catecholamines?

A

Sympathetic NS and baroreceptor reflexes are not fully mature and maintain lower catecholamine stores

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17
Q

Kids display a paradoxical respiratory depression with ___?

A

hypoxia

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18
Q

When is normal kidney function present in kids?

A

6 months old and may not achieve adult levels until 2 years old

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19
Q

What renal problems can premature babies have?

A

Impaired Na retention, glucose excretion, and bicarb reabsorption. Problems handling water and sodium = fluid sensitive

20
Q

Thermoregulation in kids…

A

Lose heat faster b/c of increased surface area. Hypothermia can lead to delayed wakening, cardiac irritability, respiratory depress, increased pulmonary vascular resistance, and altered drug responses.

21
Q

Infants cannot shiver and rely on ____ to maintain temperature

A

Metabolizing brown fat. Metabolism of brown fat is inhibited by volatile anesthetics and are dependent on quantity of fat stored.

22
Q

Inhalation is preferred for kids

A

A mixture of O2 and NO before inhalation anesthetic. With this method the patient will go through stage II (the excitation stage) during which it is important not stimulate the patient so as to avoid laryngospasm

23
Q

If laryngospasm occurs treat with___

A

constant positive pressure and then succinylcholine + atropine if positive pressure doesn’t work

24
Q

MAC is ___ in infants than adults

A

higher

25
Q

What can be used to numb veins for IV induction? How long does it take to work?

A

EMLA cream. 1hr to work.

26
Q

IM induction…

A

Ketamine onset 2-5 min., preserves respiratory drive and airway reflexes. Can use methohexital.

27
Q

Volume of distribution for most drugs is ___ in children so a standard dose leads to a ____plasma level

A

Increased. Lower.

28
Q

children are more sensitive to certain drugs, specifically ___, so a ____ plasma level leads to same effective dose.

A

Muscle relaxants. Lower

29
Q

Which ETT used?

A

ETT uncuffed until age 6-8 years. Choose size by (age/4) + 4

30
Q

Separation anxiety starts at? What can help?

A

9 months. Hospital tours and preparatory videos can help. Can give midazolam orally, intranasally, or IV, but is contraindicated in kids with obstructive sleep apnea.

31
Q

In whom is midazolam contraindicated?

A

OSA

32
Q

Maintenance fluid

A

Same as adults: 4 cc/kg/hr for first 10 kg of weight + 2 cc/kg/hr for second 10 kg of weight + 1 cc/kg/hr for remaining kilograms

33
Q

Replacing preop deficit when patient was NPO

A

Maintenance amount X number of hours patient was NPO. Half is replaced in first hour of surgery, ¼ in second hour, and ¼ in third hour.

34
Q

Third space losses

A

Superficial procedures 2-4 cc/kg/hr; moderate procedures 4-6 cc/kg/hr; major 6-8 cc/kg/hr. Given in addition to maintenance and deficit fluids.

35
Q

Blood replacement

A

Replace each 1 cc of blood lost with 3 cc of crystalloid or 1 cc of colloid or PRBC

36
Q

Post-op pain management in neonates with opioids….

A

during the first four weeks of life = increased risk for apnea

37
Q

Common post-op complication and treatment ?

A

Post-intubation croup is the result of endotracheal tube that is too tight or is moved a lot causing swelling of tracheal mucosa. Treat with racemic epinephrine and humidified mist.

38
Q

Who needs overnight observation post-op?

A

Postoperative apnea in infants: risk in preterm infants less than 60 wks post conceptual age, anemia (Hb

39
Q

Malignant hyperthermia: what is it?

A

Autosomal dominant condition that involves the ryanodine receptor gene (RYR1) located on the long arm of the chromosome 19 (25 different mutations). MH susceptibility is phenotypically/genetically related to Central Core Disease that is characterized by MH symptoms and myopathy. The ryanodine receptor is located on the sarcoplasmic reticulum (which stores calcium). RYR1 opens in response to increases in intracellular calcium levels mediated by L-type calcium channels, resulting in a drastic increase in intracellular calcium levels and muscle contraction. The process of reabsorbing excess calcium consumes large amounts of ATP and generates hyperthermia. The muscle cell is damaged by the depletion of ATP and high temperatures and cellular contents leak into the circulation (K, myoglobin, creatine, phosphate, creatine kinase).

40
Q

Malignant hyperthermia is characterized by?

A

hypermetabolism/increased CO2 production, skeletal muscle damage, hypothermia, death.

41
Q

Malignant hyperthermia presents with?

A

tachycardia, rapid rise in end-tidal CO2 (> 55 with controlled ventilation), rigidity, high fever, acidosis, arrhythmia, myoglobinuria, family history, elevated resting CK, hyperkalemia, hot soda lime canister/rapid exhaustion of soda lime, sustained jaw rigidity

42
Q

With what agents does malignant hyperthermia typically develop?

A

succinylcholine or inhalation agents

43
Q

Treat malignant hyperthermia with?

A

Dantrolene, 100% O2, bicarb for hyperkalemia, cool patient, treat arrhythmias (but NOT with calcium-channel blockers. ) Give Dantrolene 1 mg/kg every 4-6 hours for 24 hours then continue dantrolene for 36 hours

44
Q

How to test for malignant hyperthermia?

A

caffeine-halothane contracture test: muscle biopsy tested with halothane

45
Q

Demographics of malignant hyperthermia

A

Unusual before age 3 or after age 60, males>females, higher incidence in patients with maseter trismus

46
Q

What agents do NOT trigger malignant hyperthermia?

A

NO, barbiturates, benzo’s, IV induction agents, Nondepolarizing neuromuscular blocking agents, narcotics, local anesthetic.

47
Q

What is the mechanism that generates hyperthermia in malignant hyperthermia?

A

Increased intracellular Ca2+ levels - The process of reabsorbing excess calcium consumes large amounts of ATP and generates hyperthermia

Anesthesiology (9 decks)

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