Pediatric Anes. Pt. 1 (Exam 4 Final) Flashcards
1
Q
Perez on Medicine
The Pediatrician
A
https://www.nlm.nih.gov/exhibition/perez/toc.html
2
Q
Which of the following age ranges correctly defines a toddler?
A. Birth – 1 month
B. 1 month – 12 months
C. 12 months – 3 years
D. 4 – 6 years
A
C. 12 months – 3 years
Slide 4
3
Q
Which pediatric age group includes patients aged 6 to 13 years?
A. Preschool
B. School-age
C. Toddler
D. Adolescent
A
B. School-age
slide 4
4
Q
At what age does a pediatric patient transition from adolescent to adult?
A. 10 years
B. 8 years
C. 18 years
D. 12 years
A
C. 18 years
Adolescent (13-18yrs)
slide 4
5
Q
Which of the following age ranges correctly defines a Neonate?
A. Birth – 1 month
B. 1 month – 12 months
C. 12 months – 3 years
D. 4 – 6 years
A
A. Birth – 1 month
slide 4
6
Q
Which of the following age ranges correctly defines an Infant?
A. 4 – 6 years
B. 12 months – 3 years
C. 1 month – 12 months
D. Birth – 1 month
A
C. 1 month – 12 months
slide 4
7
Q
Which pediatric age group includes patients at 4-6yrs old?
A. Preschool
B. School-age
C. Toddler
D. Adolescent
A
A. Preschool
slide 4
8
Q
Select the correct gestational age with the correct term level:
Select 3
A. Full-term: 37–42 weeks
B. Preterm: < 37 weeks
C. Late preterm: 33–36 weeks
D. Term: 35–37 weeks
E. Post-term: > 42 weeks
A
A. Full-term: 37–42 weeks
B. Preterm: < 37 weeks
E. Post-term: >42 weeks
slide 5
9
Q
Matching
A
A → 3
B → 4
C → 1
D → 2
slide 5
10
Q
Transition Circulaiton
Which fetal shunt allows blood to bypass the liver?
A. Foramen ovale
B. Ductus arteriosus
C. Umbilical vein
D. Ductus venosus
A
D. Ductus venosus
slide 6
11
Q
What physiological change occurs after clamping of the umbilical arteries?
A. Increase in pulmonary vascular resistance
B. Decrease in systemic vascular resistance
C. Decrease in pulmonary artery oxygen tension
D. Increase in systemic vascular resistance
A
D. Increase in systemic vascular resistance (SVR)
slide 6
12
Q
In fetal circulation, oxygenated blood is delivered to the fetus via the ______.
A. Ductus arteriosus
B. Umbilical vein
C. Pulmonary artery
D. Umbilical artery
A
B. Umbilical vein
slide 6
13
Q
After birth, the increase in SVR leads to closure of the _______________ .
A. Ductus arteriosus
B. Foramen ovale
C. Ductus venosus
D. Umbilical artery
A
A. Ductus arteriosus
slide 6
14
Q
For a persistant patent ductus
arteriosus, a pre-ductal saturation is best measured on the ______.
A. Left leg
B. Right foot
C. Right hand
D. Left hand
A
C. Right hand
“A persistent patent ductus
arteriosus, can lead to a left to right shunting, causing the lungs to over
circulate with blood flow. With these
infants you might be asked to measure the pulse ox on the pre-ductal extremity.”
You want to measure the pre-ductal versus the post-ductal saturation
slide 6
15
Q
True or False
For a persistant patent ductus arteriosus, a post-ductal saturation is best measured on the left hand.
A
False
It can be any other extremity
“The pre-ductal extremity is on the right hand, and that’s as long as the patient has a normal functioning heart…the post-ductal is going to be any other extremity”
slide 6
16
Q
The functional closure of the ductus arteriosus typically occurs within ______ after birth.
A. 1–8 days
B. 1–2 hours
C. 1–4 months
D. Immediately at birth
A
A. 1–8 days
slide 6
17
Q
True or False
Anatomical closure of the ductus arteriosus
occurs within 1 to 3 months after birth.
A
False
Anatomical closure of the DA happens within 1-4 months after birth
18
Q
Which of the following fetal shunts help bypass pulmonary circulation? (Select 2)
A. Foramen ovale
B. Ductus venosus
C. Ductus arteriosus
D. Umbilical vein
A
A. Foramen ovale
C. Ductus arteriosus
“Most of the oxygenated blood is going to be directed to the head and neck, the brain, the
coronary arteries, the essential parts of the baby.”
slide 6
19
Q
After birth, which of the following causes a shift in blood flow through the foramen ovale, leading to its closure?
A. Decreased pulmonary vascular resistance
B. Increased right atrial pressure
C. Increased left atrial pressure
D. Patent ductus venosus
A
B. Increased right atrial pressure
“Our SVR is going to go up and our PVR is going to go down, these changes are going to lead to closures of those fetal shunts. With the increase in right atrial pressure, it’s going to change the direction of blood flow, causing a functional closure of the foramen ovale”
slide 6
20
Q
Which of the following is true regarding a patent ductus arteriosus (PDA)?
A. May require prostaglandins to remain open
B. Always requires immediate surgical closure
C. Can result in right-to-left shunting
D. Functional closure typically occurs within 8–10 days
A
A. May require prostaglandins to remain open
“If they have certain congenital heart defects, it can be life-saving for this PDA to stay open.”
slide 6
21
Q
What happens to pulmonary vascular resistance (PVR) after birth and the umbilical arteries are clamped?
A. It increases due to lung inflation and increasing PACO₂
B. It decreases as PAO₂ rises
C. It remains the same
D. It increases because of ductus arteriosus closure
A
B. It decreases as PAO₂ rises
With fetal circulation, we start with
a high PVR and a low SVR.
After birth, this is going to switch…this will increase our SVR two-fold and PVR will fall
slide 6
22
Q
The expansion of the lungs after birth triggers pulmonary vasodilation, leading to a decrease in ______.
A. SVR
B. HR
C. PVR
D. CO
A
C. PVR
PVR will fall when the lungs start expanding, and when the PAO2 rises, this is also
going to cause some pulmonary vasodilation, further decreasing our PVR.
slide 6
23
Q
The neonatal heart has fewer myofibrils and disorganized cells, which limits its ability to respond to increased ______.
A. Afterload
B. Oxygenation
C. Calcium
D. Blood pressure
A
A. Afterload
Slide 7
24
Q
The neonatal myocardium has immature ____ and T-tubules, limiting its ability to increase contractile force in response to increase SV.
A. Mitochondria
B. Sarcoplasmic reticulum
C. Baroreceptors
D. Gap junctions
A
B. Sarcoplasmic reticulum
Slide 7
25
Which ion is critical for neonatal myocardial contractility and performance?
A. Sodium
B. Calcium
C. Magnesium
D. Potassium
B. Calcium
**"They're really dependent on free ionized calcium for contractility."**
## Footnote
slide 7
26
Why is neonatal cardiac output (CO) primarily dependent on heart rate (HR)?
A. Because neonates have an elevated stroke volume
B. Because their autonomic nervous system is fully developed
C. Because they are more responsive to preload changes
D. Because their stroke volume is relatively fixed
D. Because their stroke volume is relatively fixed
*"Because of being heavily dependent on free iCa for contractility, the neonate stroke volume is relatively fixed, making cardiac
output heavily dependent on heart rate."*
## Footnote
Slide 7
27
What intervention is most appropriate if a neonate becomes hypotensive and unresponsive to fluids?
A. Administer magnesium sulfate
B. Increase oxygen flow
C. Give calcium gluconate
D. Place the infant in Trendelenburg
C. Give calcium gluconate
## Footnote
slide 7
28
Which reflex is poorly developed in neonates, contributing to limited blood pressure regulation?
A. Chemoreceptor reflex
B. Baroreceptor reflex
C. Bainbridge reflex
D. Diving reflex
B. Baroreceptor reflex
## Footnote
Slide 7
29
Which interventions help manage neonatal hypotension due to low heart rate? (Select 2)
A. Administering sodium chloride
B. Giving atropine
C. Performing fluid restriction
D. Avoiding calcium supplementation
E. Administering epinephrine
B. Giving atropine
E. Administering epinephrine
## Footnote
Slide7
30
Which autonomic branch predominates in neonates and contributes to bradycardia?
A. Sympathetic nervous system
B. Somatic nervous system
C. Enteric nervous system
D. Parasympathetic nervous system
D. Parasympathetic nervous system
## Footnote
Slide 7
31
In neonates, noxious stimulation such as __________ or ___________ can trigger bradycardia.
Select 2
A. Suctioning
B. Mommy kisses
C. Laryngoscopy
D. Spicy food
A. Suctioning
C. Laryngoscopy
| Mommy kisses might make it skip a beat... this is a joke.. kinda.. maybe
## Footnote
Slide 7
32
# Matching
A. Neonate - 4 → 140 bpm
B. 12 months - 2 → 120 bpm
C. 3 years - 1 → 100 bpm
D. 12 years - 3 → 80 bpm
## Footnote
Slide 8
33
# Matching
A. Neonate - 4 → 70–75 mmHg
B. 12 months - 3 → 95 mmHg
C. 3 years → 1 - 100 mmHg
D. 12 years → 2 - 110 mmHg
## Footnote
Slide 8
34
# Matching
A. Neonate - 4 → 40 mmHg
B. 12 months - 3 → 65 mmHg
C. 3 years - 1 → 70 mmHg
D. 12 years - 2 → 60 mmHg
## Footnote
Slide 8
35
How can the MAP of a preterm neonate be estimated?
A. By dividing heart rate by 2
B. Equal to systolic blood pressure
C. Equal to gestational age in weeks
D. Subtracting DBP from SBP
C. Equal to gestational age in weeks
*"So say you have a 25 weeker, their map is going to be around 25 and that should be normal for them."*
## Footnote
Slide 8
36
# Matching
A. Term Neonate → 4 → < 60 mmHg
B. Infants (1–12 months) → 3 → < 70 mmHg
C. Children (1–10 years) → 1 → < 70 mmHg + (2 × age)
D. Children > 10 years → 2 → < 90 mmHg
## Footnote
Slide 9
37
# Math
If your patient is 5 years old, what should their systolic blood pressure be?
5 x 2 = 10
70 + 10 = 80.
So a systolic blood pressure of 80 should be normal for a kid 5 years old.
## Footnote
Slide 9
38
What is the typical hemoglobin level at birth?
A. 10–12 g/dL
B. 12–15 g/dL
C. 16–18 g/dL
D. 18–20 g/dL
D. 18–20 g/dL
Normal adult is 12-15g/dL
## Footnote
slide 10
39
What percentage of neonatal hemoglobin is typically fetal hemoglobin (HbF)?
A. 10–20%
B. 30–50%
C. 60–70%
D. 70–90%
D. 70–90%
## Footnote
slide 10
40
Fetal hemoglobin (HbF) has a _________ P50 and shifts the oxyhemoglobin dissociation curve to the **left** which gives HbF a ____________ affinity for oxygen?
A. Lower, Higher
B. Higher, Lower
C. Lower, Lower
D. Higher, Higher
A. Lower, Higher
"Fetal hemoglobin has a lower P50 and shifts our oxyhemoglobin dissociation curve to the left, meaning it has a higher affinity for oxygen than adults."
## Footnote
slide 10
41
Physiologic anemia in infants typically occurs around what age?
A. 1-5 weeks
B. 1-2 months
C. 3–4 months
D. 5-6 months
C. 3–4 months
## Footnote
Slide 10
42
Physiologic anemia in infants occurs because of decreased ____ activity and **insufficient hematopoiesis.**
A. Aldosterone
B. Erythropoietin
C. Renin
D. Cortisol
B. Erythropoietin
## Footnote
Slide 10
43
Compared to adults, neonates have a ______ estimated blood volume per kg of body weight.
A. Lower
B. Equal
C. Higher
D. Unrelated
C. Higher
## Footnote
slide 10
44
# Matching... I'm sorrrry
A. Premature → 4 → 90–100 mL/kg
B. Newborn (<1 mo) → 3 → 80–90 mL/kg
C. Infant (1 mo–3 yr) → 1 → 75–80 mL/kg
D. Child (>6 yr) → 2 → 65–70 mL/kg
**Child and Adult are the same for volume ml/kg!!**
| ...not sorry 😈
## Footnote
Slide 10
45
The oxyhemoglobin dissociation curve for Hgb F is shifted to the ______, indicating higher oxygen affinity.
A. Center
B. Bottom
C. Right
D. Left
D. Left
"The increasing the binding of oxygen to the fetal hemoglobin, allowing the fetus to exist in an environment of relatively low PAO2"
46
What is the approximate P₅₀ of fetal hemoglobin?
A. 26.5 mmHg
B. 19 mmHg
C. 45 mmHg
D. 12 mmHg
B. 19 mmHg
## Footnote
Slide 11
47
Fetal hemoglobin is composed of two alpha chains and two ______ chains.
A. Gamma
B. Delta
C. Beta
D. Sigma
A. Gamma
## Footnote
Slide 11
48
Why does fetal hemoglobin (Hgb F) not bind 2,3-DPG?
A. It has increased PO₂
B. It lacks gamma chains
C. 2,3-DPG only binds to beta chains
D. It has low hemoglobin concentration
C. 2,3-DPG only binds to beta chains
***Adults** have two alpha chains and two beta chains*
## Footnote
Slide 11
49
# Teacher Question
Select the statements that most accurately reflect the cardiovascular system in the newborn:
(Select 2)
A. HR is the primary determinant of blood pressure
B. Phenylephrine is a first-line treatment for hypotension
C. Stress is more likely to activate the parasympathetic nervous system
D. Hypotension is defined as systolic blood pressure < 70 mmHg
A. HR is the primary determinant of blood pressure
C. Stress is more likely to activate the parasympathetic nervous system
* Phenylephrine is not our first line choice for hypotension first because we don't want to decrease the heart rate. (Calcium would be our first line choice if contractility seems to be the issue)
* For low heart rate then we would want to use something like atropine or epinephrine.
* Hypotension for a neonate
is less than 60 systolic.
## Footnote
slide 12
50
# Respiratory System
At what gestational age does alveolar ductal development begin?
A. 20 weeks
B. 22 weeks
C. 36 weeks
D. 24 weeks
D. 24 weeks
"An infant cannot sustain life until the lungs and vascular system have matured sufficiently to allow for adequate gas exchange and this is around 24 weeks gestation. So an infant born before 24 weeks has a lower survival chance."
## Footnote
Slide 13
51
Alveolar septation begins around **36 weeks** and final alveolar number and structural development continue until about ______ years of age.
A. 2
B. 4
C. 8
D. 10
C. 8
**Alveolar septation** - The formation of new interalveolar walls that increases blood-gas interface
## Footnote
Slide 13
52
What is the approximate alveolar surface area of a neonate compared to an adult?
A. Equal
B. Half
C. One-third
D. Two-thirds
C. One-third
## Footnote
Slide 13
53
Surfactant production and secretion **begin** around ______ weeks gestation.
A. 18–20
B. 22–26
C. 28–30
D. 35–36
B. 22–26
## Footnote
Slide 13
54
**Peak** surfactant production typically occurs around ______ weeks gestation.
A. 18–20
B. 22–26
C. 28–30
D. 35–36
D. 35–36
## Footnote
Slide 13
55
Which type of pneumocyte is responsible for surfactant production and secretion?
A. Type I pneumocytes
B. Type II pneumocytes
C. Alveolar macrophages
D. Goblet cells
B. Type II pneumocytes
## Footnote
Slide 13
56
# True or False
Anything less than 36 weeks gestation will need their respiratory status watched closely.
True
"....anything less than like 36 weeks you're going to really have to monitor their respiratory status. They're probably going to be in the NICU on some sort of support"
## Footnote
Slide 13
57
Neonates are going to have a very _____________ due to a lack of muscular development.
A. Overdeveloped intercostals
B. Rigid chest wall
C. Pliable chest wall
D. Increased thoracic pressure
C. Pliable chest wall
## Footnote
Slide 14
58
In neonates, the ribs are positioned more ______ compared to adults, limiting chest wall expansion.
A. Angled
B. Horizontal
C. Vertical
D. Curved
B. Horizontal
## Footnote
Slide 14
59
Neonatal **paradoxical breathing** occurs when the chest wall ______ during inhalation.
A. Expands outward
B. Stiffens
C. Collapses inward
D. Remains fixed
C. Collapses inward
"The ribs are horizontal and don't really provide a lot of structural assistance with chest wall expansion."
## Footnote
Slide 14
60
Which type of muscle fiber is most resistant to fatigue and underdeveloped in neonates?
A. Type 1
B. Type 2a
C. Type 2b
D. Type M
A. Type 1 **(slow-twitch)**
## Footnote
Slide 14
61
The ______ diaphragm shape in neonates reduces its mechanical efficiency during inspiration.
A. Dome-shaped
B. Flat
C. Inverted
D. Spherical
B. Flat
## Footnote
Slide 14
62
When the infant begins using the ______ muscles during breathing, they fatigue more quickly, which can lead to respiratory distress.
A. Intercostal
B. Diaphragmatic
C. Abdominal
D. Intercostal
A. Intercostal
## Footnote
Slide 14
63
In neonates, minute ventilation is primarily dependent on _________.
A. Inspiratory reserve volume
B. Tidal volume
C. Expiratory time
D. Respiratory rate
D. Respiratory rate
"..our infants is that
their minute ventilation is more dependent on respiratory rate than tidal volume"
## Footnote
Slide 15
64
A normal respiratory rate for a newborn is around ____________.
A. 20–30 breaths/min
B. 30–50 breaths/min
C. 40–60 breaths/min
D. 50–70 breaths/min
C. 40–60 breaths/min
"A normal respiratory rate for a newborn is around 40-60s and even up to 3 years old you'll see respiratory rates in the 30s."
65
The neonate cannot increase their tidal volume, the typical fixed tidal volume range is:
A. 4–6 mL/kg
B. 5–7 mL/kg
C. 6–8 mL/kg
D. 8–10 mL/kg
C. 6–8 mL/kg
"They have a relatively fixed tidal volume so it's usually about 6 to 8 mls per kilo
and so *they can't increase their tidal volumes to compensate for a low minute
ventilation*."
## Footnote
Slide 15
66
Due to some of the structural differences in the respiratory system like their musculature and their underdeveloped alveoli, they have a lower ____________.
A. Functional residual capacity
B. Expiratory reserve volume
C. Inspired residual capacity
D. Total lung capacity
A. Functional residual capacity
## Footnote
Slide 15
67
This low FRC is even worse when we put them under general anesthesia and then you pair that with ____________ and _______________, they're going to desaturate very very rapidly.
Select 2
A. Increased oxygen consumption
B. Decreased metabolic rate
C. Rapid central response to hypoxia
D. Increased metabolic rate
E. High inspiratory muscle strength
A. Increased oxygen consumption'
D. Increased metabolic rate
## Footnote
Slide 15
68
When managing pediatric airways, providers must prioritize ______ before intubation to delay desaturation.
A. Airway suctioning
B. Bag-mask ventilation
C. Preoxygenation
D. Administering atropine
C. Preoxygenation
"You have a lot less reserves in these patients than you do with your adult patients. So it's really important when we're ventilating and intubating infants and children that we remember to pre oxygenate them"
## Footnote
Slide 15
69
# True or False
When you're learning to do your pediatric intubations, the CRNA will allow you time for multiple attempts due to the fixed tidal volumes and increased respirations.
False
"Because these alveoli are collapsing and there low FRC, you run out of time even quicker, the CRNA steps in a lot faster than they did when you were trying to
intubate adults...getting them back to baseline is a lot harder."
## Footnote
Slide 15
70
Immature respiratory centers in the brains of premature neonates make them more prone to ______ with stimulation.
A. Hyperventilation
B. Apnea
C. Tachycardia
D. Wheezing
B. Apnea
## Footnote
slide 15
71
If apnea persists and is not corrected, it can result in ______, increasing the risk of cardiac arrest.
A. Hypertension
B. Bradycardia
C. Seizure activity
D. Hypoglycemia
B. Bradycardia
## Footnote
slide 15
72
Functional residual capacity (FRC) is approximately ______ mL/kg in neonates and ______ mL/kg in adults.
A. 30 / 34
B. 34 / 30
C. 35 / 35
D. 23 / 34
A. 30 / 34
## Footnote
Slide 16
73
Vital capacity is approximately ______ mL/kg in neonates and ______ mL/kg in adults.
A. 70 / 35
B. 35 / 70
C. 35 / 60
D. 63 / 86
B. 35 / 70
## Footnote
Slide 16
74
Total lung capacity (TLC) is about ______ mL/kg in neonates and ______ mL/kg in adults.
A. 63 / 86
B. 86 / 63
C. 70 / 70
D. 60 / 130
A. 63 / 86
## Footnote
Slide 16
75
Residual volume (RV) is approximately ______ mL/kg in neonates and ______ mL/kg in adults.
A. 35 / 30
B. 16 / 23
C. 30 / 35
D. 23 / 16
D. 23 / 16
## Footnote
Slide 16
76
Closing capacity is about ______ mL/kg in neonates and ______ mL/kg in adults.
A. 30 / 34
B. 35 / 23
C. 23 / 35
D. 30 / 30
B. 35 / 23
## Footnote
Slide 16
77
# True or false
Tidal volumes are the same, 6mL/kg, with Neonates and Adults.
True
"It does say the tidal volumes are relatively the same and other sources say our tidal volumes are a little smaller in our pediatric patients.
The big thing to be aware of is that our infants don't tolerate high pressures well so you don't want to give really really big tidal volumes."
## Footnote
slide 16
78
Oxygen consumption is around ______ mL/kg/min in neonates and ______ mL/kg/min in adults.
A. 6–9 / 3.5
B. 3.5 / 6–9
C. 5-6 / 5.3
D. 3-4 / 3.9
A. 6–9 / 3.5
## Footnote
slide 16
79
Alveolar ventilation is approximately ______ mL/kg/min in neonates and ______ mL/kg/min in adults.
A. 60 / 130
B. 130 / 90
C. 100 / 70
D. 130 / 60
D. 130 / 60
## Footnote
Slide 16
80
Average respiratory rate is about ______ breaths per minute in neonates and ______ in adults.
A. 35 / 15
B. 15 / 35
C. 25 / 25
D. 30 / 20
A. 35 / 15
## Footnote
Slide 16
81
Compared to adults, infants have a relatively ______ tongue and a ______ oral cavity.
A. smaller / larger
B. larger / smaller
C. flat / wide
D. shorter / roomier
B. larger / smaller
"...this is going to lead to just physical airway obstruction with their tongue."
"A lot of times we need an oral airway to...also when you're doing your laryngoscopy sweeping the tongue out of the way it's sometimes a little more difficult because you just don't have a lot of room in the tiny mouth."
## Footnote
Slide 17
82
The pediatric larynx sits more ______ in the neck and more ______ than adults.
A. superior / caudad
B. anterior / cephalad
C. superior / cephalad
D. posterior / caudad
C. superior / cephalad
"The larynx is more superior in the pediatric patient. It's just higher up...more cephalad than the adult patient."
## Footnote
Slide 17
83
At what vertebral level is the pediatric larynx typically located?
A. C6–C7
B. C4–C5
C. T1–T2
D. C3–C4
D. C3–C4
"It's opposite our C3-C4 vertebrae versus the C4-C5 vertebrae in the adult patient.
This creates a *more acute angle between the glottic opening and the base of the
tongue*."
## Footnote
Slide 17
84
The shape of the pediatric epiglottis is typically ______, while the adult’s epiglottis is more ______.
A. beta-shaped / omega-shaped
B. omega-shaped / broad and flat
C. alpha-shaped / broad and flat
D. omega-shaped / beta-shaped
B. omega-shaped / broad and flat
"It's short. It's stubby and it angles into the laryngeal inlet so it kind of covers
the airway a little bit more"
## Footnote
Slide 17
85
Why is it often harder to lift the epiglottis in infants with a Macintosh blade?
A. It's not curved enough
B. It doesn't go deep enough
C. Doesn't lift easily in the vallecula
D. The blade is too large
C. Doesn't lift easily in the vallecula
## Footnote
Slide 17
86
In pediatric patients, the vocal cords are:
A. Wider apart than adults
B. Angled superiorly
C. Posteriorly slanted
D. Angled anteriorly
D. Angled anteriorly
"...this makes passing the
ET tube a little bit more difficult. You'll notice like it just doesn't want to go
between the cords as well and sometimes this can help by using a stylet."
## Footnote
Slide 17
87
Which of the following best describes the overall shape of the pediatric airway?
A. Cylindrical
B. Funnel-shaped
C. Rectangular
D. Oblong
B. Funnel-shaped
## Footnote
Slide 17
88
The pediatric trachea is approximately ______ cm long, while the adult trachea measures around ______ cm.
A. 5 / 15
B. 3 / 10
C. 5 / 12
D. 6 / 15
C. 5 / 12
## Footnote
Slide 17
89
The narrowest portion of the pediatric airway is the ______, while in adults it is the ______.
A. epiglottis / vallecula
B. glottis / vocal cords
C. vocal cords / cricoid cartilage
D. cricoid cartilage / vocal cords
D. cricoid cartilage / vocal cords
## Footnote
Slide 17
90
Why are uncuffed endotracheal tubes sometimes used in pediatric patients?
A. To prevent excessive dead space
B. Because cuffed tubes are too short
C. The cricoid ring provides a natural seal
D. To avoid bronchial intubation
C. The cricoid ring provides a natural seal
"Again the narrowest portion of the pediatric airway is at the cricoid ring and this is why we use or can use uncuffed ET tubes for our pediatric patients because of this narrowing it forms a seal after the vocal cords."
## Footnote
Slide 18
91
What complication is most likely when a neonate’s head is flexed after endotracheal intubation?
A. Laryngospasm
B. Right mainstem intubation
C. Esophageal perforation
D. Complete tube occlusion
B. Right mainstem intubation
## Footnote
Slide 18
92
Extension of the neck in a neonate after intubation may cause:
A. Hyperventilation
B. Tube advancement
C. Improved seal
D. ET tube dislodgement
D. ET tube dislodgement
## Footnote
Slide 18
93
In infants and **children up to 3yrs old**, the right and left mainstem bronchi branch from the trachea at approximately what angle?
A. 25°
B. 45°
C. 55°
D. 70°
C. 55°
## Footnote
Slide 19
94
Infants are considered obligate or preferential nasal breathers until approximately ______________.
A. 5 months of age
B. 6 months of age
C. 7 months of age
D. 8 months of age
A. 5 months of age
"this is to facilitate them breathing
while feeding so they're able to eat and breathe at the same time."
## Footnote
Slide 19
95
What is choanal atresia?
A. Collapse of the trachea
B. Blockage or narrowing of one or both nasal passages
C. Premature closure of the larynx
D. Incomplete development of the nasal turbinates
B. Blockage or narrowing of one or both nasal passages
"they can have increased work of breathing or even asphyxia. Not necessarily an emergency but an urgency to fix."
## Footnote
Slide 19
96
What anatomical feature of infants contributes most to neck flexion and airway obstruction when lying supine?
A. Underdeveloped jaw
B. Posteriorly positioned epiglottis
C. Wide glottic opening
D. Large occiput
D. Large occiput
## Footnote
Slide 19&20
97
The goal of positioning an infant’s head during laryngoscopy is to align the external auditory meatus with the ______________.
A. chin
B. cervical spine
C. sternal notch
D. shoulder blades
C. sternal notch
"In infants it's not quite the
sniffing position like adults but you want to get all those axis in line so you
have a better view when you're going to intubate."
## Footnote
Slide 20
98
According to Poiseuille’s Law, airway resistance is:
A. Directly proportional to the radius of the airway
B. Inversely proportional to the fourth power of the radius
C. Equal to the square root of the tracheal length
D. Proportional to the surface area of the lungs
B. Inversely proportional to the fourth power of the radius
| Poiseuille’s Law (Resistance form):
## Footnote
Slide 21
99
# Math
A neonates normal tracheal **radius** is 2mm, how much would the resistance increase if there was 1mm radius of edema added in the airway?
A. 44% increase in airway resistance
B. 3-fold increase in resistance
C. 16-fold increase in resistance
D. Complete obstruction
C. 16-fold increase in resistance
**Decrease in 75% of cross-sectional area for breathing**
## Footnote
Slide 21
100
In an adult, 1 mm of tracheal edema reduces the cross-sectional area by approximately:
A. 44%
B. 16%
C. 75%
D. 3%
A. 44%
Only a 3x increase in resistance
## Footnote
Slide 21
101
Which statement most accurately describes the infants airway? (select 3)
A. larynx is positioned more cephalad
B. vocal cord position at C1-C2
C. narrowest part of airway is vocal cords
D. epiglottis is broad
E. right and left mainstem bronchi take off at same angle
F. vocal cords have anterior slant
A. larynx is positioned more cephalad
E. right and left mainstem bronchi take off at same angle
F. vocal cords have anterior slant
epiglottis is not broad or c-shaped its omega shaped and more narrow and stiff
vocal cords positioned at C3 C4
## Footnote
slide 22
102
Which statement about the central nervous system is correct?
A. during the first 4 months NMJ undergoes developmental changes
B. myelination is incomplete until 3 years of age
C. most neurological growth and development occurs after birth
D. immature muscles are less easily depolarized
**B. myelination is incomplete until 3 years of age
**
first 2 months NMJ undergoes developmental changes
immature muscles are EASILY depolarized
most neurological growth and development occurs in UTERO (nearly complete by 3-4 weeks gestation)
## Footnote
slide 23
103
When does rapid brain growth occur?
A. third trimester
B. during conception
C. after birth
D. in utero
C. after birth
## Footnote
slide 23
104
The Blood Brain Barrier is immature until____
A. 1 year old
B. birth
C. 3 months
D. 5 years
A. 1 year old
## Footnote
slide 23
105
# MATCHING
1.Conus medullaris termination in neonates
2.spinal cord ending at age 8
3.dural sac ends at 6y/o
A. S2 and S3
B. L2 and L3
C. L1
1: B
2: C
3: A
## Footnote
slide 24
106
What do infants have to account for growth of their brain
A. muscles
B. lobes
C. fontanels
D.sutures
C. fontanels
## Footnote
slide 25
107
What are the 2 major fontanels (select 2)
A. lateral
B. anterior
C. posterior
D. medial
B. anterior
C. posterior
## Footnote
slide 25
108
When does the posterior fontanel close? What about anterior?
A. 2y: 4m
B. 3m; 1y
C. 6m: 2y
D. 4m: 2y
D. 4m: 2y
## Footnote
slide 25
109
Often times anesthesia providers will use the fontanels as an extra vital sign to assess________ (select 2)
A. intracranial pressure
B. hydration status
C. blood pressure
D. heart rate
A. intracranial pressure
B. hydration status
high ICP then bulging
dehydration suncken in
## Footnote
slide 25
110
When will the blood brain barrier mature?
A. 6 months
B. 2 years
C. 8 months
D. 1 year
D. 1 year
## Footnote
slide 26
111
What is a risk during the first year of life related to the blood brain barrier?
A. medications and toxins penetrate BBB
B. intracerebral hemorrhage
C. hypoxia
D. hyperglycemia
A. medications and toxins penetrate BBB
## Footnote
slide 26
112
The CNS has _________ cerebral metabolic requirements and uses ______ as the primary food for the brain
A. increased: oxygen
B. decreased: oxygen
C. increased: glucose
D. decerased: albumin
C. increased: glucose
| so we use lots of dextrose containing fluids
## Footnote
slide 26
113
Due to the lack of fully developed CBF and autoregulation, what is a neonate prone to?
A. hypocarbia
B. intracerebral hemorrhage
C. stiff cerebral vessels
D. hyperkalemia
B. intracerebral hemorrhage
cerebral vessels more fragile
## Footnote
slide 26
114
Which of the following can precipitate intracranial/ intraventricular hemorrhages (select 7) -so not 3
A. hypoxemia
B. hyperoxia
C. hypercarbia
D. hypocarbia
E. hyperglycemia
F. hypoglycemia
G. hyponatremia
H. hypernatremia
I. hypotension
J. hypertension
A. hypoxemia
C. hypercarbia
E. hyperglycemia
F. hypoglycemia
H. hypernatremia
I. hypotension
J. hypertension
## Footnote
select 26
115
Due to an immature ANS what is prone to happening? (select 2)
A. bradycardia
B. SNS
C. PNS
D. tachycardia
A. bradycardia
C. PNS
can lead to cardiac collapse
## Footnote
slide 26
116
# True or false
Nephrons are still being formed up to 39weeks gestation
false
35 weeks
## Footnote
slide 27
117
When does GFR reach adult levels?
A. 8-14 months old
B. 1-2 years old
C. 5-11 months old
D. 6-12 months old
D. 6-12months old
## Footnote
slide 27
118
Match the GFR with the age
1. Premature
2. Full term
3. 2 years old
A. 2ml/min/kg
B. 0.55ml/min/kg
C. 1.6ml/min/kg
1. Premature: B. 0.55ml/min/kg
2. full term: C. 1.6ml/min/kg
3. 2 years old : A. 2ml/min/kg
## Footnote
slide 27
119
What are reasons that we need to be careful to not overload neonates with fluid? (select 3)
A. increased ADH
B. low GFR
C. stiff myocardium
D. immature renal tubules
E. Increased RAAS system
B. low GFR
C. stiff myocardium
D. immature renal tubules
## Footnote
slide 27
120
An immature renal medulla results in (select 2)
A. diminished ADH
B. sodium excretion
C. decreased ability to reabsorb glucose
D. increased RAAS system
A. diminished ADH
B. sodium excretion- might require sodium in IV fluids
reduced RAAS
## Footnote
slide 27
121
Immature renal tubules can result in (select 3)
A. excreting too much fluid
B. not excreting fluid
C. excreting too much sodium
D. hypernatremia
E. decreased ability to reabsorb glucose
B. not excreting fluid
C. excreting too much sodium
E. decreased ability to reabsorb glucose
## Footnote
slide 27
122
How much fluids for neonates require per day?
A. 150ml/kg
B. 200ml/kg
C. 75ml/kg
d. 175ml/kg
A. 150ml/kg
## Footnote
slide 28
123
Neonates have a high metabolic rate and high rate of insensible fluid losses mostly from ___________
A. radiant
B. evaporation
C. conductive
D. convective
B. evaporative
higher surface area to body weight ratio (4x that of an adult)
## Footnote
slide 28
124
True or false:
Infants have increased composition of body water
true
## Footnote
slide 28
125
At what age do glycogen stores in neonates typically reach adult levels?
A) 1 week
B) 2 weeks
C) 3 weeks
D) 4 weeks
C)3 weeks
## Footnote
slide 29
126
What percentage of glucose stores from the fetal liver is released within the first 48 hours after birth?
A) 90%
B) 70%
C) 50%
D) 100%
A) 90%
| dont return to adult levels until 3 weeks old
## Footnote
slide 29
127
What is a major risk for neonates between birth and 2 weeks of age due to decreased glycogen stores?
A) Hypoglycemia
B) Hyperglycemia
C) Hyperbilirubinemia
D) Dehydration
A) Hypoglycemia
## Footnote
slide 29
128
Neonates have liver function that is characterized by which of the following?
A) Increased enzyme activity
B) Decreased enzyme activity and low albumin production
C) Normal enzyme activity
D) Increased albumin production
B) Decreased enzyme activity and low albumin production
"issues with enxyme breakdown and albumin production is low 75-80% of adult levels
## Footnote
slide 29
129
Low plasma albumin in neonates affects drug binding in what way?
A) Increases drug binding
B) Decreases drug toxicity
C) Leads to more free-floating drugs, increasing toxicity risk
D) Leads to less free-floating drugs, increasing toxicity risk
D) Leads to more free-floating drugs, increasing toxicity risk
## Footnote
slide 29
130
What condition are neonates particularly at risk for due to low levels of clotting factors?
A) Hypertension
B) Intracranial hemorrhage
C) Hypoglycemia
D) Anemia
B) Intracranial hemorrhage
## Footnote
slide 29
131
How much vitamin K is typically administered to neonates at birth to prevent bleeding?
A) 0.1 mg
B) 0.5 mg
C) 1 mg
D) 5 mg
C) 1 mg
## Footnote
slide 29
132
Which vitamin is essential for the synthesis of clotting factors II, VII, IX, and X in neonates?
A) Vitamin A
B) Vitamin D
C) Vitamin E
D) Vitamin K
D) Vitamin K
## Footnote
slide 29
133
Plasma albumin binds to _____ drugs and alpha 1 glycoproteins bind to ______ drugs
A. acidic/ basic
B. basic/acidis
A. acidic / basic
## Footnote
slide 29
134
When do clotting factors reach adult levels?
A. 1st year
B. 6 months
C. 3 months
D. 1st week
D. 1st week
## Footnote
slide 29
135
What is the gastric pH at birth?
A) Acidic
B) Neutral
C) Alkalotic
D) Variable
C) Alkalotic
## Footnote
slide 30
136
When does the gastric pH typically decrease to normal levels after birth?
A) By day 1
B) By day 2
C) By day 3
D) By day 5
B) By day 2
## Footnote
slide 30
137
At what age do infants fully mature their ability to coordinate swallowing with respiration?
A) 4-5 months
B) 2-3 months
C) 6-7 months
D) 8-9 months
A) 4-5 months
## Footnote
slide 30
138
What condition is increased in neonates due to their GI development?
A) Constipation
B) Cholecystitis
C) Diarrhea
D) Gastroesophageal reflux disease (GERD)
D) Gastroesophageal reflux disease (GERD)
## Footnote
slide 30
139
What is a reason for the slower absorption of oral (PO) medications in neonates?
A) Increased gastric acidity
B) Faster gastric emptying
C) Delayed gastric emptying
D) Immature liver function
C) Delayed gastric emptying
## Footnote
slide 30
140
What symptom might indicate upper intestinal anomalies in a neonate?
A) Vomiting or regurgitation
B) Failure to pass meconium
C) Abdominal distension
D) Excessive crying
A) Vomiting or regurgitation
## Footnote
slide 30
141
What symptom might indicate lower intestinal anomalies in a neonate? (select 2)
A) Vomiting
B) Regurgitation
C) Poor feeding
D) Abdominal distension
E) failure to pass meconium
D) Abdominal distension
E) failure to pass meconium
## Footnote
slide 30
142
If developmental problems exist within the GI system of a neonate, when will symptoms typically appear?
A) Within 12 hours
B) Within 24-36 hours
C) Within 48 hours
D) Within 72 hours
B) Within 24-36 hours
## Footnote
slide 30
143
What is a significant challenge neonates face in regulating body temperature?
A) High metabolic rate
B) Ability to shiver
C) Increased subcutaneous fat
D) Large body surface area
D) Large body surface area
lack of subcutaneous tissue
inability to shiver
## Footnote
slide 31
144
Why do neonates have difficulty insulating their bodies?
A) Lack of subcutaneous tissue
B) High levels of subcutaneous tissue
C) High muscle mass
D) Low body surface area
A) Lack of subcutaneous tissue
## Footnote
slide 31
145
What mechanism do neonates utilize for thermoregulation since they cannot shiver?
A) Shivering thermogenesis
B) Non-shivering thermogenesis
C) Heat retention
D) Evaporative cooling
B) Non-shivering thermogenesis
## Footnote
slide 31
146
What stimulates non-shivering thermogenesis in neonates?
A) Parasympathetic nervous system
B) Central nervous system
C) Sympathetic nervous system
D) Endocrine system
C) Sympathetic nervous system
to enhance metabolism of brown fat which incerases heat production
## Footnote
slide 31
147
What can hypothermia in neonates lead to?
A) Bradycardia, acidosis, and coagulopathies
B) Hyperthermia and dehydration
C) Increased appetite and weight gain
D) Normal heart rate and respiration
A) Bradycardia, acidosis, and coagulopathies
## Footnote
slide 31
148
What effect does norepinephrine have in the context of thermoregulation in neonates?
A) Decreases heat production
B) Stabilizes body temperature
C) Inhibits shivering
D) Increases metabolism of brown fat and heat production
D) Increases metabolism of brown fat and heat production
## Footnote
slide 31
149
What are potential consequences of metabolic acidosis in neonates due to hypothermia?
A) Increased activity level
B) Bradycardia and cardiac collapse
C) Improved thermoregulation
D) Enhanced metabolism
B) Bradycardia and cardiac collapse
## Footnote
slide 31
150
What temperature should the operating room be maintained at for neonates to ensure they start warm?
A) 70 degrees Fahrenheit
B) 75 degrees Fahrenheit
C) 80 degrees Fahrenheit
D) 85 degrees Fahrenheit
D) 85 degrees Fahrenheit
151
# Matching
1. Evaporation
2. Conductive
3. Radiant
4. Convective
A. occurs through vaporization of liquid from the body cavities and respiratory tract
B. responsible for anethetic heat loss it occurs when heat is transferred from the environment and is dependent on the differences between temperature of neonate and environment
C. precipitated by air movmeent, flow of air around the baby
D.due to direct contact
1. Evaporation : A. occurs through vaporization of liquid from the body cavities and respiratory tract
2. Conductive: D.due to direct contact
3. Radiant : B. responsible for anethetic heat loss it occurs when heat is transferred from the environment and is dependent on the differences between temperature of neonate and environment
4. Convective: C. precipitated by air movmeent, flow of air around the baby
## Footnote
slide 32
152
What is the difference between sensible and insensible evaporative loss?
A) Sensible loss occurs through sweating, while insensible loss is water loss through the skin
B) Sensible loss is from breathing, while insensible loss is from sweating
C) Sensible loss is from direct contact, while insensible loss occurs without contact
D) Sensible loss is from the respiratory tract, while insensible loss occurs through the mouth
A) Sensible loss occurs through sweating, while insensible loss is water loss through the skin
## Footnote
slide 32
153
Which of the following is a method to prevent insensible heat loss in neonates?
A) Increase ambient temperature
B) Remove wet clothing and keep the infant dry
C) Use cold irrigation fluids
D) Increase air circulation around the baby
B) Remove wet clothing and keep the infant dry
use warm irrigation
wiped down after irrigation
plastic barriers over them
decrease humidity in the room
## Footnote
slide 32
154
What are ways to prevent radient heat loss? (select 2)
A. warm irrigation
B. placing bair hugger
C. wrap the baby
D. heat lamps
C. wrap the baby to prevent heat from transferring around the baby
D. heat lamps
## Footnote
slide 32
155
Which intervention helps to prevent conductive heat loss in neonates? (select 2)
A) warm irrigation fluid
B) Using an underbody bair hugger
C) Keeping the operating room cool
D) Increasing air circulation
A) warm irrigation fluid
B) Using an underbody bair hugger
## Footnote
slide 32
156
What temperature range is typically maintained in the operating room for neonates to prevent heat loss?
A) 68 to 72 degrees Fahrenheit
B) 75 to 78 degrees Fahrenheit
C) 78 to 80 degrees Fahrenheit
D) 80 to 85 degrees Fahrenheit
C) 78 to 80 degrees Fahrenheit (with some ORs going up to 85 degrees)
## Footnote
slide 32
157
What is the primary mechanism of heat loss in neonates during surgery ?
A) Conductive heat loss
B) Convective heat loss
C) Sensible evaporative heat loss
D) Radiant heat loss
D) Radiant heat loss
## Footnote
slide 32
158
How oftern does the OR air circulation change?
A. 6-12 times/hr
B. 5-10 times/hr
C. 11-15 times/hr
D. 15-30 times/hr
A. 6-12 times/hr
## Footnote
slide 32
159
A 2-week old neonate will be expected to demonstrate the following except a/an
A. increased free fraction of highly protein bound drugs
B. faster circulation time
C. larger volume of distribution of water soluble drugs
D. shorter duration of action of lipid soluble drugs
D. shorter duration of action of lipid soluble drugs
## Footnote
slide 35
160
Absorption and distribution of drugs are going to be ________ due to _______
A. increased; CO
B. decreased; immature liver function
C. decreased; immature kidney function
D. Increased; higher GFR
A. increased; CO
## Footnote
slide 36
161
# Match CO to age
Neonate
Infant
Adolescent
A. 100mL/kg/min
B. 400mL/kg/min
C. 200mL/kg/min
Neonate: B. 400mL/kg/min
Infant: C. 200mL/kg/min
Adolescent: A. 100mL/kg/min
## Footnote
slide 36
162
Neonates have a _________ elimination due to _________
A. decreased: immature blood brain barrier
B. increased: mature lungs
C. decreased: immature liver and kidneys
D. increased: cardiac output
C. decreased: immature liver and kidneys
## Footnote
slide 36
163
When do the cytochrome P450 (c450) pathways typically mature?
(a) At birth
(b) By one month old
(c) By three months old
(d) By six months old
(c) By three months old
## Footnote
slide 36
164
What characteristic of unbound, unprotein-bound molecules allows them to cross the immature blood-brain barrier?
(a) Their lipophilic nature
(b) Their hydrophilic nature
(c) Their large size
(d) Their strong protein binding
(a) Their lipophilic nature
## Footnote
slide 36
165
Which drug mentioned in lecture can cross the BBB and cause seizures
A. benzos
B. opioids
C. non depolarizing muscle relaxants
D. local anesthetics
D. local anesthetics
## Footnote
slide 36
166
# true or false
infants have a greater TBW composition than adults
true
## Footnote
slide 37
167
Infants have a larger___ compartment and a decreased ____
A. ECF; ICF
B. ICF; ECF
C. Plasma; plt
D. ICF; plasma
A. ECF; ICF
## Footnote
slide 37
168
A greater TBW, ECF and lower ICF in an infant results in a _______
A. decreased Vd for water soluble drugs
B. increased Vd for lipid soluble drugs
C. increased Vd for water soluble drugs
D. decreased Vd for lipid soluble drugs
C. increased Vd for water soluble drugs
like neuromuscular blocking drugs
## Footnote
slide 37
169
Although we have a larger distribution for neuromuscular blocking drugs redosing should be LESS because of (select 2)
A. immature blood brain barrier
B. immature acetylcholine receptors
C. neuromuscular junctions dont function as well
D. immature liver and kidney function
B. immature acetylcholine receptors
C. neuromuscular junctions dont function as well
## Footnote
slide 37
170
Why might neonates be more sensitive to lipophilic drugs?
(a) Because their c450 pathways are more developed.
(b) Because they have higher fat stores.
(c) Because they have lower fat stores.
(d) Because their blood-brain barrier is more mature.
(c) Because they have lower fat stores.
## Footnote
slide 37
171
What is a consequence of neonates having lower protein concentrations in their blood?
(a) Lipophilic drugs will be less effective.
(b) There will be less free drug available if it's highly protein-bound.
(c) Active transport systems across the blood-brain barrier will function more efficiently.
(d) There will be more free drug available if it's highly protein-bound.
(d) There will be more free drug available if it's highly protein-bound.
## Footnote
slide 37
172
A significant difference in pharmacodynamics between neonates and adults involves the function of their receptors. According to lecture, what is characteristic of fetal nicotinic acetylcholine receptors in neonates?
(a) They close more quickly than in adults.
(b) They remain open for a longer duration.
(c) They have a lower affinity for acetylcholine.
(d) They are more sensitive to depolarizing neuromuscular blocking drugs.
(b) They remain open for a longer duration.
## Footnote
slide 38
173
Due to the prolonged opening of fetal nicotinic acetylcholine receptors, neonates might exhibit:
(a) Increased sensitivity to neuromuscular blocking drugs.
(b) A predictable response to neuromuscular blocking drugs.
(c)Resistance to neuromuscular blocking drugs.
(d) A decreased risk of respiratory depression.
(c) Resistance to neuromuscular blocking drugs.
## Footnote
slide 38
174
Besides the receptor function, what other factor at the neuromuscular junction contributes to the unpredictable response to neuromuscular blocking drugs in neonates?
(a) A reduction in the acetylcholine released.
(b) An increased release of acetylcholine.
(c) A higher density of nicotinic acetylcholine receptors.
(d) Faster metabolism of neuromuscular blocking drugs.
(a) A reduction in the acetylcholine released.
## Footnote
slide 38
175
What changes occur with opioid receptors in neonates that may explain increased respiratory depression?
(a) An increase in the number and affinity of mu and kappa receptors.
(b) A decrease in the number and affinity of mu and kappa receptors.
(c) Changes in the number and affinity of mu and kappa receptors.
(d) No significant difference in opioid receptors compared to adults.
(c) Changes in the number and affinity of mu and kappa receptors.
## Footnote
slide 38
176
According to the text, how do GABA receptors in neonates compare to those in adults?
(a) They are about the same in number.
(b) They are about twice the number.
(c) They are more than three times the number.
(d) They are about one-third the number.
(d) They are about one-third the number.
## Footnote
slide 38
177
What proportion of GABA receptors in neonates have a high affinity for benzodiazepine binding or other anesthetics?
(a) About one-third.
(b) About half.
(c) The majority.
(d) Very few.
(b) About half.
## Footnote
slide 38
178
The lower MAC (Minimum Alveolar Concentration) for anesthetics in neonates, which increases around one month old, might be explained by:
(a) The increased number of GABA receptors.
(b) The lower affinity of GABA receptors for anesthetics.
(c) The higher affinity of a portion of GABA receptors for benzodiazepines or other anesthetics.
(d) The faster closure of fetal nicotinic acetylcholine receptors.
(c) The higher affinity of a portion of GABA receptors for benzodiazepines or other anesthetics.
## Footnote
slide 38
179
# summary of pediatric pharmacology
All of the following are true regarding neonates except
A. have a higher TBW composition
B. immature metabolic degradation pathways
C. reduced protein binding
D. immature BBB
E. a greater proportion of blood flow to vessel- rich organs
F. decreased CO
G.reduced GFR
H. smaller FRC
I.increased MV
J.immature receptor responsed
F. decreased CO
## Footnote
slide 39
180
# Accordng to lecture
Which 2 factors contribute to more rapid equilibration of inhaled agents in neonates?
A. Increased muscle mass
B. Increased cardiac output
C. Increased minute ventilation
D. High adipose tissue content
B. Increased cardiac output
C. Increased minute ventilation
*Dr.M: "which directs mainly to
the vessel rich groups of tissue and a reduced solubility of the inhalational
agents in the blood"*
## Footnote
Slide 40
181
MAC is ____ for neonates but ____ for infants.
A. More; Decreases
B. Less; Increases
C. More; Increases
D. Less; Decreases
B. MAC is **less** for neonates but **increases** for infants
*Dr: M: and then decreases again
to adult levels and then of course decreases even more with the elderly*
## Footnote
Slide 40
182
Inhalation agents are associated with more ___ side effects in pediatric patients.
A. Respiratory
B. Neurologic
C. Cardiovascular
D. Renal
C. Cardiovascular
*Dr. M: because of this rapid equilibration and rapid induction of anesthesia the cv side effects seen with our anesthetic gases can also happen faster*
## Footnote
Slide 40
183
Which cardiovascular side effects are commonly seen in infants receiving inhalation anesthesia?
A. Tachycardia and hypertension
B. Bradycardia and cardiac collapse
C. Hypertension and arrhythmias
D. Tachypnea and respiratory arrest
B. Bradycardia and cardiac collapse
## Footnote
Slide 40
184
Which shunt type is associated with *decreased* uptake of inhaled anesthetics?
A. Left-to-right shunt
B. Right-to-left shunt
C. Bidirectional shunt
D. AV fistula
B. Right-to-left shunt
*Dr. M: patients with congenital heart disease if they have a right-to-left shunt it's going to be a **much slower induction***
| right to left shunt it's going to take them longer to go to sleep
## Footnote
Slide 40
185
Emergence delirium is more commonly seen in which population? (Select 2)
A. Neonates
B. Adults
C. Elderly patients
D. Infants
E. Older children
D. Infants
E. Older children
## Footnote
Slide 40
186
# MAC level reference
one of the tables from apex
## Footnote
Slide 41
187
Match the patient group with the correct MAC of Sevoflurane
1 → C (Neonates: 3.3%)
2 → B (Infants 1–6 months: 3.2%)
3 → A (Children >6 months: 2.5%)
## Footnote
Slide 42
188
# Based on lecture
Why is sevoflurane the preferred agent for inhalational induction, especially in children?
A. It has a high blood solubility and is highly pungent
B. It has a lower blood solubility and is less pungent than other agents
C. It peaks at 6 months of age and has a strong odor
D. It is more soluble and causes faster airway irritation
B. It has a lower blood solubility and is less pungent than other agents
| facilitates a relatively rapid inhalation induction
## Footnote
Slide 42
189
In pediatric anesthesia, nitrous oxide is especially useful for inhalational induction in which group?
A. Infants younger than 6 months
B. Older, cooperative children
C. Neonates under 30 days
D. Adolescents refusing IV access
B. Older, cooperative children
| start with 30 to 50 nitrous
## Footnote
Slide 43
190
What is the MAC (Minimum Alveolar Concentration) of nitrous oxide (N₂O) in adults?
A. 80%
B. 94%
C. 104%
D. 114%
C. 104%
| MAC of N2O in children has not been determined
## Footnote
Slide 43
191
What is the "second gas effect" as it relates to nitrous oxide?
A. Nitrous slows the uptake of sevoflurane
B. Nitrous speeds up the uptake of sevoflurane
C. Nitrous prevents emergence delirium
D. Nitrous prolongs stage II of anesthesia
B. Nitrous speeds up the uptake of sevoflurane
## Footnote
Slide 43
192
How does nitrous oxide affect the risk of postoperative nausea and vomiting (PONV)?
A. Decreases risk in adults
B. Increases risk primarily in pediatric patients
C. Increases risk, especially in adults
D. Has no impact on PONV
C. Increases risk, especially in adults
*Dr. M: it's a little less in our pediatric patients*
## Footnote
Slide 43
193
During pediatric anesthesia cases, how is nitrous oxide typically managed after induction?
A. It is continued throughout the case
B. It is turned off after induction
C. It is replaced with desflurane
D. It is converted to a high-flow oxygen mix
B. It is turned off after induction
## Footnote
Slide 43
194
Infants and children have rapid uptake and equilibrium of *inhalational agents* due to which of the following? (Select 3)
A. Greater minute ventilation (MV)
B. Lower metabolic rate
C. Higher tidal volume (TV) to functional residual capacity (FRC) ratio
D. Higher cardiac output (CO)
E. Increased muscle mass
A. Greater minute ventilation (MV)
C. Higher tidal volume (TV) to functional residual capacity (FRC) ratio
D. Higher cardiac output (CO)
## Footnote
Slide 44
195
Decreased distribution of ___ and decreased ___ of pediatrics affect the rate of equilibration of *inhalational agents* among the alveoli, blood, and brain.
A. Blood flow; fat metabolism
B. Adipose tissue; muscle mass
C. Functional residual capacity; cardiac output
D. Sevoflurane concentration; tidal volume
B. Adipose tissue; muscle mass
Dr. M:
* **decreased distribution to adipose tissue** so it's not going to go seep into those fat stores
* **decreased muscle mass** all of this again it's going to affect how quickly it gets to the brain there's a greater percent of blood flow to the brain
## Footnote
Slide 44
196
Which of the following are true regarding myocardial depressant effects being exaggerated from *inhalational agents* in pediatric patients (Select 2)
A. Structural and functional immaturity of the pediatric heart
B. Neonates are more affected than older children
C. Increased muscle mass in neonates
D. Greater blood flow to skeletal muscles
A. Structural and functional immaturity of the pediatric heart
B. Neonates are more affected than older children
## Footnote
Slide 44
197
In pediatric patients, higher cardiac output (CO) directs more blood flow to which type of tissue during *IV anesthetic* administration?
A. Adipose tissue
B. Muscle tissue
C. Vessel-rich tissues
D. Skeletal tissues
C. Vessel-rich tissues
*Dr. M: going to have a higher proportion of that cardiac output getting to your vessel-rich groups like your brain your heart your
kidneys*
## Footnote
Slide 45
198
___ IV drugs have a longer duration of action in neonates and infants.
A. Hydrophilic
B. Lipophilic
C. Protein-bound
D. Ionized
B. Lipophilic
*Dr. M: due to less fat and muscle and because we have the immature liver and kidneys so we're not excreting them metabolizing them as quickly *
## Footnote
Slide 45
199
In pediatrics, *opioids* can cause prolonged ____ effects due to immature that immature blood-brain barrier and low fat stores.
A. Respiratory
B. Renal
C. Central nervous system (CNS)
D. Cardiovascular
C. Central nervous system (CNS)
*Dr. M: ...brain has higher stores of fat so the drugs are going to go there more so than being redistributed to other parts of the body*
## Footnote
Slide 45
200
Pediatrics require __ of *Propofol* compared to adults.
A. Smaller doses
B. Larger doses
C. Equal doses
D. Continuous infusions only
B. Larger doses
*Dr. M: dose because of that increased metabolic rate and a greater volume of distribution also the redistribution is increased to those vessel-rich organs*
## Footnote
Slide 46
201
The clearance of Propofol in preterm neonates is ____ compared to older children and adults.
A. Increased
B. Reduced
C. Normal
B. Reduced
*Dr. M: bout the same as in adults for older children*
## Footnote
Slide 46
202
# Match the Age Group with the ED₅₀ Dose of Propofol
1 → B (1–6 months old = 3 mg/kg)
2 → C (1–12 years old = 1.3–1.6 mg/kg)
3 → A (10–16 years old = 2.4 mg/kg)
## Footnote
Slide 46
203
According to lecture, in which pediatric population have a higher concern for the development of Propofol Infusion Syndrome?
A. Adolescents
B. Toddlers
C. Neonates and infants
D. Older children (>12 years)
C. Neonates and infants
## Footnote
Slide 46
204
Ketamine can be used in pediatric anesthesia for which purpose(s)?
A. Premedication only
B. Induction of anesthesia only
C. Both premedication and induction of anesthesia
D. Only emergency airway management
C. Both premedication and induction of anesthesia
*Dr. M: for some of our older kids with a maybe developmental delay that aren't cooperative of taking an oral pre-med*
## Footnote
Slide 47
205
What cardiovascular side effect is *Propofol* particularly associated with in neonates?
A. Hypertension
B. Bradycardia
C. Hypotension
D. Tachycardia
C. Hypotension
*Dr. M: because we're giving more [Propofol], more of the side effects as well so you have to play into consideration when you are giving these large doses of dosages of drugs*
## Footnote
Slide 46
206
Which of the following is NOT a common route of administration for ketamine in pediatric patients?
A. IV (intravenous)
B. IM (intramuscular)
C. PO (oral)
D. Subcutaneous
E. PR (Rectal)
F. IN (intranasal)
D. Subcutaneous
## Footnote
Slide 47
207
According to lecture, children require a ___ dose... , however neonates might need a ___ dose... of *Ketamine.*
A. Larger; Reduced
B. Reduced; Larger
C. Larger; Larger
D. Reduced; Reduced
A. Larger; Reduced
Children require a **larger** dose *because of greater clearance*, however neonates might need a **reduced** dose *because of reduced clearance*
## Footnote
Slide 47
208
Why is *Ketamine* considered a good anesthetic choice for unstable pediatric patients according to lecture?
A. It causes profound cardiovascular depression
B. It causes minimal cardiovascular and respiratory depression
C. It requires continuous cardiac pacing
D. It rapidly causes apnea and bradycardia
B. It causes minimal cardiovascular and respiratory depression
## Footnote
Slide 47
209
Why is *Etomidate* sometimes chosen for critically ill pediatric patients?
A. It enhances adrenal function
B. It causes minimal cardiovascular suppression
C. It shortens recovery time dramatically
D. It stimulates respiratory drive
B. It causes minimal cardiovascular suppression
## Footnote
Slide 48
210
What concerns limit the use of *Etomidate* in children? (Select 2)
A. High risk of renal failure
B. Adrenal suppression
C. Anaphylactoid reactions
D. Excessive sedation
E. Delayed neuromuscular recovery
B. Adrenal suppression
C. Anaphylactoid reactions
*Dr. M: if you do have a patient with adrenal insufficiency corticosteroid supplementation may be indicated*
## Footnote
Slide 48
211
Which of the following statements about *Etomidate* dosing in pediatric patients are true? (Select 2)
A. The typical induction dose is 0.2–0.3 mg/kg
B. Pediatric dosing is significantly lower than adult dosing
C. Pediatric dosing is relatively unchanged compared to adults
D. Clearance is significantly faster in children than adults
E. Etomidate has high cardiovascular suppression
A. 0.2–0.3 mg/kg,
C. Pediatric dosing is relatively unchanged compared to adults
## Footnote
Slide 48
212
What is a common use of *Dexmedetomidine* in pediatric anesthesia?
A. Emergent airway management
B. Procedural sedation
C. Muscle relaxation
D. Blood pressure augmentation
B. Procedural sedation
*Dr. M: it's the alpha 2 agonist and we use it a lot just for sedation procedures where precedex might be the only drug we give or you can use it as a pre-med*
## Footnote
Slide 49
213
What is the typical*intranasal* dose of *Dexmedetomidine* for premedication in children?
A. 10–20 mcg/kg
B. 1–2 mcg/kg
C. 0.1–0.2 mg/kg
D. 5–7 mcg/kg
B. 1–2 mcg/kg
## Footnote
Slide 49
214
What is an advantage of *Dexmedetomidine* in pediatric patients?
A. It causes profound respiratory depression
B. It causes minimal respiratory depression
C. It prolongs the neuromuscular blockade
D. It increases the incidence of emergence delirium
B. It causes minimal respiratory depression
## Footnote
Slide 49
215
The peak effect of *intranasal Dexmedetomidine* occurs approximately ____ after administration.
A. 10–20 mins
B. 20–30 mins
C. 30–40 mins
D. 40–60 mins
C. 30–40 mins
*Dr. M: takes a little while to take its peak effect...so you have to sort of prepare for that.*
## Footnote
Slide 49
216
According to lecture: Why is *Dexmedetomidine* a preferred agent for sedation in children with airway concerns or obstructive sleep apnea (OSA)?
A. It causes deep respiratory depression similar to propofol
B. It mimics natural sleep with minimal respiratory depression
C. It stimulates airway reflexes aggressively
D. It induces rapid muscle paralysis
B. It mimics natural sleep with minimal respiratory depression
*Dr. M: we give some precedex and then the ent can evaluate the airway under
a more natural like sleep*
## Footnote
Slide 49
217
*Dexmedetomidine* ____ the incidence of emergence delirium and agitation.
A. Increases
B. Decreases
B. Decreases
## Footnote
Slide 49
218
What is a potential side effect of high doses of *Dexmedetomidine*?
A. Increased risk of apnea
B. Shortened recovery phase
C. Prolonged recovery phase
D. Immediate wakefulness
C. Prolonged recovery phase
## Footnote
Slide 49
219
The typical *Morphine* dosing for pediatric patients is ____
A. 0.01–0.03 mg/kg
B. 0.05–0.1 mg/kg
C. 0.1–0.2 mg/kg
D. 0.5–1.0 mg/kg
B. 0.05–0.1 mg/kg
## Footnote
Slide 50
220
Why should *Morphine* dosing be reduced in neonates and infants, particularly for postoperative pain management?
A. They have an increased clearance of morphine
B. They are more resistant to opioid effects
C. They are at higher risk for respiratory depression
D. They metabolize morphine too quickly
C. They are at higher risk for respiratory depression
## Footnote
Slide 50
221
Neonates are ____ to the effects of *Morphine* compared to older children and adults.
A. Less sensitive
B. Equally sensitive
C. More sensitive
D. Completely resistant
C. More sensitive
## Footnote
Slide 50
222
Why must redosing of *Morphine* be adjusted in neonates?
A. They clear morphine faster than adults
B. Clearance of morphine is decreased
C. They require higher doses to maintain analgesia
D. Morphine is completely inactive in neonates
B. Clearance of morphine is decreased, leading to drug accumulation
*adult levels [of clearence reached] at 6-12 months of age
## Footnote
Slide 50
223
Which of the following side effects is associated with *Morphine* administration?
A. Severe bradycardia
B. Histamine release
C. Bronchoconstriction without any skin symptoms
D. Direct myocardial depression
B. Histamine release
*Dr. M: if you have a patient that has a history of anaphylaxis to different things or lots of allergies, histamine release can be an issue with morphine.*
## Footnote
Slide 50
224
Which opioid is described as "morphine-like" but has only about 10% of the potency of Morphine?
A. Fentanyl
B. Hydromorphone
C. Codeine
D. Methadone
C. Codeine
## Footnote
Slide 50
225
Which of the following statements about *Codeine* are true? (Select 2)
A. Codeine is 10% metabolized to morphine
B. Codeine has unpredictable metabolism
C. Codeine has 100% the potency of morphine
D. Codeine metabolism is completely predictable and safe in all patients
A. Codeine is 10% metabolized to morphine
B. Codeine has unpredictable metabolism
and **Rapid oral absorption and 90% bioavailability**
*Dr. M: have to be mindful that the metabolite can also cause some respiratory depression*
| Slide 50
226
hy does the FDA issue a *black box warning* against the use of *Codeine* in children after tonsillectomy?
A. Risk of severe hypotension
B. Risk of unpredictable respiratory depression
C. Risk of excessive bleeding at the surgical site
D. Risk of delayed wound healing
B. Risk of unpredictable respiratory depression
*Dr. M: there's some **ultra rapid metabolizers** that are a risk for increased clinical response including profound respiratory depression...they'll still give it sometimes for pain management but it's used very cautiously in pediatrics*
## Footnote
Slide 50
227
Which of the following describes *Fentanyl'*s hemodynamic effects?
A. Causes significant hypotension
B. Causes tachycardia
C. Greater hemodynamic stability
D. Greater risk of myocardial depression
C. Greater hemodynamic stability
*Dr. M: the dose is anywhere from **0.5 to 2 milligrams per kilo***
## Footnote
Slide 51
228
*Fentanyl* is the most frequently used ____ opioid in pediatric anesthesia.
A. Post-op
B. Intra-op
C. Pre-op
D. Emergency room
B. Intra-op
## Footnote
Slide 51
229
*Fentany*l has a ___ onset and a ___ duration of action (DOA).
A. Slow, short
B. Rapid, long
C. Rapid, short
D. Slow, long
C. Rapid, short
Fentanyl has a **rapid onset** and a **short duration of action** (DOA).
## Footnote
Slide 51
230
Clearance of *Fentanyl* is ___ in preterm infants but becomes ___ than in adults in older infants and children.
A. Increased; lower
B. Reduced; greater
C. Reduced; lower
D. Increased; greater
B. Reduced; greater
Clearance is **reduced** *in preterm infants* but **greater than in adults** *in older infants and children*
## Footnote
Slide 51
231
The volume of distribution (Vd) of *Fentanyl* is large in ___ and steadily declines with ___.
A. Adults; metabolism
B. Infants; clearance
C. Neonates; age
D. Children; weight
C. Neonates; age
The volume of distribution (Vd) of Fentanyl is *large in **Neonates*** and steadily *declines with **age**.*
*Dr. M: the large volume of distribution results in smaller blood concentrations after a bolus*
## Footnote
Slide 51
232
According to lecture: In neonatal anesthesia, *Fentanyl* is often the anesthetic of choice because:
A. It causes greater respiratory depression than volatile agents.
B. Sevoflurane is increased to balance MAC requirements.
C. Lower sevoflurane doses are used to minimize cardiovascular effects, and higher fentanyl doses help compensate for MAC reduction.
D. Neonates have a faster clearance of fentanyl, requiring higher doses.
C. Lower sevoflurane doses are used to minimize cardiovascular effects, and higher fentanyl doses help compensate for MAC reduction.
## Footnote
Slide 51
233
Which of the following correctly describes *Remifentanil*'s pharmacokinetics?
A. Its elimination half-life varies significantly with dose and duration.
B. It is primarily degraded by liver enzymes.
C. Its elimination half-life is 3–6 minutes and independent of dose or duration.
D. Clearance of Remifentanil depends heavily on renal function.
C. Its elimination half-life is 3–6 minutes and independent of dose or duration.
and *it degrades by that non-specific plasma esterase and tissue esterase*
## Footnote
Slide 52
234
Which statement about *Remifentanil* pharmacokinetics in neonates is correct?
A. Neonates have a slower clearance compared to older children.
B. Neonates clear Remifentanil more rapidly than older children.
C. Remifentanil has a significantly longer half-life in neonates.
D. A bolus is unnecessary prior to starting a Remifentanil infusion.
B. Neonates clear Remifentanil more rapidly than older children.
* Larger Vd, equivalent half-life
*Dr. M: so this is one of those drugs that actually they clear faster than older children*
## Footnote
Slide 52
235
Before starting a Remifentanil infusion, a ___ is required.
A. fluid bolus
B. bolus dose of Remifentanil
C. loading dose of muscle relaxant
D. preoxygenation with 100% oxygen
B. bolus dose of Remifentanil
## Footnote
Slide 52
236
What cardiovascular side effect of *Remifentanil* is particularly concerning in pediatric patients?
A. Hypertension
B. Tachycardia
C. Bradycardia
D. Hypovolemia
C. Bradycardia
*Dr. M:...because as you know bradycardia not good for our pediatric patients*
## Footnote
Slide 52
237
# True or False
Neonates and infants have *increased* sensitivity to *neuromuscular blocking drugs*.
TRUE
## Footnote
Slide 53
238
In neonates and infants, there is an increased ___ with a single dose of *neuromuscular blocking drugs*.
A) Clearance
B) Volume of distribution
C) Metabolism
D) Renal excretion
B) Volume of distribution
## Footnote
Slide 53
239
Which factors contribute to a longer duration of action of *neuromuscular blocking drugs* in neonates and infants? (Select 3)
A) Reduced clearance
B) Immature neuromuscular junction
C) Decreased release of acetylcholine
D) Increased sensitivity to neuromuscular blockers
E) Enhanced renal elimination
A) Reduced clearance
B) Immature neuromuscular junction
D) Increased sensitivity to neuromuscular blockers
## Footnote
Slide 53
240
Since *neuromuscular blocking drugs (NMBDs)* are highly ionized and not lipophilic, what adjustment might be necessary regarding dosing?
A. A larger initial dose should be given.
B. A smaller initial dose should be given.
C. A similar single dose can be used, but the redose might need to be smaller.
D. No dose adjustments are needed.
C. A similar single dose can be used, but the redose might need to be smaller.
*Dr. M:they are contained in the extracellular fluid compartment which is larger in neonates*
## Footnote
Slide 53
241
Neonates and infants are equally as sensitive to ___ but are more sensitive to ____ drugs.
A. Non-depolarizing; succinylcholine
B. Succinylcholine; non-depolarizing
C. Succinylcholine; local anesthetics
D. Non-depolarizing; benzodiazepines
B. Succinylcholine; non-depolarizing
*equally as sensitive* to **succinylcholine** but it is *more sensitive* to **non-depolarizing drugs**
## Footnote
Slide 53
242
Why do infants require a higher IV dose of *Succinylcholine* compared to older children?
A. Infants have a smaller extracellular fluid volume.
B. Infants have increased binding to plasma proteins.
C. Infants have a larger extracellular fluid volume, causing more drug redistribution.
D. Infants metabolize succinylcholine more rapidly than children.
C. Infants have a larger extracellular fluid volume, causing more drug redistribution.
*Infants require 2X IV dose (2 mg/kg) vs. children (1 mg/kg)*
## Footnote
Slide 54
243
Why can neonates and infants have a prolonged duration of action after administration of succinylcholine?
A. Increased sensitivity at the neuromuscular junction
B. Immature hepatic metabolism
C. Reduction in plasma cholinesterase activity
D. Increased renal clearance of succinylcholine
C. Reduction in plasma cholinesterase activity (which is what breaks down succinylcholine)
*Dr. M: the duration of action is about **six to ten minutes** where it’s a bit faster in older children*
## Footnote
Slide 54
244
Which side effect is most commonly associated with succinylcholine use in children under 5 years old?
A. Severe hypertension
B. Prolonged apnea
C. Bradycardia
D. Malignant hyperthermia
C. Bradycardia
## Footnote
Slide 54
245
Which serious complication may follow administration of succinylcholine, particularly after repeated doses?
A. Acute renal failure
B. Cardiac arrest
C. Pulmonary hypertension
D. Seizure activity
B. Cardiac arrest
## Footnote
Slide 54
246
What is the primary reason for the black box warning associated with succinylcholine use?
A. Risk of severe bradycardia in adults
B. Development of acute renal failure
C. Potential for severe hyperkalemia
D. Severe respiratory depression
C. Potential for severe hyperkalemia
## Footnote
Slide 54
247
In infants, the response to non-depolarizing neuromuscular blocking drugs (NDMRs) is best characterized as:
A. Less sensitive with highly predictable effects
B. More sensitive with variable responses
C. Similar sensitivity and predictable responses
D. Less sensitive but with prolonged recovery
B. More sensitive with variable responses
## Footnote
Slide 55
248
Compared to adults, infants generally require what adjustment for the initial dosing of NDMRs?
A. Higher initial doses
B. Lower initial doses
C. Similar initial doses
D. No NDMRs should be used
C. Similar initial doses
*Dr. M: the combination of increased extracellular fluid and the sensitivity result in basically the same dose needed*
## Footnote
Slide 55
249
When selecting a non-depolarizing neuromuscular blocking agent for pediatric patients, the choice primarily depends on:
A. The cheapest available agent
B. The ability to administer the agent intramuscularly
C. Side effects and the required duration of muscle relaxation
D. The patient's blood type and electrolyte levels
C. Side effects and the required duration of muscle relaxation
*Rocuronium is the only NDMR that can be given IM*
## Footnote
Slide 55
250
In assessing recovery from neuromuscular blockade in neonates and infants, which of the following values indicate sufficient recovery?
A. TOF ratio >80% and MIF >-20 cm H₂O
B. TOF ratio >90% and MIF >-25 cm H₂O
C. TOF ratio >60% and MIF >-15 cm H₂O
D. TOF ratio >50% and MIF >-10 cm H₂O
B. TOF ratio >90% and MIF >-25 cm H₂O
## Footnote
Slide 56
251
Which of the following anticholinesterase drugs are used for neuromuscular blockade reversal in pediatrics?
A. Neostigmine and Edrophonium
B. Glycopyrrolate and Sugammadex
C. Atropine and Neostigmine
D. Epinephrine and Edrophonium
A.
**Neostigmine 0.05-0.07 mg/kg**
*we want to give either **atropine or glycopyrrolate** to counteract those negative effects of the neostigmine*
**Edrophonium 0.5-1.0 mg/kg**
## Footnote
Slide 56
252
Which statement about sugammadex use in pediatric patients is correct?
A. Sugammadex is only FDA approved for neonates and infants under 6 months old.
B. Sugammadex is FDA approved for use in children greater than 2 years old.
C. Sugammadex has limited effectiveness in patients over 12 years old.
D. Sugammadex is only approved for adults and is not used in pediatrics.
B. Sugammadex is FDA approved for use in children greater than 2 years old.
* Dosing same as adult (2-4 mg/kg)
* there's not really a whole lot of major side effects
* it can cause some bradycardia or hypotension if it's given too rapidly
## Footnote
Slide 56
