Pediatric Anesthesia Flashcards
< 30 days of age?
neonate
1-12 mos of age
infant
1-12 yrs of age
children
Cardiac output of neonates and infants is dependent on _______, b\c _______ is relatively fixed by a noncompliant and poorly developed left ventricle.
heart rate; stroke volume
Describe the airway in the neonate and infant.
1) large head and tongue
2) narrow nasal passages
3) anterior and cephalad larynx
4) long epiglottis
5) short trachea and neck
6) prominent tonsils and adenoids
What is the formula to calculate pediatric ETT size for >1yr old?
Age (yr) divided by 4, plus 4
ex) 4yr old= 4/4=1 plus 4= 5mm ETT size
What is the best size ETT for a neonate <3kg?
3.0-3.5
What is the best size ETT for an infant 6mos-1yr old?
3.5-4.0
What is the best size ETT for a 1-2 yr old?
4.0-4.5
What is the formula to estimate tube length at mouth in pediatrics
Weight (kg) divided by 5, plus 12
ex) 5kg neonate= 5/5=1 plus 12= 13cm at lip
%TBW of preterms?
90%
%TBW of terms?
80%
%TBW of 6-12mos olds?
60%
Why are infants of diabetic mothers prone to hypoglycemia?
infant produces insulin in response to maternal blood sugar to control its own glucose levels—> after delivery, the cord is clamped eliminating maternal blood sugar level—> stored insulin decrease’s the newborn’s blood sugar
What is the most commonly used local anesthetic in North American?
Bupivacaine
What is the preferred concentration of local anesthetic for peripheral nerve blocks in the neonate?
0.25% bupivacaine or 0.20% ropivacaine
What is the suggested maximum dosage for bolus injection in the caudal space or epidural space for older children and neonates? For infants?
4mg/kg; 2mg/kg
What is the normal gestation period?
40 weeks
What is the definition of prematurity?
<37 weeks
Is right or left sided diaphragmatic herniation more common?
70-90% of defects are on the left side
How do you confirm a diaphragmatic hernia?
US or ultrafast fetal MRI
What percent of newborns with a diaphragmatic hernia will have congenital heart disease?
40-60%
*also high incidence of intestinal malrotation
What are the hallmark signs of a congenital diaphragmatic hernia?
1) arterial hypoxia (R–>L shunt from persistant fetal circulation)
2) barrel-shaped chest–> bowel is in the thorax
3) severe retractions (working hard to breath)
* s/s: dyspnea, tachypnea, cyanosis
Why is the avoidance of hypothermia, hypoxia, and acidosis a concern with diaphragmatic hernias?
ALL increase pulmonary vascular resistance
What is the most common form of tracheoesophageal fistulas?
85%: form that ends in a blind pouch and a lower esophagus that connects to the trachea
What are the 3 signs of tracheoesophageal fistula that can be noted when attempting to feed an infant?
1) choking
2) coughing
3) cyanosis
s/s: hypoxia and bradycardia, gastric distention with respirations, aspiration pneumonia, dehydration
How is the diagnosis of a TEF made?
by failure to pass a catheter into the stomach and confirmed by coiling of the catheter in a blind pouch
_____ % of infants with TEF have associated congenital anomalies, approximately ____% involve the cardiovascular system.
50%; 15-25%
What is VACTERL syndrome? (associated congenital anomalies with TEF)
vater plus cardiac and limb abnormalities Vertebral defect Anal atresia Cardiac anomalies Tracheoesophageal fistula Esophageal atresia Renal dysplasia Limb anomalies
What are some anesthetic concerns for TEF?
1) copious pharyngeal secretions
2) no positive pressure ventilation prior to intubation
3) awake intubation without muscle relaxants
4) neonates are dehydrated and malnourished
5) no neck extension
6) avoid instrumentation of the esophagus
7) extubate after repair is done (30% reintubation occurence)
What is pyloric stenosis?
idiopathic hypertrophy of the circular smooth muscle of the pylorus, which results in compression and narrowing of the pyloric channel
*there is narrowing or stenosis in the pylorus causing pressure to build–> build–> build–> POP–> out it goes!
