Pediatric Anesthesia Flashcards
Newborn is?
first 24 hours
Neonate is what or what?
first 30 days or 44 weeks of age from conception
Infants are?
1 month to a year
Toddler is?
1-3 years
Preschooler is?
4-6 years
School age is?
6-13 years
Prematurity is less than how many weeks gestation?
37 weeks
Postgestational age is?
gestational age plus postnatal age
3 major concerns with premature babies?
pulmonary, cardiac, retinopathy
Obligate nasal breathers until what age?
5 months
What is choanal atresia?
narrowing or blockage of the nasal passages by tissue
The larynx is _______, ________. and at what level in full term?
anterior, cephalad, C4
Larynx is at what level in preterm, age 6, and an adult?
C3; C5; C5-6
3 characteristics of peds epiglottis?
omega shaped, stubby, short
ETT is likely to hang up where in a kid?
anterior commissure
Cricoid is the narrowest point at what age?
10 years
In neonates, how many cm are from the cords to the carina?
2 cm
Which muscle cells are poorly developed at birth, leaving the diaphragm to do most of the gas exchange?
type II
Alveoli are smaller and limited in number until what age?
8 years
Which one is increased and which decreased, lung compliance and chest wall compliance?
lung compliance is decreased and chest wall compliance is increased
Why is it that infants have a limited reserve with apnea and intubation attempts?
decreased RV affects the FRC
An infant’s metabolic rate and O2 consumption is how many times that of an adult?
2
MV:FRC ratio in neonates?
5:1
What 2 things produce less reserve in a neonate?
higher minute ventilation and decreased RV
How can you prevent atelectasis in neonate?
CPAP, PEEP, higher RR
How do TVs in infants and adults compare?
they’re about the same on a mL/kg basis
How does FRC compare in neonates and adults?
about the same percentage
How do closing volumes compare in neonate and adult?
closing volumes are higher in neonate
Why do you have to be extremely vigilant about monitoring respirations after surgery in peds?
hypoxic and hypercapnic drives are not mature
How do neonates manifest hypoxia?
brief period of hyperventilation followed by hypoventilation
7 infants at risk for apnea and bradycardia after GA?
sepsis, premature
This closes with the clamping of the umbilical vein?
ductus venosus
What two openings in utero maintain a right to left shunt?
ductus arteriosus and foramen ovale
What causes a foramen ovale to open or close?
close is breath at birth/aka increased pressure in left heart. open is increased PVR and fluid overload
What causes the ductus arteriosus to constrict?
PaO2 > 50 and decreased prostaglandins released from the placenta
When does the ductus arteriosus close?
first four days of life
In a full term neonate, what is the most important factor for closing the PDA?
oxygen
Why is flow inhibited through pulmonary vasculature in utero?
pulmonary resistance is quite high due to collapsed alveoli and compression of blood vessels
Why is PVR high in utero?
low O2 and pH
Pulmonary circulation in infants is extremely sensitive to?
oxygen, pH, nitric oxide, prostaglandins
What is persistent pulmonary HTN?
what it sounds like caused by right to left shunting from hypoxia, acidosis, hypoxemia, meconium aspiration, sepsis, congenital diaphragmatic hernia, maternal use of NSAIDs
The elevated PVR in PPH causes what two holes to remain open?
foramen ovale and ductus arteriosus
What are the two signs of persistent pulmonary HTN?
severe hypoxemia and increased PaCO2 (and baby is blue)
Treatment for PPH?
ECMO, surfactant, high frequency ventilation, nitric oxide (inhaled), correcting hypoglycemia, polycythemia
Why is stroke volume fixed in infants?
less compliant ventricles
Why is the neonate’s ability to compensate for hypotension limited?
immature baroreceptors and lack the reflex tachycardia
Is PNS or SNS immature in infant?
SNS
How long until an infant responds to inotropes?
3 months
Immature baroreceptor response lasts until what age?
8 years
Why is there a peak of the Frank Starling curve in infants?
limited reserve to increase preload and afterload
Hypotension in anesthetized newborn is?
SBP
In a 1 year old, hypotension is less than?
(sbp) 70
Limited ability of the newborn’s kidney to concentrate or dilute urine?
decreased GFR and decreased tubular function
Reason newborns cannot tolerate fluid restriction well?
decreased ability to conserve water
2 reasons newborns cannot tolerate fluid overload well?
decreased ability to excrete water, decreased ability to excrete Na
If meds are excreted by GFR, what happens to the half life?
it is prolonged
When is nadir of hematocrit and how low does it get?
3-6 months; 30%
What does the presence of fetal hg mean?
higher affinity for oxygen, shifts curve to less so Hg is more likely to hold on to oxygen
HbA anemia?
10-11 g/dL
How long is liver function immature?
until 1 year
What does decreased levels of albumin mean for the free drug concentration?
decreases the protein binding and therefore you have a greater amount of free drug
What does hyperbilirubinemia mean for drug binding?
it competes w drugs for albumin and so it can further increase half lives of drugs
