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6903 > Pediatric Anesthesia > Flashcards

Pediatric Anesthesia Flashcards

1
Q

Newborn is?

A

first 24 hours

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2
Q

Neonate is what or what?

A

first 30 days or 44 weeks of age from conception

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3
Q

Infants are?

A

1 month to a year

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4
Q

Toddler is?

A

1-3 years

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5
Q

Preschooler is?

A

4-6 years

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6
Q

School age is?

A

6-13 years

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7
Q

Prematurity is less than how many weeks gestation?

A

37 weeks

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8
Q

Postgestational age is?

A

gestational age plus postnatal age

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9
Q

3 major concerns with premature babies?

A

pulmonary, cardiac, retinopathy

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10
Q

Obligate nasal breathers until what age?

A

5 months

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11
Q

What is choanal atresia?

A

narrowing or blockage of the nasal passages by tissue

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12
Q

The larynx is _______, ________. and at what level in full term?

A

anterior, cephalad, C4

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13
Q

Larynx is at what level in preterm, age 6, and an adult?

A

C3; C5; C5-6

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14
Q

3 characteristics of peds epiglottis?

A

omega shaped, stubby, short

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15
Q

ETT is likely to hang up where in a kid?

A

anterior commissure

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16
Q

Cricoid is the narrowest point at what age?

A

10 years

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17
Q

In neonates, how many cm are from the cords to the carina?

A

2 cm

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18
Q

Which muscle cells are poorly developed at birth, leaving the diaphragm to do most of the gas exchange?

A

type II

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19
Q

Alveoli are smaller and limited in number until what age?

A

8 years

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20
Q

Which one is increased and which decreased, lung compliance and chest wall compliance?

A

lung compliance is decreased and chest wall compliance is increased

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21
Q

Why is it that infants have a limited reserve with apnea and intubation attempts?

A

decreased RV affects the FRC

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22
Q

An infant’s metabolic rate and O2 consumption is how many times that of an adult?

A

2

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23
Q

MV:FRC ratio in neonates?

A

5:1

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24
Q

What 2 things produce less reserve in a neonate?

A

higher minute ventilation and decreased RV

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25
Q

How can you prevent atelectasis in neonate?

A

CPAP, PEEP, higher RR

26
Q

How do TVs in infants and adults compare?

A

they’re about the same on a mL/kg basis

27
Q

How does FRC compare in neonates and adults?

A

about the same percentage

28
Q

How do closing volumes compare in neonate and adult?

A

closing volumes are higher in neonate

29
Q

Why do you have to be extremely vigilant about monitoring respirations after surgery in peds?

A

hypoxic and hypercapnic drives are not mature

30
Q

How do neonates manifest hypoxia?

A

brief period of hyperventilation followed by hypoventilation

31
Q

7 infants at risk for apnea and bradycardia after GA?

A

sepsis, premature

32
Q

This closes with the clamping of the umbilical vein?

A

ductus venosus

33
Q

What two openings in utero maintain a right to left shunt?

A

ductus arteriosus and foramen ovale

34
Q

What causes a foramen ovale to open or close?

A

close is breath at birth/aka increased pressure in left heart. open is increased PVR and fluid overload

35
Q

What causes the ductus arteriosus to constrict?

A

PaO2 > 50 and decreased prostaglandins released from the placenta

36
Q

When does the ductus arteriosus close?

A

first four days of life

37
Q

In a full term neonate, what is the most important factor for closing the PDA?

A

oxygen

38
Q

Why is flow inhibited through pulmonary vasculature in utero?

A

pulmonary resistance is quite high due to collapsed alveoli and compression of blood vessels

39
Q

Why is PVR high in utero?

A

low O2 and pH

40
Q

Pulmonary circulation in infants is extremely sensitive to?

A

oxygen, pH, nitric oxide, prostaglandins

41
Q

What is persistent pulmonary HTN?

A

what it sounds like caused by right to left shunting from hypoxia, acidosis, hypoxemia, meconium aspiration, sepsis, congenital diaphragmatic hernia, maternal use of NSAIDs

42
Q

The elevated PVR in PPH causes what two holes to remain open?

A

foramen ovale and ductus arteriosus

43
Q

What are the two signs of persistent pulmonary HTN?

A

severe hypoxemia and increased PaCO2 (and baby is blue)

44
Q

Treatment for PPH?

A

ECMO, surfactant, high frequency ventilation, nitric oxide (inhaled), correcting hypoglycemia, polycythemia

45
Q

Why is stroke volume fixed in infants?

A

less compliant ventricles

46
Q

Why is the neonate’s ability to compensate for hypotension limited?

A

immature baroreceptors and lack the reflex tachycardia

47
Q

Is PNS or SNS immature in infant?

A

SNS

48
Q

How long until an infant responds to inotropes?

A

3 months

49
Q

Immature baroreceptor response lasts until what age?

A

8 years

50
Q

Why is there a peak of the Frank Starling curve in infants?

A

limited reserve to increase preload and afterload

51
Q

Hypotension in anesthetized newborn is?

A

SBP

52
Q

In a 1 year old, hypotension is less than?

A

(sbp) 70

53
Q

Limited ability of the newborn’s kidney to concentrate or dilute urine?

A

decreased GFR and decreased tubular function

54
Q

Reason newborns cannot tolerate fluid restriction well?

A

decreased ability to conserve water

55
Q

2 reasons newborns cannot tolerate fluid overload well?

A

decreased ability to excrete water, decreased ability to excrete Na

56
Q

If meds are excreted by GFR, what happens to the half life?

A

it is prolonged

57
Q

When is nadir of hematocrit and how low does it get?

A

3-6 months; 30%

58
Q

What does the presence of fetal hg mean?

A

higher affinity for oxygen, shifts curve to less so Hg is more likely to hold on to oxygen

59
Q

HbA anemia?

A

10-11 g/dL

60
Q

How long is liver function immature?

A

until 1 year

61
Q

What does decreased levels of albumin mean for the free drug concentration?

A

decreases the protein binding and therefore you have a greater amount of free drug

62
Q

What does hyperbilirubinemia mean for drug binding?

A

it competes w drugs for albumin and so it can further increase half lives of drugs

6903 (12 decks)

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