PEDIATRIC ANESTHESIA | Basic

Question 1

In the premature newborn, the glottis is at which level relative to the cervical spine?

Answer 1

C3

Question 2

In the premature newborn, the glottis is at which level relative to the cervical spine?

Answer 2

C4

Question 3

What percentage of a term newborn’s total body weight consists of water?

Answer 3

75%

Question 4

At what age range does physiologic anemia of the newborn occur?

Answer 4

8-12 weeks

This is caused by transition of blood production from liver/spleen to bone marrow

Question 5

What is the alveolar ventilation to functional residual capacity (FRC) ratio in a CHILD?

Answer 5

5:1

Another anatomic feature of an infant or child is the short length of the trachea. Persistent oxygen desaturation may be an indicator of unintentional
endobronchial intubation.

They are prone to oxygen desaturation and to respiratory failure due to the greater alveolar ventilation to functional residual capacity
(FRC) ratio in the child (5:1) compared with the adult (1.5:1).

Question 6

TRUE or FALSE

The infant has a reduced percent of type 1 fibers (slow-twitch, high oxidative muscle fibers) in the diaphragm thus high risk of developing atelectasis.

Answer 6

TRUE

There is increased compliance of the rib cage (due to both anatomic and physiologic features), reduced compliance of the lungs (due to the relative lack of elastin in the infant), and reduced percent of type 1 fibers (slow-twitch, high oxidative muscle fibers) in the diaphragm predisposing the basal segments of the lungs to atelectasis under the weight of the abdomen.

Question 7

Children compensate well for loss of volume and will often keep a normal blood pressure until about ___ what percent of blood volume is lost?

Answer 7

20%

A useful formula taught in the Pediatric Advanced Life Support (PALS) course, from the American Heart Association, is that for children aged 1 to 10 years of age, the 5th percentile for systolic blood pressures is 70 + 2× age in years and the 50th percentile is 90 + 2× age in years. The 5th percentile is taken as the cutoff for hypotensive shock in the PALS algorithms

Question 8

Nazneen is a 1 year old. She has no known co-morbidities. How can I compute her systolic blood pressure using the PALS 5th percentile approximation?

Answer 8

70 + 1 x (age)

Thus, 1x2 = 2
70 + 2 = 72
Systolic BP for Nazneen is 72 mmHg

Question 9

According to NELSON, Nazneen’s heart rate should be in the range of:

A. 100 - 120 bpm

B. 70 - 110 bpm

C. 80 - 120 bpm

D. 100 - 140 bpm

Answer 9

B. 70 - 110 bpm

Question 10

Patient A is a 2 year old male. He came in the ER tachycardic with mild respiratory distress. Considering the PALS guideline in determining hypotensive shock, what is the cutoff systolic BP for patient A?

A. 74 mmHg

B. 65 mmHg

C. 70 mmHg

D. 78 mmHg

Answer 10

A. 74 mmHg

**FORMULA: 70 + 2 x (age) **

Thus, 2x2 = 4
70 + 4 = 74
Hypotensive cutoff for patient A is a systolic BP of 74 mmHg

Question 11

What is the normal oxygen consumption in the brain of children:

A. 5.5 mL/100 g/min

B. 70% greater than adult

C. 3.5 mL/100g/min

D. 7.5 mL/100g/min

Answer 11

A. 5.5 mL/100 g/min

Oxygen consumption in the brain of children (5.5 mL/100 g/min) is 50% greater than that in adults (3.5 mL/100 g/min)6 and overall cerebral blood
flow (CBF) is 50% to 70% greater than in adults (70 to 110 mL/min/100 g vs. 50 mL/min/100 g) in order to meet that oxygen consumption.

Question 12

What is the normal CBF in children?

Answer 12

70 - 110mL/min/100g

Question 13

TRUE or FALSE

Autoregulation is NOT YET intact in full-term and non-stressed infants

Answer 13

FALSE

No problem here. Infant’s autoregulation is INTACT!!

Question 14

Patient A is 8 month old while patient B is 3.5 years old. Who has a higher risk of developing toxicity in local anesthetics?

Answer 14

Patient A

Keypoint:

Reduced plasma concentrations of both albumin and α1- acid glycoprotein in neonates and infants leads to an increase in the free fraction of drugs, leading to a greater dose reaching the effect site and exerting physiologic as well as possible toxic effects.

Question 15

Clinically, codeine and tramadol are no longer recommended for children less than 12 years for age. WHY?

Answer 15

Genetic polymorphism can cause either fast metabolizer or slow metabolizer. An important example of this is the opioid codeine, which may be very rapidly metabolized to its active metabolite, morphine, in “rapid metabolizers,” resulting in excessive sedation and possibly death. Conversely, it may be very slowly metabolized in “slow metabolizers” resulting in lack of effectiveness

Question 16

The glomerular filtration rate is markedly
reduced in the neonate and young infant but matures throughout childhood
reaching adult rates by:

A. 5 to 15 years of age

B. < 5 years old

C. 2 - 5 years old

D. 1 - 3 years old

Answer 16

A. 5 to 15 years of age

NOTE:

This is inconclusive because according to MILLER, the kidney is fully mature and functioning by the age of 2.

Question 17

In infant and child, succinylcholine causes bradycardia via which mechanism:

Answer 17

acetylcholine associated activation of the vagus nerve