Pediatric Anesthesia pt1 Flashcards
What age are each of these populations considered?
- Neonate:
- Infant:
- Toddler:
- Neonate: birth - 1 month
- Infant: 1 - 12 months
- Toddler: 12 months - 3 years
What age are each of these populations considered?
- Preschool:
- school age:
- adolescent:
- Preschool: 4- 6 year
- school age: 6 - 13 year
- adolescent: 13 - 18 year
At what age would a child typically be physiologically similar to an adult?
~8 years old
How many weeks is a neonate considered preterm? Full term? Post term?
- Preterm: < 37 weeks
- Full term: 37 - 42 weeks
- Post term: > 42 weeks
How much weight is considered a micropremie?
< 750 gm (0.75 kg)
What can be administered to keep the PDA open?
prostaglandin
Where would preductal sats be measured? postductal sats?
Preductal: right hand
Postductal: other extremities
What typically causes closure of the ductus arteriosus?
clamping the umbilical cord => increased SVR and decreased PVR
Neonatal cardiac output is primarily dependent on what?
fetal heart rate
fetus lacks ability to compensate with stroke volume
What is vital for myocardial performance?
Calcium is vital for myocardial performance (more squeeze)
Autonomic innervation is predominantly _____
predominantly parasympathetic => leading to bradycardic response to stimulation
immature sympathetic system
What is the typical heart rate, SBP and DBP for a neonate?
HR: 140
SBP: 70
DBP: 40
What is the typical heart rate, SBP and DBP for a 12 month old?
HR: 120
SBP: 95
DBP: 65
What is the typical heart rate, SBP and DBP for a 3 year old?
HR: 100
SBP: 100
DBP: 70
What is the typical heart rate, SBP and DBP for a 12 year old?
HR: 80
SBP: 110
DBP: 60
What general rule of thumb can be used to estimate the MAP of a neonate?
Gestational age ≈ MAP
25 weeker ≈ MAP of 25
What is considered systolic hypotension for a term neonate? (0-28 days)
< 60 mmHg
What is considered systolic hypotension for an infant (1-12months)?
< 70 mmHg
What is considered systolic hypotension for a child (1-10 year)
< 70 mmHg + (2 * years old)
5 year old: 70 + (25) = 80 mmHg (less than 80 = HoTN)*
What is considered systolic hypotension for a child > 10 years?
< 90 mmHg
What is the typical hemoglobin at birth?
18 - 20 g/dL
Fetal Hemoglobin has a ____ P50 and carboxyhemoglobin curve shifts ____? What does this mean for oxygen delivery?
- Fetal Hemoglobin has a lower P50 and carboxyhemoglobin curve shifts left?
- oxygen locks to Hgb leading to more pick up but less release
What is the estimated blood volume for a premature neonate?
90 - 100 mL/kg
What is the estimated blood volume for a newborn (<1 month)?
80 - 90 mL/kg
What is the estimated blood volume for an infant (1 mo - 3 yr)?
75 - 80 mL/kg
What is the estimated blood volume for a child (>6 yr)?
65-70 mL/kg
What is the estimated blood volume for an adult?
65 - 70 mL/kg
What is the P50 of fetal hemoglobin?
19 mmHg
Fetal hemoglobin has what kinds of chains?
- 2 alpha chains
- 2 gamma chains
no beta chains
Adult hemoglobin has what kinds of chains?
- 2 alpha chains
- 2 beta chains
2,3-DPG binding site only on beta chains
Select the statements that most accurately reflect the cardiovascular system in the newborn:
- HR is the primary determinant of BP
- phenylephrine is a first-line treatment for HoTN
- stress is more likely to activate the parasympathetic nervous system
- HoTN is defined as a SBP <70 mmHg
- HR is the primary determinant of BP
- stress is more likely to activate the parasympathetic nervous system
What likely should be administered for HoTN with a contractility issue? What about a heart rate issue?
- contractility issue: Calcium
- heart rate issue: atropine or epi
Alveolar ductal development starts around _____ gestation?
Alveolar ductal development starts around 24 weeks gestation?
Neonatal alveolar surface area is _____ of an adult?
Neonatal alveolar surface area is ~1/3 of an adult?
What does surfactant production and secretion begin?
at 22-26 weeks gestation
Why is surfactant important?
reduces surface tension in the alveoli and allows expansion
insufficient surfactant can lead to alveoli collapse
What is notable about the structure of a neonates breathing mechanics?
- pliable chest wall from lack of muscle development
- horizontal ribs lack structural supporrt
- flat diaphragm
- less type 1 muscle fibers (faster respiratory fatigue)
Neonates have a metabolic rate and O2 consumption that is about ____ of an adult
Neonates have a metabolic rate and O2 consumption that is about twice that of an adult
Neonatal minute ventilation (Vm) is more dependent on what?
Vm is more dependent on respiratory rate than tidal volume
Neonatal tidal volume is relatively fixed at about how much?
~6-8 mL/kg
lack ability to compensate Vt
What are neonates typically prone to rapid desaturation?
Decreased FRC which is even worse with general anesthesia
Neonatal FRC, vital capacity, and total lung capacity are generally ____ compared to an adult?
Decreased
Neonatal Residual volume and closing capacity are generally ____ compared to an adult?
Increased
