Pediatric Anesthesia pt1.0

Question 1

What age are each of these populations considered?

• Neonate:
• Infant:
• Toddler:

Answer 1

• Neonate: birth - 1 month
• Infant: 1 - 12 months
• Toddler: 12 months - 3 years

Question 2

What age are each of these populations considered?

• Preschool:
• school age:
• adolescent:

Answer 2

• Preschool: 4- 6 year
• school age: 6 - 13 year
• adolescent: 13 - 18 year

Question 3

At what age would a child typically be physiologically similar to an adult?

Answer 3

~8 years old

Question 4

How many weeks is a neonate considered preterm? Full term? Post term?

Answer 4

• Preterm: < 37 weeks
• Full term: 37 - 42 weeks
• Post term: > 42 weeks

Question 5

How much weight is considered a micropremie?

Answer 5

< 750 gm (0.75 kg)

Question 6

What can be administered to keep the PDA open?

Answer 6

prostaglandin

Question 7

Where would preductal sats be measured? postductal sats?

Answer 7

Preductal: right hand
Postductal: other extremities

Question 8

What typically causes closure of the ductus arteriosus?

Answer 8

clamping the umbilical cord => increased SVR and decreased PVR

Question 9

Neonatal cardiac output is primarily dependent on what?

Answer 9

fetal heart rate

fetus lacks ability to compensate with stroke volume

Question 10

What is vital for myocardial performance?

Answer 10

Calcium is vital for myocardial performance (more squeeze)

Question 11

Autonomic innervation is predominantly _____

Answer 11

predominantly parasympathetic => leading to bradycardic response to stimulation

immature sympathetic system

Question 12

What is the typical heart rate, SBP and DBP for a neonate?

Answer 12

HR: 140
SBP: 70
DBP: 40

Question 13

What is the typical heart rate, SBP and DBP for a 12 month old?

Answer 13

HR: 120
SBP: 95
DBP: 65

Question 14

What is the typical heart rate, SBP and DBP for a 3 year old?

Answer 14

HR: 100
SBP: 100
DBP: 70

Question 15

What is the typical heart rate, SBP and DBP for a 12 year old?

Answer 15

HR: 80
SBP: 110
DBP: 60

Question 16

What general rule of thumb can be used to estimate the MAP of a neonate?

Answer 16

Gestational age ≈ MAP

25 weeker ≈ MAP of 25

Question 17

What is considered systolic hypotension for a term neonate? (0-28 days)

Answer 17

< 60 mmHg

Question 18

What is considered systolic hypotension for an infant (1-12months)?

Answer 18

< 70 mmHg

Question 19

What is considered systolic hypotension for a child (1-10 year)

Answer 19

< 70 mmHg + (2 * years old)

5 year old: 70 + (25) = 80 mmHg (less than 80 = HoTN)*

Question 20

What is considered systolic hypotension for a child > 10 years?

Answer 20

< 90 mmHg

Question 21

What is the typical hemoglobin at birth?

Answer 21

18 - 20 g/dL

Question 22

Fetal Hemoglobin has a ____ P50 and carboxyhemoglobin curve shifts ____? What does this mean for oxygen delivery?

Answer 22

• Fetal Hemoglobin has a lower P50 and carboxyhemoglobin curve shifts left?
• oxygen locks to Hgb leading to more pick up but less release

Question 23

What is the estimated blood volume for a premature neonate?

Answer 23

90 - 100 mL/kg

Question 24

What is the estimated blood volume for a newborn (<1 month)?

Answer 24

80 - 90 mL/kg

Question 25

What is the estimated blood volume for an infant (1 mo - 3 yr)?

Answer 25

75 - 80 mL/kg

Question 26

What is the estimated blood volume for a child (>6 yr)?

Answer 26

65-70 mL/kg

Question 27

What is the estimated blood volume for an adult?

Answer 27

65 - 70 mL/kg

Question 28

What is the P50 of fetal hemoglobin?

Answer 28

19 mmHg

Question 29

Fetal hemoglobin has what kinds of chains?

Answer 29

* 2 alpha chains * 2 gamma chains *no beta chains*

Question 30

Adult hemoglobin has what kinds of chains?

Answer 30

* 2 alpha chains * 2 beta chains *2,3-DPG binding site only on beta chains*

Question 31

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

Answer 31

* HR is the primary determinant of BP * stress is more likely to activate the parasympathetic nervous system

Question 32

What likely should be administered for HoTN with a contractility issue? What about a heart rate issue?

Answer 32

* contractility issue: Calcium * heart rate issue: atropine or epi

Question 33

Alveolar ductal development starts around _____ gestation?

Answer 33

Alveolar ductal development starts around **24 weeks** gestation?

Question 34

Neonatal alveolar surface area is _____ of an adult?

Answer 34

Neonatal alveolar surface area is **~1/3** of an adult?

Question 35

What does surfactant production and secretion begin?

Answer 35

at 22-26 weeks gestation

Question 36

Why is surfactant important?

Answer 36

reduces surface tension in the alveoli and allows expansion *insufficient surfactant can lead to alveoli collapse*

Question 37

What is notable about the structure of a neonates breathing mechanics?

Answer 37

* pliable chest wall from lack of muscle development * horizontal ribs lack structural supporrt * flat diaphragm * less type 1 muscle fibers (faster respiratory fatigue)

Question 38

Neonates have a metabolic rate and O2 consumption that is about ____ of an adult

Answer 38

Neonates have a metabolic rate and O2 consumption that is about **twice** that of an adult

Question 39

Neonatal minute ventilation (Vm) is more dependent on what?

Answer 39

Vm is more dependent on **respiratory rate** than tidal volume

Question 40

Neonatal tidal volume is relatively fixed at about how much?

Answer 40

~6-8 mL/kg *lack ability to compensate Vt*

Question 41

What are neonates typically prone to rapid desaturation?

Answer 41

Decreased FRC which is even worse with general anesthesia

Question 42

Neonatal FRC, vital capacity, and total lung capacity are generally ____ compared to an adult?

Answer 42

Decreased

Question 43

Neonatal Residual volume and closing capacity are generally ____ compared to an adult?

Answer 43

Increased