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Summer 2020 - Advanced Anesthesia - Pediatrics > Pediatric Anesthesia - Quiz 1 > Flashcards

Pediatric Anesthesia - Quiz 1 Flashcards

1
Q

What is the age of a Neonate?

A

1 - 28 days of life

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2
Q

What is the age of an Infant vs Child?

A

Infant: 28 days - 1 yr

Child: > 1 yr

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3
Q

When does the most significant part of transition occur for a newborn?

A

24 -72 hrs after birth

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4
Q

What are the adaptive changes for a Newborn?

A

Establish FRC

Convert Circulation

Recover from Asphyxia

Maintain Core Temp

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5
Q

Where does Gas Exchange occur in regards to Fetal Respiration?

A

Placenta

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6
Q

How is the majority of O2 Transport accomplished by the Fetus?

A

Left Fetal Hgb Shift

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7
Q

What happens to O2 Unloading after birth?

A

Becomes Insufficient

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8
Q

What is the normal Hgb for a full term Neonate?

A

18 - 20 g/dL

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9
Q

How developed is the Fetal Lung at 4 weeks?

A

Lung Buds develop from Foregut

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10
Q

At what week of gestation does the Fetal Lung have Complete branching of the Bronchial Tree to 28 Divisions?

A

16 Weeks - no more cartilaginous airway formation

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11
Q

When does the Fetal Lung have Alveoli & Type II Cells w/ Surfacant?

A

24 Weeks

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12
Q

What happens w/ Fetal Lung Development at 28-30 weeks?

A

Capillary Network surrounds Saccules & baby can survive w/o support

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13
Q

When does the Fetal Lung have true Alveoli present?

A

36 - 40 weeks - about 20 million @ birth

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14
Q

What happens in Fetal Lung Development at Birth to 3 months?

A

PaO2 rises as R-to-L mechanical shunts close

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15
Q

What happens to the number of Alveoli present once the the child reaches 6 years of age?

A

Rapid increase to 350 million Alveoli

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16
Q

When does the Fetus start to “Guppy Breathe” in Utero?

A

30 weeks at a rate of 60 breaths/min

Prenatal Respiratory Practice

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17
Q

What happens in utero that could cause Lung Hypoplasia?

A

Denervation or damage to the Diaphragm

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18
Q

How does the Carotid, Aortic, and Peripheral Chemoreceptors play a role in Fetal Breathing?

A

Does NOT alter fetal breathing or Initation of Ventilation at birth

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19
Q

What initiates in utero Rhythmic Breathing?

A

Clamping of Umbilical Cord & Increasing O2 Tension from Air Breathing

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20
Q

What augments and maintains continuous rhythmic breathing?

A

Hyperoxia w/ Air Breathing & Low Fetal PaO2

Continuous breathing does NOT depend on PaCO2

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21
Q

What depresses or abolishes continuous breathing?

A

Hypoxia

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22
Q

What happens to the Fetal Lungs w/ onset of Ventilation?

A

↓Pulm. Vascular Resistance d/t ↑PO2 & ↓PCO2

&

↑Pulm. Blood Flow

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23
Q

The primary event of Respiratory transition is the Initiation of Ventilation. How do Alveoli change at this point?

A

Fluid-filled Alveoli to Air-Filled

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24
Q

What helps overcome the Large Surface Tension forces in the Newborn’s Lungs?

A

Small Radius of the Diaphragm’s Curve

&

High Negative Pressure of -70 cm H2O generated by the baby

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25
What is the FRC for a Newborn?
25 - 30 mL/kg - buffer for PO2 & PCO2 changes b/t breaths
26
Neonates have weak elastic recoil and intercostal muscles, making them prone to what?
Lung and Intra-Thoracic Airway Collapse during Exhalation
27
What happens when Closing Volumes are equal or above the FRC?
Small airway closure Lung Collapse V/Q Mismatch
28
What is unique about how the infant's lungs work that prevents their lungs from collapsing all the time?
Infants end their expiratory phase early This creates **PEEP** & a higher FRC Anesthesia inhibits this function
29
Do neonates have respiratory control in response to hypercarbia?
Yes, but the control is still immature. They will hyperventilate, but the slope of response is decreased
30
What depresses the Neonate's response to CO2?
Hypoxia
31
What are the 2 phases of the Neonate's response to Hypoxia?
**First Phase**: Hyperpnea **Second Phase**: Depressed Respirations after 2 min.
32
What abolishes the Neonate's Hyperpnea response to Hypoxia?
Hypothermia & Anesthetic Gas
33
How does Hypoxia affect the baby's heart rate?
**Profound** Bradycardia
34
What is Apnea of Infancy?
Respiratory pause \> 20 sec or w/ Bradycardia or Cyanosis
35
What factors contribute to Apnea of Infancy?
↑Work of Breathing ↑O2 Consumption & Closing Volume Compliant Upper Airway & Ribs = Easy Collapse Inefficient Diaphragmatic Contraction Only 25% Type 1 Diaphragm Muscles (vs. 55% in Adults) ↓FRC
36
Why do Fetal Intracardiac & Extracardiac Shunts Exist?
To Minimize blood flow to Lungs & Maximize flow to Organs
37
What are the Fetal Shunts that develop in birth?
Ductus Venosus Foramen Ovale Ductus Arteriosus
38
How does Fetal Blood circulate?
Deoxygenated blood --\> Descending Aorta --\> Umbilical Arteries --\> Placenta --\> Oxygenated Blood --\> Umbilical Vein --\> 50% to Liver / 50% to Ductus Venosus --\> IVC --\> RA --\> RV --\> Ductus Arteriosus --\> PA & Aorta
39
The Umbical Arteries to the Placenta have very _____ resistance to blood flow
The Umbical Arteries to the Placenta have very **Low** resistance to blood flow
40
What is the PO2 of the Oxygenated blood that returns via the Umbilical Vein?
35 mmHg
41
With Fetal Circulation, the Pulmonary Vascular Resistance is very _____ & the SVR is very \_\_\_\_\_\_
With Fetal Circulation, the Pulmonary Vascular Resistance is very **High** & the SVR is very **Low**
42
What is the PO2 of the Blood entering the Descending Aorta that then goes to the Placenta?
22 mmHg
43
In Fetal Circulation, which pathway does O2 rich blood go directly from the Right Atrium to the Left Atrium?
Foramen Ovale
44
What happens during the Transitional Fetal Circulation when the Umbilcal Cord is cut?
↑SVR Reversal of Shunts Breathing Starts ↓Pulm. Vascular Resistance ↑LA Pressure ↓RA Pressure Foramen Ovale Closes
45
What happens to Pulmonary Blood Flow when Fetal Ventilation first starts?
450% Increase in Pulm Blood Flow
46
During Transitional Circulation, how does increased PO2 affect the Ductus Arteriosus?
Constricts w/in Minutes and Circulating Prostaglandins decrease
47
How long does it take for the Ductus Arteriosus to close?
**Physiologic**: 10 -15 hrs **Anatomic**: 2-3 wks
48
What causes Persistent Pulmonary Hypertension of the Newborn (PPHN)?
Persistent Fetal Shunting after Transition Period Hypoxia Acidosis
49
What can cause the Reopening of The Foramen Ovale?
Persistent Pulmonary Hypertension in the Neonate & Cold Stress
50
What are the symptoms of PPHN?
Cyanosis Tachypnea Acidosis R-to-L Shunt across FO & DA
51
What causes the normal condition of _Transient_ R-to-L shunting before anatomical ductus closure?
When baby coughs, bucks, or strains during induction or emergence
52
How is PPHN treated?
Hyperventilation Pulmonary Vasodilators - Prostaglandin Minimal Handling Avoid Stress
53
What is the major function of the Fetal Renal System?
Passive Urine formation contributing to Amniotic fluid
54
Fetal kidneys have ____ Renal Blood Flow & GFR
Fetal kidneys have **Low** Renal Blood Flow & GFR
55
What happens to the Renal System during the Transitional Stage?
↑SVR ↓Renal Vascular Resistance ↑Kidney Size & Fxn
56
At what gestational period are all fetal nephrons developed?
34 weeks
57
What is the Urine Osmolarity of a Neonate at birth?
700 - 800 mOsm/L
58
What is the Creatnine of a Neonate at birth?
0.8 - 1.2 mg/dL
59
Why does the Neonate have trouble Concentrating Urine?
Inadequate Sodium Conservation Neonates have normal Renin-Angiotensin System, but immature Tubules The baby is an "Obligate Sodium Loser"
60
What is the Normal Urine Sodium in an Adult vs Baby?
**Adult**: 5-10 mEq/L **Neonate**: 20-25 mEq/L
61
What is an important point in regards to fluid management in the Neonate?
Fluids must contain Sodium Ideal Fluid: D5 0.2% NS
62
Why is a Hematocrit of 35% the lowest acceptable for the Neonate?
High O2 Demand Limited ability to Increase CO Increased Blood Volume & CO per weight
63
What is the Blood volume for a Term Baby vs. a Pre-Term Baby?
**Term:** 90mL/kg **Pre-Term**: 100mL/kg
64
Why are Neonates more susceptible to heat loss?
Small Size Increased Surface Area Increased Thermal Conductance
65
How does the Neonate produce heat?
Voluntary/Involuntary Muscle Activity & Non-Shivering Thermogenesis
66
How does Non-Shivering Thermogenesis work?
Metabolism of Brown Fat located in the Mediastinum b/t the Scapulae & around the Adrenals in the Axilla
67
What mediates Non-Shivering Thermogenesis?
Sympathetic Nervous System

Summer 2020 - Advanced Anesthesia - Pediatrics (6 decks)

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