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SNRAObPedGer > Pediatric Lecture 1 > Flashcards

Pediatric Lecture 1 Flashcards

1
Q

Preterm

A

Before 37 weeks, post conceptual age

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2
Q

Newborn

A

First 24 hours

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3
Q

Neonate

A

First 30 days

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4
Q

Infant

A

1 month to a year

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5
Q

Children

A

1 to 12 years

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6
Q

Adaptation to extrauterine life

A
  • Gas exchange(O2 andCO2) function transferred from placenta to lungs
  • SBP falls initially, then increases progressively c/age
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7
Q

• Subcutaneous/muscle tissue develop during_______

A

third trimester

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8
Q

Organogenesis =

A

first 8 wks (try not do anesthesia during that time)

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9
Q

• Premature =

A

weigh < 2,500g

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10
Q
  • Growing:

* Birth weight doubles by________, triples by_____

A

6 months; 1 yr

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11
Q

• Post-term neonate defined as being born

A

42 weeks gestation

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12
Q

• Length doubled by what age

A

4 years of age

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13
Q

• Preterm neonate =

A

born before 37 weeks gestation

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14
Q

• Estimation: Wt (kg) =

if >8

A

Wt (kg) = 2 × Age (years) + 9

• > 8yr = age (yr) x 3

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15
Q

Neonatal Circulation
First _____
• PVR experiences Major ___ to low “adult” levels during _____days
During the 1st wk of life, PVR___________
There is_______or pulmonary vasculature
There is __________+_________

A

↓ Pulmonary vascular disease (PVR)
decline ; 2-3 days

• During 1st wk of life, PVR decreases further
• 2° remodeling of pulmonary vasculature
• Thinning of vascular smooth muscle
+ recruitment of new vessels

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16
Q

Neonatal Circulation. What are the 2 crucial events for transition

A

↓PVR,↑SVR (closes FO, reverses

ductus arteriosus shunt)

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17
Q

Cardiovascular Physiology : Resting CO is

and because of a fixed SV there is

A 
Resting CO maxed out
Fixed SV
- Decreased myocardial function
- Increase Number of myocytes
- More mitochondria needed for growth 
- Less organized
-Stiff Heart
- Limited functional reserve
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18
Q

Elaborate on Immature SNS
what is it driven by?
Left ventricle is

A

Driven by the parasympathetic

Left ventricle is noncompliant poorly developed

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19
Q

During the first 3 months

A

Unable to respond to stress with inotropic support

Limited ability to increase CO even with limited stress

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20
Q

Atropine vs Glycopyrrolate

A

Debatable,which intervention is more effective

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21
Q 
LV has limited contractile reserve:
There is a\_\_\_\_\_\_\_\_\_ in the number of alpha receptors
There is \_\_\_\_\_\_\_\_\_of catecholamines
\_\_\_\_\_\_\_\_\_Recruitable SV
Immature\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_ventricular compliance
A 
↓ # alpha receptors
• ↑catecholamines
• Limited recruitable SV
• Immature Ca2+ transport system
↓ ventricular compliance
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22
Q

Which receptors are better developed_______. Therefore use to maintain BP

A

Beta; beta agonists

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23
Q 
Pediatrics
They are prone to \_\_\_\_\_\_\_\_\_
Unable to \_\_\_\_\_\_\_\_
Use caution with \_\_\_\_\_\_\_
Cardiac output is
A

Bradycardia
Handle pressure or volume problems
Intraoperative fluids
Rate dependent

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24
Q

Mean Heart rate for premature

A

120-170

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25
Q

Mean HR for 0-3 months

A

100-150

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26
Q

Mean HR for 3-6 months

A

90-120

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27
Q

Mean HR for 6-12 months

A

80-120

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28
Q

Mean HR for 1-3 years

A

70-110

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29
Q

Mean HR for 3-6 years

A

65-110

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30
Q

Mean HR for 6-12 years

A

60-95

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31
Q

Mean HR for >12 years

A

55-85

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32
Q

Premature BP

A

SBP 55-75 / 35-45

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33
Q

0-3 months BP

A

SBP 65-85/45-55

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34
Q

3-6months BP

A

SBP 70-90/50-65

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35
Q

6-12 months BP

A

SBP 80-100/55-65

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36
Q

Pulmonary Physiology

_______Chest wall compliance(3)

A

Increased chest wall compliance

  • underdeveloped intercostal muscles
  • small chest cavity
  • High diaphragm
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37
Q

Airway and alveoli develop until age?

A

age 8

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38
Q

Role of surfactant

Preemies and maternal diabetes=

A

Get rid of alveoli wall tension

Decreased production of surfactant

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39
Q

Pulmonary changes at birth

A

As the chest passes through the birth canal , the lungs are compressed –> Subsequent recoil of chest wall produces passive inspiration of air into the lungs

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40
Q

What establishes lung volume during fetal vaginal delivery?
It is required to_________
________ pressure is __________ and is for_________(in lung)

A

Fluid compressed from fetal lung during vaginal delivery = establishes lung volume
expand alveoli
• Negative inspiratory pressure (40-80 cm H2O)
Lung expansion

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41
Q 
LA Place
\_\_\_\_\_\_\_Required to keep bubble inflated
Pt = 
If fluid lining of alveoli were purely interstitial
fluid =
A

Pressure (Pt) required to keep a “bubble” inflated
= surface tension (T) at interface divided by the
radius of the bubble
• Pt = 2T/r
• If fluid lining of alveoli were purely interstitial
fluid = very high transmural pressure required

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42
Q

Ventilation
There is switching from________filled to______Filled
Normal ventilatory pattern TV within

A

Fluid; air

5-10 ins

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43
Q

TV is
Increased RR
mirrors______
There is _______metabolic demands

A

6-8 ml/kg
40-60, unable to increase TV
Increase in oxygen consumption

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44
Q

Ratio of MV to FRC

A

2-3x adults

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45
Q

Rapid induction or emergence

A

Because or ration of MV to FRC

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46
Q

Laryngeal location adult vs child

A

Adult C3-C6

Neonate C2-C4

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47
Q

Narrowest location of airway: adult vs child

A

Glottis

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48
Q

Narrowest location of airway: adult vs child

A

Glottis(cricoid?)

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49
Q

Right Mainstem Bronchus

A

Adult:more vertical
Child: less vertical

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50
Q

Tongue of the child

A

Larger in proportion to mouth

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51
Q

Epiglottis child

A

U shaped, Flappier bigger than adult

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52
Q

Lungs in child

A

less capacity

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53
Q

Trachea in child

A

Narrow and less rigidity in child

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54
Q

Most common Airway obstruction

A

Large tongue

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55
Q

Babies are __________

A

Obligate nose Breathers

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56
Q

PVR formula

A

PVR = 80 ( MPAP-PAWP)/CO

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57
Q

Normal PVR

A

<250 dynes

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58
Q

Child has ________Vocal cords

A

Anterior slanting vocal cords

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59
Q

Child has ______Occiput because of

A

large; High glottis

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60
Q

Major changes after birth

A 
PVR low
SVR HIGH (closes foramen ovale, reverses ductus arteriosus)
61
Q

Muscle fibers Type 1

A

Slow twitch, high oxidation

62
Q

Muscle fibers Type 1__________for ________Activity

A

Slow twitch, high oxidation

sustained active

63
Q

Muscle fibers Type 2 _________For_________activity

A

Fast twitch, low oxidation

Immediate, short activity

64
Q

In the diaphragm type 1 muscles aren’t

A

Matured until 8 months

65
Q

In the Ribcage type 1 muscles aren’t

A

Mature at 2 months

66
Q

Neonates have limited _______because they cannot

A

Functional reserve; increase CO

67
Q

What closes shunt

A

the increase in SVR

68
Q

PEEP does what

A

Suck airways closed
Pliable rib cage
High closing volume
Look for retractions

69
Q

Apply peep at

A

5-8cm H2O

70
Q

As far as renal physiology, neonates are obligates_______why? two reasons
daily requirements?

A

sodium losers
-because of immature tubular cells,
-They lose 20-25 mEq Na in urine, vs adult losing 5-10 mEq Na in urine
3-5 mEq/kg

71
Q

Axis of deviation (left for adult), right for child why?

A

Right atrium , SA node more likely to go left because of large ventricule
Electricity goes through thick muscle

72
Q

Hematology BV depends on

A

When cord was clamped

73
Q

BV in premies ______Than neonates, why?

A

BV in premies greater (90/105mL/kg) than in full-tern

neonates because of increased plasma volume

74
Q
  • Capillary sampling vs venipuncture
  • Term infants normally experience____Hgb during 9-12th wk, then ↑
  • ____erythropoiesis,______ lifespan of RBC
  • Normal physiologic adjustment to extrauterine life
  • O2 delivery not compromised
  • Why?
A

Normal Hgb 14-20
decrease
Decrease
Decrease

Increase 2,3 DPG (tells body to deliver O2)
CADET

75
Q

Neonates have______Vagal reflex

A

strong

76
Q

Hematopoiesis =

A

occurs in liver until 6 wks, then bone marrow

77
Q

•_________ first 24 hr
• ___________end of first wk of life (neutrophils =
lymphocytes)

A

21,000/mm3

12,000/mm3

78
Q

• Through 4 yo what is the predominant WBC??

After 4 years old, what is the predominant WBC?

A

lymphocyte predominant cell

79
Q

Infants,____________ associated with mechanical

ventilation

A

Thrombocytopenia

80
Q

Vit K dependent factors @________ of adult values at birth because of ________

A

20-60% • Immature liver

81
Q

What is the most common cause of metabolic problems

in the newborn?

A 
hyperinsulinemia
MOST  COMMON Persistent hyperinsulinemic hypoglycemia of infant 
Sepsis
Hypothyroid
Inborn errors of metabolism
Intrauterine growth retardation
Hypoxia
Large for gestation
Maternal infection
82
Q

Hyperalimentation

Balance risk of

A

Hypoglycemia(dextrose in IVF)
keep tube feeding running and TPN
Augmentation of ischemic injury

83
Q 
Physiology Jaundice of the neonate
High albumin due to 
by 12 weeks gluconeogenesis
15 weeks glyconenolysis 
Protein clotting factors are \_\_\_\_\_\_\_
A

Hyperalbuminemia secondary to
-increase bilirubin load (transition of Hgb-F to Hgb-A)
- Poor hepatic conjugation (decrease production of UDP-Glucuronyl transferase)
More proteins acidotic

84
Q

Neonate pancreas

Placenta is _______To 2 hormones

A
  • Placenta impermeable to insulin and glucagon = baby is on their own!
  • Fetal pancreas begins secreting insulin week 11
85
Q

• Fetal pancreas begins secreting insulin

A

week 11

86
Q

• Maternal hyperglycemia leads to

A

hypertrophy/plasia fetal islets of Langerhans

87
Q

• ↑insulin in fetus

A

→ alters lipid metab. → macrosomia (big baby)

88
Q

Babies prone to__________ after being born

A

rapid hypoglycemia

89
Q
  • Abnormal glucose concentrations:
  • _________in first 3 hrs of birth
  • _________between 3-24hrs birth
  • __________after 24 hrs
A

< 35 mg/dL
< 40 mg/dL
<45 mg/dL

90
Q

Glucose > 150 mg/dL

A

• Stressed neonates, receiving glucose in IVF during

elective surgery

91
Q

Peristalsis begins at _____(wk)

A

13 wks gestation

92
Q

Duodenal motility marked maturation Which week?

A

@ 29-32 wks

93
Q

Limits tolerance of enteral feeding before

A

29-30 wks gestation

94
Q

Meconium contained in GI tract before birth

A

Usually passed a few hours after birth, almost always within 48 hrs

95
Q

Temperature regulation
Most heat lost where?
Neonate have _____occiput

A

large surface area
most heat is lost in head
Large

96
Q

Unable to generate _______Of heat

they have poor _____

A

Large amounts of heat
Non-shivering THERMOGENESIS
Insulation

97
Q

Central Chemoreceptors

A

hypoxia depressed hypercapnic ventilatory response

98
Q

Heat production

A

By fatty acid metabolism
26-30 weeks
2-6% weight

99
Q

Barotrauma and volutrauma

A

when over ventilating (VOLUTRAUMA more dangerous)

100
Q

______Fat in heat production
Formed_______
located in 2 locations

A

Brown
26-32
scapula , sternum

101
Q

VO2 HIgh in child

A

Double as fast consumption of O2

102
Q

FRC to body weight

A

Decrease ; FRC keeps airway open

103
Q

Closing volume

A

Point where alveoli start to collapse

STAY ABOVE

104
Q

TLC

A

160

105
Q

Temperature Regulation in OR

A

Adequate ambient temperature

106
Q

Preterm_____C
Full term_____C
Adult______C
Use

A 
34 C
32 C
28 C
Bear huggers
Fluid warmers
107
Q

FRC = Closing volume

A

Airway compromise start

108
Q

The CNS is anatomically ________and functionally _________

A

complete at birth,

Functionally immature

109
Q

CNS myelination done at _____years

A

7 years

110
Q

2 growth spurts of CNS

A

15-20 weeks

20weeks to 2 years

111
Q

CNS develops in

A

Cephalocaudal direction

112
Q

Mental development depends on

A

maturation of CNS

113
Q

Law of laplace

A

Tell us how things stay open

Transmural pressure required to maintain balloon inflated

114
Q

BBB allows passage

A

selective passage of glucose, organic acids and amino acids.

115
Q

BBB is damaged by

A

Hypoxemia/ ischemia–> Edema

116
Q

Fluid maintenance

A

4-2-1
NPO deficit 1/2 first hour
1/4 2nd and 3rd hours

117
Q

Traction of small airways keep alveoli open

A

more than surfactant

118
Q

Surfactant are like

A

Detergents

119
Q 
EBV
Premies
newborn
3months to 1 year
>1 year 
Adult
A 
100 ml/kg
90 ml/kg
80 ml/kg
70-75 ml/kg
65-75ml/kg
120
Q

Minute ventilation

A

TV (small in child) x RR

RR increase better to increase minute ventilation

121
Q

VS RR

A

30-60

122
Q

VS HR

A

110-160

123
Q

Bronchial tree

A

week16

124
Q

BP 1-2 kg

A

50/25mmhg

125
Q

BP >3kg

A

65/40mmhg

126
Q

Meconium Aspiration Syndrome

A

Meconium stained fluid indicative of fetal hypoxia
Not related to meconium present during delivery
Tx–> Conservative, suction until clear, NOT MORE THAN 3 times

127
Q

Supine neonates

A

FRC small, less outward pressure of chest, more elastic recoil

128
Q

COPD of neonates

A

Bronchopulmonary dysplasia

Disease of prematurity

129
Q

________lung changes as bronchopulmonary dysplasia

A

Cystic

130
Q

Treatment of bronchopulmonary dysplasia

A

Inhales anesthetics
Diuretics
Mechanical ventilation

131
Q

Necrotizing Enterocolitis

A

Disorder of intestinal mucosa
Abdominal distention, Blood diarrhea, acidosis , Apnea
–>Septic Shock

132
Q

Vocal cords of child

A

more anterior airway, (the smaller chin)

133
Q

Intraventricular hemorrhage
Increased risk if
Grade 1-2?
Grade 3&$

A

premie with a history of stroke within several day s or birth
<30 weeks
Small amount of bleeding NO LONG TERM PROBLEMS
Severe bleeding ; blood presses on brain tissue, clots block CSF.

134
Q

When is surgery safe?
Medically optimization (Medical vs surgical emergencies)
3 common concerns

A

Post op apnea
Post op bradycardia
Gestational and post conceptual age

135
Q

Post conceptual age(PCA)

A

Gestational age+ Post maternal age

136
Q

PCA <60 weeks

A

Have highest risk for post-anesthetic complications

137
Q

PCA 46-60 weeks

A

Include full-term neonate less than 2 months

monitor for 24 hours post-op

138
Q

Intubated child give _____

Masked child give

A

give PEEP

positive pressure

139
Q

Nephrogenesis

Tubular

A

36weeks, adult 2 years old

140
Q

Fetus 2 things: related to acid base balance

A

mild respiratory acidosis, kidney tend to crease more bicarb

more endogenous acid production with kids

141
Q

Kids are more ______than adults

A

acidic

142
Q

Parasympathetic nerves rises

A

3,7,9,10

143
Q

Vit K dependent factors

A

2,7,9,10

144
Q

PHHI

A

Hyperglycemic and hypoglycemic

145
Q

Myelination happens from

A

Cephalocaudal :top to bottom(move arms freely before legs)

146
Q

kg +______

A

40ml/hr for hourly maintenance.

147
Q

Too much oxygen leads to the production of

A

free radicals

148
Q

Anesthesia shouldn’t be given to __________(higher risk for apnea)

A

less than 2 months

SNRAObPedGer (25 decks)

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