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Intro Anesthesia > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Patient (peds) outcomes affected by

A

immaturity of organ systems

psychological

physical stress of surgery

effects of anesthetics

related pathology

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2
Q

Immaturity of ograns mostly significant until what age

A

2 yo

per therman

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3
Q

age of neonates

A

<30 days

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4
Q

infant age

A

1-12 months

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5
Q

preterm infant

A

born before 37 weeks

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6
Q

»Term infant:

A

born after 37 wks & before 42 wks

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7
Q

»Post term infant:

A

born after 42 wks

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8
Q

»Low birth weight:

A

< 2500 gms

•Regardless of gestational age

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9
Q

»Extremely low birth weight:

A

< 1000 gms

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10
Q

•Children: ___years of age

»Toddler: ___ years of age

»Preschool: ___ years of age

»School age: ___ years of age

A

•Children: 1-12 years of age

»Toddler: 1-3 years of age

»Preschool: 3-6 years of age

»School age: 6-13 years of age

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11
Q

•Adolescent: ___ years of age

A

•Adolescent: 13-18 years of age

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12
Q

contractile components of myocardium

A

sacroplasmic reticulum

t-tubule system

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13
Q

•Myocardium pepends on what for contractility

A

free ionized Ca++

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14
Q

•Capable of limited ↑ in SV

up to LA pressures of ___ mmHg
when afterload remains low

A

10-12

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15
Q

things that can increase afterload which leads to further decrease in cardiac output

A

acidosis

hypothermia

pain

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16
Q

CO depends on what

A

HR

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17
Q

2 things that cause

dec CO & organ perfusion threatened

A

hypovolemia + bradycardia

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18
Q

drug that increase contractility + inc HR

A

epi

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19
Q

HR

1st day of life:

1st month of age:

Adolescence:

A

1st day of life: 120

1st month of age: 160

Adolescence: 75-100

20
Q

sleep HR lower than

21
Q

HR inc up to __ with pain

22
Q

predominant driver producing bradycardia with even minor clinical interventions (eg suctioning, laryngoscopy)

A

ANS causes HR variation

parasympathetic dominance

23
Q

T wave upright due to

A

Right ventricular (RV) dominance

24
Q

considered Hypotension in asnethetized

newborn

1 year old

other child

A
  1. newborn <60 mmHg
  2. 1 year old < 70
  3. other child SBP 70 + age(yrs)x2
25
Q

calculation for child > 1 to determine if hypotension

A

70 + age*2

26
Q

lowest BP “according to Barash chart”

  1. 0-3 mo
  2. 3-6 mo
  3. 6-12 mo
  4. 1-3 years
  5. 3-6 years
  6. 6-12 years
  7. >12 years
A
  1. 0-3 mo 65
  2. 3-6 mo 70
  3. 6-12 mo 80
  4. 1-3 years 90
  5. 3-6 years 95
  6. 6-12 years 100
  7. >12 years 110
27
Q

Lowest BP “according to Nagelhout chart”

neonate

12 mo

3 years

12 years

A

neonate 70

12 mo 95

3 years 100

12 years 110

28
Q

predominant hemoglobin species in neborn contributing to 70-90% of total

29
Q

explain how/why the fetus is able to “exist” in such a low PaO2 environment in utero

A

O2 affinity

fetal Hg > Adult Hg

fascillitates O2 uptake thru placental circ.

30
Q

lowest Hg during this age

A

3 months

nadir

bc of dec erythropoesis and dec life span of of newborns RBC

31
Q

Review

  1. O2 rich environment p birth
  2. decreased erythroid activity, dec hematopoesis
  3. dec erythroposis + dec lifespan of newborn RBC
  4. –> lowest Hg by 3 months
  5. Physiologic Anemia of Infancy
  6. Does NOT compromise fetus bc RIGHT O2/hg/diss curve
  7. More released to tissue
  8. inc 2,3 DPG and inc Hemaglobin A (adult) replacing fetal 3-6 mo
A

Review

  1. O2 rich environment p birth
  2. decreased erythroid activity, dec hematopoesis
  3. dec erythroposis + dec lifespan of newborn RBC
  4. –> lowest Hg by 3 months
  5. Physiologic Anemia of Infancy
  6. Does NOT compromise fetus bc RIGHT O2/hg/diss curve
  7. More released to tissue
  8. inc 2,3 DPG and inc Hemaglobin A (adult) replacing fetal 3-6 mo
32
Q

Vitamin K dependent clotting factors

which are 20-50% of adult levels

even lower in premature

A

II, VII, IX, X

2, 7, 9, 10

33
Q

newborn’s blood volume depends on what

A

time of cord clamping

blood volume

immediate clamping < if clamping after placenta out

34
Q

newborn EBV

A

80 - 90 ml/kg

35
Q

% loss of IVF immediately/postnatal period

A

dec 25%

inc over next 2 months

peaks 2 months of age

36
Q

EBV by age

  1. premature
  2. newborn
  3. infant 3 mo - 3 yo
  4. > 6 yo children
  5. adults
A
  1. premature 90-100
  2. newborn 80-90
  3. infant 3 mo - 3 yo 75 -80
  4. > 6 yo children 65-70
  5. adults 65-70
37
Q

fetus able to sustain life what weeks of gestational age

A

24-26 weeks

38
Q

•_____ million terminal sacs develop into alveoli after birth

39
Q

alveolar formation accelorates what age

A

12-18 mo postnatally

40
Q

alveoli increase in # and SIZE until what age

41
Q

alveoli # btw 8-10 yo

A

200-300 million

42
Q

•______ __ _______ - production & secretion of surfactant

A

Type II pneumocytes

43
Q

surfactant (type II pneumocytes) begins at what wks and peaks

A
  • Type II pneumocytes - production & secretion of surfactant
  • Begins ~ 22-26 wk; Peaks ~ 35-36 wk gestation
44
Q

explains relationship btw dec surface tension within the alveoli to decrease alveolar collapse

A

Law of Laplace

45
Q

control of breathing depend on what 3 things

A
  1. PaO2
  2. PaCO2
  3. Ph - central chemoreceptors
46
Q
  • Inspiratory pause lasting 10 seconds followed by ↑ ventilation
  • More common in premature
  • Occurs more often during REM
A

•Periodic breathing:

Intro Anesthesia (5 decks)

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