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ABA ITE > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Define the oculocardiac reflex. What are the nerves involved? How do you treat it?

A

Decrease in heart rate of 10% following pressure on the globe or manipulation of the eye muscles.
Afferent limb: ophthalmic division of the Trigeminal nerve, efferent: Vagus nerve
Treatment: ask surgeon to stop stimulus, make sure patient is deep enough, turn up FiO2, if bradycardia doesn’t resolve, consider atropine 20mcg/kg

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2
Q

What are the blood volumes assigned to each age group?

A 
Adult female: 60-75 ml/kg
Adult male: 65-70 ml/kg
Child 1-12 years: 70-75
Child 3-12 months: 70-80
Full term newborn: 80-90
Pre-mature: 90-100
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3
Q

What is the anesthetic management of CDH?

A
  1. pre-ductal sats 90-95

2. PIP < 25, with low TV

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4
Q

For pediatric heart cases, what two types of medications should you be careful about mixing, and why?

A
  1. opiods and benzos
  2. These kids have decreased CP reserve due to heart defects. Anything that would cause vasodilation will worsen perfusion to the rest of the body
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5
Q

What are the side effects of PGE1?

A

apnea, bradycardia, fever, flushing, gastric outlet obstruction, and CNS irritability

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6
Q

What is the difference in codeine and morphine metabolism in neonates and school aged children?

A

Neonates: Decreased CYP2D6 activity, so less codeine is converted to morphine, therefore they are less sensitive
Morphine: two other enzymes that convert opioids to inactive metabolites and morphine to its two metabolites are low at birth, leading to increased sensitivity of the drug in neonates

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7
Q

What is the main way that babies keep warm? What factors increase this heat production? What inhibits heat production?

A
  1. non shivering thermogenesis: breakdown of brown fat into TG
  2. NE, thyroxine, glucocorticoids
  3. inhaled anesthetics and B blockers
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8
Q

How would you describe the trend of DM 1 and 2 in children? increasing? or decreasing?

A

Both are increasing

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9
Q

What abnormalities are associated with Trisomy 21?

A
  1. heart defects: AVSD > VSD > TOF > PDA
  2. Duodenal atresia
  3. Pulmonary HTN
  4. Difficult IV access, difficult airway
  5. Subglottic stenosis
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10
Q

What causes persistent fetal circulation?

A

Increased pulmonary pressures (I.e. hypoxia, acidosis, and hypothermia

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11
Q

What are the criteria for starting a newborn on PPV? When do you start CPR?

A
  1. persistent cyanosis, HR < 100

2. HR < 60

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12
Q

How do you treat mild post-intubation croup vs. moderate to severe?

A
  1. mild: cold, humidified air

2. mod-severe: racemic epinephrine and monitoring for at least 4 hours following extubation

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13
Q

What is the first surgical correction step for pulmonary atresia?

A
  1. BT shunt placement: This is a shunt between the R subclavian artery and the pulmonary artery. Therefore blood goes from the aorta –> R subclavian –> pulmonary artery –> lungs
    “what will not flow will not grow”
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14
Q

What are the optimal leak pressures for a cuffed vs. uncuffed tube?

A
  1. Cuffed: 20 cm H20
  2. Uncuffed: 20-30 cm H20
    - if the leak pressure is >20-30 then the cuff is TOO BIG
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15
Q

What agent should be avoided in patients with the MHTFR mutation?

A

N20

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16
Q

How do you induce a patient with congenital emphysema? What should you avoid?

A
  1. use spontaneous ventilation with minimal PIP

2. avoid n20

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17
Q

What are the early signs of MH?

A
  1. masseter muscle spasm
  2. Increased EtCO2
  3. Hyperthermia
  4. Tachycardia
  5. Tachypnea
18
Q

What are the symptoms of propofol infusion syndrome? What is the one organ NOT effected?

A
  1. Cardiac abnormalities
  2. Renal failure (hyperkalemia, rhabdo)
  3. Liver problems
  4. metabolic acidosis

BUT pulmonary edema is NOT see

19
Q

What does VACTERL stand for?

A
  1. vertebral
  2. Anal atresia
  3. cardiac
  4. TEF
  5. Renal
  6. limb
20
Q

True or false: high cognitive ability is associated with increased risk for peri-operative anxiety

A

true

21
Q

What is the youngest age of a child that would benefit from midazolam? Why?

A

9 months. That’s when separation anxiety begins

22
Q

Define Klippel-Feil syndrome

A

congenital fusion of the cervical spine

23
Q

What are the risk factors for post op apnea in kiddos?

A
  1. prematurity
  2. anemia
  3. GA or local w/ sedation
  4. hx of apnea
24
Q

Why do infants have an increased WOB?

A
  1. Highly compliant chest wall and poorly supported airway structures leads to functional airway closure with each breath
  2. increased metabolic demand
  3. smaller diameter of airways = increased R
25
Q

What is the first sign of total spine anesthesia in a neonate?

A
  1. respiratory distress and apnea

2. hemodynamic changes and autonomic effects are minimal

26
Q

In comparing gastroschisis and omphalocele:

  1. which is more common?
  2. which is associated with chromosomal abnormalities?
  3. which has an encasing?
  4. which is associated with increased rates of infection and heat loss?
A
  1. Omphalocele
  2. Omphalocele
  3. Omphalocele
  4. Gastroschisis
27
Q

What is the most efficacious treatment of PONV in kiddos?

A

Zofran, NOT the use of propofol

28
Q

What are the risk factors for PONV in kids?

A
  1. Older than 3
  2. Surgery > 30 minutes
  3. strabismus surgery
  4. FMH of PONV
29
Q

Explain the factors that lead to a faster induction of anesthetic in kids.

A
  1. Greater MV compared to FRC (most important)
  2. Greater blood flow to vessel rich organs in kids (i.e. the brain)
  3. Kids have lower blood:gas partition coefficients
  4. Gas is LESS soluble in tissue, meaning that there is an increase in blood concentration of gas and therefore an increase in speed of induction
30
Q

What drug is specifically CI following tonsillectomy and why?

A

Codeine. Some kids are rapid metabolizers, while others are not! That means that you cannot predict the anesthetic effect, whereas you can predict the effect of morphine since it is not a pro-drug.
REMEMBER: codeine ..> morphine via CYP2D6

31
Q

What are the metabolic derangements seen in pyloric stenosis? What is the most reliable indicator of readiness for surgery?

A
  1. metabolic alkalosis, with an compensation of resp acidosis
  2. Hypochloremia –> most reliable indicator
  3. Hypokalemia (though 1/3 are hyperkalemic)
  4. Hyponatremia
32
Q

What is the most effective way to warm a child in the OR?

A

Forced Air heating blankets

33
Q

Describe the differences between mild, moderate, and severe dehydration in regards to:

  1. weight loss
  2. fluid deficit
  3. skin turgor
  4. fontanelle
  5. eyes
  6. urine
  7. urine specific gravity
A

Weight loss (%) 5 10 15
Fluid deficit (mL/kg) 50 100 150
Skin turgor Normal Decreased Greatly decreased
Anterior fontanel Normal Sunken Markedly sunken
Eyes Normal Sunken Markedly sunken
Mucous membranes Moist Dry Very Dry
Urine flow (mL/kg/hr) < 2 < 1 < 0.5
Urine specific gravity < 1.020 1.020-1.030 > 1.030

34
Q

What is the initial fluid bolus used in a kid with severe dehydration?

A

20 ml/kg of NS

35
Q

How does the weight based dosing in kids change in comparison to adults?

A
  1. increased weight based dosing due to larger Vd, larger ECF compartment compared to TBW
36
Q

When should intrathecal bupivicaine be discontinued in neonates? What should be used for long term infusions instead?

A

After 48 hours, this is due to increase risk for toxicity 2/2 decreased protein binding. Use lidocaine instead! You can measure it’s serum levels

37
Q

What agents can help decrease post op myalgias following succinylcholine administration?

A
  1. Lidocaine
  2. Mg
  3. NDMB (roc)
  4. NSAIDs
38
Q

Patients with strabismus are MORE susceptible to what as a result of succinylcholine administration compared to the general pediatric surgical population?

A

Masseter muscle spasm

39
Q

Describe the facial features seen with Crouzon syndrome

A
  1. early fusion of cranial sutures
40
Q

Describe Pierre Robin sequence

A

Micrognathia, large tongue, u shaped cleft palate

41
Q

What does the pneumonic ASk for a CD stand for?

A

Mapleson A: spontaneous ventilation

Mapleson D: controlled ventilation

42
Q

Rank the bioavailability of midazolam from most to least

A

IV > IM > Intranasal > rectal > oral

ABA ITE (16 decks)

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