Pediatrics Flashcards
The narrowest airway area in pediatrics is ….
Glottic area
Apgar score are 5 components …
A: Activity (muscle tone) P: Pulse G: Grimas (reflex) A: Appearance (color) R: Respiratory effort
Apgar score 0 points are
A: flaccid P: Absent G: no response A: Blue/pale R: absent
Apgar scores 1 point
A: Flexion P: <100 G: Grimace A: pink body, blue ext R: slow irregular
Apgar scores 2 points
A: Active P: > 100 G: cough/sneeze A: pink body & Ext R: Good, crying
newborns frequently loose a point in Apgar score due to …
Peripheral color for being blue.
BLS in neonates with bradycardia & cynosis, difference is
starting positive pressure before chest compression
When meconium aspiration suspected….
Intubate -> suction -> then ventilate.
Umbilical Arterial ABG in newborn (normal values)
7.28/50(CO2)/20
Umbilical Venous ABG in newborn (normal values)
7.35/40/30(O2)
Umblical ABG in neoborna at 60 min
7.30 - 7.35
30 PaCO2
60 PaO2
Which one has higher PaO2, Ductus venosis or Ductus Atreriosus
Ductus Venosis: high PaO2
What nerve risk for damage during PDA ligation
Left Recurrent laryngeal (it arches the aorta and close to PDA)
Fetal Thiopental concetration are low during general anesthesia for CS because
- Maternal distirbution
- Metabolism by fetal liver.
Water % of bodyweight in term vs preterm neonates
70% Term
80% Preterm
When … the rate of the work of breathing is similar in neonates and adults
corrected for weight & metabolic rate
O2 consumption for work of breathing in neonates is …% of total body O2 consumption
1-2%
first step when child is breath hodling during induction is
positive pressure with 100% O2
the best sign for reversal of NMB is …. and the best clinical sign in infants is … compared to adults …
ToF > 0.9
lifting of legs in infants
masseter muscle tone in adults, indicates >0.8 ToF (note the best sign is ToF >0.9)
spinal anesthesia in neonates differ than adults in dose …
neonates needs larger doses due to increase in CSF volume compared to adults
spinal anesthesia in neonates differ than adults in duration …
shorter block in neonates due to rapid turnover of CSF
High blocks in neonates manifests as
Apnea rather than hypotenstion
The most common indication for spinal in pediatrics is
ex-premature presenting for inguinal hernia repair
the incidence of PDPH in children is … compared to adult
lower
The dural puncture and total spinal is more common in neonates than adults because
the anatomy of dural sac ends lower
Dose Mg cross placenta? and whats the antidote?
Yes
Calcium
In order to prevent retinopathy of prematurity, the PaO2 should kept below
70 mmHg
BP & HR at birth vs at 1 year
Birth: 65/40, HR 140
1 year: 95/65, HR 120
Reason for desaturation in neonates & infants
increased metabolic rate and O2 consumption (not decreased FRC or FRC/TLC ratio)
The loss of heat is faster in neonates compared to adults because
their larger surface area-bodyweight ratio (they also have less SQ fat and therefor have less insulation for heat preservation).
Neonates heat production is dependent on
metabolism of brown fat
Refrance weight for neonates is 3 kg vs 70k in adults. what would be TV, VC, FRV and dead space differnces
TV 6 ml/kg in both
VC 35 ml/kg (70ml/kg in adults)
FRC 30 ml/kg (35 ml/k adults)
Dead space is same 0.3xTV
When adult breathing circuit is used for infants, TV should be … to compensate for the compliance of tubing
Increased
Would you proceed to OR if EMLA cream applied to a broken skin unintentionally on neonates?
better to postpone and observe for methemoglobenemia (ELMA is eutectic miture of lidocaine & prilocaine, pro;pcaine increase risk of methemoglobenemia)
Best option for induction in child with epiglottitis is
gental mask induction with sevoflurane + O2 100%
Parental presence benefits
reducing separation anxiety but wont prevent pr decrease postoperative delirium
fasting interval in children for clear liquid
2 hours
fasting interval in children for human milk
4 hours
fasting interval in children for non-human milk
6 hours same as light meal
Fetal Hg can falsely elevate COHb levels upto … in first weeks of life
7-8%
RFs for postoperative apnea in premature infants are
who should be admitted and monitored (and for how long) after outpatient surgery.
The most conservative approach is to admit (for monitored 24 hour observation) all infants younger than 60 weeks post-conceptual age
Why Pierre Robin is difficult airway
Glossoptosis
Why Treacher Collins is difficult airway
Micrognathia
Why Klippel-Feil is difficult airway
Cervical spine immobility
Would you proceed to OR with 1 week old African american with hx of SCD in family?
Yes, fetal Hb provides protection from sickling
when is a physiological decrease in Hb concentration in infants (physiological anemia)
at age of 3 months due to declining fetal Hb
what needs to be managed before pyloric myotomy?
fluid & electrolyte imbalance. its not an acute emergency
metabolic abnormalities seen with pyloric stenosis
hypoCl-, HypoK, HypoNa, metabolic alkalosis. (metabolic acidosis if untreated)
commonest type of Tracheoesophageal fistula is
Type C (fistula between the lower esophagus and the trachea (one form of TEF) with a blind esophagus upper pouch)
ideal ET position in TE fistula?
above carina but belo the fistula. breath sounds should be bilateral, no sounds over stomach, or no leakage of gas through gastrostomy tube
Anomalies associated with TE fistula
Vertebral, cardiac, renal, radial anomalies
MoA of agents used for pulm Htn:
PGE2
NO
PGE2 -> cyclic AMP
NO -> cyclic GMP
Mgmt of Pulm Htn in CHD
- Increase FiO2
- Avoid acidosis
- moderate hyperventilation
- moderate hypocapnia
- Avoid hypothermia
- Inhaled NO
- PGE2
Anesthesia Concern for Congenital diaphragmatic hernia
- Pulm hypoplasia
- Pulm Htn
- Risk for PTX due to high airway pressures
- Bag & mask ventilation (overdistension of stomach & herniation across the midline)
Ventilator strategies in Congenital diaphragmatic hernia
- Low TV
- Peak airway pressures < 25 cm
- Permissive hypercarbia to achive preductal O2 Sat 90-95%
Neonatal Continental defects that associated with CHD?
- Congenital diaphragmatic hernia
- Omphalocele
- TE fistula
Meningomyelocele is associated with
Arnold-CHiari malformation & Hydrocephelus
Components of ToF
PROVe pulm stenosis RVH Overriding aorta VSD
preferred induction agent in ToF tetspells
Ketamine
tetspells occur when PVR increases or SVR decreases (ketamine maintains or increases SVR)
TTx of Tetspells in ToF
- 100% O2
- BB
- IVF
- Phenylephrine to increase SVR
Anesthetics goals in ToF reair
- Maintain intravascular volume
- Higher FiO2
- Maintain SVR (use Neo)
- Ketamine induction (maintain SVR)
- Propranpolol for infundibular spasm
Continues machinery murmur best heard at … and its specific for …
Left clavicle
PDA
Why neonates with PDA would have wide puls pressure
reduced diastolic pressure
PGE1 … PDA patency
keeps it open (indomethacin closes it)
Hpoplastic left heart syndrome occurs when parts of left heart is not completely develop, thoses parts are
MV
L ventricular AV
and aorta
blood pumped to body through RV which has to pass through PDA to reach systemic circulation
Anamoly that both pulm & systemic venis returns to RA is
Total Anamolous pulmonary return (TAPVR)
ASD?VSD needed to pass from RA to left
Single vessel recives blood from both R & L ventricle and then devised into aorta & pulm artery is
Truncus Areriosus
do they need PDA in Truncus Areriosus for life?
No because mixing has already occurred
one CHD in which PDA not essential for life
Truncus Areriosus
CHD in which ODA essential for life
Pulm stenosis Aortic stenosis ToF Transposition of great vessels TAPVR Hypoplastic L heart syndrom
whats the name & indications of procedure that diverts venous blood from RA to pulmonary circulation bypassing RV
Fontan procedure
- Hypoplastic L heart syndrome
- Tricspid atresia with intact ventricular septum
Hypothermia or hyperthermia that increases Pulm vasoconstriction and increases R->L shunts
Hypothermia
A disorder of lung parenchyma that results into hyperinflation of lung & respiratory distress from newborns to 6 months
Congintal lobar emphysema
- Avoid high peal airway pressure with ventilation
- Avoid NO
- Assisted ventilation is required
NMB overall dose should be reduced in neonates due to
their large volume distirbution, NMJ and liver is immature