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Thurman > Pediatrics Part 2 > Flashcards

Pediatrics Part 2 Flashcards

1
Q

what should be included on preoperative evaluations of the pediatric population

A 
all illnesses
review of organ systems
previous hospitalization
childhood syndromes
medication list
herbal remedies
allergies (abx, latex)
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2
Q

herbal remedies are associated with what?

A

CV instability
coagulation disturbances
prolonged anesthesia
immunosuppression

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3
Q

common uses for Echinacea

A

prophylaxis and treatment of virla, bacterial and fungal infection
pharmacologic effects: stimulation of the immune system, long term use may be immunosuppressive

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4
Q

potential perioperative complications with Echinacea

A

reduced effectiveness of immunosuppressants
potential for wound infection
hepatoxicity

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5
Q

common use for ginseng

A

used to protect the body against stress and restore homeostasis; pharmacologic effects: possible potentiation of y-aminobutyric acid (GABA) transmission

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6
Q

potential perioperative complications with ginseng

A

potentiates sedative effects of anesthetic agents. possible withdrawal syndrome after sudden abstinence; kava-induced hepatoxocity

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7
Q

common use of garlic

A

antihypertensive, lipid lowering agent, anti-thrombus forming; pharmacologic effects: inhibits platelet aggregation (partially irreversibly) in a dose dependent manner. lowers serum lipid and cholesterol levels.

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8
Q

potential perioperative complications with garlic

A

may potentiate other platelet inhibitors, concerns for perioperative bleeding.

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9
Q

common use for st. johns wort (goat weed, amber, hard hay)

A

treatment of depression and anxiety; pharmacologic effects potentiation of GABA neurotransmission

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10
Q

potential perioperative complications with st. johns wort

A

potentiates sedative effects of anesthetic agents. withdrawal-type syndrome with sudden abstinence.

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11
Q

when should herbal remedies be discontinued?

A

2 weeks prior to surgery

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12
Q

active or resolving URI results in what potential complications?

A

increased airway reactivity
risk of atelectasis
mucus plugging
postop hypoxemia

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13
Q

if procedure is emergent and patient has active URI, what is the appropriate course of action?

A

must proceed

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14
Q

if procedure is elective and non urgent, what would alert you to the need to postpone for 4-6 weeks?

A 
fever >38.4 C 
malaise
productive cough
wheezing
rhonchi
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15
Q

if patient displays mild symptoms such as nonproductive cough, sneezing, nasal congestion what is the appropriate course of action?

A

proceed if regional or GA with mask; if requires ETT, wait 2-4 weeks

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16
Q

what should be evaluated preop for URI patients

A

hydration status
airway humidification
drugs like anticholinergic and beta agonists (helps airway secretions and hyperreactivity)

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17
Q

proceed with caution in these situations

A

child just has runny nose or is ‘much better’
active and happy child
clear rhinorrhea
clear lungs and symptoms that have leveled off
older child
hardship for parents to be away from work or insurnace will run out
no fever
outpatietn procedure that wont expose child to infectious agent

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18
Q

consider cancellation in these situations

A

parents confirm symtoms: fever, malaise, cough, poor appetitite, new symptoms
lethargic or ill appearing
purulent nasal discharge
wheezing, rales that don’t clear
<1 yr or ex premie
history or reactive airway disease, major operation, oett required
fever >38.5 C
inpatient procedure that exposese child to infection

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19
Q

are routine Hgb and UA indicated for most elective procedures?

A

no

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20
Q

when should Hgb levels be obtained?

A

procedures with potential for blood loss
specific risk factors for hemoglobinopathy
formerly preterm infants
<6mo of age

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21
Q

when should coags be obtained

A

major reconstructive surgeries

T&A

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22
Q

are routine CXRs necessary?

A

no

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23
Q

is pregnancy testing necessary?

A

yes; all those of childbearing age

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24
Q

what are some pharmacokinetic/dynamic considerationsf or the pediatric population?

A 
TBW composition
immaturity of metabolic degradation pathways
reduced protein binding
immaturity of BBB
greater blood flow to vessel rich organs
reductions in GFR
smaller FRC
increased MV
immature receptor responses
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25
Q

muscle mass % for preterm infant

A

15

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26
Q

muscle mass % for full term infant

A

20

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27
Q

muscle mass % for adult

A

50

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28
Q

fat % for preterm infant

A

3

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29
Q

fat % for full term infant

A

12

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30
Q

fat % for adult

A

18

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31
Q

TBW for preterm infant

A

90%

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32
Q

TBW for full term infant

A

80%

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33
Q

TBW for adult

A

60%

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34
Q

extracellular fluid for preterm infant

A

50%

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35
Q

extracellular fluid for full term infant

A

40%

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36
Q

extracellular fluid for adult

A

20%

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37
Q

intracellular fluid for preterm infant

A

40%

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38
Q

intracellular fluid for full term infant

A

40%

39
Q

intracellular fluid for adult

A

40%

40
Q

administered drug/plasma concentration

A

volume of distribution

41
Q

lower plasma concentrations (dilute) of water soluble drugs occurs due to what?

A

larger ECF and greater TBW

42
Q

is a higher or lower dose required for water soluble drugs?

A

higher

43
Q

higher plasma concentrations for lipid soluble drugs occurs due to what?

A

decreased fat and muscle

44
Q

what occurs with reduced plasma proteins (infant)

A

more free drug

45
Q

when do proteins reach adult equivilence?

A

5-6 mo

46
Q

when are proteins fully funcitonal?

A

1 year

47
Q

phase I of drug metabolism includes what?

A

3 enzyme reactions catalyzed by P450 system; oxidative, reduction, and hydrolysis

48
Q

what is the result of phase I metabolism?

A

water-soluble metabolic product

49
Q

phase II drug metabolism consists of what process?

A

conjugation (immature at birth)

50
Q

what does conjugation do?

A

couples drug with substratefor excretion

51
Q

enzyme systems are present at birth but activity is reduced, this does what to drug elimination half lives

A

increases

52
Q

major objectives of premedication in the pediatric population

A 
allay anxiety
block autonomic (vagal) reflexes
reduce airway secretions
produce amnesia
provide prophylaxis against pulmonary aspiration of gastric contents
facilitate induction of anesthesia
provide analgesia if needed
53
Q

what should be considered when selecting a drug for premedication?

A 
childs age
ideal body weight
drug history
allergic status
underlying conditions
parent and child expectations
child psychological status 
route; oral, intranasal, parenteral, rectal
54
Q

rectal dose of methohexital

A

20-40 mg/kg

55
Q

IM dose of methohexital

A

10mg/kg

56
Q

rectal thiopental dose

A

20-40 mg/kg

57
Q

oral dose of diazepam

A

0.1-0.5mg/kg

58
Q

rectal dose of midazolam

A

1 mg/kg

59
Q

oral dose of midazolam

A

0.25-0.75 mg/kg

60
Q

nasal dose of midazolam

A

0.2 mg/kg

61
Q

IM dose of midazolam

A

0.1-0.15 mg/kg

62
Q

oral dose of lorazepam

A

0.025-0.05 mg/kg

63
Q

oral ketamine dose

A

3-6 mg/kg

64
Q

nasal dose of ketamine

A

3 mg/kg

65
Q

rectal dose of ketamine

A

6-10 mg/kg

66
Q

IM dose of ketamine

A

2-10mg/kg

67
Q

oral dose of clonidine

A

0.004 mg/kg

68
Q

oral dose of fentanyl

A

0.010-0.015 mg/kg (10-15 mcg/kg)

69
Q

IM dose of morphine

A

0.1-0.2 mg/kg

70
Q

IM dose of meperidine

A

1-2 mg/kg

71
Q

nasal dose of sufenta

A

1-3mcg/kg

72
Q

nasal dose of fentanyl

A

1-2 mcg/kg

73
Q

midazolam half life

A

2 hrs - short acting

74
Q

advantageof midazolam

A

rapid uptake and elimination

75
Q

peak plasma concentration for midazolam

A

10 minutes after intranasal
16 minutes for rectal
53 inutes for oral

76
Q

IV dose of midazolam

A

0.025-0.1 mg/kg

77
Q

younger child may require higher or lower doses of midazolam?

A

higher

78
Q

IV dose of morphine for preop pain

A

0.05-0.1 mg/kg

79
Q

oral dose of fentanyl for premedication

A

10-15 mcg/kg (onset 10 minutes)

80
Q

intranasal dose of fentanyl usually given when?

A

after induction

81
Q

intranasal dose of sufentanil for premed

A

1.5-3 mcg/kg

82
Q

ketamine does what

A

dissociation of cortex from limbic system

preserves upper airway and respiratory drive

83
Q

disadvantage of ketamine

A

sialorrhea
nystagmus
psychological reactions (consider use of midazolam and glyco)

84
Q

use of anticholinergics

A

prevent bradycardia
minimize autonomic vagal effects
reduce secretions

85
Q

side effects of anticholinergics

A

dry mouth, skin erythema, tachycardia, hyperthermia

86
Q

which anticholinergics cross the BBB?

A

atropine and scopolamine

87
Q

which anticholinergic does not cross the BBB

A

glycopyrrolate

88
Q

dose of atropine

A

0.01-0.02 mg/kg

89
Q

glyco dose

A

0.01 mg/kg

90
Q

are the doses of acetaminophen used in anesthesia toxic?

A

rarely

91
Q

dose for acetaminophen for myringotomies

A

10-15 mg/kg

92
Q

dose of acetaminophen for T&A

A

preop 40 mg/kg + 20 mg rectally in 2 hrs

total 24 hr dose not >100mg/kg

93
Q

ofirmev dose for >13 year old or >50kg

A

1000 mg q 6 hrs or 650 mg q 4hrs

94
Q

2 yo or < 50 kg

A

15 mg/kg q 6 hrs or 12.5 mg q 4 hrs

Thurman (5 decks)

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