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Thurman > Pediatrics Part 3 > Flashcards

Pediatrics Part 3 Flashcards

1
Q

Risk of aspiration is increased with this population

A 
developmentally delayed
GERD
previous esophageal surgery
difficult airway
obese
traumatic injury
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2
Q

Dose for bicitra (antacid)

A

30mL (0.5-1mL/kg up to 30mL)

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3
Q

dose for metoclopramide (prokinetic)

A

0.1-0.15 mg/kg

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4
Q

dose for cimetidine (H2 antagonist)

A

5-10mg/kg

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5
Q

dose for ranitidine (H2 antagonist)

A

2-2.5 mg/kg

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6
Q

dose for famotidine (H2 antagonist)

A

0.3-0.4 mg/kg

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7
Q

factors that affect FA/FI ratio

A 
inspired anesthetic concentration
inhalation agent blood gas partition coefficient
alveolar ventilation
cardiac output
distribution of CO to vessel rich organs
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8
Q

neonates have a ___ MAC

A

lower

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9
Q

infants (1-6mo) have a ____ MAC

A

higher

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10
Q

MAC ____ with ____ age

A

MAC decreases with increasing age

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11
Q

Inhalation induction is more ___ in pediatrics

A

rapid

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12
Q

inhalation induction is associated with a ___ incidence of myocardial depression than in aduts

A

higher

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13
Q

MAC of sevo for 0-6 mo

A

3-3.2% in O2

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14
Q

MAC of sevo 6mo-1yr

A

2.5-2.8%

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15
Q

what is the inhalation agent of choice for pediatrics

A

sevo

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16
Q

sevo has what effect on respirations

A

depresses MV; at deeper levels depresses RR

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17
Q

myocardial depression is dependent on what in Sevo

A

concentration

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18
Q

inhaltion induction with Iso is associated with what?

A

breath holding, coughing, laryngospasm

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19
Q

there is a dose dependent decrease in these parameters in infants

A

HR, BP, MAP

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20
Q

MAC of Iso in infants and children

A

1.6% in O2

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21
Q

MAC of Des for infants

A

9%

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22
Q

MAC of Des for children

A

6-10%

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23
Q

What has the lowest blood gas coefficient?

A

Des (0.42)

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24
Q

What is inhalation induction with Des associated with?

A

breath holding, laryngospasm, coughing, increased secretions (too pungent for inhalation)

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25
Q

When is des appropriate in children?

A

maintenance

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26
Q

which IV anesthetic has a rapid onset, short duration of action and decreases the incidence of post op N/V

A

propofol

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27
Q

dose for propofol in infants

A

2.5-3mg/kg

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28
Q

dose of propofol for children

A

2-2.5 mg/kg

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29
Q

ED50 for propofol for infants (1-6mo)

A

3 +/- 0.2 mg/kg

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30
Q

ED50 for propofol for children (1-12 yrs)

A

1.3-1.6 mg/kg

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31
Q

ED50 for children (10-16 yrs)

A

2.4 +/- 0.1 mg/kg

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32
Q

what is appropriate for pretreating pain associated with injection of propfol?

A

lidocaine

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33
Q

propofol infusion syndrome is associated with what?

A

lactic acidosis
rhabdo
hyperkalemia
lipidemia

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34
Q

which induction drug is associated with lipid solubility and rapid distribution?

A

ketamine

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35
Q

onset of anesthesia with ketamine after IV doses?

A

30 seconds

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36
Q

IV dose of ketamine for induction

A

1-3mg/kg

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37
Q

IM dose of ketamine for induction

A

5-10mg/kg

38
Q

duration of action of ketamine

A

5-8 minutes

39
Q

sedation dose for ketamine IV

A

0.25-0.5 mg/kg

40
Q

sedation dose for ketamine IM

A

1-2mg/kg

41
Q

contraindications for ketamine

A

intracranial hypertension

corneal laceration

42
Q

induction dose of etomidate

A

0.2-0.3 mg/kg IV

43
Q

injection of etomidate is associated with what?

A

pain

44
Q

what is the induction agent of choice for critically ill infants?

A

etomidate

45
Q

nondepolarizing paralytics are associated with what pharmacokinetic properties?

A

highly ionized

low lipophilicity

46
Q

nondepolarizers are associated with a ____ release of acetylcholine

A

slower

47
Q

acetylcholine receptors are ____ sensitive to nondepolarizers

A

more

48
Q

when does the NMJ mature?

A

after 2 months

49
Q

___ plasma level is required to achieve clinical level of blockadge with nondepolarizers

A

lower (does not mean lower dose)

50
Q

onset of action of nondepolarizers is ____ in neonates

A

faster

51
Q

what contributes to less redosing of nondepolarizers?

A

large volume of distribution and slower clearance

52
Q

what muscle is the most reflective of diaphram activity?

A

adductor pollicis

53
Q

infants are ___ resistant to succinylcholine than adults

A

more

54
Q

onset of action of succs in infants

A

3 mg/kg (30-40 seconds)

55
Q

onset of action of succs in children

A

1 mg/kg (35-55 seconds)

56
Q

what is recommended to avoid arrhythmias with the administration of succs

A

vagolytic

57
Q

what is recommended as a rescue drug (laryngospam) or emergency intubation of children < 8 years old?

A

succs

58
Q

intubating dose of succs for infants

A

3 mg/kg

59
Q

intubating dose of succs for children

A

1.5-2 mg/kg

60
Q

intubating dose of cisatracurium for infants

A

0.1 mg/kg

61
Q

intubating dose of cisatracurium for children

A

0.1-0.2 mg/kg

62
Q

intubating dose of atracurium for infants

A

0.5 mg/kg

63
Q

intubating dose for atracurium for children

A

0.5 mg/kg

64
Q

intubating dose for roc in infants

A

0.25-0.5mg/kg

65
Q

intubating dose for roc in children

A

0.6-1.2 mg/kg

66
Q

intubating dose for pan in infants

A

0.1 mg/kg

67
Q

intubating dose for pan in children

A

0.1mg/kg

68
Q

intubating dose for vec in infants

A

0.07 - 0.1 mg/kg

69
Q

intubating dose for vec in children

A

0.1 mg/kg

70
Q

clinical signs of recovery from neuromusclar blockade

A

flexing of arms
lifting legs and flexing thighs to abdomen
normal response to nerve stimulation
-32 H2O inspiratory force = leg lift

71
Q

what corresponds to leg lift?

A

-32 H2O inspiratory force

72
Q

dose for neostigmine for TOF with fade

A

20-25 mcg/kg + atropine 10-20 mcg/kg or glyco 5-10 mcg/kg

73
Q

neostigmine dose may be repeated up to what dose?

A

70 mcg/kg

74
Q

what physical findings should be considered when evaluating for difficult airway

A 
mouth, neck, head
facial skeletal features
size and shape of mandible and maxilla
absence of dentition
size of tongue in relation to oral cavity
presence of loose dentition
ROM of neck
75
Q

what history should be considered when evaluating for difficult airway

A

snoring
difficulting breathing with feeding
current or recent URI
past history of croup

76
Q

should previous anesthesia records be evaluated for difficult airway?

A

duh.

77
Q

guidelines for potential difficult airways

A

avoid NMBs
have variety of equipment ready
consider awake fiberoptic, sedation, anesthetizing spray, inhalation induction
after deep plane of anesthesia- O2 100%
glyco or atropine to decrease secretions
maintain SV
use external manipulation of trachea to improve view
have glidescope, fast-track LMA, light want (?), blind nasal, cricothyrotomy ready
use difficult airway algorithm

78
Q

what are signs of alertness for emergence and extubation

A

grimacing, eye opening, purposeful movement

79
Q

when are patients more prone to laryngospasm?

A

extubation

80
Q

when is it best to extubate children?

A

after fully awake

81
Q

when should deep extubations be performed?

A

after suctioning of oropharynx and stomach in patients with normal airway and empty stomach

82
Q

how should child be positioned after extubation?

A

lateral

83
Q

what is recommended for transfer of children to PACU?

A

supplemental O2

84
Q

early stage of awake extubation

A

intermittent cough and gag; nonpurposeful movement

85
Q

middle stage of awake extubation

A

unresponsive, apneic, agitated, breathholding, desaturate

86
Q

late state of awake extubation

A

quitet, spontaneous breathing, purposeful movement, coughing, grimacing, opening eyes

87
Q

deep extubation requires what MAC level?

A

1.5-2 & regular respirations

88
Q

deep extubation with sevo should be performed at what %?

A

3.6-5% end tidal & regular respirations

89
Q

true or false, timing of LMA removal affects the incidence of upper airway adverse events

A

false; does not affect adverse events

90
Q

what increases risk of upper airway adverse events with LMA removal?

A

URI
specific volatile agent
surgery

91
Q

Who recommends removal of LMA when pt is fully awake

A

Barash

92
Q

emergence delay could be the result of what?

A

drug overdoses
increased sensitivity to drugs
failure to reduce anesthetic
presence of hypothermia

Thurman (5 decks)

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