Pediatrics Part 4 Flashcards
perioperative fluid homeostasis is altered by
volatile agent
OR temp
iatrogenic hyperventilation
surgical stress
GA modifies which aspect of fluid balance
neuroendocrine control
surgical effect on fluid balance depends on what?
procedure
preop fluid deficit calculation
NPO hrs x maintenance fluid rate
maintenance fluid rate for 0-10kg
4 mL/kg/hr
maintenance fluid rate for 10-20kg
40mL + 2mL/kg/hr for each kg > 10
maintenance fluid rate for >20kg
60mL + 1mL/kg/hr for each kg >20
minimal third space losses
add 3-4 mL/kg/hr
moderate third space losses
add 5-6 mL/kg/hr
major third space losses
add 7-10 mL/kg/hr
what type of IV fluids are preferred?
glucose free; typically LR
critically ill patient or weight < 10 kg are at risk for what
hypoglycemia
crystalloids do not produce what?
allergic reactions
LR mOsm/L
273
Na of LR
130 mEq
K of LR
4
Ca2 of LR
3
Cl of LR
109
HCO3 of LR
28
Estimated blood volume of premie
90-100mL/kg
EBV of ful term infant
80-10mL/kg
EBV of 3mo-3yr
75-80 mL/kg
EBV >6 yrs
65-70 mL/kg
Intravascular volume formula
wt (kg) x blood volume (mL)
true or false, minimum acceptable Hct varies with each child
true
for accurate blood loss values what should be weigheD?
drapes
sponges
towels
what is equivillent of 1 mL blood loss
1G of weight
ABL =
ABL= EBV x (H0-H1)/HA
blood loss is replaced with what?
crystalloids at a rate of 3 mL/mL
for blood loss < than ABL what rate should be used for replacement?
1 mL/mL
if blood loss is equal to or greater than ABL what should be used for replacement?
PRBCs
what volume of PRBCs should be adminstered to raise Hgb by 1g/dL
4mL/kg of PRBCs raises Hgb 1g/dL
formula for determining PRBC volume administered (Nagelhout)
(EBL-ABL) x desired crit (30%) / 75%
crit of PRBCs according to nagelhout
75%
formula for determing PRBC volume administered (Cote)
(desired crit- present crit) x EBV/60%
crit of PRBCs accoring to Cote
60%
when do patients require overnight stay (based on age)
< 36 weeks gestation
<60 weeks postconceptual
what increases the risk of postop N/V
motion sickness age volatile agent nitrous oxide opioids (risk increases with increased risk factors present)
decadron dose
0.0625 mg/kg (max 10mg)
odansetron
0.05-0.15 mg/kg
miller blade size for preterm and neonate
0
miller blade for neonate-2yrs
1
miller blade for 2-6 years
none
miller blade for 6-10 years
2
miller blade >10 years
2 or 3
Wis-Hipple blade for 2-6 years
1.5 (whatever the f that is)
Mac blade for 2-6 years
1 or 2
Mac blade for 6-10 years
2
Mac blade for > 10 years
3
size for unfuffed tube 1000g
2.5
uncuffed tube for 1000-2500 g
3.0
uncuffed tube for neonate-6 mo
3.0-3.5
uncuffed tube for 6mo-1yr
3.5-4.0
uncuffed tube for 1-2yrs
4.0-5.0
uncuffed tube for >2 yrs
(age in years + 16)/4
cuffed tube for neonate-6mo
3.0-3.5
cuffed tube for 6mo-1yr
3.0-4.0
cuffed tube for 1-2 yrs
3.5-4.5
cuffed tube > 2yrs
(age in years/4) + 3
approximate distance of insertion even with alveolar ridge- preterm < 1000g
6-7 cm
approximate distance of insertion even with alveolar ridge- preterm 1000-2000g
7-9 cm
approximate distance of insertion even with alveolar ridge- term newborn
9-10 cm
approximate distance of insertion even with alveolar ridge- 1 year
11-12 cm
approximate distance of insertion even with alveolar ridge- 2 years
12-13 cm
approximate distance of insertion even with alveolar ridge- 6 years
15-16 cm
approximate distance of insertion even with alveolar ridge- 10 years
17-18 cm
approximate distance of insertion even with alveolar ridge- 16 years
18-20 cm
approximate distance of insertion even with alveolar ridge- 20 years
20-22 cm
LMA (unique) for neonate up to 5 kg
3.5
LMA for infant 5-10 kg
4.0
LMA for infant children 10-20kg
4.5
LMA for children 20-30 kg
5.0
LMA for 30-50 kg
5.5
LMA for large adolescents 70-100 kg
6.0
LMA for anyone >100kg
N/A