Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AP Summer > Pediatrics - Pyloric Stenosis & Neonatal Apnea > Flashcards

Pediatrics - Pyloric Stenosis & Neonatal Apnea Flashcards

1
Q

What is the incidence of apnea of prematurity when the child is less than 30 weeks gestation?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some contributing factors to apnea of prematurity?

A

CNS disease, Systemic illness, thermal/metabolic disturbances, airway anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 patterns of apnea?

A

Central: no airflow at nares and no muscular activity

Obstructive: muscular effort without nasal airflow

Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is ventilation regulated?

A 
Central rhythm (pattern) generator--root cause
Central chemoreceptors (CO2)
Peripheral chemoreceptors (O2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some possible causes of a less pronounced (flatter) CO2 response curve?

A

Prematurity
Flatter at 2 days than at 4 weeks postnatal age
Flatter in preterms with apnea than those without
Flatter during hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the premature infants ventilatory response to hypoxia?

A

Initial increase followed by a sustained decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

At what age does the sustained increase ventilatory response mature?

A

At 1 week in term infants and about 3 weeks in preterm infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What enhances the initial increase in ventilation?

A

CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What effects do halogenated anesthetics have on FRC and muscle tone?

A

Reduced FRC

Decreased muscle tone of airway, chest wall and diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What effect do halogenated anesthetics have on the CO2 response curve?

A

Dose-dependent decrease in slope and right shift of CO2 response curve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What effect do halogenated anesthetics have on the ventilatory response to hypoxia?

A

Depress ventilatory response to hypoxia (even at sub anesthetic doses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the post conceptual age?

A

Age since birth - weeks premature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of pharmacological prophylaxis could potentially be used to help with AOP?

A

Caffeine (not routinely used, but helpfun)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the recommendations for elective surgery for patients with AOP?

A

Delay elective surgery beyond 46 weeks post conceptual age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

At what age should infants be hospitalized and monitored with AOP?

A

<52 weeks PCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of emergency is pyloric stenosis?

A

Medical, not surgical

17
Q

Infants with pyloric stenosis should present to the operating room only after what has been normalized?

A

Adequate rehydration and normalized electrolytes

18
Q

Patients with pyloric stenosis are treated as at risk for what?

A

Aspiration

19
Q

What causes pyloric stenosis?

A

Hypertrophy of the muscularis layer of the pylorus

20
Q

What is the incidence of pyloric stenosis?

A

1: 300-500 live births
4: 1 male to female

21
Q

At what age does pyloric stenosis typically present?

A

2-6 weeks

22
Q

How does pyloric stenosis present?

A 
Recurrent vomiting
Varying degree of malnutrition/dehydration
Palpable "olive" in the epigastrium
Visible peristalsis
Bradycardia
Jaundice (5-10% of cases)
23
Q

How is pyloric stenosis confirmed?

A

Barium swallow or ultrasound

24
Q

What are the three main anesthetic considerations for a patient with pyloric stenosis?

A

Aspiration risk
Dehydration
Metabolic derangements

25
Q

What are the physical findings for 5% dehydration?

A

Poor tissue turgor, dry mouth

26
Q

What are the physical findings for 10% dehydration?

A

Sunken fontanelle, tachycardia, oliguria

27
Q

What are the physical findings for 15% dehydration?

A

Sunken eyeballs, resting hypotension

28
Q

What are the physical findings for 20% dehydration?

A

Stupor, coma

29
Q

What are the two main serum electrolyte disturbances associated with pyloric stenosis?

A

Hypochloremic metabolic alkalosis

Hypokalemia

30
Q

What happens to urine as potassium and chloride stores are depleted?

A

Urine becomes more acidic

31
Q

What are some important considerations for preoperative management of patients with pyloric stenosis?

A

Acute volume repletion for shock
Deficit replacement over 12-48 hours
Establish normal urine output
Normalize electrolytes

32
Q

What is the goal for normalizing chloride and bicarbonate pre operatively?

A

Cl > 90

HCO3 < 30

33
Q

How is the procedure for pyloric stenosis usually performed?

A

Laparoscopically

34
Q

What are some important anesthetic management considerations for a pyloric stenosis operation?

A

Evacuate stomach by suction
Pre-oxygenate and RSI or awake intubation
Avoid narcotics
Extubate awake

AP Summer (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions