Peds

Question 1

Peds - Postoperative Monitoring After Anesthesia

Answer 1

Do not require 24 hours monitoring if:
- Premature but > 60 weeks PCA (GA+current age)
- Term but > 44 weeks PCA

Question 2

CDH

Answer 2

Impaired lung tissue maturation –> intrapulmonary shunting and worsening of pHTN

pHTN causes extrapulmonary shunting (left to right through PDA +/- PFO

Avoid excessive PPV to avoid insufflating stomach and worsening compression on lung tissue (drop NG tube)

Question 3

Umbilical Line Placement

Answer 3

UVC: IVC/Atrial junction - can use as infrahepatic peripheral access if needed

UAC: iliohypogastric artery –> iliac –> aorta - should sit T7-T10 level ideally

Question 4

TEF Types

Answer 4

A: total esophageal atresia, no fistula
B: proximal fistula, no distal fistula
C: most common, distal fistula, proximal esoph atresia
D: distal and proximal fistula
E: H-type fistula

Question 5

Preinduction Anxiolysis for Pediatrics

Answer 5

Multiple routes of administration - PO, IV, IM, IN, PR
Shared decision making with parents for which is most likely to be successful
Midazolam, Dexmedetomidine, Ketamine, Fentanyl

Question 6

Why Faster Induction in Peds

Answer 6

Higher Minute Ventilation to FRC Ratio

Increased blood flow to vessel-rich groups

Blood/gas coefficient in neonates is lower

Question 7

Neonatal Temp Regulation

Answer 7

Non-shivering thermogenesis - brown fat metabolism (not very efficient)

Premature/sick infants have less fat, and volatile anesthetics blunt this process