Peds Flashcards
Why fluids are Not the initial treatment option hypotensionin neonates? and what would it be?
Infants have immature cardiac contractile mechanisms with poor lusitropy. Their cardiac output is relatively insensitive to increased preload as their stroke volume is relatively static. Heart rate in neonates, however, is highly variable and is the major determinant of cardiac output.
Atropine is an initial treatment option for the euvolemic neonate in response to hypotension.
Why bradycardia or hypotension in neonates is typically very responsive to atropine, not with exogenous catecholamines like Epi/NorEpi?
The autonomic nervous system of newborns is not mature. It is characterized by low catecholamine stores and poor responsiveness to exogenous catecholamines. Conversely, the parasympathetic nervous system is intact in newborns and predominates.
What gas analysis expected drawn from umbilical arterial vs venous vessels?
Umbilical ARTERIAL are carrying blood away from the fetus and that a normal sample will appear “venous.” Similarly, a normal umbilical VENOUS blood gas sample will appear “arterial” since it is carrying maternal arterial blood to the fetus. In fact, an umbilical venous blood gas sample can be used to assess the mother’s acid-base status.
Normal SBP in person? Formula
70+ [2x age] up to age of 10
90 after age of 10
Formula calculating systolic BP in <10 years old
70 + (2 x age )
After 10 years, SBP is 90 mmHg
Why infants have a higher uptake and faster induction with volatile anesthetics compared to adults?
due to their minute ventilation to FRC ratio.
Infants have a lower FRC compared with adults which provides less “air” to dilute the volatile anesthetic being breathed. However, the infant’s higher minute ventilation places more volatile anesthetic in the alveoli where it can be taken up.
the most effective medication to prevent post operative nausea and vomiting in children is …
Ondansetron
The number needed to treat (NNT) for dexamethasone is 4. A dose of 0.15 mg/kg is commonly employed.
The NNT for droperidol is 5, with a recommended dose of 10-15 mcg/kg.
The NNT for ondansetron is 2-3 at a dose of 0.1-0.15 mg/kg
Sub-hypnotic doses of propofol may also be beneficial to treat and prevent PONV, recommended dose is …
Doses studied include a 1 mg/kg bolus followed by an infusion of 20 mcg/kg/min. Adult doses of propofol for PONV treatment have a similar infusion rate with a lower initial bolus rate.
Why inhalation induction is faster in Peds?
inc. MV
increased MV/FRC ratio (5:1 in neonates, 1.5:1 in adults)
lower blood gas partition coeff.(faster rise in FA/FI)
lower tissue:blood partition coeff.
greater distribution of CO to vessel rich organs (inc. brain)
How to treat hypoxemia on induction with TOP patient?
Phenylephrine
It increases SVR and therefore LV pressure, decreasing the shunt fraction from right to left (cyanosis) due to RV outflow obstruction (RV pressure are high in setting of low LV pressure after induction, it increases portion of deoxygenated blood shunting from RV to LV across VSD).
