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NUNA 692 Principles III > Peds A&P anesthesia considerations > Flashcards

Peds A&P anesthesia considerations Flashcards

1
Q

organogenesis

A

1st 8 gestational weeks

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2
Q

rapid growth during the _____ trimester

A

2nd

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3
Q

weight increase (both sub-cu and muscular) during the _____ trimester

A

3rd

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4
Q

preterm

A

< 37 weeks

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5
Q

term

A

37-42 weeks

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6
Q

post-term

A

> 42 weeks

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7
Q

low birth weight (LBW)

A

< 2,500 grams

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8
Q

very low birth weight (VLBW)

A

< 1,500 grams

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9
Q

extremely low birth weight (ELBW)

A

< 1,000 grams

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10
Q

micro-preemie

A

< 750 grams

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11
Q

babies can be _____, ______, or _______ for gestational age

A

small (SGA), appropriate (AGA), or large (LGA)

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12
Q

gestational age is assessed by _________, 1st trimester, ultrasound

A

crown-rump length

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13
Q

gestational age assessed by

A

1st day of LMP

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14
Q

most accurate assessment of gestational age AFTER birth

A

Dubowitz score (combo of physical and neurologic characteristics to estimate gestational age)

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15
Q

Dubowitz score physical characteristics

A

ear, skin, sole of foot, breast tissue, genitalia

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16
Q

Dubowitz score neurologic characteristics measured

A

tonicity, grasp, moro, sucking, reflexes

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17
Q

growth measurements on ex-preemies:

A

corrected gestational age (not chronological age)

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18
Q

corrected gestational age on ex-preemies should be used until child is

A

2 years old

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19
Q

ex: child born at 28 weeks gestation and is now 6 chronological months (24 weeks) old, that same child is

A

52 post-conceptional weeks

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20
Q

for the 52 post-conceptual week old child, a growth plot for a ________ should be used

A

3 month old (12 weeks)

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21
Q

failure to thrive (FTT) definition

A

significant failure to reach average weight for age

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22
Q

FTT causes:

A
  • genetics (parents, chromosomal disorders)
  • nutrition (malabsorption syndromes, CF)
  • congenital malformations (cardiac, urinary)
  • infection
  • metabolic/endocrine disorders (hypothyroid)
  • prematurity
  • malignancy
  • bronchopulmonary dysplasia
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23
Q

current age of viability

A

23 - 24 weeks

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24
Q

at age of viability (23 - 24 wks), lungs have developed gas-exchanging ______ and _______

A

surface and surfactant

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25
Q

airways:

A

bronchial tree down to terminal bronchioles formed by the 16th week

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26
Q

alveoli:

A

present at birth with continued proliferation up to 8 years of age

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27
Q

pulmonary vasculature:

A

bronchial tree by 16th week, complete at late adolescence

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28
Q

glandular stage (___-___ weeks): segmental airways, vessels, cartilage differentiation in the ______ and ______

A

7 - 16 weeks
trachea and bronchi

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29
Q

CANALICULAR STAGE (___-___ wks): formation of gas exchanging surface and ______ ______

A

16 - 24 weeks
surfactant production

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30
Q

surfactant production is by

A

type II pneumocytes

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31
Q

alveolar stage (___-___ wks): surface area grows quickly, membrane thins, and _______ levels in ______ ______ become indicator of lung maturity

A

24 weeks to term
surfactant
amniotic fluid

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32
Q

3rd week of gestation: ________ is formed, connects to arterial and venous systems, _____ divides

A

heart tube
aorta

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33
Q

bronchial arteries develop between ___-___ wks

A

9 - 12

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34
Q

7th week of gestation ______ ______ in place

A

fetal circulation

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35
Q

main pulmonary artery goes to ______

A

lungs

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36
Q

patent ductus arteriosus (PDA) goes to ____

A

aorta

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37
Q

lungs go to pulmonary veins and then to ______ _____

A

left atrium

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38
Q

fetal circulation is ______ circuits not ______ like adults

A

parallel
series

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39
Q

right and left ______ provide systemic flow

A

ventricles

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40
Q

oxygenated blood from the placenta enters the fetus through the _____ _____

A

umbilical vein

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41
Q

most of the newly oxygenated blood bypasses the liver via the ____ _____

A

ductus venosus

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42
Q

and combines with deoxygenated blood in the ______ ______ ______

A

inferior vena cava

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43
Q

blood then joins deoxygenated blood from the ______ _______ ______ and empties into the right atrium

A

superior vena cava

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44
Q

since the pressure in the right atrium is larger than the pressure in the left atrium, most blood will be shunted through the ______ _____

A

foramen ovale (PFO)

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45
Q

some blood does travel from the right atrium to the right ventricle through the pulmonary trunk but most blood bypasses the pulmonary arteries and moves directly to the aorta via the ______ ______

A

ductus arteriosus (PDA)

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46
Q

deoxygenated blood returns to the placenta via the ______ ______ originating from the internal iliacs near the bladder

A

umbilical arteries (2)

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47
Q

must know 3 shunts:

A
  1. ductus venosus
  2. PFO
  3. PDA
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48
Q

transition to air critical event:

A

1st gasp

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49
Q

huge distention of pressure —> fluid movement out of the _____ —> increasing pulmonary blood flow —> increase in _______ ______

A

alveoli
pulmonary oxygenation

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50
Q

decreased ______ and increased ______ leads to closure of the foramen ovale and reversal of shunt through ductus arteriosus

A

PVR
SVR

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51
Q

INCREASED PVR d/t hypoxia and/or acidosis leads to persistent fetal circulation (PFC) with pulmonary HTN and results in _____-_____ _______

A

right-left (cyanotic) shunting

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52
Q

physiologic right-left shunting occurs for several hours after birth until:

A

unexpanded regions of lung are ventilated

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53
Q

infant accessory muscles are _____ and ______

A

weak and ineffective

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54
Q

chest wall is floppy due to high amount of ______, little _______, and poorly developed _______

A

cartilage, little calcification, and poorly developed musculature

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55
Q

low level of ______ fibers (_____ fibers) leading to easy respiratory fatigue/failure

A

Type I (slow twitch/marathon fibers)

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56
Q

_____ ______ lowest at infancy, peaks in adolescence, then declines

A

elastic recoil

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57
Q

elastic recoil is BIG determinant of _____ _____ ______

A

static lung volume

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58
Q

_____ ____ ______ is low d/t weaker, inefficient inspiratory muscles

A

total lung capacity (TLC)

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59
Q

_______ ______ ______ is similar on a per kg basis at all ages

A

functional residual capacity (FRC)

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60
Q

BUT - low _____ _____ puts FRC at 10% predicted instead of near 40% predicted in adults

A

elastic recoil

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61
Q

NET RESULT of low elastic recoil - apnea leads to a disproportionate low _____ ______ leading to ____ _______

A

O2 reserve
rapid hypoxemia

reason for rapid desaturation in infants with airway loss

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62
Q

______ ______ cannot be measured in children < 5 years old

A

closing volume

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63
Q

infants probably have some closed peripheral airways throughout tidal breathing leading to ______ _____ ______

A

trapped gas volumes

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64
Q

r/t airway dynamics high ______ in newborns, even higher in preemies

A

resistance

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65
Q

resistance decreases markedly in the _______ airways (_____ generations) around 5 years of age

A

peripheral airways (> 12th generation)

reason for severe resp impairment in very young children with only minimal airway inflammation (bronchiolitis)

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66
Q

tracheal compliance ____ higher in infants increasing the risk for _____ _____

A

2x
tracheal collapse

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67
Q

regulation of breathing - _____ is the driver

A

CO2

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68
Q

increased ______ causes increased Vt and RR

A

PaCO2

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69
Q

decreased ____, ____, and _____ stress leads to decreased ventilatory drive

A

decreased BG, Hct, and cold stress

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70
Q

hering-breuer reflex:

A

lung inflation causes induced apnea (often seen with positive pressure extubation)

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71
Q

periodic breathing:

A

5 - 10 second pauses followed by bursts of increased breathing

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72
Q

periodic breathing must be differentiated from ______

A

apnea

73
Q

apnea is:

A

prolonged pauses leading to desaturation, bradycardia, and hypotonicity

74
Q

apnea is common in ______ and can be severe in ______ _____

A

preemies
extreme preemies

75
Q

apnea may self resolve or it may require:

A

tactile stimulation or bag-mask ventilation

76
Q

apnea can be treated with ________ that increase central ventilation drive, _____ for chest-wall stabilization or _______

A

theophyllines
CPAP
stimulation

77
Q

apnea of _______ has HUGE anesthesia implicaitons

A

prematurity

78
Q

highest risk at ______ post-conceptual age

A

< 55 weeks PCA

79
Q

if premature is < 55 weeks, they must be ______ _______ for ________

A

admitted post-op for monitoring

80
Q

example: ex-28 weeker, now 5 months old, presents for hernia repair, admit post-op?

A

YES but this applies to PRE-TERM INFANTS ONLY

81
Q

infant O2 consumption is _______

A

higher than adults

82
Q

infants increase their alveolar ventilation through ______ _____ ______

A

increasing respiratory rate

83
Q

PaO2 is _______ in neonates

A

decreased

84
Q

but they compensate with increased _____ _____ ______

A

O2 carrying capacity

85
Q

fetal Hgb is _____ of total Hgb

A

50%

86
Q

_____ shifted O2 hgb dissociation curve

A

LEFT

87
Q

PaO2 gradually ______ throughout childhood, _____ in adolescence, and gradually _______ throughout adulthood

A

increases
peaks
decreases

88
Q

wide variation in _____ _____

A

normal HR

89
Q

newborn mean HR

A

120 bpm

90
Q

1 month old mean HR

A

160 bpm

91
Q

mean adolescence HR

A

75 bpm

92
Q

6 week - 1 year mean systolic BP

A

99 mmHg

93
Q

1 year - 6 years mean SBP

A

minimal change

94
Q

> 6 years mean SBP

A

gradual rise to adult mean

95
Q

measuring cardiac output (3)

A
  1. Fick (O2 extraction) method
  2. PAC (rarely used d/t shunting)
  3. DOPPLER ECHOCARDIOGRAPHY
96
Q

resting CO is ______ that of an adult

A

2-3x

97
Q

probably d/t increased _____ _____ and ______ ______

A

metabolic rate and O2 consumption

98
Q

increased O2 consumption probably d/t ____ ____

A

heat loss (relatively larger surface area to body mass)

99
Q

____ ______ increases with age (EKG)

A

PR interval

100
Q

____ _______ increases with age (but > 0.10 always ______)

A

QRS duration
pathologic

101
Q

QRS axis ____ at birth

A

right

102
Q

QRS axis rotates _____ during 1st month

A

Left

103
Q

in utero, large urine volumes make up ____ ______

A

amniotic fluid

104
Q

in utero, homeostasis maintained by _____

A

placenta

105
Q

at birth, GFR is _____ of adult value - adult value attained by _____ _____

A

< 30%
2 years

106
Q

decreased GFR leads to poor excretion of _____, _____, and _____

A

Na+, H2O, and drugs

107
Q

_____ poorly reserved leading to physiologic ______

A

bicarbonate
acidosis

108
Q

infants can maintain normal _____

A

BUN

109
Q

increased BUN signifies _____ _____ or other ______

A

renal failure
illnesses

110
Q

kidneys can grow into ______

A

adulthood

111
Q

so removed or damaged kidney can lead to ______ of remaining kidney with ______ of total fxn

A

hypertrophy
takeover

112
Q

biliary tract is completed at ______ gestation

A

10 weeks

113
Q

placental blood goes through _____ _____ bypassing the _____ and to the IVC

A

ductus venosus
liver

114
Q

_____ _____ closes soon after birth

A

ductus venosus

115
Q

liver function is _____ in newborns

A

immature (worse in preemies)

116
Q

at term, glycogen stores are _______, but preemies are at risk of _______

A

adequate
hypoglycemia

117
Q

protein synthesis in _______ (a -fetoprotein)

A

liver

118
Q

the proteins needed for clotting are _____ for the 1st few days

A

low (poor clotters, need Vit K)

119
Q

drug ______ and _______ altered in newborns

A

metabolism and binding

120
Q

immature _______ ______ system, less protein

A

cytochrome P-450

121
Q

non-hemolytic physiologic hyperbilirubinemia:

A

increased bilirubin production d/t RBC breakdown and deficient conjugation (immature liver)

122
Q

worsened by

A

breast-feeding

123
Q

other causes:

A
  • Rh/ABO incompatibility
  • inherited blood disorders
  • infection
  • biliary atresia
  • stress
124
Q

treatment:

A
  • can self-resolve
  • phototherapy
  • exchange transfusion (if extreme)
125
Q

kernicterus:

A

encephalopathy d/t increased bilirubin

126
Q

highest risk for kernicterus

A

preemies

127
Q

commonly seen: ______ ______ in preemies and LBWs d/t long term TPN

A

cholestatic jaundice

128
Q

preemies tolerate protein loads _____

A

poorly

129
Q

at 5-7 wks gestation, GI tract “_____ and _____” into abdominal position

A

migrates and rotates

130
Q

duodenal motility matures between ____-____ weeks gestation

A

29 - 32

131
Q

GI anomolies

A
  • esophageal atresia
  • tracheoesophageal atresia/fistula (TEF)
  • intestinal atresia/stenosis
  • hirschprung’s
  • meckel’s
  • omphalocele
  • gastroschisis
132
Q

______ requires neuromuscular coordination that is poorly developed in preemies

A

swallowing

133
Q

peristaltic waves are absent in infant’s ____ _____ leading to spitting

A

lower esophagus
(even in term newborns)

134
Q

_____ damage leads to inadequate swallowing

A

CNS

135
Q

_____ of newborns have reflux for several days

A

40%

136
Q

severe cases of reflux:

A
  • persistent vomiting
  • failure to thrive
  • hematemesis
  • anemia
  • strictures
137
Q

GE/reflux can cause ____/______ in preemies

A

apnea/bradycardia

138
Q

meconium should be passed in the 1st ______

A

48 hours

139
Q

late meconium passage could be d/t:

A
  • ileus
  • atresia
  • hirschprung’s
  • imperforate anus
  • cystic fibrosis
140
Q

NEWBORN NIGHTMARE

A

meconium aspiration

141
Q

meconium aspiration causes:

A
  • pneumonia
  • PTX
  • persistent pulm HTN (PPHN) - failure to convert from fetal circulation resulting in severe hypoxemia, hypercarbia, acidosis
142
Q

maternal hyperglycemia leads to fetal pancreatic _____ and _____

A

hypertrophy and hyperplasia

143
Q

this leads to increased fetal _____

A

insulin

144
Q

and the newborn will be ____ and _____ at birth

A

large and overweight

145
Q

increased insulin levels at birth cause rapid ________ and must be closely monitored

A

hypoglycemia

146
Q

SGAs and preemies are easily hypoglycemic d/t poor _________ and decreased _____ _______

A

gluconeogenesis
glycogen stores

147
Q

maintain newborn glucose at

A

> 40 - 45

148
Q

can have extreme hypoglycemia without _______

A

symptoms

149
Q

hypoglycemia symptoms

A

jittery, lethargic, seizures

150
Q

preemies and LBWs also at risk for _______

A

hyperglycemia

151
Q

hyperglycemia can cause _____ ______ and ________

A

cerebral bleeding and infection

152
Q

avoid by keeping _____ _____ glucose level with pumps

A

steady state

153
Q

initial blood volume is dependent on ____ _____

A

cord clamping

154
Q

blood volume approx _______ with immediate clamping

A

80 ml/kg

155
Q

blood volume approx ________ with immediate clamping in preemies

A

90 ml/kg

156
Q

newborn Hgb:

A

14 - 20 g/dL
(when this drops, physiologic anemia occurs)

157
Q

newborn Hgb drops to ______ around 3 months and then begins to increase

A

10 g/dL

158
Q

greatest Hgb decrease happens in preemies at ______

A

2 months old

159
Q

this physiologic anemia is ________ _______ to extrauterine life

A

normal adjustment

160
Q

_____ shift of the oxyhemoglobin dissociation d/t increase in 2,3 DPB and replacement with adult Hgb

A

RIGHT
(anemia tolerated well)

161
Q

VLBWs may be treated with _______

A

erythropoietin

162
Q

normal Hgb from 3 months - 2 years:

A

12 g/dL

163
Q

neonates have immature _____ leading to increased risk of ________

A

WBCs
infection

164
Q

________ common in preemies

A

thrombocytopenia

165
Q

mechanical ventilation and artificial membranes (ECMO) lead to _______

A

thrombocytopenia

166
Q

polycythemia (HCT ____) may require partial exchange transfusion d/t decreased ______, increased ___ ______, and _____ _____

A

Hct > 65%
viscosity
O2 transport
blood flow

167
Q

newborns have decreased ____ ____ dependent factors

A

vitamin K

168
Q

Vit K dependent factors:

A

II, VII, IX, X

169
Q

all newborns should receive ____ ____ _____

A

vitamin K injection

170
Q

surgery during 1st week without exogenous Vit K can be ___-_____

A

life-threatening

171
Q

decreased perinatal mortality has NOT decreased _____ _____

A

cerebral palsy (CP)

172
Q

CP predictors:

A
  • congenital anomalies
  • decreased placental birth weight
  • fetal position
  • perinatal asphyxia
173
Q

malnutrition during the 1st two years of life can cause impaired _______ leading to ______

A

myelination
handicapping

174
Q

_____, ______, ______ cause blood brain barrier breakdown leading to neurologic damage

A

hypoxia, ischemia, edema

175
Q

developmental milestones may ____

A

vary

176
Q

_____ _____ ______ frequently used

A

Denver Developmental Screening

177
Q

preemies WILL BE _______

A

delayed
assess by conceptual age not chronologically

178
Q

children and adults with CP and/or sensory/motor deficits can have _______ cognitive fxn

A

NORMAL

179
Q

drug interactions, hepatic (and renal) fxn and enzyme induction must be considered

A

NUNA 692 Principles III (20 decks)

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