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Peds S. Horvath > peds anesthesia 2018 Rachel > Flashcards

peds anesthesia 2018 Rachel Flashcards

1
Q

pre-term

A

prior to 37 weeks gestational age

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2
Q

neonate

A

1-28 days of life

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3
Q

infant

A

28 days - 1 year

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4
Q

child

A

> 1 year

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5
Q

most significant transition occurs when?

A

first 24-72h after birth

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6
Q

what are 4 main adaptive changes

A

establish FRC, convert circulation, recover from birth asphyxia, maintain core temo

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7
Q

what is the % for fetal hb

A

70-90%

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8
Q

what is the Hgb for full term neonate

A

18-20g/dl

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9
Q

the fetal hgb shifts the oxyhemoglobin dissociation curve to the left, meaning…

A

increased 02 loading in the lungs/placenta, decreased unloading at the tissues. (remember left=love, right=release, so decreased unloading)

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10
Q

what happens in the fetal lungs at 4 weeks

A

primitive lung buds develop from forgut

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11
Q

what happens in the fetal lungs at 16 weeks

A

branching of bronchial tree complete to 28 divisions, no further formations of cartilaginous airways

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12
Q

what happens in the fetal lungs at 24 weeks

A

primitive alveoli (saccules) and type 1 cells are present; surfactant is detectable, and survival is possible with artificial ventilation

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13
Q

what happens in the lungs 28-30 weeks

A

capillary networks surrounds saccules; unsupported survival

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14
Q

what happens in the lungs 36-40 weeks

A

true alveoli present, roughly 20 million at birth

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15
Q

lungs birth - 3 months

A

pa02 rises are R to L mechanical shunts close

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16
Q

lungs up to 6 years

A

rapid increase in alveoli at 350 million at age 6

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17
Q

does guppy breathing in utero respond to chemical stimuli ?

A

yes

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18
Q

what have fetal lamb studies shown

A

can remove all of the chemoreceptors and they will still breathe, but if you de-enervate the diaphragm, they will not breathe.

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19
Q

normal ABG for mother at term

A

7.4 90 30

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20
Q

normal ABG for umb vein placenta–> fetus

A

7.35 30 40

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21
Q

normal ABG for umb artery fetus —> placenta

A

7.3 20 50

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22
Q

normal ABG for newborn at 10 min

A

7.2 50 50

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23
Q

normal ABG for newborn at 1 hr

A

7.35 60 30

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24
Q

normal ABG for newborn at 24h

A

7.35 70 30

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25
Q

the primary event for resp system transition is

A

initiation of ventiliation

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26
Q

in order to inflate the lungs what does the infant need

A

high negative pressure, -70mmHg

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27
Q

with the onset of ventilation, what happens to PVR and pulm blood flow

A

PVR decreases and blood flow increases

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28
Q

with the onset of ventilation what happens to PO2, CO2

A

Po2 up, CO2 down

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29
Q

what is the FRC in newborn

A

25-30ml/kg

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30
Q

why dont infants have lung collapse all of the time

A

because infants terminate the expiratory phase of breathing before reaching their true FRC which results in intrinsic PEEP and higher FRC

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31
Q

how to do you prevent lung collapse in an infant

A

want at least PEEP 5cm/h20

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32
Q

when is respiratory control system normal in neonate

A

3-4 weeks

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33
Q

how do infants respond to hypercarbia at birth

A

increasing ventilation, but the slope of the response curve is decreased.

34
Q

hypoxia ___ the neonate’s response to CO2

A

depresses

35
Q

response to hypoxia is biphasic meaning

A

initial hyperpnea followed by depression of resp in about 2 min

36
Q

what abolishes the initial hyperpneic response

A

hypothermia and low levels of anesthetic gases

37
Q

by __ weeks of age, hypoxia produces sustained hyperventailiton

A

3

38
Q

what is apnea of infancy defined as

A

resp pauses exceeding 20 sec or those accompanied by bradycardia or cyanosis

39
Q

type 1 muscle fibers in diaphragm are __ and make up ___ in infant and ___ in adult

A

fatigue resistant , 25%, 55%

40
Q

when the umbilical cord is cut, SVR is ___.

A

increased

41
Q

during onset of breathing, PVR is ___

A

decreased

42
Q

how many adults have a PFO

A

25-30%

43
Q

physiologic closure of shunts happens in

A

10-15 hours

44
Q

anatomic closure of shunts happens in

A

2-3 weeks

45
Q

what are the 3 shunts

A

foramen ovale, ductus arteriosus, and ductus venosus

46
Q

when shunts close, flow through FO and DA becomes __ to __

A

left to right

47
Q

in utero, PVR is ___ and SVR is ___

A

high, low

48
Q

born - PVR is ___ and SVR is ___

A

low, high

49
Q

PPHN is

A

persistant pulm htn of the newborn.

50
Q

PPHN is the persistence of ___ beyond the normal transition period in absence of ____

A

fetal shunting , structural heart defect.

51
Q

etiology of PPHN is

A

hypoxia and acidosis

52
Q

before anatomic closure of the fetal shunts, transient ____ to ____ shunting may occur in normal neonates during coughing bucking or straining during induction or emergence

A

right to left

53
Q

PPHN tx

A

adequate ventilation and oxygenation - hyperventilation (maintain alkalosis), pulmonary vasodilators (prostaglandin), minimal handling, avoidance of stress

54
Q

what is the function of the renal system in a fetus

A

passive production of urine which contributes to the formation of amniotic fluid.

55
Q

2 characteristics of the fetal kidney

A

low renal blood flow, low GFR

56
Q

the renal system in a neonate - systemic pressure is ___ and RVR is ___

A

low, high

57
Q

newborn renal - systemic pressure ___ and RVR ___

A

rises, falls

58
Q

by __ weeks all nephrons are developed

A

34

59
Q

why cant an infant concentrate urine?

A

immature neonatal tubules do not completely reabsorb NA under teh stimulus of aldosterone - so the neonate will continue to excrete NA even in the presence of a severe Na deficit. neonate is an “obligate sodium loser”

60
Q

urine osmolarity at birth

A

700-800

61
Q

creatinine at birth

A

0.8-1.2 mg/dl

62
Q

in the first week of life, what percentage of filtered NA can neonates conserve

A

70%

63
Q

in the second week of life, what percentage of filtered NA can neonates conserve

A

84

64
Q

neonate urine na level

A

20-25 meq/L

65
Q

maintenance fluid for a baby should be

A

d5.2NS (need the glucose!)

66
Q

lowest acceptable hct

A

35% because of high o2 demand with limited ability to increase CO

67
Q

do not let hemoglobin fall below

A

10

68
Q

___ ml/kg blood volume in term baby

A

90

69
Q

___ ml/kg blood volume in pre-term baby

A

100

70
Q

neonates and infants have an ___ blood volume and cardiac output per unit weight

A

increased

71
Q

two stages of heat loss in an infant

A

transfer of heat from body core to skin surface (internal temp gradient) and dissipation of heat from skin surface to the environment (external heat gradient)

72
Q

how do you prevent convection in a neonate

A

reduce air movement across body surface

73
Q

how do you prevent radiation in a neonate

A

warm operating room - radiant lamps

74
Q

how do you prevent evaporation in neonate

A

cover exposed body cavities, heat and humidify inspired gases

75
Q

non shivering thermogenesis is metabolism of

A

brown fat

76
Q

brown fat develops in the fetus between ____ weeks gestation

A

26-30

77
Q

brown fat comprises ___% of the neonates total body

A

2-6%

78
Q

non-shivering thermogenesis occurs with ___ stress and is mediated by the ___

A

cold, SNS

79
Q

heat produced during non-shivering thermogenesis is a product of

A

fatty acid metabolism

80
Q

cold stress causes ___ surfactant production which causes

A

decreased, collapse of alveoli and reopening of fetal circulation

Peds S. Horvath (2 decks)

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