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Peds Anesthesia > Peds Anesthesia and Perioperative Considerations > Flashcards

Peds Anesthesia and Perioperative Considerations Flashcards

1
Q

Pre-Term, Neonate, Infant and Child (days-years)

A

Pre-Term = prior to 37 weeks gestation
Neonate = 1-28 days
Infant = 28 days - 1 year
Child = > 1 year

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2
Q

Most significant part of transition occurs
within…….

A

first 24-72 hours after birth

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3
Q

4 Adaptive Changes

A

Establish FRC
Convert Circulation
Recover from birth asphyxia
Maintain core temperature

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4
Q

Where does fetal gas exchange occur?

A

PLACENTA

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5
Q

Fetal Hgb shifts oxyhemoglobin dissociation curve to the …..

A

LEFT!

-Increased O2 loading in the lungs/placenta, decreased O2 unloading at tissues]

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6
Q

O2 transport is accomplished by ______which totals _______.

A

fetal Hgb
70-90%

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7
Q

Hgb. full term neonate

A

18-20g/dl

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8
Q

Hgb does not go below …….

A

10!
0-30 days

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9
Q

4 Weeks fetal lung

A

primitive lung buds develop from foregut

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10
Q

Branching of bronchial tree complete to 28 divisions, no further formation of cartilaginous airways

A

16 weeks

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11
Q

primitive alveoli (saccules) and type II cells present; surfactant detectable; survival possible with artificial ventilation

A

24 weeks

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12
Q

capillary network surrounds saccules; unsupported survival

A

28-30 Weeks

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13
Q

true alveoli present, roughly 20 million at birth

A

36-40 Weeks

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14
Q

PaO2 rises as R to L mechanical shunts close

A

Birth-3 months

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15
Q

“Guppy Breathing in Utero” starts when?

A

From 30 weeks gestation, present 30% of the time at a rate of 60 breaths/min.

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16
Q

What are responsible for the decrease in neonatal PVR?

A

Changes in PO2, PCO2, and pH
-Increase in PO2, Decrease in CO2, Decrease in Pulmonary Vascular Resistance

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17
Q

The primary event of the respiratory system transition is ________.

A

INITIATION OF VENTILATION!

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18
Q

Infant must generate _____ negative pressure,
_____ cm H2O, to inflate the lungs

A

high
-70 cm H20

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19
Q

Established to act as a buffer against cyclical alterations in PO2 and PCO2 between breaths

A

FRC of approx. 25-30ml/kg

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20
Q

Why are neonate and infant lungs prone to collapse?

A

-Weak elastic recoil
-Weak intercostal muscles
-Intra-thoracic airways collapse during exhalation

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21
Q

What can help maintain FRC/lung inflation in the neonate during anesthesia?

A

PEEP of 5cm H2O

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22
Q

Infants terminate the expiratory phase of breathing before reaching their true FRC which results in ________.

A

intrinsic PEEP and a higher FRC.

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23
Q

Initial hyperapneic response is abolished by ______ and ______.

A

hypothermia and low levels of anesthetic gases

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24
Q

What causes profound bradycardia in babies?

A

HYPOXIA!

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25
Q

Contributing factors for apnea in infancy

A

-Increased O2 consumption 6ml/kg

-Decreased FRC (non-functional residual capacity)

-Increased closing volume

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26
Q

Why do intra and extra cardiac shunts exist?

A

to minimize blood flow to the lungs while maximizing flow/O2 delivery to organ systems

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27
Q

3 shunts of CV system in babies

A

Ductus Venosus
Foramen ovale
Ductus Arteriosus

28
Q

Deoxygenated blood travels through the _______ to the _______ to the __________. (very low resistance to flow)

A

descending aorta
umbilical arteries
placenta

29
Q

Oxygenated blood returns via _______

A

the umbilical vein (PO2 35 mm Hg)

30
Q

_________ diverts approx. 50% of blood away from the liver into the IVC then to the RA

A

Ductus venosus

31
Q

This causes O2 rich blood to be directed across the foramen ovale which connects the right and left atrium

A

Preferential streaming

32
Q

This process feeds the coronary and cerebral circulations

A

O2 rich blood fed to the LV and ejected into the aorta

33
Q

PVR is _____ in fetal circulation.

A

HIGH

34
Q

RV output is delivered across the __________ which connects the _______ to the ________

A

-Ductus Arteriosus
-PA
-Descending Aorta

35
Q

Blood entering the _________returns to the placenta and feeds__________. (PO2 22mmHg)

A

-descending aorta
- the lower body

36
Q

Umbilical cord cut =

A

Increases SVR, reversal of shunts

37
Q

Decrease PVR and reversal of shunts =

A

Onset of breathing

38
Q

Initiation of ventilation does what to PVR?

A

decreases drastically
blood flow increase 450%

39
Q

Effect of LA and RA upon birth

A

LA pressure increases
RA pressure decreases

40
Q

Ductus Arteriosus: _________ closure in 10-15 hours.
_________ closures in 2-3 weeks.

A

Physiologic
Anatomic

41
Q

_________,_________,_________ are the shunts needed for effective fetal circulation that must close after birth to allow effective newborn circulation

A

foramen ovale, ductus arteriosus, and ductus venosus

42
Q

pulmonary vascular resistance high, systemic vascular resistance low

A

in Utero

43
Q

SVR high,
PVR low,
shunts functionally close

A

Born

44
Q

flow through FO and DA becomes left to right, shunts close, and circulation becomes like that of an adult

A

Increased SVR, decreased PVR

45
Q

Consequences of PPHN (acidosis and hypoxia)

A

Increased PVR
Decreased PBF
RAP > LAP
Increased ductal flow

This can open the foramen ovale

46
Q

S/S of PPHN

A

Marked cyanosis
Tachypnea
Acidosis
Right to left shunt across FO and DA = marked cyanosis
(right to left = cyanotic shunt)

47
Q

Treatment of PPHN

A

ADEQUATE VENTILATION AND OXYGENATION IS KEY

Hyperventilation – maintain alkalosis

Pulmonary vasodilators – prostaglandin

Minimal handling
Avoidance of stress

48
Q

Major of function of the fetal renal system

A

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

49
Q

Function of amniotic fluid

A

is important for normal development of the fetal lung and acts as a shock absorber for the fetus

50
Q

Characteristics of the fetal kidney

A

Low renal blood flow
Low GFR

51
Q

Sodium excretion in neonate

A

the neonate will continue to excrete Na even in the presence of a severe Na deficit

52
Q

The neonate is considered an _______ (Renal)

A

“obligate sodium loser”

53
Q

The primary compensatory mechanism for the reabsorption of the Na and H2O losses of plasma, blood, GI tract fluid, and third space fluid during surgery

A

the RAAS

54
Q

Best fluid for all neonates and premies?

A

D5 .2% Na
Fluids must contain Na!

55
Q

The neonate’s limited thermal range is a function of their _____,______,______.

A

Small size
Increased surface area to volume ratio
Increased thermal conductance

56
Q

2 stages of heat loss

A

-Transfer of heat from body core to skin surface
-Dissipation of heat from skin surface to the environment

(Both stages governed by the laws of conduction, convection, radiation, and evaporation )

57
Q

electromagnetic energy from the body to colder objects in the room (highest % of loss)

A

Radiation

58
Q

Heat production is achieved by ……..

A

Voluntary muscle activity
Involuntary muscle activity
Non-shivering thermogenesis-major component in the neonate

59
Q

Major component of thermal regulation

A

Non-shivering thermogenesis

60
Q

Cold stress potential consequence in baby

A

Reopening of fetal circulation (foramen vale and ductus arteriosus)

61
Q

Lowest acceptable Hgb/Hct

A

35%
because of high O2 demand with limited ability to increase CO

62
Q

If not crying?
If crying?

A

If not crying? = monitors first then mask
If crying? = mask first then monitors

FIRST MONITOR IS ALWAYS PULSE OX

63
Q

Pediatric Airway characteristics

A

-smaller larynx
-narrowest portion is cricoid cartilage
-epiglottis is longer and narrower
-tongue is proportionally larger
-neck is much shorter
-LARYNX IS MORE ANTERIOR ANDC CEPHALAD

64
Q

Risk of mainstem intubation is much higher in peds d/t _______.

A

short teachea and bronchus

65
Q

Cold infants will be ______,_______,and ______.

A

bradycardic, hypotensive, and slow to awaken

-remember infants can not shiver to increase
their own body heat

66
Q

Laryngospasm highest risk during which stage of anesthesia

A

Stage 2

If extubated deep or LMA removed deep and brought straight to PACU – patient will
go through Stage 2 while in PACU
DO NOT STIMULATE THE CHILD UNTIL AWAKE

67
Q

Newborn vitals

A

Systolic = 70
Diastolic = 40
HR = 140
RR = 40-60

Peds Anesthesia (3 decks)

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