peds deck 13 Flashcards
anesthetic considerations with hydrocephalus
- intubation technique depnds on condition - if present with vomiting and lethargy = RSI 2. avoid succinylcholine due to increased ICP 3. keep intubated with PEEP post op if preop apnea and bradycardia was present
causes of bradycardia intraoperatively
- younger = more susceptible 2. insufflation 3. INH agent on too long
tx of intraop bradycardia
- tx cause (insufflation = stop insufflation; gas on too long = turn gas down) 2. determine severity 3. glycopyrrolate 4. atropine *if < 6 months will start with atropine
tx for emergence delirium
- parental presence 2. distraction technique 3. precedex 4. propofol 5. physostigmine (0.5 mg/kg)
T/F: postop shivering is uncommon with infants and younger children
TRUE
tx of shivering?
- meperidine (most common) 2. precedex 3. zofran 4. clonidine
increase cause for PONV
- eye surgery 2. ear surgery 3. intraop opioids 4. fluid def
tx of PONV
- zofran (0.1-0.2 mg/kg) 2. promethazine (0.25-1 mg/kg) 3. decrease use of opioids, use non-opioid 4. adequate hydration
development of the heart in utero: primitive heart tube is present by day __________, it is contracting by day ___________, circulating by day _________, and complete by day _____________
15; 22; 26; 63
if the primitive heart tube does a levo twist (L-loop) this leads to __________________
abnormal heart; R ventricle on left side of heart and left ventricle on right side of heart
Primitive heart tube should twist in the _____________ direction for normal heart development and the ventricles to be on the appropriate side of the heart
right (D-loop)
examples of left to right shunts
- VSD 2. ASD 3. PDA 4. anomaly of coronary arteries 5. endocardial cushion defect
HD goals for L –> R shift
- avoid increase in SVR 2. avoid decrease in PVR
examples of right to left shunt
- TOF 2. eisenmeger syndrome 3. ebsteins anomaly 4. tricuspid atresia
HD goals with R –> L shunt
- maintain SVR 2. decrease PVR
L –> R shunt is known as _____________ and R–> L shunt is known as _____________
acyanotic; cyanotic
what is the sequelae of a L –> R shunt
increased pulmonary blood flow (overcirculation) –> pulmonary HTN –> eventual R.sided hypertrophy and eventual heart failure
what is the sequelae of R –> L shunt
decreased pulmonary blood flow –> hypoxemia –> Lsided volume overload –> LV dysfunction
what are the 3 types of ASD
- ostium venosum (upper) 2. ostium secundum (middle) 3. ostium primum (lower)
which type of ASD is the most common
ostium secundum (75%)
place in order from most common to least of the different types of ASD
- secundum (most) 2. primum (second) 3. venosum (least)
if you have a L –> R shunt that leads to pulmonary htn and RV failure –> decreased RV compliance and shift of shunt R –> L this would be called what
Eisenmengers
closure of ASD is required when pulmonary : systemic blood flow ratio is > ___________
1.5
all ASDs have a R-axis deviation except for ______________
primum (L-axis)
an ASD __________ cm will have large shunt with substantial HD consequences
0.5; 2
S/Sx of ASD
- typically asymptomatic 2. may have split S2 3. could have Lsided 2nd ICS systolic ejection murmur 4. R-axis deviation 5. dyspnea on exertion/fatigue 6. eventual Atrial arrhythmias (a.fib, a.flutter, SVT)
CXR with ASD
- prominant pulmonary artery 2. peripheral pulmonary artery
ways to correct ASD
- surgical - open one atrium and patch under direct visualization 2. percutaneously w/ amplatzer septal occluder
percutaneous closure of ASD is indicated for __________________ ASD with sufficient rim of tissue around the defect
secundum
what is the most common congenital heart defect
VSD
25-40% of VSD close spontaneously between ages ___________
10-Feb
differnt types of VSD
- membranous portion of septum (70%) 2. muscular part of septum (20%) 3. below the Ao (5%) 4. near Mv/Tv - aka AV canal defect (5%)
what is the most common location of VSD
membranous
T/F: Eisenmengers is more common with ASD than VSD
false; more common with VSD
with VSD you will have a ______________ murmur at the _____________ sternal boarder
holosystolic; Left
with VSD if you have pulmonary htn develop (Eisenmenger) what s/sx would you see
- RV heave 2. holosystolic murmur would decrease and would develop mumur of pulmonary regurg (Graham Steels murmur) 3. Cyanosis/clubbing
EKG changes with small vSD
none
EKG changes with large VSD
signs of L atrial enlargement (unusual p-wave) and Ventricular enlargement (lg R wave in V6, V5, AvL, I)
CXR with VSD
- “shunt vascularity” 2. marked enlargement of pulmonary artery
T/F: VSD is more common in females than males
false; incidence is equal M = F
tx for VSD
- smaller ones will spontaneously close on their own 2. medical management with glycosides, loop diuretics, and ACEI 3. device closure for certain pts 4. surgical repair
why is surgical repair of VSD “complicated”
because of close proximity to the conduction system of the heart
s/sx of PDA
- bounding peripheral pulses 2. widened pulse pressure 3. continous “machinery” murmur 4. larger defect –> fatigue, dyspnea, palpitations, LVH and pulmonary htn
if you have a small PDA, most often pts are asymptomatic; howver, they are at increased risk for _________________
infective endocarditis
tx of PDA
- surgical ligation without CPB 2. percutaneous closure via piccolo
T/F: due to risk of infective endocarditis even small PDA should be repaired
TRUE
pulmonary stenosis often co-exists with what other CHD in children
- ASD 2. VSD 3. PDA 4. TOF
90% of pulmonary stenosis is pediatrics is __________________
valvular
if pt has _________________ pulmonary stenosis you would expect narrowing of pulmonary trunk/bifurcation/peripheral branches
supravalvular
what is the most common cause of aortic stenosis
bicuspid aortic valve
