Peds PPt-Josh Flashcards
What is normal ICP oin small children
2-4 mmHg
why is a childs ICP less
- Skull of a newborn doesn’t fuse until about the end of 1st year of life
- Inracranial space more compliant
- Dura can expand in response to edematous brain tissue fro trauma or mass lesion
b/c the Skull of a newborn doesn’t fuse until about the end of 1st year of life and Inracranial space more compliant
Dura can expand in response to edematous brain tissue fro trauma or mass lesion, what does this mean????
May no exhibit s/s of increased ICP until disease is advanced
what is the goal of ICP at ANY age?
<20
what is the recommended CPP for children younger than 8 (remember adults is about 70)
>40
What is the recommended CPP for children older than 8? (remember adult is 70)
> 60
A CPP less than __ is correlated w/ worse outcomes w/ any ICP in children
<40
CBF is tightly coupled to ____ _____
metabolic demand
There is a larger proportion of ___ to the brain of an infant
CO
Autoregulation of CBF is what in newborns?
20-60
the neonate is at risk of cerebral _____ and ____ w/sudden hypotension and HTN
Ischemia
IVH
What are methods to lower ICP?
- Same as in adult
- Elevate head
- Keep head neutral (prevent kinking of Jugular (JUGGLAR)
- Hyperventilation
- Steroids
- Diuretics
Preoperative Eval and Prep:
what should all children get preop? and why? (hint.. a test not labs or drugs)
- Echo and CV consult
- B/c CHD may not be appearent immediatel after birth
Preoperative Eval and Prep:
shoudl kids get anxioloysis meds?
Fuck yeah!!!!
How can Midaz be given
oral
Nasal
IV
Intraoperative and Induction:
what is a good induction tech for these munchkins?
Inhalation induction w/ sevo and N2O/O2 and a NDMR
or Propofol
RSI for ones w/ risk of aspiration
the larynx is funnel shaped and the narrowest point is a the level of the ____
Cricoid
the larynx is funnel shaped and the narrowest point is a the level of the cricoid, this puts the pt at risk for what?
- Subglottic obstruction from mucosal swelling postop
what can happen the the ETT during the surgery if the surgeon places flexion on the neck
Migrate
Since the ETT can migrate what type of intubation is prefered by some providers
nasal intubation
(this just doesn’t make any fucking sense, first you want a fast and non-stimulating intubation, well forget that wth this. and 2 the tube seems like it would still migrate considering the nasal passage is located just cephalad the oral cavity…. but thats just me not the test)
what happens to the need for NMB in pts on chronic anticonvusants
they may require larger doses, b/c of induced enzymatic metabolism
anesthestic preferences are the same as the adult
VAA 1/2 MAC, opioid, etc
what fluid to you want to administer NS or LR
NS
Do you want to keep pt warm or noral temp or cold
warm (large surface area
same as adult
- A-line
- Precordial
- EEG, SSEP. MEP
- Mannitol
- etc
- No differences here not redoing the shit
Physiologic Effects of Patient Positioning:
Head elevated (4)
- Enhanced cerebral venous drainage
- Decreased Cerebral Blood flow
- Increased Venous pooling in lower extremities
- Postural hypotension
Physiologic Effects of Patient Positioning
Head down (3)
- Increased Cerebral venous and intracranial pressure
- Decreased Functional residual Capacity (lung fxn)
- Decreased Lung compliance
Physiologic Effects of Patient Positioning
Prone ( 3)
- Venous Congestion of face
/tongue/ and neck - Decreased Lung compliance
- Increased abdominal pressure can lead to venocaval compression
Physiologic Effects of Patient Positioning
Lateral Decubitus (1)
- Decreased Compliance of down side lung
whare does teh Kid go post extubation
- ICU w/ serial neurological examination
what are 3 common pediactric Neuro procededures
- Hydrocephalus
- Myelomeningocele
- Craniosynostosis
what is the most common procedure in ped neuro sx
VP Shunt:
VP Shunt:
is the overproduction of CSF or outfloe obstruction d/t a ____ or ____ _____
- Tumor
- Chiari Malformation
VP Shunt:
what determines the anesthestic management?
Mental status
VP Shunt:
what is teh main purpose of the shunt
COntrol intacranial HTN
VP Shunt:
is often done in neonates at the same time as a _______ repair
Myelomeningocele
What is the most common congenital defect of the CNS
Myelomeningocele
Myelomeningocele:
is teh posterior protrusion of the spinal cord and meninges through a defect in the spinal column usually in what region of the back?
Lumbar
Myelomeningocele:
these kids may also have what d/o
Chiari Malformation
Myelomeningocele:
they must have urgent sx w/in ____ hours of birth
24 hrs
Myelomeningocele:
positioning is a challenge how would you position for intubation
- Donut under back
- laterally
Myelomeningocele:
case is done in what position?
Prone
Myelomeningocele:
what do you want to avoid and why?
- Latex
- 70% of children w/ Myelomeningocele report latex allergy later in life
Myelomeningocele:
what temo to you wnat to keep these kids
warm
Myelomeningocele:
what is the fluid amounts for these kids
LR or NS
25 mL/kg 1st hr
6-8mL/kg/hr thereafter
Myelomeningocele:
they have a significant risk for what?
Hypothermia
Craniosynostosis:
what is it
whan 1 or more of the bones in the skull fuse together arlier than normal
Craniosynostosis:
what should always be available for these sx’s? and why?
- PRBCs
- significant blood loss
- More blood loss w/ increased # of sutures
Craniosynostosis:
there is a risk of VAE, this can minimized how?
- Early detection
- Euvolemia
thats it for baby shit!!! flip for reward
