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Principles IV > Peds PPt-Josh > Flashcards

Peds PPt-Josh Flashcards

1
Q

What is normal ICP oin small children

A

2-4 mmHg

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2
Q

why is a childs ICP less

A
  • 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
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3
Q

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????

A

May no exhibit s/s of increased ICP until disease is advanced

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4
Q

what is the goal of ICP at ANY age?

A

<20

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5
Q

what is the recommended CPP for children younger than 8 (remember adults is about 70)

A

>40

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6
Q

What is the recommended CPP for children older than 8? (remember adult is 70)

A

> 60

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7
Q

A CPP less than __ is correlated w/ worse outcomes w/ any ICP in children

A

<40

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8
Q

CBF is tightly coupled to ____ _____

A

metabolic demand

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9
Q

There is a larger proportion of ___ to the brain of an infant

A

CO

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10
Q

Autoregulation of CBF is what in newborns?

A

20-60

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11
Q

the neonate is at risk of cerebral _____ and ____ w/sudden hypotension and HTN

A

Ischemia

IVH

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12
Q

What are methods to lower ICP?

A
  • Same as in adult
  • Elevate head
  • Keep head neutral (prevent kinking of Jugular (JUGGLAR)
  • Hyperventilation
  • Steroids
  • Diuretics
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13
Q

Preoperative Eval and Prep:

what should all children get preop? and why? (hint.. a test not labs or drugs)

A
  • Echo and CV consult
  • B/c CHD may not be appearent immediatel after birth
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14
Q

Preoperative Eval and Prep:

shoudl kids get anxioloysis meds?

A

Fuck yeah!!!!

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15
Q

How can Midaz be given

A

oral

Nasal

IV

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16
Q

Intraoperative and Induction:

what is a good induction tech for these munchkins?

A

Inhalation induction w/ sevo and N2O/O2 and a NDMR

or Propofol

RSI for ones w/ risk of aspiration

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17
Q

the larynx is funnel shaped and the narrowest point is a the level of the ____

A

Cricoid

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18
Q

the larynx is funnel shaped and the narrowest point is a the level of the cricoid, this puts the pt at risk for what?

A
  • Subglottic obstruction from mucosal swelling postop
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19
Q

what can happen the the ETT during the surgery if the surgeon places flexion on the neck

A

Migrate

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20
Q

Since the ETT can migrate what type of intubation is prefered by some providers

A

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)

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21
Q

what happens to the need for NMB in pts on chronic anticonvusants

A

they may require larger doses, b/c of induced enzymatic metabolism

22
Q

anesthestic preferences are the same as the adult

A

VAA 1/2 MAC, opioid, etc

23
Q

what fluid to you want to administer NS or LR

A

NS

24
Q

Do you want to keep pt warm or noral temp or cold

A

warm (large surface area

25
Q

same as adult

A
  • A-line
  • Precordial
  • EEG, SSEP. MEP
  • Mannitol
  • etc
  • No differences here not redoing the shit
26
Q

Physiologic Effects of Patient Positioning:

Head elevated (4)

A
  • Enhanced cerebral venous drainage
  • Decreased Cerebral Blood flow
  • Increased Venous pooling in lower extremities
  • Postural hypotension
27
Q

Physiologic Effects of Patient Positioning

Head down (3)

A
  • Increased Cerebral venous and intracranial pressure
  • Decreased Functional residual Capacity (lung fxn)
  • Decreased Lung compliance
28
Q

Physiologic Effects of Patient Positioning

Prone ( 3)

A
  • Venous Congestion of face
    /tongue/ and neck
  • Decreased Lung compliance
  • Increased abdominal pressure can lead to venocaval compression
29
Q

Physiologic Effects of Patient Positioning

Lateral Decubitus (1)

A
  • Decreased Compliance of down side lung
30
Q

whare does teh Kid go post extubation

A
  • ICU w/ serial neurological examination
31
Q

what are 3 common pediactric Neuro procededures

A
  1. Hydrocephalus
  2. Myelomeningocele
  3. Craniosynostosis
32
Q

what is the most common procedure in ped neuro sx

A

VP Shunt:

33
Q

VP Shunt:

is the overproduction of CSF or outfloe obstruction d/t a ____ or ____ _____

A
  • Tumor
  • Chiari Malformation
34
Q

VP Shunt:

what determines the anesthestic management?

A

Mental status

35
Q

VP Shunt:

what is teh main purpose of the shunt

A

COntrol intacranial HTN

36
Q

VP Shunt:

is often done in neonates at the same time as a _______ repair

A

Myelomeningocele

37
Q

What is the most common congenital defect of the CNS

A

Myelomeningocele

38
Q

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?

A

Lumbar

39
Q

Myelomeningocele:

these kids may also have what d/o

A

Chiari Malformation

40
Q

Myelomeningocele:

they must have urgent sx w/in ____ hours of birth

A

24 hrs

41
Q

Myelomeningocele:

positioning is a challenge how would you position for intubation

A
  • Donut under back
  • laterally
42
Q

Myelomeningocele:

case is done in what position?

A

Prone

43
Q

Myelomeningocele:

what do you want to avoid and why?

A
  • Latex
  • 70% of children w/ Myelomeningocele report latex allergy later in life
44
Q

Myelomeningocele:

what temo to you wnat to keep these kids

A

warm

45
Q

Myelomeningocele:

what is the fluid amounts for these kids

A

LR or NS

25 mL/kg 1st hr

6-8mL/kg/hr thereafter

46
Q

Myelomeningocele:

they have a significant risk for what?

A

Hypothermia

47
Q

Craniosynostosis:

what is it

A

whan 1 or more of the bones in the skull fuse together arlier than normal

48
Q

Craniosynostosis:

what should always be available for these sx’s? and why?

A
  • PRBCs
  • significant blood loss
  • More blood loss w/ increased # of sutures
49
Q

Craniosynostosis:

there is a risk of VAE, this can minimized how?

A
  • Early detection
  • Euvolemia
50
Q

thats it for baby shit!!! flip for reward

A

Principles IV (19 decks)

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