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AP Summer Final > Postanesthetic Apnea in the Former Preterm Infant > Flashcards

Postanesthetic Apnea in the Former Preterm Infant Flashcards

1
Q

After an anesthetic, former premature infants should be admitted to the hospital overnight for cardio-respiratory monitoring. True or false?

A

True.

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2
Q

What is the incidence of apnea for premature infants:

< 30 weeks gestation
30-31 weeks
34-35 weeks

A

80%

50%

7%

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3
Q

What are contributing factors causing apnea due to prematurity? (4)

A

CNS disease
Systemic illness
Thermal/metabolic disturbances
A/w anomalies

CAST

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4
Q

What are the types of apnea? (3)

A

Central: no nasal airflow, no muscular activity

Obstructive: no nasal airflow WITH muscular activity

Mixed

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5
Q

What is the correlation between a preterm infant and brainstem conduction time?

A

Immature infants have increased brainstem conduction time.

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6
Q

For an infant that is ~28 weeks preterm, the age at last day of apnea is generally around _____.

A

2 months

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7
Q

For an infant that is ~29 weeks preterm, the age at last day of apnea is about _____.

A

1 month

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8
Q

How is ventilation generally regulated? (3)

A

Central rhythm (pattern) generator

Central chemoreceptors (CO2) not fully developed in pre-term

Peripheral chemoreceptors (O2) not fully developed in pre-term

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9
Q

What is the ventilatory response to CO2 in preterm infants? (4)

A

Flatter response

Flatter at 2 days postnatal age than at 4 weeks

Flatter in preterms with apnea than those without

Flatter during hypoxia than during normoxia or hyperoxia

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10
Q

What is the ventilatory response to hypoxia for term and preterm infants? (3)

A

Increase followed by sustained decrease
Reverse response to hyperoxia
Initial increase blunted in preterms

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11
Q

When is a sustained increase response seen in

term infant
preterm infant

A

1 week

3 weeks

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12
Q

What is the pre-term’s response to hypoxia?

A

Initial increase
Then, sustained decrease until see 100% O2

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13
Q

What can affect upper airway function and induce apnea? (3)

A

Irritants can induce reflex apnea

Intrinsic upper airway instability

Delayed chemoreceptor activation of upper airway muscles relative to diaphragm

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14
Q

Suction can cause apnea without having an anesthetic because of reflexes. True or false?

A

True.

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15
Q

What are the effects of halogenated anesthetics? (4)

A

Decreased muscle tone of airway

Reduced FRC

Dose dependent decrease in CO2 response & right shift of CO2 response curve

Depress response to hypoxia (even at subanesthetic doses)

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16
Q

What minimum MAC results in a decreased response to hypoxemia with halogenated agents?

A

1/10 MAC

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17
Q

Increased incidence of apnea in infants < ____ weeks so don’t let kids go home < _______ weeks.

A

42

52

18
Q

What is a risk factor in itself for predicting apnea?

A

anemia

19
Q

Strict regional is _______ against apnea.

If regional is combined with any type of anesthetic, what occurs?

A

PROTECTIVE, but does not rid risks of apnea

Back to same risks as general if not worse.

20
Q

The use of ketamine with a spinal in an apneic risk infant will decrease risk of apnea. True or false?

A

False

21
Q

What can help with bradycardia and O2 saturation?

A

Caffeine

22
Q

What are general pediatric recommendations for surgery? (4)

A

Delay elective surgery beyond 46 weeks post-conception

Hospitalize < 52 weeks post-conception

Consider caffeine prophylaxis

Consider use of STRICT regional anesthesia

23
Q

Pyloric stenosis is a surgical emergency. True or false?

A

False.

24
Q

When should infants with pyloric stenosis present to the operating room? (2)

A

Adequately hydrated

Electrolytes normalized

25
Q

What is the great risk for hypertrophic pyloric stenosis infants?

A

ASPIRATION

26
Q

What is hypertrophic pyloric stenosis?

What occurs as a result?

A

Hypertrophy of the muscular layer of pylorus

Gastric outlet obstruction

27
Q

What is the M:F ratio of occurence of hypertrophic pyloric stenosis?

A

4:1 male:female

28
Q

What predisposes an infant to have hypertrophic pyloric stenosis?

A

family history

Otherwise, unknown etiology.

29
Q

How does hypertrophic pyloric stenosis present? (5)

A

Recurrent projectile vomiting
Palpable “olive” in the epigastrum
Visible peristalsis
Bradypnea
Jaundice

30
Q

When does hypertrophic pyloric stenosis present?

A

2 - 6 weeks of age

31
Q

How is hypertrophic pyloric stenosis confirmed? (2)

A

Barium swallow

Ultrasound

32
Q

What are anesthetic considerations for hypertrophic pyloric stenosis? (3)

A

Risk of aspiration

Dehydration

Metabolic derangements

33
Q

What are signs of dehydration in infant with hypertrophic pyloric stenosis when there is___% dehydration:

5
10
15
20

A

poor tissue turgor, dry mouth

sunken font, tachycardia, oliguria

sunken eyeballs, hypotension

stupor,coma

34
Q

If HCO3 > ____, more indication of vomiting and dehydration.

What situation can result?

A

30

Hypochloremic metabolic alkalosis. Hypokalemia also.

35
Q

Urine becomes acidotic as ____ stores are depleted.

As a result the body saves ____ and ______ while excreting _____.

What is the resulting pH of the urine?

A

K+

stores Na, H2O and excretes H+

ACIDIC

36
Q

How do you preoperatively replace fluid deficits?

A

D5 ½ NS + 20-40 meq/L potassium

37
Q

What are the goals for the following electrolytes?

Cl
HCO3

A

Cl > 90

HCO3 < 30

38
Q

What is the anesthetic management for pyloric stenosis? (4)

A

Suction stomach

Preoxygenate

RSI or awake

Maintain with N2O, unless lap.

39
Q

What should you avoid in pyloric stenosis?

A

NARCOTIC

40
Q

When should you extubate in an infant with pyloric stenosis?

A

AWAKE

AP Summer Final (7 decks)

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