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Quarter 4 > Principles II > Flashcards

Principles II Flashcards

1
Q

Location of Glottis in neonates vs. adults

A

C3-C4

(adults have a lower glottis at C4-C5)

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2
Q

Describe the differences in Respiratory Systems of neonates

A
  • poor respiratory control
    • sensitive to respiratory depressant effects of opioids and inhalational agents
  • high risk of post-anesthetic apnea
    • 52-60 weeks post conceptual age
  • 2-3x O2 consumption
  • depressed CO2 response curve
  • decreased energy reserves
  • equivalent tidal volumes, but faster breathing
  • prone to atelectasis
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3
Q

Describe the differences in Cardiovascular System in Neonates

A
  • less compliant myocardium
  • HR dependent
  • immature SNS, so cardiac output can only increase by 30-40%
  • preload insensitive
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4
Q

Describe the differences in the Hepatic System of Neonates

A
  • functionally immature liver
    • reaches adult levels within 1st few months
  • longer half-life of drugs
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5
Q

Describe the differences in the Hematologic System of Neonates

A
  • HbF makes up 75% of total hemoglobin
  • Hemoglobin around 17 g/dL
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6
Q

How much blood loss can critically ill newborns take?

A

HCT > 35% or blood loss > 15%

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7
Q

Describe Heat Loss in Neonates

A
  • increased body surface to weight
  • non-shivering thermogenesis
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8
Q

Consequences of Hypothermia in Neonates

A
  • hyperviscosity
  • increased O2 consumption
  • lactic acidosis
  • depression of respiration, circulation, metabolism, and glucose levels
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9
Q

Ideally, how old should an infant be before surgery

A

greate than 60 weeks old if anemic and 50 weeks old if apenic

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10
Q

Size formula for Pediatric ETT

A

age/4 + 4

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11
Q

Pre-operative dose of Atropine prior to Sux

A

0.02 mg/kg

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12
Q

Dose of Succinylcholine in Pediatrics

A

2 mg/kg IV

or

4 mg/kg IM

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13
Q

Treatment for Post-Extubation Croup in Pediatrics

A

racemix Epi via nebulizer

(0.5 mL of 2% solution)

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14
Q

Treatment for Hypocalcemic Peds

A

1 - 2 mL/kg 10% calcium chloride

(or gluconate)

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15
Q

Treatment for Hypoglycemic Peds

A

250 - 500 mg/kg bolus of glucose (D25)

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16
Q

What may cause retinopathy of prematurity?

A

High O2 concentrations

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17
Q

Range of Hypoglcemia in Infants

A

< 30 mg/dL

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18
Q

Children with URI symptoms are at increased risk for ______ weeks after the onset of symptoms

  • laryngospasm, bronchospasm, desaturation
A

4 - 6 weeks

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19
Q

Pre-operative dose of Versed for Pediatrics

A

0.25 - 0.5 mg/kg

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20
Q

Normal Systolic Blood Pressure in Pediatrics

A
  • Newborn to 1 month
    • 60 mmHg
  • 1 month to 1 year
    • 70 mmHg
  • > 1 year
    • (age * 2) + 70mmHg
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21
Q

Typical/expected diastolic Blood pressure

(equation)

A

2/3 x SBP

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22
Q

Normal Pulse for Pediatrics

A
  • Newborn to 1 year
    • 140 bpm
  • 1 year to 4 years
    • 120 bpm
  • 4 years to 12 years
    • 100 bpm
  • > 12 years
    • 80 bpm
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23
Q

Normal Respiratory Rates for Pediatrics

A
  • Newborn to 1 year
    • 40
  • 1 to 4 years
    • 30
  • 4 to 12 years
    • 20
  • > 12 years
    • 15
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24
Q

Why does inhalational inductino occur faster in pediatric patients?

A

higher minute ventilation and small FRC

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25
Q

Why do pediatric patients develop respiratory fatigue easily?

A

muscles of respiration poorly developed

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26
Q

Congenital Diaphragmatic Hernia (CDH)

A

hole in the diaphragm allows abdominal organs to move into the chest, which prevents the lungs from developing normally, resulting in pulmonary hypoplasia

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27
Q

What is the pulmonary problem in patients with CDH?

A
  • compression of lungs leads to pulmonary hypoplasia
  • arterial hypoxemia occurs because of right-to-left shunt through ductus arteriosus
  • increased pulmonary vascular resistance
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28
Q

Which side does CDH usually occur?

A

Left

(75% of cases)

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29
Q

How is CDH usually diagnosed?

A

prior to birth by US

chest X-ray shows loop of bowel in chest

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30
Q

How is an infant with CDH treated immediately after birth?

A
  • decompression of stomach with OG/NG
  • supplemental oxygen
  • AVOID PEEP
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31
Q

Intubation in patient with CDH

A

awake intubation

  • do not let peak airway pressures exceed 25-40 cmH2O
    • too high of pressures will cause pneumothorax
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32
Q

What size ETT should be used for a full term baby?

A

3.0 - 3.5

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33
Q

Formula for ETT depth

A

age/2 + 12

or

I.D. of ETT x 3

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34
Q

Which hand gives a pulse ox reading of preductal saturation?

A

right hand

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35
Q

Importance of avoiding hypothermia in CDH patients

A

hypothermia will increase PVR and increase right-to-left shunt, and increase O2 consumption and acidosis

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36
Q

What are the signs of a pneumothorax?

A
  • decrease in lung compliance
  • deterioration of oxygenation and blood pressure
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37
Q

In CDH surgery, once the hernia is reduced, should attempts be made to inflate the hypoplastic lung?

A

No

it is unlikely to expand and contralateral lung may be damaged by excessive positive pressure

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38
Q

Should glucose containing fluids be used to replace blood or for third–space losses?

A

No

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39
Q

Indications for CABG

A
  • angina not controlled by medical treatment
  • unstable angina or episodes of myocardial ischemia
  • unacceptable angina, despite optimal therapy
  • prinzmetal angina with coronary artery obstruction
  • acute MI, intractable arrhytmias
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40
Q

How do you calculate left ventricular function?

A
  • history of MI and angina
  • symptoms
    • dyspnea, nocturnal orthopnea, pitting edema
  • Cardiac catheterization, angiography, and ECHO
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41
Q

What are the (3) major determinants of myocardial O2 consumption?

A
  • myocardial wall tension
  • contractility
  • heart rate
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42
Q

Determinants of Coronary Blood Flow

A
  • aortic diastolic pressure
  • LVEDP
  • patency of coronary arteries
  • coronary vascular tone
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43
Q

Systemic Oxygen demand decreases ____% for every degree of temperature drop

A

9%

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44
Q

Normal Pulmonary Capillary Wedge Pressure

A

4 - 12 mmHg

(more than 18 mmHg reflects heart failure)

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45
Q

Common complications of Swan-Ganz catheter

A
  • infection
  • hematoma
  • air embolism
  • thrombosis
  • catheter shearing and embolization
  • arrhythmias
  • pulmonary infarction
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46
Q

Complications of Swan-Ganz catheter from Subclavian approach

A
  • pneumothorax
  • hemothorax
  • hydrothorax
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47
Q

Diagnostic uses of TEE

A
  • Monitoring left ventricular filling and ejection
  • Detection of hypokinesia, akinesia, and dyskinesia
  • Detection of air embolism
  • Detection of valvular regurgitation
  • Analysis of congenital cardiac lesions
  • Diagnosis of thoracic aorta pathology
  • Diagnosis of cardiac tumors
  • Detection of other cardiac lesions and cardiac tamponade
48
Q

Cardiovascular effects of Volatile Agents

A
  • depression of ventricular function
  • vasodilation
  • decreased CO and sympathetic tone
49
Q

What should you do during sternal splitting?

A

stop ventilations and deflate lungs

50
Q

Would you monitor pulmonary capillary wedge pressure continuously?

A

no

may cause pulmonary infarction

51
Q

What anticoagulant would you give before CPB?

A

heparin in doses of 300 U/kg

  • measure heparin activity with ACT
52
Q

Heparin and ACT during CPB

A
  • onset of ACT prolongation in radial artery occurs within 1 minute
  • obtain baseline prior to heparin
  • check ACT 3-5 minutes after heparin administration and then every 30-60 minutes
  • no less than 300sec during normothermia and 400sec during hypothermia
53
Q

Cardioplegia

A

hypothermic and hyperkalemic solution

  • used to induce electromechanical dissociation
  • infused between clamp and aortic valve
54
Q

What should you check if the patient will not wean from CPB?

A
  • adequacy of repair
  • TEE
  • hemodynamic variables
  • institute pharmacologic therapy
55
Q

Signs of Anaphylaxis

A
  • hypoxemia
  • rash or hives
  • hypotension
  • tachycardia
  • broncospasm or wheezing
  • increased peak inspriatory pressure (PIP)
  • angioedema
56
Q

Treatment for Anaphylaxis

A
  • discontinue potential allergens and volatile agents
  • 100% O2
  • IV fluid bolus and epinephrine
  • consider vasopressin
  • Treat symptoms with albuerol, Epi, H1 antagonist and H2 antagonist
  • consider intubation and IV access
57
Q

Signs of Local Anesthetic Toxicity

A
  • tinnitus or a metabolic taste
  • altered mental status
  • seizures
  • hypotension
  • bradycardia
  • ventricular arrhythmias
  • cardiovascular collapse
58
Q

Treatment of Local Anesthetic Toxicity

A
  • If pulseless, start CPR
  • stop local anesthetic and avoid vasopressin
  • call for intralipids
    • 1.5 mL/kg bolus of 20% intralipid IV
59
Q

Signs of Myocardial Ischemia

A
  • depression or elevation of ST segment
  • arrhythmias
  • regional wall motion abnormalities
  • chest pain in awake patient
60
Q

Treatment for Myocardial Ischemia

A
  • increase 100% O2
  • treat hypotension (or hyper)
  • beta blocker
61
Q

Where does an AAA usually occur

A

beween renal and mesenteric arteries

62
Q

Normal intraocular pressure

A

10 - 20 mmHg

63
Q

What type of drugs should you avoid in glaucoma patients?

A

anticholinergics

64
Q

Phenylephrine in Ophthalmic surgery

A

dilates pupil

65
Q

Epinephrine in Ophthalmic surgery

A

decreases aqueous secretions

66
Q

Ecothiophate

A

long-acting topical anticholinesterase

  • needs to be off 2-3 weeks before surgery to allow plasma cholinesterase levels to return to normal
67
Q

Acetazolamide in Ophthalmic surgery

A

diuretic used to lower IOP

  • can cause hypotension if given too quickly
68
Q

Preoperative issues in patients undergoing Ophthalmic surgery

A
  • claustrophobic
  • can they lie still on their backs
  • do they cough a lot?
69
Q

Strabismus

A

“cross eyed”

  • imbalance of intraocular muscles
  • surgery has high incidence of nausea and vomiting
  • type of muscle disorder, so there may be a higher risk of MH
70
Q

Pterygium

A

growth on surface of eye due to excess sun exposure

71
Q

Ptosis

A

droopy eyelids

72
Q

Orchiopexy

A

surgery to move an undescended testicle into the scrotum

  • may need general and regional
  • vagal response and nausea
73
Q

Pectus Excavatum

A

congenital chest wall deformity that causes the chest to cave in

  • respiratory problems and cardiac compromise
  • restrictive lung disease
74
Q

Mediastinal Mass Excision

A
  • assess child’s ability to breath
  • some may not be able to lay flat
  • CPB and rigid bronchoscopy available
75
Q

Wilm’s Tumor

A

Nephroblastoma

  • most common liver cancer of children
76
Q

VP shunt

A
  • increased ICP
  • high risk of latex allergy
77
Q

Craniotomy

A
  • children more likely to have infratentorial tumors
    • fine movement and balance
  • Risk of venous air embolism dur to beach chair position
78
Q

Craniosynotosis

A

premature closure of a cranial suture

  • increases ICP
  • risk of blood loss and venous air embolism
79
Q

NDMR in neonates

A

needs a higher dose inititally

smaller redoses and less often

80
Q

Total body of water in newborns

A

70-85%

81
Q

Trends in body compartment volumes from neonate to adult

A

total body water - decrease

intracellular fluid - same

blood volume - decrease

muscle mass - increase

fat - increase

82
Q

Why are neonates more susceptible to the cardiovascular effects of inhalational agents?

A
  • hearts are more sensitive
  • rapid uptake and distribution
  • right-to-left shunt has a slower rate of rise in arterial contraction
  • MAC is lower in newborns than infants
83
Q

Cardio differences in Neonates

A

less compliant, fixed stroke volume, HR dependent, decrease contractile mass, and decreased velocity

84
Q

Atropine dose in neonates

A

0.03 - 0.05 mg/kg

(compared to 0.01 in adults)

doses less than 0.1 mg may produce paradoxical bradycardia!

85
Q

Which narcotic will migrate more?

Fentanyl or Morphine

A

Morphine

it is more hydrophilic compared to Fentanyl which is lipophilic

86
Q

Why is Pancuronium a good MR in children?

A

potent vagolytic

can increase HR

87
Q

Which type of local anesthetics are more preferable in neonates?

A

esters

amides are metabolized in the liver, but their liver may not be well developed yet. Esters are metabolized by plasma esterases

88
Q

Omphalocele

A

organs stick out through the belly button

89
Q

organs stick out in a hole besides the belly button

A

gastroschisis

90
Q

Pyloric Stenosis

A

narrowing of pyloris

(stomach to duodenum)

  • presents 3-6 weeks of age
  • dehydrated and nutrient deprived
  • aspiration risk
  • Needs an OG/NG placed
91
Q

TEF

A

Transesophageal Fistula

92
Q

Transesophageal Fistula

A

blind esophageal pouch connecting it to the trachea

93
Q

Meningomyelocele

A

“Spina Bifida”

spinal canal and the backbone don’t close before the baby is born, letting the spine and membranes protrude through the baby’s back

94
Q

PDA

A

Patent Ductus Arteriosus

95
Q

Patent Ductus Arteriosus

A

large left-to-right shunt

96
Q

Coronary Artery Disease

A

artherosclerosis of the blood vessels supplying the heart

  • leads to myocardial ischemia
97
Q

Risk factors for CAD

A
  • genetics
  • diet
  • environment
  • hypertension
  • smoking
  • diabetes
98
Q

What part of the heart is most vulnerable to ischemia

A

left ventricular subendocardium

99
Q

Drug of choice for coronary spasm

A

Nitroglycerin

100
Q

Which venodilating drug decreases venous return and ventricular filling pressure?

A

Nitroglycerin

101
Q

Which drug increases the MVO2 requirements due to increased coronary perfusion pressure?

A

Phenylephrine

102
Q

Which CCB is good for SVT?

A

Verapamil

103
Q

Normal Pulmonary Wedge Pressure

A

12

104
Q

An ejection fraction < ____ indcates myocardial dysfunction

A

0.4

105
Q

“LAMPS” before CPB

A
  • Laboratory
  • Anesthesia
  • Monitor
  • Patient
  • Support
106
Q

(7) Components of CPB

A
  • circuit
  • oxygenator
  • pump
  • heat exchanger
  • primer
  • anticoagulants
  • myocardial protection
107
Q

In CPB, blood is drained from the ____ and returned to the ____

A

right atrium, ascending aorta

108
Q

Two types of Oxygenators in CPB

A

bubble and membrane

109
Q

3 types of CPB pumps

A

roller, centrifugal, and pulsatile

110
Q

Hypothermia during CPB

A

10 - 15 oC

111
Q

Systolic BP should be reduced to _____ before aortic cannulation to reduce risk of aortic dissection

A

80-100 mmHg

112
Q

What is the most likely cause of neurologic injuryafter CPB

A

emboli

with increased risk if hypotensive

113
Q

Why should Versed be given before rewarming after CPB?

A

increased risk of awareness

114
Q

Dose of Protamine on CPB?

A

1 mg/100 units heparin

(usually 3 mg/kg)

115
Q

Risks of Protamine

A

hypotension and mast cell degraulation

116
Q

Intra-Aortic Balloon Pump

A

deflates before systole to decrease afterload

inflates during diastole to increase coronary blood flow

117
Q

Manifestations of Cardiac Tamponade

A
  • hypotension
  • equalization of diastolic filling pressures
  • fixed stroke volume
  • peripheral vasoconstriction
  • tachycardia
  • potential myocardial ischemia

Quarter 4 (15 decks)

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