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Peds Anesthesia - Summer 2013 > Prod...Prematurity > Flashcards

Prod...Prematurity Flashcards

1
Q

What is the definition of a premature infant?

A

Birth before 37 weeks gestation

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2
Q

What are the normal vital signs for a preterm infant?

A
  • HR = 120 to 160
  • RR = 30 to 60 (increase to 100 to 150 when lung compliance is decreased)
  • BP of a 1000 gram baby 50/25
  • BP of a 4000 gram baby 70/40
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3
Q

How are premature infants classified according to birth weight?

A
  • <1000 grams = extreme low birth weight
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4
Q

Can digitalis be used to promote increased cardiac contractility int the premature infant?

A
  • NO

- does not increase contractility or ventricular ejection, but it does slow the heart rate which is bad.

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5
Q

What is retinopathy of prematurity?

A
  • occurs in half of babies <1500 grams
  • Related to
  • vasoconstriction of retinal vessels to high O2
  • O2 radicals on retinal spindle cells
  • induction of vascular endothelial growth factor
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6
Q

Why would indomethacin be administered to a premature neonate?

A

-Potent prostaglandin inhibitor (helps close the ductus arteriosus)

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7
Q

Is nitrous effective in premature infants?

A

Not really…it is a poor choice.

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8
Q

How does MAC compare between premature infants and full term infants.

A

-MAC is decreased in premature infants. (Can reduce systolic BP by 30%)

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9
Q

What airway abnormalities commonly associated with prematurity result in a decreased airway diameter and increased resistance to airflow?

A
  • Subglottic stenosis
  • Tracheal stenosis
  • Tracheobronchomalacia
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10
Q

Which agents are commonly used in the treatment of apnea in the premature infant?

A

-Theophylline 10 mg/kg (converted into caffeine in the liver)

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11
Q

Why do premature infants have a decreased ability to compensate for hypovolemia?

A
  • Immaturity of the contractile cells
  • Immature autoregulation
  • Anesthesia blunts the limited compensatory mechanism
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12
Q

What two significant condition can occur due to the presence of a patent ductus arteriosus?

A
  • Pulmonary hypertension

- Congestive heart failure

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13
Q

How do low surfactant levels in the premature infant predispose th patient to hypoxia?

A

-Causes intrapulmonary shunting and V/Q mismatch resulting in hypoxia especially during anesthesia

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14
Q

What are the factors that contribute to the development of postoperative apnea in the premature infant?

A
  • Postconceptual age < 50 - 60 weeks
  • Hypothermia
  • anemia
  • necrotizing enterocolitis
  • neurologic problems
  • sepsis
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15
Q

What factor increases apnea the most postoperative?

A

-Postconceptual age < 50 - 60 weeks

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16
Q

How does the heart of a premature infant differ from that of a full term neonate?

A
  • Premature hear contain more connective tissue
  • Contractile elements are less organized
  • contractility has more dependence upon the extracellular calcium concentration
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17
Q

What are the treatment regimens for postoperative apnea in the premature infant?

A
  • Cardiorespiratory monitoring
  • correction of anemia or hypovolemis
  • IV caffeine to stimulate respiration (Theophylline)
  • Nasal CPAP
18
Q

Does regional anesthesia eliminate the risk for postoperative apnea in the premature infant?

A

-NO (only reduces apnea)

19
Q

What are the effects of increased pulmonary vascular resistance on a patient with a patent ductus arteriosus?

A

-Increase the right to left shunt

20
Q

What is the definition of postoperative apnea?

A
  • Apnea greater than 15 second

- Apnea that is accompanied by bradycardia

21
Q

Why is apnea common postoperatively in premature infants?

A

Anesthetic combined with the underdeveloped medullary respiratory control center predispose the patient to:

  • Hypercapnia
  • hypoxia
  • apnea
22
Q

Does the premature infant’s heart exhibit a greater or less sensitivity to catecholamines?

A

Less sensitive to catecholamines due to maximal level of beta adrenergic stimulation

23
Q

What are the ventilatory goals during the anesthesia of a premature infant?

A
  • minimize inspired O2 concentraion and peak inspiratory pressures
  • Have adequate O2 and ventilation
24
Q

When does surfactant production in the lungs begin?

A

23 - 24 weeks (typically inadequate until 36 weeks of gestation)

25
Q

How does tracheobronchomalacia result in increased airway resistance in the premature infant?

A

-collapses the intrathoracic airway during exhalation

26
Q

Do subglottic stenosis require a smaller endotracheal tube?

A

Yes

27
Q

Does tracheal stenosis require a smaller endotracheal tube?

A

NO, but there is increase in airway resistance.

28
Q

What is the mortality rate for respiratory distress syndrome in the premature infant? Why does it occur?

A
  • Also known as hyaline membrane disease
  • 50 to 75 % mortality
  • Inadequate surfactant in the alveoli
29
Q

What factors increase the risk for retinopathy of prematurity?

A
  • 32 weeks gestation has a decreased risk
  • PaO2 of 100 or 150
  • respiratory distress
  • hypercarbia
  • acidosis
  • anemia
  • heart disease
  • infection
30
Q

Describe the premature infant’s ventilatory response to hypoxia?

A

-Premature infants exhibit a biphasic ventilatory response to hypoxia. The inital response is an increase in ventilation . After several minutes, however, ventilation decreases and apnea may occur.

31
Q

Why are premature infants more susveptible to hypothermia?

A
  • little adipose tissue
  • surface area to mass is high
  • regulation of skin blood flow is not well developed
  • Mechanism of thermogenisis dependent upon brown fat is underdeveloped
32
Q

Why would a premature infant be prediposed to hyponatremia?

A
33
Q

Are premature infants at an increased risk for developing hyperglycemia or hypoglycemia?

A
  • Risk for developing both hypo and hyper glycemia
    1. Decreased stores of adipose tissue and lower glycogen stores predispose them to hypoglycemia during fasting
    2. Decrease in insulin production makes them more susceptible to hyperglycemia from dextrose infusion
34
Q

How does hyperglycemia affect outcomes in episodes of local and global cerebral ischemia in premature infants?

A

-Hyperglycemia exert a neuroprotective effect during episodes of cerebral ischemia
(Mild hypOglycemia can cause brain damage)

35
Q

What are the anesthetic implication for the premature infant with regard to their liver function?

A
  • Liver function is decreased
  • metabolism of drugs may be prolonged
  • albumin is not adequately produced in the liver yet for drugs that are protein bound will have a higher free form in circulation.
36
Q

A premature infant is undergoing laparotomy for necrotizing enterocolitis. What significant risk is closely associated with this procedure?

A

-Spontaneous liver hemorrhage (Recombinant factor VIIa may be use to treat this condition)

37
Q

What is the most common surgical emergency in the neonate?

A

-Necrotizing enterocolitis

CAUSES

  • umbilical artery catheterization
  • exchange blood transfusion
  • patent ductus arteriosus
  • cyanotic heart disease
  • respiratory distress syndrome
  • hyperosmolar feeding
38
Q

What inspired O2 concentration should be used to avoid the development of retinopathy of prematurity?

A

-Lowest inspired concentration to maintain O2sat of 92 to 96%

39
Q

In what premature infants would desflurane be a poor choice for general anesthesia?

A

-Bronchopulmonary dysplasia

40
Q

Is fentanyl suitable for use in premature infants?

A

YES (30 to 50 mcg/kg)

-half life prolonged in these patients

41
Q

Can remifentanil be used in premature infants?

A

YES

-Half life exhibits little difference in premature infants.

42
Q

How does the elimination half life of propofol in premature infants compare to that of children and adults? Why?

A

-Elimination half life is longer due to less muscle mass and fat tissue

Peds Anesthesia - Summer 2013 (14 decks)

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