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1
Q

What is the normal Hgb for a full term infant?

A

18-20 g/dL

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2
Q

The primary event of the respiratory system transition is ___________________________.

A

Initiation of ventilation

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3
Q

How much negative pressure must an infant generate to inflate the lungs?

A

—> -70cm H2O

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4
Q

What helps the infant maintain FRC/lung inflation during anesthesia?

A

PEEP of 5 cmH2O

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5
Q

The initial hyperpneic response is abolished by __________ and ________.

A

Hypothermia

Low levels of anesthetic gases

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6
Q

What does hypoxia cause in babies?

A

Profound bradycardia

** resuscitative efforts must occur when HR <60

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7
Q

T/F fetal circulation runs in parallel and PVR is high.

A

True

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8
Q

What is the treatment for persistent pulmonary hypertension?

A
  • adequate ventilation and oxygenation - 10mL/kg is an adequate tidal volume up to 10 years
  • avoid stress
  • minimal handling
  • hyperventilate
  • prostaglandin (alprostadil infusion)
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9
Q

Why is the neonate considered an obligate sodium loser?

A
  • tubules do not completely reabsorb Na under the stimulus of aldosterone
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10
Q

What is the lowest acceptable Hct in an infant and why?

A

35% is lowest Hct

  • increased blood volume per unit weight
  • increased CO per unit weight
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11
Q

How is heat production achieved in the neonate?

A

Non-shivering thermogenesis

—> metabolism of brown fat

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12
Q

Once a premie always a ______________.

A

Premie—> prone to laryngospasms

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13
Q

In an uncooperative induction, what is the order for application of monitoring equipment?

A

1st: pulse ox
2nd: ECG
3rd: BP cuff

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14
Q

If a pt is extubated deep and brought straight to the PACU, what are they at risk of?

A

Post-op laryngospasm while going through stage 2 in PACU

—> DO NOT STIMULATE THE CHILD UNTIL AWAKE!

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15
Q

Where is the pediatric larynx located and what are some characteristics in this area?

A

Larynx located at C3-4
Airway is funnel shaped
* narrowest portion is the cricoid cartilage *

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16
Q

How long is the trachea up to 1 year of age?

A

5-9 cm—> don’t bury the ETT!

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17
Q

What shape is the epiglottis in the infant?

A

Ω (omega) or U shaped

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18
Q

What is the FRC in an infant?

A

Small, 27-30mL/kg, but not functional

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19
Q

What are s/s of epiglottitis?

A
  • rapid clinical progression
  • high fever >39ËšC
  • dysphasia
  • drooling
  • dysphonia
  • strider
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20
Q

Treatment for epiglottitis?

A
  • urgent intubation in OR with ENT present
  • do nothing to agitate the child
  • maintain spontaneous ventilation
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21
Q

Where is the most common site for foreign body aspiration and what do you do if airway obstruction is present?

A
  • most frequent site is right mainstem

- inhalation of volatile agent in O2 maintaining spontaneous ventilation

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22
Q

When is the peak time for post tonsillectomy bleeding?

A

POD 7

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23
Q

Describe gastroschisis.

A
  • 1:15,000-30,000
  • isolated lesion
  • lateral defect
  • umbilical cord normal
  • bowel exposed, thickened, edematous
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24
Q

Describe omphalocele.

A
  • 1: 5,000-7,000
  • associated anomalies common
  • central defect
  • umbilical cord within defect
  • sac covers organs, bowel normal
25
When is it unsafe to close the abdomen?
- intragastric pressure >20mmHg - change in CVP >4mmHg above baseline - ETCO2 > 50mmHg - PIP > 35cmH2O
26
What is pyloric stenosis and when does it occur?
- stenosis of the pyloric sphincter causing forceful projectile nonbilious vomiting —> results in hyponatremia, hypokalemia metabolic alkalosis - occurs between 2-8 weeks of life
27
Is pyloric stenosis a medical or a surgical emergency?
Medical emergency - treat electrolyte and fluid imbalances before surgical correction * * aspiration of gastric fluid is primary concern
28
What is the greatest concern with congenital hip dislocation?
- LOSS OF AIRWAY during spica casting
29
With osteogenesis imperfecta what must you keep in mind?
- Succinylcholine induced fasiculations can cause fractures | - gentle manipulation of C spine and airway is vital
30
With cerebral palsy what must be remembered if seizure disorders are present?
Anti seizure meds should be taken up to and including day of surgery
31
What are different considerations with different degrees of scoliosis?
- thoracic curvature > 25˚ requires an echo - > 40 ˚ curvature requires surgical intervention - > 65–> restrictive lung disease
32
During scoliosis repair what area key considerations?
- prone procedure - high risk of bleeding - decreased CO - increased intra abdominal pressure - IVC compression
33
How do you calculate and prepare the appropriately sized ETT?
(16 + age in years)/4 Always prepare calculated tube and 1/2 size smaller * there should be an air leak around the tube at a pressure between 15-25 cm H2O
34
How would you calculate succinylcholine doses for laryngospasm, both IV and IM?
IV: 0.4mg/kg IM: 4mg/kg * succinylcholine vial concentration = 20mg/mL
35
What does stage 1 look like?
``` Awake Eyes midline Pulse irregular BP normal resp. Irregular ```
36
What does stage 2 look like?
``` Hyper-excitable Eyes divergent Resp. Irregular HR irregular and fast BP high ```
37
What does stage 3 look like?
``` Asleep Eyes midline Resp. Even Pulse steady and slow BP normal ```
38
What does stage 4 look like?
``` Cardiovascular reflexes are anesthetized Eyes midline Pulse weak and thready BP low Resp. Slow and shallow ```
39
Why is IV induction advantageous?
- asleep without going through stage 2 | * ** risk of laryngospasm is very low
40
What is the most common cause of bradycardia in a child?
Hypoxia | You should really know this
41
How does congenital diaphragmatic hernia present clinically?
Herniation of abdominal organs into thoracic cavity - dyspnea - cyanosis - apparent dextrocardia - bulging chest - scaphoid abdomen - decreased breath sounds - distant heart sounds - bowel sounds in chest
42
How is congenital diaphragmatic hernia treated?
Medical management for 24-48 hours prior to surgery —> maximize arterial oxygenation- intubate, mechanical ventilation, correction of acidosis, improve pulmonary perfusion - prevent hypothermia - prevent pain
43
What are some precautions that should be taken when caring for the CDH pt?
- minimize barotrauma - do not bag mask ventilate—distends the stomach - hyperventilate (goal PaCO2 is 25-35) - fentanyl - minimal handling - do not use N2O!! - prevent hypothermia
44
What is tracheoesophageal fistula and how does it present?
Esophageal Atresia with or without a fistula between the esophagus and trachea - inability to manage oral secretions - excessive salivation - choking on first feed - coughing - cyanosis - aspiration - gastric distention - PNA * * diagnosed by inability to pass catheter or OGT into stomach, CXR
45
T/F VACTERL is not associated with tracheoesophageal fistula.
False | It is one of the associated anomalies of VACTERL
46
What are anesthetic considerations for TEF?
- concern for aspiration - gastric distention - respiratory comprise on induction - in unstable infants consider awake intubation - on stable infants inhalation induction with spontaneous ventilation - avoid high PPV - maintain small tidal volume - AVOID N2O - position in lateral decubitus position for right thoracotomy
47
What are intra-op and post op complications for TEF?
``` intra-op: - airway compromise - hypothermia - hypoglycemia - return to fetal circulation (R to L shunt) Post-op: - DO NOT extend head - DO NOT suction beyond level of esophageal anastomosis ```
48
What are NPO guideline for peds?
2 hours clears 4 hours breast milk 6 hours formula 8 hours solids
49
What is unique about the pediatric larynx when compared to the adult?
Proportionately smaller | More anterior and cephalad
50
What is the narrowest portion of the airway in a child?
Cricoid cartilage (below the vocal cords)
51
What are the epiglottis and tongue in a child like compared to the adult?
Epiglottis is longer and narrower | Tongue is proportionately larger
52
What area the head and neck like in a child compared to the adult?
Head and occipital are proportionately larger | Neck is much shorter
53
Are the adenoids larger or smaller in a child?
Larger
54
T/F risk of mainstem intubation is much higher in pediatric patients due to short trachea and bronchus?
True
55
What are commonly seen characteristics in down’s syndrome?
- smaller than normal for age - craniofacial: microbrachycephaly - short neck, low set ears - macroglossia, microdontia with fused teeth - mandibular hypoplasia - narrow nasopharyngeal with hypertrophic lymphatic tissue: T and A - generalized hypotonia
56
What are common heart defects associated with down’s syndrome?
- AVSD (most common) - VSD - TOF - PDA
57
What are anesthetic considerations for the down’s syndrome pt?
- strong underlying vagal tone —> BRADYCARDIA WITH GA INDUCTION HAPPENS VERY QUICKLY***** - OSA, MR, Pulm HTN, CHD with hypoxemia - atlantoaxial instability - subglottic stenosis * minimal head movement- smaller ETT
58
What causes metabolism of brown fat?
Cold stress mediated by the SNS
59
Cold stress in an infant causes what?
“Cold stress” cascade—> acidosis, hypoglycemia, right to left shunting

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