Systems 3 Flashcards
Key differences between adult and kids airway
- tongue larger
- long floppy epiglottis use miller
- shorter trachea and neck
- narrowest part in subglottic region at cricoid (typically)
Child laying flat on back will… so you will need a…
obstruct, roll under neck
For Pediatrics, higher or lower FRC for child? less or more compliant lungs? more or less oxygen? High or low CO? Sensitive or nonexistent baroreceptor?
lower. less. more 2x O2. High CO. no baroreceptor
Main pediatric cardiac output up to age 2 is…
Heart Rate. CANNOT let kid get brady (need atropine to give kick)
Peds have increase or decrease in GERD.
Increased GERD
Renal and hepatic maturity
renal will mature at 6 months but not reach adult func until 2 years. Hepatic need 42 weeks
Kids will become anemic after birth but will increase to normal by when
6 months. 3 months
Peds, preop versed dose and mixer
Drink fast you are thristy!…. 0.5 mg/kg P.O. (up to 10mg) and mix with Tylenol
Teenager considerations
modesty, fear of death, fear of pain
Peds NPO guidelines
- clears ?
- breast milk ?
- nonhuman ?
- no solids ?
clears 2 hours (apple juice counts
breast milk 4 hours
nonhuman 6 hours
no solids after midnight
Peds IV sites
saphaneous and love vein near ring finger aim towards middle of wrist.
4-2-1 rule
do one or 12kg kid 24 kg kid
look it up for kiddos to be sure and add matenance mL/hr = (4 x first 10kg) + (2 x second 10kg) + (1 x every 1kg after)
Peds anestesthesia setup
SUX, atropine, epi airway= weight and age based (use little pinky finger nail size for ETT) baby BP monitor pulse ox bandaid like peds
LMA flippy technique used with adults or pediatrics
pediatrics really up to 5 years old for this flippy tech
What age do we think about a cuff?
8 years old. heart conditions as well?
Poiselles law with peds. why do we care
Resistance increases greatly! bc radius is raised to the fourth power.
ETT tube sizing for kiddos... Preterm ? 1000g ? 1000-2500g ? neo to 6 mon ? 6mon to 1 ? 1-2 years ? over 2 years ?
Preterm 2 1000g 2.5 1000-2500g 3 neo to 6 mon 3-3.5 6mon to 1 3.5-4 1-2 years 4-4.5 over 2 years (age in years + 16)/4
Peds induction for DAN
normal 70/30 NO2 then sevo 8 %
rapid- prime w/ 8% Sevo, 100% O2
hide under here method- N2O/O2 place mask under blanket with kid
Increased or decreased MAC for kids?
Decreased! YOUNG HOT SALTY ALCOHOLICS
How do we know if too much anesthesetic is too much?
Listen to HR then turn down if heart rate is going down
Crying child induction
- use the normal or hide under method
- excitement stage ready
- once pulse slows cut to 3%
- Do NOT overextend the neck
- Gentle CPAP helps open airway
- Let them breathe
Eldery Cardiac output
1% per year after age 30. mickey 2% haha
Eldery FRC increased or decreased
increased
What is the most perioperative mortality in eldery surgical patients? Urine output minimum? (hint has to do with urine)
Acute renal failure. so we wantUrine output = >0.5 ml/kg/hr
Neo nate vital signs
FILL IN side 24
Elderly Increased or decrease amount of epi/nore given?
increased 2-4x dose
Eldery BMR decrease after age 30
1% BMR decrease
Eldery less, more, or same muscle relaxant?
no diff generally
Eldery why do we have to wait for prop to set in?
LOW CO
Organ donation expiration time
- LIver
- heart and lungs
- pancreas
- kidneys
Liver 8-10 hours
hearts and lungs 4-6 hours
pancreas 15 hours
-kidneys 24-36
LIver transplant setup
CVP, PA cath, A-line after induction, no VA if acute (Go TIVA) but if chronic its okay
Hepatic disease why do we not want to mess with esophagus?
varices can rupture
What diuretic used in renal transplant
Mannitol. used to force urine production in people with acute (sudden) kidney failure.
Mannitol dose for renal protection
12.5 to 25 grams
Where does anesthesia occur outside the OR?
radiology (C, MRI), radiation therapy, cardiology (Cardioversion, PPM insertion, catheterization), psych (ECT), gastroenterology (EGD, Colonoscopy), Urology (ESWL)
JCAHO standards for outside OR (just read them)
SAME FOR OR ESSENTIALLY
-oxygen, suction, machine with battery backup, scavenging, Emergency cart with defib, Emergency drugs, two way communication need assistant,
- presed assessment
- continuous physiologic monitoring
- credentialing of individuals providing different levels of sedation
- postsedation recovery and discharge
- maintenance of instituion wide standards of care and quality assurance for all levels of care
