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Pediatrics > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Due to higher pressure in left heart

Blood flows back to right heart via ASD/VSD

Type of shunt

What is the result

A

Left to Right

Pulmonary HTN

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2
Q

Blood bypasses the lungs and flows through ASD/VSD

Type of shunt

Results in

A

Right to Left

Cyanosis

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3
Q

Types of simple left to right shunt

A

ASD

VSD

AVSD

AP window

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4
Q

Simple right to left shunts

A

Tetrology of Fallot

Pulmonary atresia

Tricuspid atresia

Ebstein anomaly

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5
Q

Complex shunts

A

Transposition of Great Arteries

Truncus Arteriosus

Double outlet right ventricle

Hypoplastic left heart syndrome

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6
Q

Secundum ASD causes

A

Left to right shunt

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7
Q

What hemodynamic alteration may worsen a left to right shunt

A

Increase in SVR

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8
Q

Most common congenital defect in children

A

VSD

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9
Q

VSD is what type of shunt

A

Left to right

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10
Q

Complete AV septal defect results in

A

Left to right shunt

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11
Q

Both atrial and ventricular components of defect and single common AV valve

A

Complete atrioventricular septal defect. AVSD

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12
Q

Blood flows from aorta to PA

Type of shunt

A

Patent ductus arteriosus

Left to right shunt

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13
Q

When does ductus arteriosus normally close

A

Within a few hours to few days after birth

Due to changes in pressures of the pulmonary vasculature

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14
Q

Name physiologic factor most responsible for closure of the ductus arteriosus after birth

A

Increased arterial oxygen tension (major factor)

Reduction in circulating prostaglandins

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15
Q

Foramen ovale is closes due to what type of closure

A

Mechanical closure

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16
Q

Shunt of PDA is what type of shunt

A

Left to right

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17
Q

With PDA what CV changes occur

A

Increased workload on L side of heart

LV hypertrophy

Increased PVR

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18
Q

Probable problem if pediatric patient has systolic and diastolic murmur

A

PDA

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19
Q

Preductal placement of pulse ox

A

Right hand

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20
Q

Postductal pulse ox placement

A

Lower limb

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21
Q

If pulse lost from lower limb during test clamp indicates what

A

Aorta inadvertently clamped

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22
Q

Preductal pulse ox location is index of what

A

Neonatal cerebral oxygenation

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23
Q

Postductal pulse ox in indicative of

A

Severity of right to left shunt

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24
Q

Where should arterial BP be measured in pt undergoing repair of PDA

A

Peripheral artery (femoral)

Post ductal

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25
Q

4 components of Tetrology of Fallot

A

Pulmonary stenosis

VSD

overriding aorta

RV hypertrophy

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26
Q

Tetrology of Fallot results in what type of shunt

A

Right to left

Cyanosis

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27
Q

Most common cyanotic CHD

A

Tetrology of Fallot

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28
Q

Tets spells occur when

A

There is and increase in right to left shunt

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29
Q

Decree of hypoxemia in tets spell depends on

A

Relationship between RV outlet tract obstruction and SVR that determines the degree of right to left shunt

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30
Q

To reverse shunt in tets spell need to

A

Increase SVR to reverse shunt

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31
Q

6 treatments for tets spell

A

100% 02

Hyperventilation

Increase preload

Sedation

Vasoconstriction (increase SVR)

Beta blocker to relax infundibular spasm and reduce HR

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32
Q

Surgical management of Tetrology of Fallot

A

Complete repair

Closure of VSD and RVOTO

Modified BT shunt

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33
Q

Modified BT shunt MOA

A

Conduit attatch in R subclavian to PA

Passive flow to lungs

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34
Q

Post of pulmonary blood supply is size of predominantly dependent on size of BT shunt

Too small

Too large

A

Small- low sat

Large- heart failure, pulmonary edema

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35
Q

Pulmonary blood flow is dependent on size of BP shunt and what

A

SBP

Greater BP=more flow to lungs = higher saturation

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36
Q

Which way does blood flow through VSD in Tetrology of Fallot

A

Right to left

Cyanosis

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37
Q

What pharmacological agent decreases right to left shunt

Why

A

Phenylephrine

Increases SVR to decrease shunt

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38
Q

Anatomy of transposition of great vessels

A

Aorta from RV

PA from LV

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39
Q

Ductal patency of DA is maintained after birth with

A

Prostaglandin 1 infusion

Ballon atrial septostomy

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40
Q

Most crucial part of successful outcome of arterial switch operation in transposition of great vessels

A

Coronary arteries connected to neo-aortic root

41
Q

Arterial switch repair with transposition of great vessels occurs when

A

Early (2-3 weeks)

42
Q

Common truncal calve and mixing of oxygenated and deoxygenated blood

A

Truncus arteriosus

43
Q

Path of truncus arteriosus

A

Common arterial outlet for aorta and PA associated with single valve and VSD

44
Q

Truncus arteriosus results in what if untreated

A

High pulmonary blood flow= heart failure and pulmonary HTN

45
Q

Tx for truncus arteriosus

A

Surgery to separate PA from systemic circulation and close VSD

46
Q

Path of hypoplastic left heart syndrome

A

Very small LV

Mitral and aortic valve stenosis/atresia

Hypoplastic aortic arch

Single ventricle

47
Q

Pulmonary blood flow in hypoplastic left heart syndrome is from

A

LA via ASD to RA/RV

48
Q

Systemic blood flow in hypoplastic left heart syndrome is from

A

RV to PA to aorta via PDA

49
Q

At birth neonates with hypoplastic left heart syndrome present with what S/S

A

Tachypnea

Tachycardia

Cyanosis

Systolic murmur

50
Q

Several surgeries are required to repair hypoplastic left heart syndrome. End result is

A

Single ventricle circulation

51
Q

3 surgeries to repair hypoplastic left heart syndrome

A

Norwood

Bidirectional Glenn

Fontan

52
Q

Norwood procedure occurs at what age

A

Days after birth

53
Q

Bidirectional Glenn repair occurs when

A

6 months

54
Q

Fontan procedure occurs when

A

1.5-3 years old

55
Q

Norwood stage operation is what

A

Creation of neo-aorta

Placement of BT shunt (flow from R subclavian to PA)

56
Q

Flow through BT shunt is dependent on what

A

Pressure

Is passive flow

57
Q

Post Norwood blood supply to lungs is from where

A

BT shunt of Sano modification

From subclavian to RA

58
Q

Norwood anesthetic considerations

A

High dose opiods

Avoid IJ venous access

Balance SVR and PVR

Sternum will remain open

59
Q

Bidirectional Glenn shunt procedure

A

BT shunt taken down

Connection of SVC to PA

60
Q

Fontan procedure

A

Connect IVC to PA

61
Q

Pulmonary blood flow after Fontan comes from

A

Passive flow from SVC and IVC

62
Q

Post op Fontan considerations

A

PVR must remain balanced

Inotrope (milrinone) often needed

Early extubation beneficial

63
Q

How does FiO2 have an influence on PVR

Hypoplastic left heart syndrome

A

Hypoxia causes pulmonary vasoconstriction but systemic vasodilation

High FiO2 significantly reduces PVR and increases blood flow to lungs away from systemic circulation

64
Q

Why is it dangerous to administer high FiO2 to HLHS patient

A

Decreases PVR steals blood away from systemic circulation = decreased cardiac output

65
Q

Which do potent volatiles decrease more

PVR or SVR

A

PVR

66
Q

Ways to decrease PVR

A

Increased FiO2

Hypocapnia

67
Q

PVR is increased with what

A

PEEP

Acidosis

Hypothermia

Low FiO2

68
Q

Why is phenylephrine used to reduce R to L shunt and increase L to R shunt

A

Increases SVR more than PVR

69
Q

7 factors that increase PVR

A

Hypoxemia

Hypercapnia

Acidemia

Hypothermia

Atelectasis

Transmitted positive airway pressures (PEEP)

Stress response/stimulation/light anesthesia

70
Q

Anesthesia for HLHS

A

Spontaneously breathing

FiO2 21%

Prostaglandin E1 infusion

Normal/high PaCO2

71
Q

If PDA is undesired to remain open what do you do

A

Indomethacin

PDA ligation

72
Q

Subacute Bacterial Endocarditis prophylaxis

A

Amoxicillin PO

Ampicillin IV/IM

Cefazolin IV/IM

Ceftriaxon IM/IV

73
Q

Induction drug of choice for cardiac anesthesia

Why <1.5 MAC

A

Sevo

> 1.5 MAC slows HR and respiratory depression

74
Q

CHD patients respond to bradycardia in what way

A

Reduced cardiac output

Hypoventilation

Hypercarbia

Hypoxia

All = RISE IN PVR

75
Q

Sevo effect on SVR

A

Mil decrease

76
Q

Young infants with severe CHD induction

A

High opioid (3-5mcg/kg fentanyl)

Pancuronium

Low dose Sevo/ISo

77
Q

In what patients should N2O be avoided

Why

A

Limited pulmonary blood flow

Pulmonary HTN

Depressed myocardial function

Decreases cardiac output

78
Q

Propofol should be avoided in what patients

A

Fixed cardiac output

Severe AS/MS

Causes severe hypotension

79
Q

Nitric oxide MOA

A

Very specific pulmonary vasodilator

Results in pulmonary vascular smooth muscle relaxation

80
Q

Cath lab usage of inhaled nitric oxide

A

Assess reactivity of pulmonary vasculature

81
Q

Dose of inhaled nitric oxide in cath lab

A

20-40 ppm

82
Q

Flolan MOA

A

Naturally occurring prostaglandin

Potent vasodilator (SVR and PVR)

Treatment for primary pulmonary HTN

83
Q

Flolan is contraindicated in which patients

A

CHF due to severe LV systolic dysfunction

84
Q

Medications to avoid in EP study

A

Lidocaine

Opioids

Volatiles

Dexmedetomidine

85
Q

4 defects involved with tetrology of Fallot

A

VSD

RVOT obstruction

RV hypertrophy

Overriding aorta

86
Q

Goals of anesthetic management of patient with tetrology of fallot

A

Avoid tets spell

Maintain IV volume and SVR

Avoid increases in PVR

87
Q

Infant with tetrology of fallot. Which ABG parameter will not be changed

A

PaCO2 and pH will be normal

88
Q

What agents might be selected to decrease shunt and increase O2 sat in tetrology of fallot patient with desaturation due to increased shunt

A

IVF

Alpha agonist (phenylephrine)

89
Q

3 conditions that increase right to left shunt in tetrology of fallot

A

Acidosis

Hypercarbia

Hypotension

90
Q

Should upper extremity BP be monitored in neonate with preductal coarctation of aorta be measured in R or L arm

A

Right radial artery

91
Q

Best site to obtain ABG from neonate

A

Right radial artery bc preductal

92
Q

Preductal oxygen saturation reflects

A

Cerebral oxygenation

93
Q

Anesthetic concern for pediatric patient undergoing repair of VSD with significant pulmonary HTN

A

Avoid manipulations that may increase PVR

Hypoxia 
Hypercarbia
Acidosis
Hypothermia
Atelectasis
SNS stimulation
Polycythemia
94
Q

R to L intracranial shunt is present in patient with VSD with Eisenmengers. What alterations may worsen R to L shunt of VSD

A

Abrupt increase in PVR or decrease in SVR

95
Q

Will R to L shunt slow or accelerate inhalation induction

A

Slow

Blood bypasses lungs

96
Q

Will R to L shunt slow or accelerate IV induction

A

Accelerate

Don’t need lungs

97
Q

will L to R shunt slow or accelerate inhalation induction

A

Accelerate

Rate of transfer from lungs to blood is increased

98
Q

Will L to R shunt slow or accelerate IV induction

A

Slow

Pediatrics (6 decks)

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