Test 2 OB Complications/Management Flashcards
The 3 significant risk factors for preterm
- History of preterm labor
- Non-Hispanic black race
- Multiple gestation
- Side effects of f terbutaline 5
-
Side effects of f terbutaline
- hypotension
- tachycardia
- pulmonary edema
- hyperglycemia
- hypokalemia
Factors assoc. with Breech Presentation:
Main 4:
Factors assoc. with Breech Presentation:
Main 4:
- Uterine distention or relaxation
- Abnormalities of uterus or pelvis
- Abnormalities of fetus
- OB conditions
Factors assoc. with Breech Presentation:
These may cause: Uterine distention or relaxation:
- multiparity
- multiple gestation
- macrosomia
- hydramnios
Factors assoc. with Breech Presentation:
These may cause: Abnormalities of uterus or pelvis
- Pelvic tumors; contractures
- Uterine anomalies
Factors assoc. with Breech Presentation:
Abnormalities of fetus
- Hydrocephalus
- Anencephaly
Factors assoc. with Breech Presentation:
OB conditions
- Previous breech delivery
- Preterm
- Oligohydramnios
- Cornual-fundal placenta
- Previa
Fetal complications assoc with multiple gestation
- preterm delivery
- congenital anomalies
- polyhydramnios
- cord entanglement
- cord prolapse
- fetal growth restriction
- twin to twin transfusion
- malpresentation
Maternalcomplications assoc with multiple gestation
- pPROM
- preterm labor
- prolonged labor
- pre-eclampsia/eclampsia
- DIC
- forceps/csec
- uterine atony
- OB trauma
- ante/post partum hemorrhage
most common medical disorder of pregnancy:
effects 6-10%
gestational cause: 5%
HTN
No proteinuria with HTN ,may consider Pre-eclamptic if any of following are present
- No proteinuria with HTN ,may consider Pre-eclamptic if any of following are present
- 1) persistent epigastric or RUQ pain
- 2) persistent cerebral symptoms
- 3) fetal growth restriction
- 4) thrombocytopenia
- 5) elevated liver enzymes
-
Chronic hypertension with superimposed preeclampsia
- Will menifest how?
- will see New onset proteinuria
- or sudden INC in proteinuria or hypertension or both
- Pre-eclampsia w/o severe features includes what parameters for each:
- BP
- Proteinuria
- protein - Cr ratio
- dip stick urine
- BP >140/90
- Proteinuria >/= 300mg/24h
- protein - Cr ratio >/= 0.3
- dip stick urine 1+ protein
Diagnostic criteria for SEVERE Pre-eclampsia
- BP > 160/110
- plt < 100k
- Cr > 1.1 or > 2x baseline
- pulm edemer
- new onset cerebral/visual disturbance
- impair liver fx
Pre-eclampsia: symptoms
CNS
- severe HA,
- hyperexcitability
- hyperreflexia
- coma
- visual disturbances (scotoma, amaurosis, & blurred vision)
Pre-eclampsia: symptoms
Airway
- pharyngolaryngeal edema
- subglottic edema (made worse with preeclampsia)
- Dysphonia, stridor, hoarseness, snoring, and hypoxemia are s/s of airway swelling
Pre-eclampsia: symptoms
Pulmonary
- INC colloid osmotic pressure + INC vascular permeability & loss of intravascular fluid & protein into interstitium = pulmonary edema
Pre-eclampsia: symptoms
CV
- hypertension
- vasospasm
- end-organ ischemia
- hyperdynamic state ( INC CO, hyperdynamic LV function, INC SVR) – exaggerated response to circulating catecholamines
Pre-eclampsia: symptoms
Hematology
- thrombocytopenia (most common hematologic abnormality);
- platelet counts < 100,000 mm3 seen in severe stages & in HELLP DIC can occur if severe liver involvement
- intrauterine fetal demise
- placenta abruption
-
postpartum hemorrhage
- Disease state can begin with hypercoagulability but progresses to hypocoagulability
Therapeutic range for serum Mg level:
mg/dLs
mEq/L
- Therapeutic range for serum Mg level:
- 5-9 mg/dLs (Chestnut’s)
- 4-6 mEq/L (M&M)
-
Hypermagnesemia: changes with these levels
- 12 mg/dL
- 15-20 mg/dL
- > 25 mg/dL
-
Hypermagnesemia: when pass therapeutic levels and get toxic
- 12 mg/dL Patellar reflexes lost i(deally stop gtt at this time)
- 15-20 mg/dL Respiratory arrest
- > 25 mg/dL Asystole
GA: indications in Preeclampsia
- GA: indications in Preeclampsia
- severe maternal hemorrhage
- fetal bradycardia
- severe thrombocytopenia &/or coagulopathy
-
Placenta Previa (cont)
- Classic sign:
-
Placenta Previa (cont)
- Classic sign:
- Painless vaginal bleeding 2nd or 3rd trimester
- Classic sign:
-
Anesthetic management: Previa
- Technique depends on: 3
-
Anesthetic management
- Technique depends on:
- indication & urgency of delivery
- severity of maternal hypovolemia
- obstetric history
- Technique depends on:
most common cause of maternal mortality
obstetric hemorrhage is the most common cause of maternal mortality and postpartum hemorrhage contributes to 80% of that.
Major risk factors for VTE in PP period: need at least one of these to be able to be put on anticoagulation
- immobility (strict bed rest >= week during antepartum
- previous VTE
- Preeclampsia w/ fetal growth restriction
- Thrombophilia
- AT III def
- Fact V leiden (homo or heterozygous)
- PT G20210A “ “
- Medical
- SLE
- HD
- Sickle cell
- PP hemorrhage >= 1000ml and surgery
- PP infection
- Blood tx
Minor risk factors for VTE in PP period: need at least two of these to be able to be put on anticoagulation
- BMI > 30 kg/m2 (Obesity)
- Csec (E)
- multiple pregnancy
- PP hemorrhage > 1000 ml
- Smoking > 10 cig/day
- Fetal growth restriction
- Thrombophilia
- Protein C or Protein S deficiency
- Preeclampsia
Uterine artery/blood supply
Chronic BF reduction – usually due to:
- abnormal placental development
- maternal disease (preeclampsia)
- In pregnancy, flow may differ between R & L uterine arteries
- In the uterine arteries (compared with contralateral artery):
- Vessel diameter is __ greater (on side of placenta)
- Blood flow is ___greater (on side of placenta)
- In the uterine arteries (compared with contralateral artery):
- In pregnancy, flow may differ between R & L uterine arteries
- In the uterine arteries (compared with contralateral artery):
- Vessel diameter is ~ 11% greater (on side of placenta)
- Blood flow is ~ 18% greater (on side of placenta)
- In the uterine arteries (compared with contralateral artery):
uterine BF increases during pregnancy
3 phases of increase:
- 1) before & during implantation & early placentation
- 2) growth & remodeling of uteroplacental vasculature
- 3) progressive uterine artery vasodilation to meet fetal needs
- 3 major factors that decrease UBF:
1) hypotension
2) vasoconstriction (uterine)
3) contraction (uterine)
- Common causes of hypotension during pregnancy
- ACC
- Hypovolemia
- Sympathetic blockade w/ NAA
use UPP, UVR, UAP and UAP to make 2 formulas for UBF:
- Uterine blood flow =
- Uterine blood flow =
- Uterine blood flow = UPP/UVR
- Uterine blood flow = (UAP – UVP)/ UVR
- Embryonic placenta circulation begins about __weeks gestation
- about 8 weeks gestation
- Mature placenta:
- Ave diameter __ cm
- Weight __ g
- Thickness__ mm
- At term, fetal-placental weight is __% of maternal wt
- Mature placenta:
- Ave diameter 18.5 cm
- Weight 500 g
- Thickness 23 mm
- At term, fetal-placental weight is 6% of maternal wt
where most of the placental exchange of nutrients, gases and wastes occur.
terminal villi - where most of the placental exchange of nutrients, gases and wastes occur.
-
UBF at term:
- Max __ ml/min (~ 10% CO)
- __ ml/min to myometrium
- __ ml/min to decidua
- Remainder to intervillous space ~ __% UBF
- Max __ ml/min (~ 10% CO)
-
UBF at term:
- Max 700-900 ml/min (~ 10% CO)
- 150 ml/min to myometrium
- 100 ml/min to decidua
- Remainder to intervillous space ~ 80% UBF
- Max 700-900 ml/min (~ 10% CO)
- Passive Transport Depends on:
- concentration & electrochemical difference
- molecular weight
- lipid solubility
- degree of ionization
- membrane surface area & thickness
Things that make facilitated transport different from passive transport: Facilitated involves these: 4
1) Saturation kinetics
2) Competitive & noncompetitive inhibition
3) Stereospecificity
4) Temperature influences – a higher temp will result in a greater transfer
- Other Factors Influencing Placental Transport
- Maternal & fetal blood flow
- placental binding
- placental metabolism
- diffusion capacity
- maternal & fetal plasma protein binding
- gestational age
- lipid solubility
- pH gradients
- plasma protein levels
- disease states
- Uterine blood flow is about ___**mL/minute
- Uterine cord blood flow is about ___ mL/minute
- Uterine blood flow is about 700 mL/minute
- Uterine cord blood flow is about 300 mL/minute
-
Oxygen
- Placenta provides ___ml O2/min/kg fetal body weight—it acts as the lung for the fetus; however:
-
Oxygen
- Placenta provides 8 ml O2/min/kg fetal body weight—it acts as the lung for the fetus; however:
- Transfer of Respiratory Gases & Nutrients
-
Carbon Dioxide
- Transfer occurs through several forms:
- dissolved CO2
- carbonic acid
- bicarbonate ion
- carbonate ion
- carbaminohemoglobin
- Concentration of amino acids is highest in this order: (highest to lowest)
- Concentration of amino acids is highest in this order: (highest to lowest)
- Placenta
- umbilicus venous blood (Umbilical vein)
- maternal blood
what determines the fetus’s exposure to drugs that the mother has received.
Placental permeability and pharmacokinetics
-
Drug Transfer
- Factors affecting drug transfer across the placenta:
- lipid solubility
- protein binding
- tissue binding
- pKa
- pH
- blood flow
- Rate of diffusion (Drug Transfer) depends on:
- Maternal-to-fetal concentration gradient
- maternal protein binding
- molecular wt of substance
- lipid solubility
- degree of ionization of substance
- placental properties
- hemodynamic events within the fetomaternal unit
- Maternal blood concentration of a drug is typically the primary determinant of how much drug will ultimately reach the fetus. Factors that effect this are:
- Dose
- Mode and Site of administration
- Additive drugs (ex- epinephrine added to a local)
- Transfer of drugs from maternal circulation to the fetal unit is determined primarily by diffusion.
- Factors favoring diffusion include:
- Low molecular weight
- High lipid solubility
- Low degree of ionization
- Low protein binding
factors that minimize drug effects on fetus
- Dilution
- fetal cardiac output
- acid base status of fetus
Extremely high levels of local, such as those with unintended maternal intravascular injection, can cause:
- fetal bradycardia,
- ventricular arrhythmias
- acidosis
- severe cardiac depression
Roles of Amnio fluid
1) Facilitates fetal growth
2) Provides of microgravity environment that cushions fetus
3) Generates defense mechanism against invading microorganisms
Amniotic fluid
- Between 10 & 20 weeks, volume increases from ~ __ to __
- Between 10 & 20 weeks, volume inc from ~ 25 ml to 400 ml
Amnio fluid
- Near term fetal urine production is __ mL/ day, respiratory tract __ mL/kg fetal body weight/day, and swallowing is __ml/kg fetal body weight/day
- Near term fetal urine production is 600-1200 mL/ day, respiratory tract 60-100 mL/kg fetal body weight/day, and swallowing is 200-250 ml/kg fetal body weight/day
amnio fluid
- b/w amniotic fluid and fetal blood w/in placenta
- b/w amniotic fluid and maternal blood within the uterus
- intramembranous - b/w amniotic fluid and fetal blood w/in placenta
- transmembranous - b/w amniotic fluid and maternal blood within the uterus
Amniotic Fluid
-
Composition
- Keratinization + fetal production of urine results in:
Amniotic Fluid
-
Composition
- Keratinization + fetal production of urine results in:
- urea & creatinine
- Na+ & Cl-
- osmolality
- Keratinization + fetal production of urine results in:
composition of amnio fluid complete by this many wks gestation
25 weeks
Play important role in fetal intestinal development (within amnio fluid):
there are six
-
Growth factors: Play important role in fetal intestinal development
- epidermal growth factor
- transforming growth factor-alpha
- transforming growth factor-beta 1
- insulin-like growth-factor 1
- erythropoietin
- granulocytes colony-stimulating factor
-
Antimicrobial defenses
- Humoral mediators:
- alpha-defensins
- lactoferrin
- calprotectin
- leukocyte protease inhibitor
- cathelicidin
- In fetal tissues, hypoxia occurs at oxygen tension < __ mm Hg
- (normal, 20-25 mm Hg)
- In adults, hypoxia= PO2 <__ mmHg
- In fetal tissues, hypoxia occurs at oxygen tension < 17 mm Hg
- (normal, 20-25 mm Hg)
- In adults, hypoxia= PO2 <20 mmHg
Normal and only source of glucose is
- Normal and only source of glucose is transfer across placenta
- Fetal glucose concentrations are Range of ___ to ___ mg/dl
- Fetal glucose concentrations are Range of 54-90 mg/dl
Umbilical cord uptake is ______ (uptake speed /min) at normal maternal arterial plasma glucose concentrations
- Umbilical cord uptake is 5mg/kg/min at normal maternal arterial plasma glucose concentrations
Total lactate production is about ___ (per min) though the exact source has not been identified by studies.
- Total lactate production is about 4mg/kg/min though the exact source has not been identified by studies.
name of maternal-fetal difference in temperature
- Heat clamp
Fetal intravascular volume: ml/kg
% in placenta:
fetal body blood volume:
- Fetal intravascular volume ~ 110 ml/kg
- 25% of this blood voulme is in placenta
- Blood volume in fetal body is about ~ 80 ml/kg
-
Systolic BP
- 16 weeks: Systolic BP inc from ____ mmHg
- 28 weeks: inc to ___ mmHg
- Systolic BP
- 16 weeks: Systolic BP inc from 15-20 mmHg
- 28 weeks: inc to 30-40 mmHg
-
Diastolic ventricular pressure slower & smaller increases
- 16-18 weeks: __ mmHg or less
- 19-26 weeks: __ mmHg
- Diastolic ventricular pressure slower & smaller increases
- 16-18 weeks: 5 mmHg or less
- 19-26 weeks: 5-15 mmHg
timing of SNS and PNS development
- PNS ~ 8 wks
- SNS ~9-10 wks
- Full maturation of vagal response not observed until __ mo after birth
- Full maturation of vagal response not observed until 1-2 mo after birth
- At birth, ANS can mediate hemodynamics via changes in: 3
- HR
- PVR
- Redistribution of blood flow
-
True alveoli develop ~ __wk
- Majority occur in__ months of life
-
True alveoli develop ~ 36 wk
- Majority occur in 6-18 months of life
- Pulmonary circulation documented at __days gestation
- Pulmonary vasculature starts early w/ full pulmonary circulation at the __days
- Pulmonary circulation documented at 34 days gestation
- Pulmonary vasculature starts early w/ full pulmonary circulation at the 34 days
- Attempt respiratory movement starts at:
- Attempt respiratory movement starts at end of 1st trimester
- Vessel reactivity to local & hormonal influences seen after __wk
- Vessel reactivity to local & hormonal influences seen after 20 wk
- During this time of pregnancy, respiratory movement are inhibited
- Last 3-4 months of pregnancy respiratory movement inhibited
↓ PVR at birth due to:
- Creation of alveolar surface tension
- Abrupt surge in pulmonary blood flow r/t the change in breathing movements & sheer stress
- Predominance of vasodilators (e.g: nitric oxide & prostacyclin) vs vasoconstrictors
-
Expulsion of lung liquid
- In utero, fetal lungs are filled with fluid to maintain proper expansion for normal pulmonary development
- one of the last systems to develop before birth
Pulmonary surfactant system: one of the last systems to develop before birth
- Fetal surfactant production can be accelerated by:
“TAG”
- thyroid hormones
- autonomic transmitters
- Glucocorticoids
mainly regulates the fluid and electrolyte balance, as well as the acid-base balance for the fetus
- The placenta mainly regulates the fluid and electrolyte balance, as well as the acid-base balance for the fetus
- Fetal glomeruli develop__weeks
- Fetal glomeruli develop 8-9 weeks
Produce urine at __ weeks
Produce urine at 10 weeks
- At 20 weeks,____% of amniotic fluid is provided by kidneys
- At 20 weeks, > 90% of amniotic fluid is provided by kidneys
- GFR at birth: ____
- At 1 mo of age: increases to _____
- The GFR levels continue to increase until they reach adult levels between 1 and 2 years of age
- GFR at birth: 20 ml/min/1.73m2
- At 1 mo of age: increases to 50 ml/min/1.73m2
- The GFR levels continue to increase until they reach adult levels between 1 and 2 years of age
- Kidneys filter, reabsorb, & secrete (tubular function) begins ___ weeks gestation
- Kidneys filter, reabsorb, & secrete (tubular function) begins 14 weeks gestation
- but… regulation of fetal ECF volume and electrolyte balances are almost nonexistent until late fetal life
- 2 erythroid lineages (in hematology)
- Primitive (embryonic) – support transition from embryo to fetus
- Definitive (adult) – transition from fetal to extrauterine life
adult vs fetal hemaglobin chain make up
- Tetramer for HGB F (fetal): (a2y2)
- 2 a - chains (alpha)
- 2 y - chains (gamma)
- Tetramer for HGB A (adult): (a2B2)
- 2 a - chains
- 2 B - chains
Term:
- HGB A ≈ __%
- P50 ≈ __ mmHg
-
Term:
- HGB A ≈ 25%
- P50 ≈ 19 mmHg
- Intestinal villi start to appear at:
- Peristaltic waves & motility
7 weeks gestation - Villi
8 weeks gestation - Peristalsis
- Active absorption of glucose & amino acids
-
10-12 weeks gestation
- Active absorption of glucose & amino acids
- Teniae (ribbons of smooth muscle on outside of colon) appear & contract to form haustra (bulges) in colon (what week?)
- 12 weeks - Teniae –> haustra bulges in colon
Peyer patches in ileum being to appear what week
- 20 weeks gestation - Peyers
swallowing starts when
injest amnio how much per day!
- 15 wks - swallowing
- Ingests about 500-750 ml/day amniotic fluid
meconium first appearance
whats in it?
10-12 weeks gestation - meconium
- intestinal secretions
- squamous cells
- lanugo hair
- bile pigments
- blood and H2O
fetal colonic contents appear
14-22 - colon contents
-
Structural & Functional Brain Development
- 4 wk:
- 8-12 wk:
- 20 wk:
- 24-28 wk:
- 3rd TRI:
- 1st fetal movement:
- EEG activity ~
-
Structural & Functional Brain Development
- 4 wk: primary neuromodulation & neural tube formation
-
8-12 wk: prosencephalon development is initiated
- As well as the subplate layer
- 20 wk: cortical development, organization, & synapse formation
- 24-28 wk: subplate layer disintegrates
- 3rd TRI:cerebral cortexvolume increases4x
- 1st fetal movement: end of 1st TRI
- EEG activity ~ 24 wks
fetus relies on what type of metabolism for energy
primary source of energy of cerebral energy
oxidative metabolism
glucose
- Development of neural tube begins with formation of ___ ___
- Development of neural tube begins with formation of vascular channels
- 10 wk: extensive network of ______arteries covering brain
- 10 wk: extensive network of leptomeningeal arteries covering brain
- cutaneous sensory receptors present when
- current evidence: fetal nociception at cortical level begins 24-30 wks
- 7 wks cutaneous sensory receptors present
- current evidence: fetal nociception at cortical level begins 24-30 wks
- term: cutaneous sensory same or exceeds adult
reliability of fetal scoring systems
- Scoring systems not reliable for identifying high-risk fetuses b/c more than half infants with asphyxia had none of the risk factors on the scoring systems
- One of the most important determinants of placental function
One of the most important determinants of placental function is UBF
Compensatory responses of healthy fetus if there is a transient decrease in UBF: 4
-
Compensatory responses of healthy fetus if there is a transient decrease in UBF:
- 1) decreased oxygen consumption
- 2) vasoconstriction of nonessential vascular bed
- 3) redistribution of blood flow to vital organs
- 4) humoral responses
initial fetal response to hypoxia per studies
bradycardia is the initial fetal response to hypoxia
normal baseline FHR
-
Normal: 110-160
- determined by assessing mean over 10 min;
- Rounded to increments of 5 bpm
- Term HR < preterm (greater PNS activity)
define FHR variability
Fluctuation in FHR of 2 cycles or more per min
role of SNS vs PNS in FHR variability
which has more important role
PNS > SNS
SNS least important role
Differential Diagnosis of decreased variability
- Differential Diagnosis of decreased variability:
- Hypoxia
- sleep state
- neurologic abnormality
- decreased CNS from drug exposure (opioids)
Late decels + dec/absent variability
combination of these type of decels and variability pattern IS an omnious sign of fetal compromis
- PFO closes → more blood directed to __
- PDA closes → more blood directed to __
- PFO closes → more blood directed to RV
- PDA closes → more blood directed to PA
- Fetal breathing at __weeks
- Fetal breathing at 11 weeks
- Fetal lung liquid is an ultrafiltrate of plasma
- Volume is ~ __ mL/kg
- Fetal lung liquid is an ultrafiltrate of plasma
- Volume is ~ 30 mL/kg
- Fetal lunf fluid - 2/3 expelled during birth
- Retained liquid thought to cause _________
- Fetal lunf fluid - 2/3 expelled during birth
- Retained liquid thought to cause transient tachypnea of newborn (TTN)
surfacant released during lung inflation, present at birth but not significant until __ wks
surfacant released during lung inflation, present at birth but not significant until 34-38 wks
Characteristics of persistent PHTN/fetal circ: 3
- Characteristics of persistent PHTN/fetal circ:
- Sustained ↑ PVR
- ↓ lung perfusion
- Continued right-to-left shunting (patent foramen ovale & ductus arteriosus)
Persistent Fetal Circ also Associated with these diseases/conditions:
- Persistent Fetal Circ also Associated with these diseases/conditions:
- Severe birth asphyxia
- Meconium aspiration
- Sepsis
- Congenital diaphragmatic hernia (CDH)
- Maternal use of NSAIDS
Persistent pulmonary HTN of newborn (cont)
- Primary Precipitating Factors:
Persistent pulmonary HTN of newborn (cont)
- Primary Precipitating Factors:
- Hypoxemia
- Acidosis
- Pneumonia
- Hypothermia
“Other” risk factors persistent pulm HTN/fetal circ:
- “Other” risk factors persistent pulm HTN/fetal circ:
- Maternal diabetes
- Maternal asthma
- Cesarean delivery
Treatment for Persistent Pulm HTN
- Correcting predisposing disease (hypoglycemia, polycythemia, etc)
- Goal:
- improve oxygenation
- PaO2 50-70 mmHg
- PaCO2 50-55 mmHg
- Mechanical ventilation; high-frequency ventilation
- Exogenous surfactant
- Inhaled nitric oxide
- Alkalinization of blood
- ECMO
- Goal:
- Rapid change in hematopoietic physiology – “physiologic anemia” contributed to by the following 3 items & peaks at ~ 3 months of age:
- Rapid change d/t oxygen
- Decrease in erythropoiesis
- Decrease lifespan of RBC
when do terminal bronchi form
when do these turn into alveoli
2 TRI
after birth
when do type 2 cells produce surfactant
beginning 22-26 week
in terminal airways 34-38 weeks
initial negative ITP needed to expand alveoli
40-60 cm H2O
- CBF in a premature infant is about __ mL/100g/min
- CBF in the older child is about ___ mL/100g/min
- CBF in a premature infant is about 40 mL/100g/min
- CBF in the older child is about 100 mL/100g/min
- Loss of autoregulation (CBF) can occur with
- Hypoxia
- severe hypercapnia (>80 mmHg)
- blood-brain barrier disruption after head trauma
- subarachnoid or intracerebral hemorrhage
- cerebral ischemia
- high concentration of volatile agents
- vasodilators (such as Nipride)
- Liver begin to develop at __wk gestation
- Starts functioning at __ wk
- Fetal liver starts storing glycogen at __ wk
- Liver begin to develop at 10 wk gestation
- Starts functioning at 12 wk
- Fetal liver starts storing glycogen at 14 wk
- At about ___wks the bone marrow starts producing RBCs
- At about 4-6 wks the bone marrow starts producing RBCs
- Neonate has low GFR (___ ml/min/kg) & renal blood flow
- 4 reasons:
- 1) low systemic arterial pressure
- 2) high renal vascular resistance
- 3) low permeability of the glomerular capillaries
-
4) small size & number of glomeruli
- Does not tolerate fluid overload
- < ____ml/kg/hr indicative of hypovolemia or decreased renal function
- < 1ml/kg/hr indicative of hypovolemia or decreased renal function
- Limited ability to concentrate urine
- Neonate __mOsm/L
- Adult __ mOsm/L
- Limited ability to concentrate urine
- Neonate 700 mOsm/L
- Adult 1200 mOsm/L
- Factors responsible for heat loss after birth: (not evaporation, conduction, rad, etc)
- Cold environment
- high ratio of surface area-to-body weight
- reduced SQ fat
- poor shiver response to cold
- Compensatory response: nonshivering thermogenesis
Perioperative cause of hypothermia:
- cold OR
- anesthetic-induced vasodilation
- room-temp IVF
- open body cavities
- cool irrigation fluid
- inspiration of cool anesthetic gases
____ heat loss is responsible for most heat loss.
(ie conv, evap, rad, etc)
Radiant heat loss is responsible for most heat loss.
Factors affecting metabolism of drugs in neonates:
- volume of distribution
- Reduced protein binding
- fat content
Cardiac output
- ___ ml/kg/min in newborn
Cardiac output
- 200 ml/kg/min in newborn
- normal renal drug excretion by ___ weeks of age
- Renal fxn reaches adult levels b/w ___months
- normal renal drug excretion by 3-4 weeks of age
- Renal fxn reaches adult levels b/w 8-12 months
- Inhalation Agents
- Equilibrate more rapidly in neonate bc: (3)
- Increased level of ventilation
- Increased cardiac output
- Reduced solubility in blood
- Preferred concentration for peripheral nerve block:
- Bupivacaine__% or __%, ropivacaine __%
- (yes or no) Cross the blood-brain barrier
- Bupivacaine: max dose for neonates & infants:
- __mg/kg bolus or__mg/kg/hr infusion
- Ropivacaine; less toxicity; bolus: __ mg/kg; infusion: __ mg/kg/hr
- Bupivacaine 0.25% or 0.125%,
- Ropivacaine 0.2%
- Major adverse effect of bupivacaine is toxicity related to CV or CNS
- Bupivacaine: max dose for neonates & infants:
- 2mg/kg bolus
- 0.2mg/kg/hr infusion
- Ropivacaine; less toxicity;
- bolus: 2 mg/kg
- infusion: 0.2 mg/kg/hr
- Blood vol in Full-term newborn: __ ml/kg
- Preterm: __ ml/kg
- Approximately __ ml/kg is plasma volume
- Blood vol in Full-term newborn: 85 ml/kg
- Preterm: 90-100 ml/kg
- Approximately 50 ml/kg is plasma volume
Urine osmolality, specific gravity, & serum osmolality important for managing intraop fluids
- Urine osmolality: __mOsm/L
- Specific gravity: __
- Serum osmolality: __mOs/kg
Urine osmolality, specific gravity, & serum osmolality important for managing intraop fluids
- Urine osmolality: 200-400mOsm/L
- Specific gravity: 1.006-1.012
- Serum osmolality: 270-280 mOs/kg
