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Spr25 AdvPrin A > Test 4: Pediatric Anesthesia Pt. 1 (Andy's Cards) > Flashcards

Test 4: Pediatric Anesthesia Pt. 1 (Andy's Cards) Flashcards

1
Q

Heat is exchanged between the body and its environment in both directions, by what 4 mechanisms?

Of the 4 mechanism, what is the most important factor to heat loss in the OR?

A
  • Conduction
  • Convection
  • Radiation (most important factor to heat loss in the OR)
  • Evaporation
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2
Q

Heat loss d/t the body contacting a cold object.

A

Conduction

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3
Q

What are ways to mitigate heat loss through conduction for pediatric patients?

A
  • Warm the OR and the OR bed
  • Use warming blanket
  • Warm fluids (long cases)
  • Warm irrigation fluids
  • Bair hugger
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4
Q

Heat loss d/t air movement around the body

A

Convection

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5
Q

What are ways to mitigate heat loss through convection for pediatric patients?

A
  • Warm the rooms
  • Close the doors
  • Head covers (thermal insulation)
  • Bair hugger
  • Body covering
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6
Q

Heat loss from an infant’s uncovered head may represent as much as ____% of total heat loss in the OR

A

60%

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7
Q

Temp for rooms: Newborn

A

80º F

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8
Q

Temp for rooms: 1-6 months

A

78º F

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9
Q

Temp for rooms: 6mo - 2yr

A

76ºF

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10
Q

Temp for rooms: > 2 years old

A

74ºF

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11
Q

Heat loss d/t infrared radiation being emitted from the body to cooler objects in the environment.

A
  • Radiation
  • Radiation is the most important factor to heat loss.
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12
Q

What are ways to mitigate heat loss through radiation for pediatric patients?

A
  • Warm the room
  • Use radiant heat lamps
  • Body coverings
  • Aluminized plastic coverings
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13
Q

Heat loss d/t the heat of vaporization taking place at the skin and lungs.

A

Evaporation

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14
Q

What are ways to mitigate heat loss through evaporation for pediatric patients?

A
  • Using a heat and moisture exchanger (HME)
  • Heated humidifier (Concha-therm)
  • Fluid warmers
  • Knowledgeable provider
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15
Q

What are potential problems that can occur if a child becomes too cold in the OR?

A
  • Decreased metabolism will affect rate of drug distribution, slow to wake.
  • Blood coagulation is slowed with hypothermia
  • Shivering in the PACU (may cause bleeding with tonsillectomies)
  • Peripheral vasoconstriction (harder to start an IV)
  • Cardiac arrhythmias
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16
Q

What percentage of total body heat loss is due to evaporation?

A

20%

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17
Q

Spontaneous ventilation normally is ____ºC at the pharynx with humidity of ____%.

A

Spontaneous ventilation normally is 32ºC at the pharynx with humidity of 86%

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18
Q

How does brown fat metabolism increase heat production?

A

With brown fat metabolism, lipase is released that splits triglyceride into glycerol and fatty acids, which increases heat production

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19
Q

What can cause a baby to have mottled skin after surgery?

A

A cool OR will increase norepinephrine production, resulting in peripheral vasoconstriction leading to mottled-looking skin on a child in the PACU.

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20
Q

What is the pediatric dose of IV Succinylcholine?

What is the pediatric dose of IM Succinylcholine?

A
  • Succinylcholine IV: 2 mg/kg
  • Succinylcholine IM: 4 mg/kg
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21
Q

What is the pediatric dose of IV Atropine?

What is the pediatric dose of IM Atropine?

A
  • Atropine IV: 0.01 mg/kg
  • Atropine IM: 0.02 mg/kg
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22
Q

What is the pediatric induction dose of IV Propofol?

What is the infusion dose?

A
  • Propofol IV: 2-3 mg/kg
  • Propofol infusion: 50-200 mcg/kg/min
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23
Q

What is the pediatric IV dose of lidocaine?

A
  • Lidocaine IV: 1 mg/kg
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24
Q

List the monitoring equipment needed for a pediatric patient.

A
  • 3 lead EKG
  • Precordial stethoscope
  • Two pulse oximeters (upper and lower extremities)
  • Temp probe (Axillary)
  • BP Cuff
  • FiO2, ETCO2, and Agent monitors
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25
Q

What is the most common anesthesia delivery system?
What are the benefits of this system?

A

Circle System

  • light weight
  • can use LOW gas flows
  • resistance in valves and CO2 absorber
26
Q

What anesthesia delivery system is used to transport a pediatric patient?

A
  • Jackson Rees
  • Light weight-no valves so less resistance to breathing feel of respirations
  • HIGH gas flows at least 1 to 2.5 X minute volume to ensure no rebreathing
  • You will waste gases and loose heat and humidity quickly
27
Q

What is the difference between a Jackson Rees and a Bain circuit?

A

Bain circuit has a pop-off valve

28
Q

According to Dan Ernst, what contributes to deadspace in pediatric patients?

A
  • HME’s
  • CO2 adaptors
  • Low flow
  • Faulty valves
  • Exhausted sodasorb or channeling
  • Endotracheal Tube/Mask
  • Elbow
  • First 12-10 inches of the circuit
29
Q

How many hours must a patient be NPO if they consume clear liquids?

A

2 hours

30
Q

How many hours must a patient be NPO if they consume breast milk?

A

4 hours

31
Q

How many hours must a patient be NPO if they consume infant formula?

A

6 hours

32
Q

How many hours must a patient be NPO if they consume non-human milk (cow milk)?

A

6 hours

33
Q

How many hours must a patient be NPO if they consume a light meal?

A

6 hours

34
Q

How many hours must a patient be NPO if they consume a meal with fat?

A

8 hours

35
Q

What is the dose for PO Versed for pediatric patients?

PO Versed should be given how long before induction?

A
  • 0.5 mg/kg (16 mg max)
  • 20-30 minutes before induction
  • Need a good strong taste to dilute the Versed in if you don’t have the premade syrup preparation
36
Q

Factors that contribute to pediatric anxiety?

A
  • 1-5 years-olds
  • Shy/sensitive type
  • High IQ/ Lack good adaptive ability
  • Previous surgeries
  • Parental anxiety
37
Q

Kids are natural ________ breathers

A

Nasal

GET THE MOUTH OPEN

38
Q

What is different about pediatric airway anatomy compared to adults?

A
  • Larger tongue relative to the mouth
  • The larynx is higher in the neck (superior, not anterior)
  • Larger head, prominent occiput, naturally flexed
  • Short neck, smaller nare
  • Epiglottis is narrower and angled away from axis of the trachea (more difficult to lift epiglottis)
  • Vocal cords have a lower attachment anteriorly than posteriorly
39
Q

What level will the larynx be in a preterm infant?

A

C3

40
Q

What level will the larynx be in a full-term infant?

A

C3-C4 interspace

41
Q

What level will the larynx be in an adult?

A

C4-C5

42
Q

Why do straight blades facilitate better visualization of the infant’s larynx?

A

The more cephalad location creates difficulty in visualizing the laryngeal structure because of the more acute angulation between the base of the tongue and the glottic opening, making it difficult to use a curved blade.

43
Q

Compare the tongue of a pediatric patient to an adult patient

A

Larger tongue relative to the mouth in a pediatric patient

44
Q

Compare the larynx of a pediatric patient to an adult patient

A

The larynx is higher in the neck (superior, not anterior)

45
Q

Compare the head of a pediatric patient to an adult patient

A

Larger head, prominent occiput, naturally flexed

46
Q

Compare the neck and nare of a pediatric patient to an adult patient

A

Short neck, smaller nare

47
Q

Compare the epiglottis of a pediatric patient to an adult patient

A

Epiglottis is narrower and angled away from axis of the trachea (more difficult to lift epiglottis)

48
Q

Compare the vocal cords of a pediatric patient to an adult patient

A

Vocal cords have a lower attachment anteriorly than posteriorly, causing the tip of the ETT to be held up at the anterior commissure of the cords. (Slanted cords)

49
Q

What is the narrowest portion of the larynx in a pediatric patient?

A

Cricoid cartilage

50
Q

What kind of shape is the pediatric larynx?

A

Cone shape

51
Q

Pediatric Airway

A

Pediatric Airway

52
Q

ET Tube Size for Preemie 1 kg and under

A

2.5

53
Q

ET Tube Size for Preemie 1-2.5 kg

A

3.0

54
Q

ET Tube Size for term neonate to 6 months

A

3.0-3.5

55
Q

ET Tube Size for 6 months to 1 year

A

3.5-4.0

56
Q

ET Tube Size for 1-2 years

A

4.0-4.5

57
Q

What is the ET-Tube size formula for pediatric patients older than two years?

A

(Age + 16)/ 4

58
Q

If the radius of the tube is halved, how much does resistance increase?

A

Resistance is increased 16-fold (Poiseuille’s law)

59
Q

A leak around the tube at _______ cm H20 (range) is the best method in determining the proper size of an ETT for a child.

A

20-30 cm H2O

60
Q

When would you want to use a cuff ETT on a pediatric patient?

A
  • Routinely used around 11-12 years old
  • Full stomachs
  • Very non-compliant lung
  • History of reflux of stomach contents
  • Hiatal hernia
  • Bloody oral surgery (cleft palate repair)
  • Cuffed tubes are made down to size 3.0
61
Q

What is the formula for determining what depth the tube (cm)?

A

(Age/2) + 12

Spr25 AdvPrin A (11 decks)

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