Valley...Review Flashcards
What is the definition of a neonate?
Less than 30 days of age.
What is the definition of an infant?
1 - 12 MONTH of age
What is the definition of children?
1 -12 YEARS of age
T/F: The cardiac output of neonates and infants is dependent on heart rate?
TRUE
Neonates and infants stroke volume is relatively _______ by a noncompliant and poorly developed ______ ventricle
Fixed, Left
What are some physiologic characteristics of neonates and infants compared with adults?
- Cardiac output is dependent on heart rate
- Faster heart rate
- Lower blood pressure
- Faster RR
- Lower lung compliance
- Greater chest wall compliance
- Lower functional residual capacity
- Higher ratio of body surface area to body weight
- Higher total body water content
What are some anatomic characteristics of neonates and infants compared with adults?
- Noncompliant left ventricle
- residual fetal circulation
- Difficult venous and arterial cannulation
- Large head and tongue
- Narrow nasal passages
- anterior and cephalad larynx
- Long epiglottis -Short trachea and neck
- Prominent tonsils and adenoids
- Weak intercostal and diaphragm muscles
- High resistance to airflow
What are some pharmacologic characteristics of neonates and infants compared with adults?
- Immature hepatic biotransformation
- dDecreased protein binding
- Rapid induction and revorvery
- Increased minimum alveolar concentration
- Large volume of distribution for water soluble drugs
- Immature neuromuscular junction
What are some airway significance in a pediatric patient?
- Narrow nares
- Large tongue
- High glottis (more cephalad)
- Slanting vocal cords
- Narrow cricoid ring that is subglottic
T/F: Adults have 12 times the resistance due to narrow nares.
FALSE (Pediatric have….)
T/F: Infants are obligate nose breathers.
True
Cricoid cartilage is _______ point of the airway in children younger the __ ____ old of age.
Narrowest, 5, years
The equation for ETT diameter for a pediatric patient.
4 + (age/4) = ETT size in mm
T/F: Proper tube size is identified by gas passage into larynx with a leak at 15 - 25 cm H2O.
TRUE
What is the proper length equation needed to place an ETT?
10 + (age/2)
_____ FRC in neonates results in a more ____ induction with inhaled anesthetics.
Small, Rapid
_____ closing volume and _______ FRC make neonate prone to atelectasis and _______ during anesthesia.
Increased, decrease, hypoxia
Neonates are diaphragmatic breathers because of chest structure:
- Intercostal muscles are underdeveloped
- Diaphragm is high
- chest cavity is small
Estimated blood volume of Premature?
90 ml/kg
100-120
Estimated blood volume of Infants less than 3 months?
90 ml/kg
Estimated blood volume of Toddler?
75 ml/kg
What is the definition of a toddler?
6 weeks to 2 years of age
Estimated blood volume of child?
72 ml/kg
Estimated blood volume of adult male?
70 ml/kg
Estimated blood volume of adult female?
65 ml/kg
What type of circulation does a fetus have?
Parallel
What type of circulation does a just born neonate have?
Transitional Circulation
What type of circulation does a infant have?
Normal Circulation ;)
What is the total body water in a preterm?
90%
What is the total body water in a term?
80%
What is the total body water in a 6 -12 month old?
60%
List the body fluid in percent for an infant (iCF, ECF, EBL)?
- ICF = 40%
- ECF = 35 - 40%
- EBL = 8 - 10%
List the body fluid in precent for an adult?
- ICF = 40%
- ECF = 20
- EBL = 7%
Why are infants of diabetic mothers prone to hypoglycemia?
The infant will produce its own insulin due to the elevated maternal blood sugar, therefore when the cord is ligated the infant will have stored insulin levels causing hypoglycemia.
If the infant has a incompetent lower esophageal sphincter resulting in gastroesophageal reflux and pulmonary aspiration; the infant will present with?
- Apnea
- Bradycardia
Prematurity is defined as what?
-birth before 37 weeks of gestation.
T/F: Small for gestation is define as an age adjusted weight less than the fifth percentile.
TRUE
What are anesthesia concern for premature neonates and infants?
- Airway control
- Fluid management
- Temperature regulation
- Rentinopathy of prematurity (retrolental fibroplasia)
- Fentranyl favored over volatile anesthetics
What are etiology of congenital diaphragmatic hernia?
- Occurs 5-10 weeks of fetal life
- gut herniate through right or left posterolateral foramen of Bochdalek or can herniate through anterior foramen of Morgagni
- Left side is more common (70 - 80 %)
- mortality is 40 - 50 %
What are the hallmark signs of congenital diaphragmatic hernia?
- Hypoxia
- Scaphoid abdomen
Causes of mortality of congenital diaphragmatic hernia?
- Respiratory insufficiency
- Persistent pulmonary hypertension of new borns
What is the treatment of congenital diaphragmatic hernia?
- sedation,paralysis, and moderate hyperventilation
- extracorporeal membrane oxygenation
- NO for persistant pulmonary hypertension
What are the anesthesia concerns for diaphragmatic hernia?
-Decrease gastric distension
-low O2 delivery pressure
-reight sided pneumothorax is a concern
awake intubation
-no nitrous oxide
no paralysis
peak inspiratory pressures should be < 30 cm H2O
T/F: The most common form of tracheoesophageal fistula is the form that ends in a blind pouch and a lower esophagus that connects to the trachea.
TRUE
What are some S/S to watch for with tracheoesophageal fistula?
- Gastic distension with repsiration
- Feeding leads to choking,coughing, and cyanosis
- Diagnoses made by the failure to pass a cathere into the stomach
- aspiration pnuemonia is common
- VATER
What are anesthesia concern for tracheoesophagela fistula?
- Frequent suctioning
- No positive pressure ventilation prior to intubation
- neonate is degydrated and malnourisged
- no neck extension
- avoid instrumentation of the esophagus
Most common type of tracheoesophageal fistual??
IIIB (90%)
What are some S/S to look for with pyloric stenosis?
- Patient presents with METABOLIC ALKALOSIS
- Rapid sequence indction with cricoid pressure
- Hypochloremic metabolic alkalosis and hypokalemia
- Avoid LR
What are symptoms of Acute epiglottitis?
- High fever
- Difficulty swallowing
- Inspiratory stridor
- drooling
- Lethargy
- sitting forward
- tachypnea
- cyanotic
- Acidotic
- dehydrated
- elevated CO2
- Decreased pH
What are symptom of laryngotrachel bronchitis?
- low grade fever
- slow onset
- Less airway obstruction
- croupy bough
- rhinorrhea
- inspiratory stridor
How do you treat acute epiglottitis?
Ampicillin
How do you treat Laryngotracheal bronchitis?
- Humidity
- O2
What is the etiology of acute epiglottitis?
Haemophilus influenza type B
What is the etiology of laryngotracheal bronchitis?
Common cold
What are anesthesia role for acute epiglottitis?
O2 (NO NITROUS)
- NO muscle paralysis
- Induce in sitting position
- small tube with leak
- Immediate intubation
- extubate in O.R
- Monitor x1 hour in O.R>
What are the signs and etiology of omphalocele?
- base of umbilicus
- Sac
- Anomalies such as trisomy 21, diaphragmatic hernia, and bowel malformation
- occurs at 6 - 8 weeks of gestation
What are the signs and etiology of gastroschisis?
- Lateral to umbilicus
- No SAC
- Prevent hypOthermia,infection, and dehydration
- Occurs at 12 - 18 weeks of gestation
What are anesthesia concerns for omphalocele and gastroschisis?
- Decompress stomach prior to induction
- Muscle relaxant to replace bowel into abdominal cavity
- Keep intubated 1-2 days
- Monitor blood sugars
- Warm operating room
What is prune belly syndrome anesthesia?
- Risk of aspiration
- thin weak abdominal wall
- cannot cough well
- concerns for pulmonary complication
- awake intubation
- treat as full stomach
- renal involvement
- no muscle relaxant drugs with renal excretion use with care/caution
What is intestinal malrotation and volvulus?
Spontaneous abnormal rotation of the midgut around the mesentery (Superior mesenteric artery)
It intestinal malrotation and volvulus an emergency?
YES
What are S/S of intestinal malrotation and volvulus?
- bilius vomiting
- progressive abdominal distention and tenderness
- metabolic acidosis
- hemodynamic instability
- bloody diarrhea may be indicative of bowel infarction
What are S/S of Pierre Robin Syndrome?
- cleft palate
- small face and glottis
What are signs of treacher collins syndrome?
-Small mouth
facial mouth deformity
more sever than pierre robin
What to know about trisomy 21 syndrome?
- Extra chromosome (Down’s syndrome)
- short neck
- irregular dentition
- mental retardation
- hypotonia
- large tongue
What is associated with trisomy 21 syndrome?
- congenital heart disease
- subglottic stenosis
- tracheoesophageal fistula
- chronic pulmonary infections
- seizure
- usually requires several surgeries
- neonates are often premature and small for their gestational age
What are the aneshesia concerns for trisomy 21 syndrome?
- Difficult airway
- Smaller OET
- Watch for postoperative stridor and apnea
- Atlanto occipital dislocation due to congenital laxity of the ligaments
- avoid air bubbles in IV possible right to left shunt.
What is cystic fibrosis?
- Hereditary diseases of exocrine glands of pulmonary and gastrointestinal systems
- Thick secretion
- Malabsorptionsyndrome
- Increased residual volume
- airway resistance
- decreased vital capacity
- Decreased expiratory flow rate
What do you want to avoid with cystic fibrosis?
-Hyperventilation
What is scoliosis?
Lateral rotation and curvature of the spine and deformity of the thoracic cage.
What to know about tonsillectomy and adenoidectomy?
-increased risk for perioperative airway problems
What are anesthesia concerns for tonsillectomy and adenoidectomy?
- Postpone surgery if upper respitory tract infection
- Give anticholinergic to decrease phayrngeal secretions
- Reinforced ETT
- PONV
- Bleeding
What to do if MH occurs?
- Stop agents and drugs causing
- O2 100%
- Sodium bicarbinate
- dantrolene 2.5 mg/kg IV
- Cooling measures
- Ventricular arrhythmias with procainamide 200mg
- Additional dantrolene if needed
- Change soda lime and circuit
- Monitor urine output and electrolyte levels,
- Treat electrolyte levels bnhh
