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Peds Anesthesia - Summer 2013 > Valley...Review > Flashcards

Valley...Review Flashcards

1
Q

What is the definition of a neonate?

A

Less than 30 days of age.

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2
Q

What is the definition of an infant?

A

1 - 12 MONTH of age

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3
Q

What is the definition of children?

A

1 -12 YEARS of age

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4
Q

T/F: The cardiac output of neonates and infants is dependent on heart rate?

A

TRUE

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5
Q

Neonates and infants stroke volume is relatively _______ by a noncompliant and poorly developed ______ ventricle

A

Fixed, Left

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6
Q

What are some physiologic characteristics of neonates and infants compared with adults?

A
  • 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
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7
Q

What are some anatomic characteristics of neonates and infants compared with adults?

A
  • 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
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8
Q

What are some pharmacologic characteristics of neonates and infants compared with adults?

A
  • 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
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9
Q

What are some airway significance in a pediatric patient?

A
  • Narrow nares
  • Large tongue
  • High glottis (more cephalad)
  • Slanting vocal cords
  • Narrow cricoid ring that is subglottic
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10
Q

T/F: Adults have 12 times the resistance due to narrow nares.

A

FALSE (Pediatric have….)

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11
Q

T/F: Infants are obligate nose breathers.

A

True

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12
Q

Cricoid cartilage is _______ point of the airway in children younger the __ ____ old of age.

A

Narrowest, 5, years

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13
Q

The equation for ETT diameter for a pediatric patient.

A

4 + (age/4) = ETT size in mm

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14
Q

T/F: Proper tube size is identified by gas passage into larynx with a leak at 15 - 25 cm H2O.

A

TRUE

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15
Q

What is the proper length equation needed to place an ETT?

A

10 + (age/2)

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16
Q

_____ FRC in neonates results in a more ____ induction with inhaled anesthetics.

A

Small, Rapid

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17
Q

_____ closing volume and _______ FRC make neonate prone to atelectasis and _______ during anesthesia.

A

Increased, decrease, hypoxia

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18
Q

Neonates are diaphragmatic breathers because of chest structure:

A
  • Intercostal muscles are underdeveloped
  • Diaphragm is high
  • chest cavity is small
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19
Q

Estimated blood volume of Premature?

A

90 ml/kg

100-120

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20
Q

Estimated blood volume of Infants less than 3 months?

A

90 ml/kg

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21
Q

Estimated blood volume of Toddler?

A

75 ml/kg

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22
Q

What is the definition of a toddler?

A

6 weeks to 2 years of age

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23
Q

Estimated blood volume of child?

A

72 ml/kg

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24
Q

Estimated blood volume of adult male?

A

70 ml/kg

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25
Q

Estimated blood volume of adult female?

A

65 ml/kg

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26
Q

What type of circulation does a fetus have?

A

Parallel

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27
Q

What type of circulation does a just born neonate have?

A

Transitional Circulation

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28
Q

What type of circulation does a infant have?

A

Normal Circulation ;)

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29
Q

What is the total body water in a preterm?

A

90%

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30
Q

What is the total body water in a term?

A

80%

31
Q

What is the total body water in a 6 -12 month old?

A

60%

32
Q

List the body fluid in percent for an infant (iCF, ECF, EBL)?

A
  • ICF = 40%
  • ECF = 35 - 40%
  • EBL = 8 - 10%
33
Q

List the body fluid in precent for an adult?

A
  • ICF = 40%
  • ECF = 20
  • EBL = 7%
34
Q

Why are infants of diabetic mothers prone to hypoglycemia?

A

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.

35
Q

If the infant has a incompetent lower esophageal sphincter resulting in gastroesophageal reflux and pulmonary aspiration; the infant will present with?

A
  • Apnea

- Bradycardia

36
Q

Prematurity is defined as what?

A

-birth before 37 weeks of gestation.

37
Q

T/F: Small for gestation is define as an age adjusted weight less than the fifth percentile.

A

TRUE

38
Q

What are anesthesia concern for premature neonates and infants?

A
  • Airway control
  • Fluid management
  • Temperature regulation
  • Rentinopathy of prematurity (retrolental fibroplasia)
  • Fentranyl favored over volatile anesthetics
39
Q

What are etiology of congenital diaphragmatic hernia?

A
  • 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 %
40
Q

What are the hallmark signs of congenital diaphragmatic hernia?

A
  • Hypoxia

- Scaphoid abdomen

41
Q

Causes of mortality of congenital diaphragmatic hernia?

A
  • Respiratory insufficiency

- Persistent pulmonary hypertension of new borns

42
Q

What is the treatment of congenital diaphragmatic hernia?

A
  • sedation,paralysis, and moderate hyperventilation
  • extracorporeal membrane oxygenation
  • NO for persistant pulmonary hypertension
43
Q

What are the anesthesia concerns for diaphragmatic hernia?

A

-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

44
Q

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.

A

TRUE

45
Q

What are some S/S to watch for with tracheoesophageal fistula?

A
  • 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
46
Q

What are anesthesia concern for tracheoesophagela fistula?

A
  • Frequent suctioning
  • No positive pressure ventilation prior to intubation
  • neonate is degydrated and malnourisged
  • no neck extension
  • avoid instrumentation of the esophagus
47
Q

Most common type of tracheoesophageal fistual??

A

IIIB (90%)

48
Q

What are some S/S to look for with pyloric stenosis?

A
  • Patient presents with METABOLIC ALKALOSIS
  • Rapid sequence indction with cricoid pressure
  • Hypochloremic metabolic alkalosis and hypokalemia
  • Avoid LR
49
Q

What are symptoms of Acute epiglottitis?

A
  • High fever
  • Difficulty swallowing
  • Inspiratory stridor
  • drooling
  • Lethargy
  • sitting forward
  • tachypnea
  • cyanotic
  • Acidotic
  • dehydrated
  • elevated CO2
  • Decreased pH
50
Q

What are symptom of laryngotrachel bronchitis?

A
  • low grade fever
  • slow onset
  • Less airway obstruction
  • croupy bough
  • rhinorrhea
  • inspiratory stridor
51
Q

How do you treat acute epiglottitis?

A

Ampicillin

52
Q

How do you treat Laryngotracheal bronchitis?

A
  • Humidity

- O2

53
Q

What is the etiology of acute epiglottitis?

A

Haemophilus influenza type B

54
Q

What is the etiology of laryngotracheal bronchitis?

A

Common cold

55
Q

What are anesthesia role for acute epiglottitis?

A

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>
56
Q

What are the signs and etiology of omphalocele?

A
  • base of umbilicus
  • Sac
  • Anomalies such as trisomy 21, diaphragmatic hernia, and bowel malformation
  • occurs at 6 - 8 weeks of gestation
57
Q

What are the signs and etiology of gastroschisis?

A
  • Lateral to umbilicus
  • No SAC
  • Prevent hypOthermia,infection, and dehydration
  • Occurs at 12 - 18 weeks of gestation
58
Q

What are anesthesia concerns for omphalocele and gastroschisis?

A
  • Decompress stomach prior to induction
  • Muscle relaxant to replace bowel into abdominal cavity
  • Keep intubated 1-2 days
  • Monitor blood sugars
  • Warm operating room
59
Q

What is prune belly syndrome anesthesia?

A
  • 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
60
Q

What is intestinal malrotation and volvulus?

A

Spontaneous abnormal rotation of the midgut around the mesentery (Superior mesenteric artery)

61
Q

It intestinal malrotation and volvulus an emergency?

A

YES

62
Q

What are S/S of intestinal malrotation and volvulus?

A
  • bilius vomiting
  • progressive abdominal distention and tenderness
  • metabolic acidosis
  • hemodynamic instability
  • bloody diarrhea may be indicative of bowel infarction
63
Q

What are S/S of Pierre Robin Syndrome?

A
  • cleft palate

- small face and glottis

64
Q

What are signs of treacher collins syndrome?

A

-Small mouth
facial mouth deformity
more sever than pierre robin

65
Q

What to know about trisomy 21 syndrome?

A
  • Extra chromosome (Down’s syndrome)
  • short neck
  • irregular dentition
  • mental retardation
  • hypotonia
  • large tongue
66
Q

What is associated with trisomy 21 syndrome?

A
  • 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
67
Q

What are the aneshesia concerns for trisomy 21 syndrome?

A
  • 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.
68
Q

What is cystic fibrosis?

A
  • 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
69
Q

What do you want to avoid with cystic fibrosis?

A

-Hyperventilation

70
Q

What is scoliosis?

A

Lateral rotation and curvature of the spine and deformity of the thoracic cage.

71
Q

What to know about tonsillectomy and adenoidectomy?

A

-increased risk for perioperative airway problems

72
Q

What are anesthesia concerns for tonsillectomy and adenoidectomy?

A
  • Postpone surgery if upper respitory tract infection
  • Give anticholinergic to decrease phayrngeal secretions
  • Reinforced ETT
  • PONV
  • Bleeding
73
Q

What to do if MH occurs?

A
  • 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

Peds Anesthesia - Summer 2013 (14 decks)

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