Nu 592 -- Exam 2

Front 1

When does true mechanical closure of openings b/t left and right side circulation by fiberous tissue occur in the nb?

Back 1

by 2-3 weeks

Front 2

What causes the ductus venosus to close at birth

Back 2

decrease in portal circulation pressure

Front 3

what causes the foramen ovale to close at birth

Back 3

Increase in left sided heart pressures due to increased peripheral vascular resistance

Front 4

what are the 3 factors that cause the ductus arteriosus to close at birth

Back 4

lung expansion
exposure of blood to oxygen
loss of low resistance through the palacental blood flow

Front 5

What are the main differences in the nb heart?

Back 5

**More prone to biventriculair failure**

Less compliant (less cellular mass for increasing contractility)
-cardiac output is more dependent on heart rate
-poor tolerance to increased afterload
-do not tolerate volume loading
-Rely on exogenous CA+, so increased susceptibility to myocardial depression

Front 6

why are the nb's cardiac calcium stores reduced (making them rely on exogenous Ca+)?

Back 6

this is due to immaturity of the sarcoplasmic reticulum

Front 7

what is the hallmark sign of dehydration and fluid depletion in infants

Back 7

Hypotension without tachycardia

Front 8

what is more important to Cardiac Output in the NB: SV or HR?

Back 8

HR
-they have a fixed SV due to a poorly developed and less compliant L ventricle

Front 9

What is the normal Oxygen consumption of a nb?

Back 9

5-8 cc/kg

Front 10

What is the normal Oxygen consumption of a child?

Back 10

4-6 cc/kg

Front 11

Do nb and children have a higher or lower metabolic rate than adults?

Back 11

higher

Front 12

at what age to intercostal muscles achieve adult configuration of type I muscles in children?

Back 12

Age 2

Front 13

How much more is a premature child's WOB than an adults

Back 13

3X an adult's

Front 14

At what gestational age is independent life possible outside the womb

Back 14

24-26 weeks

Front 15

How old is a child wehn the alveoli stop increasing in size and number?

Back 15

8 yo

Front 16

What is the main anatomic difference in the childs' airways

Back 16

smaller diameter of airways causes increased resistance to flow

Front 17

Why do infants have lower FRCs?

Back 17

b/c their chest wall is highly compliant and poorly supported by surrounding structures (unable to create a large negative pressure)

Front 18

do infants have hypoxic and hypercapnic respiratory drives?

Back 18

yes, but they are poorly developed

Front 19

What are the 5 main difference in the infant airways (anatomical structures)?

Back 19

1. Large tongue in relation to oropharynx (increased likelihood of obstruction)
2. Larynx is located higher in the neck
3. Epiglottis short and stubby and angled over the laryngeal inlet (more difficult to control with blade)
4. Vocal cords are angled
5. Funnels shaped larynx; narrowest portion is at cricoid cartilage

Front 20

What is the % TBW of an infant?

Back 20

80%
they have more TBW b/c they have a decreased ability to conserve sodium and concentrate urine due to decreased GFR and tubular finction

Front 21

What does the decreased GFR and tubular function of the neonate put them at high risk for?

Back 21

hyponatremia, hypocalcemia
and hypoglycemia

Front 22

what is the formula for Vol. of distribution?

Back 22

Vd = TAB (total amt of drug in Body)/drug in Plasma

Front 23

How is the half life of renally excreted drugs different in infants from adults

Back 23

half life of renally excreted medications is prolonged

Front 24

What drug half lifes are prolonged due to prolonged phase II reaction in the liver of the infant?

Back 24

benzodiazepines and morphine

Front 25

Why is the MAC higher in infants?

Back 25

Increased RR
Increaed Cardiac index
Increased proportional flow to vessel rich groups

Front 26

what is the CYP450 system funciton at birth compared to an adult

Back 26

50% of adult funtion

Front 27

How does the liver ability to metabolize drugs increase after birth?

Back 27

increased hepatic blood flow
the enzyme systems develop and are induced by drugs

Front 28

at what age does liver function reach adult acitvity?

Back 28

1 year

Front 29

How do infants(0-3 months old) make heat

Back 29

by metabolizing brown fat (nonshivering thermogenesis) b/c they are unable to shiver during first 3 months of life

Front 30

What inhibits the metabolism of brown fat, putting the infant at risk for hypothermia?

Back 30

Anesthesia

Front 31

what benzo is contraindicated in child < 6 months old

Back 31

Diazepam (valium)

Front 32

How much does a mother's CO increase during pregnancy?

Back 32

40%

Front 33

what is the main cause of the increased in CO in the parturient?

Back 33

Increase in SV : 30-35%
other contributing factors:
Increase HR 15-30%
and reduced SVR (15%) al

Front 34

when the blood volume increases in pregnancy, where does most of the increased (1000-1500 ml) volume go?

Back 34

Uterus
kidneys
breasts
striated muscle

Front 35

What are the 2 purposes of the increased in blood volume during pregnancy?

Back 35

1. facilitates maternal and fetal exchange of nutreints, gases, and metabolites
2. Reduces the impact of maternal blood loss at delivery

Front 36

why is there a Dilutional Anemia seen in pregnancy?

Back 36

b.c there is a total blood volume increased, but most of this is an increase in plamss (45%) and a smaller amount is an increase in Red cell mass (25%)

Front 37

What causes an increase in CO during labor?

Back 37

Auto transfusion from the uterus 300-500 ml
Pain: increased catecholamine release

Front 38

what is the most critical time for the partrureint in terms of cardiac stress?

Back 38

immediate postpartum period
due to volume shifts

Front 39

when is cardiac output at its highest in the partrurient?

Back 39

immediate postpartum period

Front 40

why is CO at its highest in the immediat postpartum period?

Back 40

1. complete auto transfuionof the uterus
2. sudden relief of the inferior vena cava obstrucion
3. High circulating endogenous catecholamines

Front 41

what happens to coagulation in pregnancy?

Back 41

Hypercoagulable state (all factors increased except 11 and 13)
*this helps to limit blood loss at timeof delivery

Front 42

what happens to serum psuedocholinesterase levels during pregnancy

Back 42

they fall
the lowest levels are seen during the first 7 days postpartum (35% reduction)
this puts 10% of women at risk

Front 43

What happens to oxygen consumption during pregnancy?

Back 43

Increases up to 50% above normal by the end of the second trimester

Front 44

How is MAC affected by pregnancy?

Back 44

decreased by 40%
Due to:
1. increased minute ventilation
2. decreased FRC (favors rapid replacement of alveolar content with inspired agent)

Front 45

How does the enorgement of the vnous plexus affect the CNS during pregnancy?

Back 45

1. Decreased CSF volume
2. Decreased the potential epidural space
3. increases epidural space pressure

Front 46

What is the main feature of most neonatal respiratory issues?

Back 46

Extension of smooth muscle into the distal respiratory units

Front 47

What is the cause of meconium aspiration

Back 47

chronic fetal hypoxia (usually in third trimester)

Front 48

When is oral suctioning recommended at birth?

Back 48

Recommended to be done routinely, regardless of Apgar score

Front 49

What is the cause of Bronchopulmonary dysplasia in infants?

Back 49

Often results from long term ventilation of premature infants treated for RDS (occurs in very premature infants and low birth weight infant s(500g - 1 kg)

Front 50

What is the cause of 50-75% of deaths in preterm infants?

Back 50

Respiratory Distress syndrome (RDS)

Front 51

What are the main characteristics of Respiratory Distress Syndrome?

Back 51

Progressive impairment of gas exchange at alveolar level due to deficient production and secretion of surfactant

Front 52

At what point in gestational age are mature levels of surfactant present?

Back 52

35 weeks

Front 53

What are the signs of RDS at birth?

Back 53

tachypnea, intercostal and substernal retractions, nasal flaring, cyanosis

Front 54

When treating Respiratory Distress syndrome in infants, what do you want the O2, CO2, pH, and HCT to be?

Back 54

PaO2: 55-70
PaCO2: 45-65
pH: 7.25 - 7.45
HCT: 40

Front 55

Define Apnea in the infant

Back 55

Cessation of breathing that lasts 20 seconds or longer or is accompanied by bradycardia or cyanosis
*Obstructive vs Central (Immature respiatory control mechanisms)

Front 56

How does Oxygen therapy help in treatment of apnea in the infant?

Back 56

It improves CO2 sensitivity,
decreases the hypoxic respiratory depression,
decreases periodic breathing, and
enhances diaphragmatic strength

Front 57

How long after surgery do anesthetics (inhales and IV) affect the control of breathing in the infant?

Back 57

12 hours

Front 58

What are the most common initial signs of necrotizing enterocolitis in infants?

Back 58

Feeding intolerance, abdominal distention, and bloody stools

Front 59

What is Necrotizing Enterocolitis

Back 59

char. by ulceration and necrosis of the small bowel and colon; cuase is unknown
Intestinal obstruction, perforation and sepsis may follow
VERY SICK and dont toleratate induction very well

Front 60

What type of IV fluid should be avoided in infants with Hypertrophic pyloric Stenosis?

Back 60

LR b/c they have a hypercholoric metabolic alkalosis from persistent vomiting (correction of the alkalosis requires NaCl and K)

Front 61

What is Kernicterus?

Back 61

a neurological disorder caused by toxic effects of unconjugated bilirubin in the brain stem nuclei and basal ganglia

Front 62

What are the anesthsia implications with Kernicterus

Back 62

Caution with solutions containing benzyl alcohol (Vecuronium)
avoid hyppoxia, acidosis and hyperosmolarity

Front 63

When is fetal Hgb replace with adult Hgb?

Back 63

3-4 months

Front 64

How does Fetal Hgb change the oxyhemoglobin dissociation curve?

Back 64

It causes a Left Shift, so Hgb holds on to oxygen and is less will to give it up

Front 65

When would hgb level of 7 be a problem for an infant?

Back 65

if they have a congenital heart disease

Front 66

What is the normal Hgb level for a preterm infant?

Back 66

13-15 g/dl

Front 67

what is the normal Hgb for a newborn?

Back 67

17 g/dl

Front 68

When is Halothane contraindicated in pediatrics?

Back 68

when they have congenital heart disease (b.c of its profound myocardial depressant effects)

Front 69

Which Non depolarizing Muscle relaxant should not be given to newborns?

Back 69

Vecuronium

Front 70

What are the common signs of CHF in infants?

Back 70

poor feeding, tachycardia, sweating, poor cutaneous perfusion

Front 71

What is the most common (90%) tracheal Esophageal Fistula in pediatrics?

Back 71

3B (fistular b/t the stomach and the trachea; esophagus not connenected to anything)

Front 72

What is Hyperoxia believed to contribute to?

Back 72

Retinopathy of prematurity (ass. with premature infants less than 1000g)

Front 73

Why do you want to maintian infants O2 sat 89-94% when using oxygen therapy?

Back 73

to avoid Retinopathy of prematurity

Front 74

What are the s/s of pyloric stenosis (Hypertrophy of esophageal sphincter)

Back 74

Palpable olive in the RUQ
projectile vomiting, metabolic alkalosis, hypovolemia, hypochloremia, hyonatremia

Front 75

List the Anesthetic Considerations for Pyloric Stenosis

Back 75

Correct metabolic and fluid imbalance
NGT to suction prior to induction
awake intubation and IV induction
Normla saline with K
Extubate fully awake
**Extreme increased r/o Aspiration*

Front 76

What is VADER syndrome?

Back 76

Vertebral defects, anal atresia, tracheo-esophageal fistula, radial dysplasia

Front 77

What is a mjor complication of prematurity?

Back 77

Intracranial hemorrhage

Front 78

What is the most important type of intracranial hemorrhage in the nb?

Back 78

IVH: Intraventicular Hemorrhage

Front 79

What is the most common metaboic probelm in newborns?

Back 79

Hypoglycemia (due to inadequate glycogen stores adn deficient gluconeogenesis)

Front 80

When is the incidence of hypoglycemia the highest?

Back 80

SGA: small for gestational age infants

Front 81

What type of ventilation should be avoided in patients with tracheal esophageal fistula

Back 81

postitive pressure vnetilation
*Also, should do an awake intubation

Front 82

why is the positioning of the ETT so important in pt's with tracheal esophageal fistula?

Back 82

b.c have to place into b/t the fistula and the carina so anesthetics go into the lungs and not the stomach

Front 83

What are the s/s of hypoglycemia in the infant?

Back 83

irritability, apnea, cyanotic spells, seizures, hypotonia, lethargy

Front 84

At what glucose level do you start to see CNS symptoms in the infant during first 72 hours of life?

Back 84

< 20 mg/dl (premature infants)
< 30 mg/dl (term infnats)

Front 85

What is the most comon cause of neonatal seizures?

Back 85

Hypocalcemia

Front 86

What is the serum calcium level for diagnosis of hypocalcemia int he neonate?

Back 86

serum Ca < 8 (in term infants)
Serum Ca < 7 (preterm infants)
Ionized Ca < 4.4

Front 87

What is the treatment for hypocalcemia in neonates?

Back 87

IV Ca gluconate or Ca chloride

Front 88

What is the ave. weight and hight of a newborn

Back 88

3.5 kgs (3500 gm) = 7.7 lbs
50 cm

Front 89

What is the ave weight and height of a 1-6 month old

Back 89

4 kgs (4000 gm ) = 8.8 lbs
54 cm

Front 90

What is the ave. weight and height of 1-2 yr. old

Back 90

10 kgs = 20 lbs.
75 cm

Front 91

What is the ave. weight and height of 2-3 yr old

Back 91

13 kgs = 28.6 lbs
86 cm

Front 92

what is the ave. weight and hieght of 7 yr old

Back 92

25 kgs = 55 lbs
95-110 cm

Front 93

What is the ave. weight and height of 12 yrs old

Back 93

40 kgs = 88 lbs
132-149 cm

Front 94

What is the calculation to figure out ave. weight in pediatrics

Back 94

2 x age + 9 = weight in kg

Front 95

What are the anesthetic considerations for Intracranial Hemorrhage in pediatrics

Back 95

Maintian normla BP and avoid large swings
slow volume expansion.
Correct metabolic imbalances
normal BP is at low end of autoregulatory limit

Front 96

What is the most common type of congenital diaphragmatic herniation?

Back 96

Left sided herniation (90%)

Front 97

What are the hallmark signs of congenital diaphragmatic herniation?

Back 97

Hypoxia, scaphoid abdomen, evidence of bowel in the thorax

Front 98

What are the anesthetic considerations for congenital diaphragmatic herniation?

Back 98

NGT: to alleviate gastric distention
Avoid high pressure ventilation -- basically goingot be doing one lung ventioation
awake intuabtion often without muscle relaxants
Keep inspiratory pressuresl < 30 cm H2O
Sudden fall in lung compliance, BP or O2 could signal contralateral pneumothorax
Caution with expansion of ipsilateral lung following surgical decompression

Front 99

During surgery to fix a diaphragmatic hernia, what s/s be a sing of contralateral pneumothorax?

Back 99

Sudden fall in lung compliance, BP or Oxygenation

Front 100

What are the 4 main characteristic sof Tetralogy of Fallot
Hint: PVOR

Back 100

1. Pulmonary Stenosis (Right Venticular Outflow Obstruction)
2. VSD (Ventral Septal Defect)
3. Overriding Aorta
4. Right Ventricular Hypertorphy

Front 101

What is another name for acute Epiglottitis?

Back 101

supra-Glottic Edema

Front 102

What is the cause of acute epiglottitis?

Back 102

bacterial infection (Haemophilus Influenza)
Treat with Ampicillin

Front 103

What are the main diff. b/t acute epiglottitis and Croup

Back 103

Epiglottitis: Bacterial, 2-8 yrs old, sudden onset, dysphagia, droolong, no cough, muffled voidce, increased RR, sitting up
Croup: 3 mos - 3 yrs, Viral, slow onset, cough, no drooling, hoarse voice, increased RR, lay down

Front 104

What is the treatment for Croup?

Back 104

racemic Epi, nebs, humidified air/O2

Front 105

What is the treatment for acute epiglottitis?

Back 105

Intubate in OR (if possible0
Use smaller ETT with cuff leak (2x smaller)
ICU -- stay intubated for 48-62 hours and extubate when cuff leak demonstrated

Front 106

What are the fasting guidleines for child < 6 months old?

Back 106

milk:4 hours
Clear liquids: 2 hours

Front 107

What are the fasting guidelines for children 6-36 months?

Back 107

Milk/solids: 6 hours
Clear liquids: 3 hours

Front 108

What are the fasting guidelines for children > 36 months old (3 yrs Old)

Back 108

Milk/solids: 8 hours
Clear liquids: 3 hours

Front 109

How long after a viral infeciton (URI) will airways be hyperreactive in pediatrics?

Back 109

up to 6 weeks

Front 110

How long do children have sleeping disturbances postop?

Back 110

5-14 days

Front 111

what induction drug is most often used for tetralogy of fallot pts? why?

Back 111

ketamine
b/c it maintains SVR and does not

Front 112

What are the main anesthetic goals in tetralogy of fallot?

Back 112

Maintain Intravascular volume
Maintain SVR
decrease HR to increase filling time
Avoid Acidosis, increases in pulmonary vascular resistance and excessive airway pressures

Front 113

Why do you want to avoid Acidosis in tetralogy of fallot pts?

Back 113

b.c acidosis cause a leftward shift on the oxyhemoglobin curve and the Hgb holds onto oxygen rather than giving it up the cells

Front 114

List the contraindications to preop sedation in pediatrics

Back 114

Altered MS
elevated ICP
difficult airway
hypovolemia
respiratory dysfunction

Front 115

What is the calculation to determine ETT size in pediatrics?

Back 115

4 + (Age/4)

Front 116

Ketamine
IM dose
PO dose
IV dose

Back 116

IM: 4-10 mg/kg
PO: 8 mg/kg
IV: 1-2 mg/kg

Front 117

If using Ketamine in pediatrics, what drugs should be given with it?

Back 117

Midazolam (postop dilirium) and atropine or glycopyrrolate (secretions)

Front 118

what can happen to ETT with neck flexion in pediatrics?

Back 118

R main stem intubation

Front 119

Which type of dead space changes during pregnancy and why?

Back 119

Physiological dead space is decreasd b/c some nonfucntinal alveoli improve secondary to increases in TV and minutle ventilation
anantomic dead space is unchanged

Front 120

How much does PaCO2 decrease during pregnancy

Back 120

15%

Front 121

How does the oxyhemoglobin dissociation curve shift during pregnancy

Back 121

Low CO2 causes a left shift, but compensatory increase in serum bicarb and 23DPG help return the curve to right (releases more oxygen)

Front 122

What 2 things cause an increased minute ventilation during pregnancy?

Back 122

Increase in RR (2-3 bpm)
increase in TV (40%)

Front 123

What is Mendelson's syndrome?

Back 123

Gastric contents > 25 cc and pH < 2.5
at risk for pneumonitis
should be treated with a nonparticulant antacid prior to induction

Front 124

At what point in pregnancy are partrurients considered at risk for aspiration?

Back 124

8-10 weeks gestation

Front 125

What is the fisrt line therapy of adrenergic agonist for partrurients?

Back 125

Ephedrine
(b/c uterus is sensitive to alpha agonist and phenylephrine stimulates mostly amooth muscle alpha receptors, but ephedrine does alpha and beta)

Front 126

What are the 3 main factors that decrease uterine blood flow

Back 126

Systemic Hypostension
Uterine vascular vasoconstriction
Uterine contractions

Front 127

what % of CO goes to uterine blood flow

Back 127

10%

Front 128

Does uterine blood flow autoregulate?

Back 128

No, the uterine vasculature is maximally dilated, so autoregulation is absent
*Certain things can cause vasoconstriction*

Front 129

3 Main points regarding uterine blood flow

Back 129

1. 10% of CO
2. Autoregulation is absent
3. Sensitvie to Alpha Agonists (use ephedrine)

Front 130

Where does exchange of nutrients gases and waste occur in the placenta?

Back 130

in the capillaries of the villi
Villi are projections of fetal tissue

Front 131

what is the volume of blood flow through the umbilical cord at term

Back 131

120 ml/kg/min or 360 ml/min

Front 132

List the 5 mechanisms used for exchange of substance across the placenta membrane

Back 132

Diffusion (respiratory gases)
Bulk flow (water)
Active transport amino acids, water soluble vitamins)
Pinocytosis (Immune globulins)
Breaks (Rh+ red cells)

Front 133

How much more oxygen can fetal hgb carry than maternal hemoglobin

Back 133

20-30%

Front 134

What are the 3 compensatory mechanism that give the fetus the ability to survive for up to 10 minutes during O2 deprivation

Back 134

1. Redistribution of fetal blood flow to brain and heart
2. Decreased O2 consumption
3. Anaerobic metabolism

Front 135

what 3 mechanisms aid oxygen tranfer across the placenta to the fetus

Back 135

1. Fetal Hgb has more affinity for O2 (left shifted)
2. Fetal Hgb concentration is 50% greater than maternal
3. Double Bohr Effect (loss of CO2 makes the ftetal blood more alkaline, allowing it to carry more O2 and the maternal blood acceiting the CO2 becomes more acidotic, causing it to release even more O2)

Front 136

What is the PaO2 of well oxygenated blood in the placenta?

Back 136

40 torr

Front 137

What is the goal of fetal circulation?

Back 137

to maximally perfuse the placenta and to bypass nearly all of the nonfunctional lung an liver

Front 138

what % of fetal CO goes to the placenta?

Back 138

50%

Front 139

Wha tis the average saturation of the fetal blood in the umbilical vein (returning from the placenta) and what is its sat once it passes through the ductus venosus (mixing with deoxygenated blood?

Back 139

80%
67%

Front 140

What have you tried playing in the classroom?

Back 140

교실에서 뭐 놓고 간 일/ 적 있어요?

Front 141

What is the first priority on the eclamptic patient

Back 141

Control convulsions
Magnesium (2-4 Gm)
Benzos (versed 1-4 mg)
Barbituates (Thiopental 50-100 mg)

Front 142

What is HELLP Syndrome

Back 142

Hemolytic Elevated Liver Enzymes, Low Platelets

Front 143

the most rapidly growing segment of the over 65 population is....

Back 143

over age 85 years

Front 144

How much of the trauma and critical care resources inthe US do the elderly consume?

Back 144

over one fourth

Front 145

in the elderly patient, does an increased afterload (caused by stiffening of the outflow tract) affect cardiac output and EF?

Back 145

No, but maximal HR, earobic capacity and peak exercise cardiac output are decreased

Front 146

What is thought to be the main cause of aging?

Back 146

it is thought to de due to oxidative stress (we don't htave the ability to scavenge all the free radicals)
Increased # of free radicals cause damage to membranes, protiens, and genetic integrity cuasing a loss of tissue and organ functional reserve

Front 147

In aging, is the progressive loss of functional reserve linear?

Back 147

NO -- extent and onset of changes in highly variable among individuals

Front 148

Name some factors that play a part in aging

Back 148

activity level
Nutrition
genetic background

Front 149

What are the 3 main Cardiovascular changes ass. with aging?

Back 149

1. Loss of HR variability: heart becomes unable to ramp up during exercise
2. vascular changes: loss of elastice tissues, decreased arterial changes, increased SVR (HTN), decreased beta adrenergic receptors (decreased vasodilation)
3. CAD

Front 150

The incidence of CAD increases......with age

Back 150

Exponentially

Front 151

What are the major changes in the conducting airways of the elderly?

Back 151

-loss of elastin, collagen and water
-loss of pharyngeal muscular support
1. Increased diameter of trachea and central airway (increased residual volume
2. Decreased airway reflexes: increased risk of aspiration

Front 152

Is the response to hypercapnia increased or decreased in the elderly?

Back 152

Decreasede

Front 153

What neurotransmitters are decreased in the elderly?

Back 153

dopamine, Ach, serotonin
Not Glutamate

Front 154

how doe the CNS reaction ot pain change in the elderly?

Back 154

The threshold for pain increases
CNS sensitivity to depression increases

Front 155

What is most important in predicting postop function and delirium in the elderly?

Back 155

preop cognitive function

Front 156

what is the most common electrolyte imbalance occuring in 10-20% of hospitalized elders?

Back 156

hyponatremia
due to decreased GFR, decreased free water clearance, diuretics and poor oral intake

Front 157

Why is biotransformation of drugs (in the liver) altered in the elderly?

Back 157

decreased liver mass and less blood flow to the liver
(enzyme acitvity is unchanged)

Front 158

What body compostition changes in the elderly contribute to changes in the pharmokinetics of drugs?

Back 158

decreased total body water and lean body mass
Increased body fat
(*Helathy, active elders ahve little to no changes in plasma volume)

Front 159

Elderly account for ......of all drug prescriptions

Back 159

30%

Front 160

What are the pharmacokinetics in elderly related to barbituates?

Back 160

Increased Vd (bc of increased adipose tissue - longer duration of action, however Vd of central compartment is decreased due to decreased intravascular water), so higher plasma levels
should give a decreased dose

Front 161

List the 8 predictors of postop pulmonary complications in the elderly

Back 161

1. postop NG tube
2. Productive cough preop
3. Lung anesthetic (GA)
4. COPD
5. Smoking
6. Alchohol Abuse
7. chronic steroid use
8. Impaired LOC/CVA (preexisting CVA)

Front 162

Why is temperature monitoring especially important inthe elderly?

Back 162

b/c shivering can lead to ischemia

Front 163

during the first stage of labor what level of the spinal cord is involved?

Back 163

T10-L1

Front 164

During the second and third stage of labor what level of the spinal cord in involved?

Back 164

S2-S4

Front 165

When an epidural is placed at L2-3, how many dermatones will is spread (to affect more levels)

Back 165

2-3, so an epidural at L2-3 will also numb L4, S1, and S2

Front 166

Do opioids cross the placenta?

Back 166

yes
they can cause respiratory depression, acidosis and sedation in the fetus

Front 167

Why is Ketamine avoided in the partrurient?

Back 167

Low apgar scors and fetal depression are seen in doses greater than 1 mg/kg

Front 168

List the absolute contraindications to Epidurals

Back 168

Patient refusal
coagulaopathy
Skin infection at the site
Raised ICP
Hypovolemia (uncorrected)

Front 169

List the relative contraindications to epidurals

Back 169

Uncooperative patietn
pre-existing neurological disorders
fixed cardiac output (AS, HOCM, complete heart block)
anatomical abnormalties of vertebral column (kyphosis)
previous back surgery (rods)

Front 170

What 2 things do you give a pt prior to placing an epidural?

Back 170

30 cc bicitra (nonparticulant antacid)
500-1000 LR fluid bolus

Front 171

What is the typical depth from skin to the lumbar epidural space?

Back 171

5 cm

Front 172

What do you test dose an epidural with?

Back 172

Lidocaine (1.5%) with Epi (1: 200,000): give 3 ml; this is 45 mg Lido and 27 mcg Epi
Lido tests for intrathecal placement
Epi tests for intravascular placement

Front 173

If an ep\pidural is accidentally placed in the intrathecal space, how do you continue to use it as an epidural?

Back 173

give 1/10th the mg volume dose and LABEL as intrathecal

Front 174

What are the toxic affects of bupiviacaine on the heart

Back 174

Stops automacity of the heart = heart stops

Front 175

Who gets Spinals for labor

Back 175

the Multip Partrureint b.c their labor is typically fast (and spinals' suration cannot be extended or converted for emergency CS)

Front 176

what is the drug and sose used for spinals in the parturient?

Back 176

PRESERVATIVE FREE:
Morphine 0.15 - 0.25 mg
Fentanyl 12.5 - 25 mcg

Front 177

Is there sympathetic blockade with a spinal?

Back 177

no, so hypotension is rare
Feta HR may decrease and this is due to rapid desecent as the patrurient relaxes

Front 178

What controls the Fetal HR

Back 178

Autonomic nervous system
Inhibitory: Vagus Nerve
Excitatiry: sympathetic nervous stystem

Front 179

List 3 nonreassuring signs in a FHR

Back 179

1. Absence of accelerations
2. Sustained Decrease in baseline variability
3. Late Decelerations

Front 180

What type of FHR is considered healthy?

Back 180

A FHR with Baseline Variability
-reflects a healthy nervous system, chemoreceptors, baroreceptors and cardiac responsiveness
-Variability should be normal after 32 weeks

Front 181

What is the most commonly encountered pattern of FHR during labor

Back 181

Variable Decelerations
-caused by cord compression

Front 182

If using regional anesthesia for a C-section, what is the required level of block?

Back 182

T4

Front 183

Is the use of Inhaled Anesthetics associated with decreased uterine activity, increased uterine bleeding, or neonatal depression?

Back 183

No, as long as the use is short term and at low concentrations (2/3 to 1/2 MAC with Nitrous 50-70%)

Front 184

What is the RR and HR of a Neonate

Back 184

RR (assessed by ausculatation): 30-60
HR (assessd by palpation at the base of the cord):120-160

Front 185

What is a normal Apgar score?

Back 185

7-10
4-6: moderate impairment
0-3: needs resuscitation

Front 186

If a parturient needs nonobstetric surgery, what drugs should be avoided?

Back 186

Benzos, Nitrous, Ketamine

Front 187

During nonobstetric surgery in the parturient, how do you treat preterm labor?

Back 187

Tocolytics: Ritodine and Terbutaline

Front 188

What is the most common abnormal fetal presentation?

Back 188

Breech

Front 189

What are the symptoms of placenta previa (prevents or block fetal delivery)

Back 189

Painless vaginal bleeding
the placenta blocks the os
may require immediate C/S (large voluume loss)

Front 190

What are the symptoms of Abruptio Placentae (premature separation of the placenta for the uterine wall)?

Back 190

Painful Vaginal Bleeding
Risk Factors: ETOH, HTN, trauma, short umbilical cord, multiparity, cocaine abuse

Front 191

How does PDPH usually present?

Back 191

a severe, dull non-throbbing headache that is fronto-occipital and is aggravated with sitting up or straining (coughing) and diminishes when lying flat.

Front 192

When is an epidural patch done for a dural puncture?

Back 192

Not within the first 24 hours.
after 24hours, if the PDPH is moderate to severe and interfers with daily acitivties, an patch would be considered

Front 193

How often is an epidural blood patch effective in treating PDPH?

Back 193

95% of the time, so if relief is not obtained with an EBP, then the original diagnosis should be questioned

Front 194

When does organ function develop in utero?

Back 194

second tirmester

Front 195

when does organogenesis occur inutero?

Back 195

first 8 weeks after conception

Front 196

How does Sevo affect HR and SBP in pediatric patients?
What are the MACs

Back 196

Increased HR and Decreases SBP
Neonate: 3.2
Infant: 3.2
small child: 2.4
Adult: 2.0

Front 197

Which causes more bronchospasm and laryngospasm in pediatrics Halothane or Sevo

Back 197

No difference. Sevo has slightly less incidence of coughing

Front 198

Why is the dose of propofol required for induction increased in younger children?

Back 198

volume of distribution is increased
the neonate has 90% TBW
4 month old has 80% TBW

Front 199

How is propofol metabolized in infants and newborns?

Back 199

Predominantly phase I (Rapid Redistribution) and Phase II (clearance)
(phase II (clearanc from poorly perfused tissues) doesn't really occur in nb and infants

Front 200

Who clears remifentanyl faster, neonates or adults?

Back 200

Neonates

Front 201

After the first breath, how long does it take for pulmonary vascular resistance ot decrease to normal levels?

Back 201

3-4 days