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57 Cards in this Set

  • Front
  • Back
Where is the larynx located in neonates and infants?
more anterior and cehalad
narrowest pt or the airway?
cricoid cartilage

funnel shaped larynx b/c small, underdeveloped cricoid cartilage
when do kids stop nasal breathing?
5 mos
how many alveoli do newborns have vs. 18 mo. old?
newborn = 20 million
18 mos = 300 million
What is the primary muscle for ventilation in the infant?
How many type I vs. type II muscle fibers do premies/infants have?
newborn 25% type I
premie 10% type I
8 mos old (mature) 55%
type I muscle fibers prevent fatigue
Why do kids rapid desat during periods of apnea?
1. limitied number of alveoli
2. increased compiance of rib cage
3. weak intercostals and diaphragm (promote chest wall collapse)
4. decreased FRC
Why is CO heart rate dependant in neonates and infants?
poorly developed left ventricle, limited ability to increase myocardial contractility and SV
What is a major cause of bradycardia in neonates?
What is the hallmark of fluid depletion in infants?
hypotension without tachycardia
(lower catecholamine stores, immature baroreceptors)
Major mechanism for heat production is metabolism of brown fat -- this is called?
nonshivering thermogenesis
What inhibits thermogenesis in brown fat?
inhalational agents
What are the implications of low GFR in the newborn?
1. impairs the ability to concentrate or dilute urine
2. immature tubular cells unable to completely reabsorb Na in response to aldosterone
3. impaired bicarb reabsorption
What is a good balanced cyrstaloid solution for newborn?
What are the differences in electrolytes in the newborn?
K 6.0-6.5
Bicarb lower
PH first 10 min 7.2
1 hr 7.35
1 week 7.4
lower protein concentration reduces oncotic pressure
Describe fetal hemaglobin, of which a neonate has 70%.
1. high affinity for O2
2. left shift (p50 18-20mmHg)
3. compensated by higher hemoglobin lvls and inc CO
Normal VS for neonate
RR 40
HR 140
SBP 65
DBP 40
Normal VS for infant
RR 30
HR 120
SBP 95
DBP 65
Normal VS for 3 yo
RR 25
HR 100
SBP 100
DBP 70
Normal VS for 12 yo
RR 20
HR 80
SBP 110
DBP 60
what are the doses for anticholinergics?
glycopyrrolate = 0.01mg/kg
atropine 0.02mg/kg (0.1mg min)
What is the dose for succinylcholine?
neonates/infants 3mg/kg
children 2mg/kg
IM 4-6mg/kg
What happens when neonate given morphine?
longer 1/2 life, decreased plasma clearance due to immature liver
what happens with admin of fentanyl/sufentanil in children?
clearance may be higher due to high hepatic blood flow which increases biotransformation and elimination
What is dose of propofol infusion?
150-250 mcg/kg/min
Why is ketamine useful for infants?
inhibits reuptake of NE resulting in increased HR which offsets brady
-potent bronchodilator
-increased salivation
-IM 6-10mg/kg
-IV 1-2mg/kg
What is the most effective pre-op midazolam route?
oral 0.5-0.75mg/kg

if have IV- 0.05mg/kg
Reasons to cancel pedi case...URI
fever, wheezing, lower resp tract infection, producive cough
At JMH what labs do u need for T&A?
Fasting recommendations:
clears 2 hr
breast milk 4 hr
formula 6 hrs (4hr for neo)
milk 6 hr
light meal 6 hr
heavy meal 8 hr
Stage 1 anesthesia
-initial loss of induction
-loss of consciousness
Stage 2 anesthesia
-delirium stage
-reflex and irrational responses to stim
-irreg RR and HR
-pupil dilation, eye disconj
-increased salivation
-breath holding, vomiting, spastic movements
-higher risk laryngospasm, bronchospasm
-preserved pharyngeal muscle tone and ability to protect airway
Stage 3 anesthesia
-return of reg RR
-char. by inc degree of muscle relaxation
-protective airway reflexes absent
-surgical plane
Stage 4 anesthesia
-severe brain stem depression
-cessation of respiration
-potential CV collapse
What is inhalational agent of choice for inhalation induction?
How much leak should be around ETT?
15-20cm H2O - should be audible
What is formula for ETT size?
(age + 16)/4
age/4 +4

depth = age +10 (guideline, ETT should pass 1-2 cm past glottis)
What should vent setting be for kid < 10KG?
PIP 15-18cm H2O
What is caudal block used for?
urogenital, rectal, inguinal, and lower extremities
What LA is used for caudal block?
Bupivicaine (0.175%-0.125%)
lasts 4-6 hr post-op
Complications of caudal block
-LA toxicity
-IV injection (sz, hypotension, dyshythmias)
Where is the caudal block placed?
-sacral portion of epidural space
-penetration of sacrococcygeal ligament that covers the sacral hiatus (area b/w fused s4-s5)
-LA injected p aspiration test
Where does the dural sac end in children?
S3 level
(higher risk of injection into sa space)
Why do premies have a lower anesthetic requirement?
1. immature nervous system
2. immature BBB
3. elevated endorphins
4. progesterone from mamma
What is the MAC b/w birth and 3 mos for sevo?
2.5% - highest at this time
Laryngospasm is most common with
Larynospasm is caused by stim of?
superior laryngeal nerve
Treatment of laryngospasm
1. 100% O2
2. Forward jaw thrust
3. Positive pressure vent
4. IV lidocaine (1-1.5mg/kg)
5. IF pt becomes hypoxic
Succinycholine 0.25-1mg/kg
IM 4-6mg/kg
What is post intubation croup from?
glottic or tracheal edema
most common in kids up to 4yrs
What are signs of impending respiratory failure with post op croup?
barky cough, audible stridor at rest, sternal wall retraction, lethargy, decreased LOC, dusky.
What increases the risk of post-op croup?
multiple intubation attempts
prolonged surgery
head and neck procedures
large ETT
coughing and moving pt's head with ETT in place
Treatment of post-op croup
1. racemic epi 0.25-0.5cc of 2.25% solution diluted in 2.5cc NS (last up to 2 hrs)
2. Dexamethasone 0.25-0.5mg/kg may prevent edema)
Pt's at higher risk for MH?
Musculoskeletal dz
Duchenne's MD
central core diseases
surgical procedures with higher risk for MH
head and neck
cleft palate
S/S of MH
muscular rigidity
hypermetabolic state
metabolic acidosis
tachycardia (early sign)
hyperthermia (late sign)
cardiac arrest
incidence of MH in Kids vs adults
kids 1:15,000
adults 1:40,000
Treatment for MH
1. D/c agent
2. 100% O2, high flow
3. Dantrolene 2.5mg/kg IV
4. cooling
5. inotropes
6. change circuit, soda lime
7. monitor uop, K, Ca, ABG, coags
8. consider dextrose/insulin for K
9. Aline, CVP
10 800-MH-HYPER