Pedi - Basics Of Anesthesia

Front 1

Where is the larynx located in neonates and infants?

Back 1

more anterior and cehalad
C4

Front 2

narrowest pt or the airway?

Back 2

cricoid cartilage

funnel shaped larynx b/c small, underdeveloped cricoid cartilage

Front 3

when do kids stop nasal breathing?

Back 3

5 mos

Front 4

how many alveoli do newborns have vs. 18 mo. old?

Back 4

newborn = 20 million
18 mos = 300 million

Front 5

What is the primary muscle for ventilation in the infant?

Back 5

diaphragm

Front 6

How many type I vs. type II muscle fibers do premies/infants have?

Back 6

newborn 25% type I
premie 10% type I
8 mos old (mature) 55%
type I muscle fibers prevent fatigue

Front 7

Why do kids rapid desat during periods of apnea?

Back 7

1. limitied number of alveoli
2. increased compiance of rib cage
3. weak intercostals and diaphragm (promote chest wall collapse)
4. decreased FRC

Front 8

Why is CO heart rate dependant in neonates and infants?

Back 8

poorly developed left ventricle, limited ability to increase myocardial contractility and SV

Front 9

What is a major cause of bradycardia in neonates?

Back 9

hypoxemia

Front 10

What is the hallmark of fluid depletion in infants?

Back 10

hypotension without tachycardia
(lower catecholamine stores, immature baroreceptors)

Front 11

Major mechanism for heat production is metabolism of brown fat -- this is called?

Back 11

nonshivering thermogenesis

Front 12

What inhibits thermogenesis in brown fat?

Back 12

inhalational agents

Front 13

What are the implications of low GFR in the newborn?

Back 13

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

Front 14

What is a good balanced cyrstaloid solution for newborn?

Back 14

D5LR

Front 15

What are the differences in electrolytes in the newborn?

Back 15

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

Front 16

Describe fetal hemaglobin, of which a neonate has 70%.

Back 16

1. high affinity for O2
2. left shift (p50 18-20mmHg)
3. compensated by higher hemoglobin lvls and inc CO

Front 17

Normal VS for neonate

Back 17

RR 40
HR 140
SBP 65
DBP 40

Front 18

Normal VS for infant

Back 18

RR 30
HR 120
SBP 95
DBP 65

Front 19

Normal VS for 3 yo

Back 19

RR 25
HR 100
SBP 100
DBP 70

Front 20

Normal VS for 12 yo

Back 20

RR 20
HR 80
SBP 110
DBP 60

Front 21

what are the doses for anticholinergics?

Back 21

glycopyrrolate = 0.01mg/kg
atropine 0.02mg/kg (0.1mg min)

Front 22

What is the dose for succinylcholine?

Back 22

neonates/infants 3mg/kg
children 2mg/kg
IM 4-6mg/kg

Front 23

What happens when neonate given morphine?

Back 23

longer 1/2 life, decreased plasma clearance due to immature liver

Front 24

what happens with admin of fentanyl/sufentanil in children?

Back 24

clearance may be higher due to high hepatic blood flow which increases biotransformation and elimination

Front 25

What is dose of propofol infusion?

Back 25

150-250 mcg/kg/min

Front 26

Why is ketamine useful for infants?

Back 26

inhibits reuptake of NE resulting in increased HR which offsets brady
-potent bronchodilator
-increased salivation
-IM 6-10mg/kg
-IV 1-2mg/kg

Front 27

What is the most effective pre-op midazolam route?

Back 27

oral 0.5-0.75mg/kg

if have IV- 0.05mg/kg

Front 28

Reasons to cancel pedi case...URI

Back 28

fever, wheezing, lower resp tract infection, producive cough

Front 29

At JMH what labs do u need for T&A?

Back 29

PT/PTT

Front 30

Fasting recommendations:

Back 30

clears 2 hr
breast milk 4 hr
formula 6 hrs (4hr for neo)
milk 6 hr
light meal 6 hr
heavy meal 8 hr

Front 31

Stage 1 anesthesia

Back 31

-initial loss of induction
-loss of consciousness

Front 32

Stage 2 anesthesia

Back 32

-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

Front 33

Stage 3 anesthesia

Back 33

-return of reg RR
-char. by inc degree of muscle relaxation
-protective airway reflexes absent
-surgical plane

Front 34

Stage 4 anesthesia

Back 34

-"overdose"
-severe brain stem depression
-cessation of respiration
-potential CV collapse

Front 35

What is inhalational agent of choice for inhalation induction?

Back 35

sevoflurane

Front 36

How much leak should be around ETT?

Back 36

15-20cm H2O - should be audible

Front 37

What is formula for ETT size?

Back 37

(age + 16)/4
age/4 +4

depth = age +10 (guideline, ETT should pass 1-2 cm past glottis)

Front 38

What should vent setting be for kid < 10KG?

Back 38

PIP 15-18cm H2O

Front 39

What is caudal block used for?

Back 39

urogenital, rectal, inguinal, and lower extremities

Front 40

What LA is used for caudal block?

Back 40

Bupivicaine (0.175%-0.125%)
lasts 4-6 hr post-op

Front 41

Complications of caudal block

Back 41

-LA toxicity
-IV injection (sz, hypotension, dyshythmias)

Front 42

Where is the caudal block placed?

Back 42

-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

Front 43

Where does the dural sac end in children?

Back 43

S3 level
(higher risk of injection into sa space)

Front 44

Why do premies have a lower anesthetic requirement?

Back 44

1. immature nervous system
2. immature BBB
3. elevated endorphins
4. progesterone from mamma

Front 45

What is the MAC b/w birth and 3 mos for sevo?

Back 45

2.5% - highest at this time

Front 46

Laryngospasm is most common with

Back 46

desflurane

Front 47

Larynospasm is caused by stim of?

Back 47

superior laryngeal nerve

Front 48

Treatment of laryngospasm

Back 48

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

Front 49

What is post intubation croup from?

Back 49

glottic or tracheal edema
most common in kids up to 4yrs

Front 50

What are signs of impending respiratory failure with post op croup?

Back 50

barky cough, audible stridor at rest, sternal wall retraction, lethargy, decreased LOC, dusky.

Front 51

What increases the risk of post-op croup?

Back 51

multiple intubation attempts
prolonged surgery
head and neck procedures
large ETT
coughing and moving pt's head with ETT in place

Front 52

Treatment of post-op croup

Back 52

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)

Front 53

Pt's at higher risk for MH?

Back 53

Musculoskeletal dz
Duchenne's MD
central core diseases

Front 54

surgical procedures with higher risk for MH

Back 54

ortho
ophthalmic
head and neck
cleft palate
T&A
dental

Front 55

S/S of MH

Back 55

muscular rigidity
hypermetabolic state
hypercarbia
metabolic acidosis
tachycardia (early sign)
hyperthermia (late sign)
rhabdomyolysis
hyperkalemia
cardiac arrest

Front 56

incidence of MH in Kids vs adults

Back 56

kids 1:15,000
adults 1:40,000

Front 57

Treatment for MH

Back 57

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