Pediatric Overview

Front 1

*What years are each stage of childhood? Newborn, neonatal, infant, child?

Back 1

Newborn: 24 hours of life;

neonatal: first month of extrauterine life;

infant: 1-12 months;

child: 1 year to puberty

Front 2

What can you use as a MAP indicator in a neonate?

Back 2

Weeks in age

Front 3

What % of newborn Hg is Hgb F? What does it not bind with?

Back 3

75; 2,3-DPG

Front 4

Hgb-F is replaced with what, and does what to the oxyhemoglobin dissociation curve? At what age?

Back 4

Hgb-A; to the right to enhance O2 delivery; 4-6 months

Front 5

*Newborn's oxyhemoglobin dissociation curve is shifted to the ___.

Back 5

left

Front 6

At what age does a child’s hgb reach adult levels?

Back 6

2

Front 7

*When does the foramen ovale close?

Back 7

3-12 months

Front 8

When does surfactant appear in gestational age? When does it increase in concentration?

Back 8

23-24 weeks; last 10 weeks

Front 9

*Lack of surfactant results in __ __ __ or ____ in premature infants.

Back 9

hyaline membrane disease or RDS ["stiff lung"]

Front 10

What differences exist in alveolar ventilation and CO2 between neonates and adults?

Back 10

double alveolar ventilation; increased CO2 production

*increased rate + increased CO2 production = normal PaCO2

Front 11

How many weeks is considered premature?

Back 11

less than 36 weeks

Front 12

*How do infants increase their cardiac output?

Back 12

Increase HR

Front 13

Why do patients get hyaline membrane disease?

Back 13

lack of surfactant

Front 14

What does surfactant do?

Back 14

Reduces surface tension in the lungs, reduces the force required to keep the lungs filled with air at the end of expiration

Front 15

*Increased alveolar ventilation maintains __ PaCO2 in neonates.

Back 15

normal

Front 16

Tidal volume is based on weight __ to adults.

Back 16

equal

Front 17

____ production is increased in neonates.

Back 17

Carbon dioxide

Front 18

Tell me about postop apnea.

Back 18

Any premature born infant may have apneic spells up to 12 hours post op in premature kids up to 55 weeks postconception

Front 19

*How do newborns produce heat? *How do they lose it, what is the rate of loss compared to adults?

Back 19

Newborns produce heat primarily by non-shivering thermogenesis by metabolism of brown fat which is regulated by the autonomic nervous system; radiation; 4x

Front 20

What are the different warming devices available for babies? What is the best way to maintain infant’s body temperature?

Back 20

Beir hugger, wrapping and draping with plastic sheets, humidification of inspired gases. Maintain high ambient temperature.

Front 21

Apneic spells have been reported in prematurely born infants up to what age?

Back 21

55 weeks postconception

Front 22

When does GFR reach adult levels? Term infants have a GFR what percentage that of adults?

Back 22

2 years; 40% --- tolerates fluids poorly

Front 23

*True/false – as time goes on, you are less water?

Back 23

yes-- 80 to 60%

Front 24

What is the ECF of a child compared to an adult?

Back 24

44 to 20; more water soluble drugs will have a larger volume of distribution compared to the adult

Front 25

What is something that can cause upper airway collapse in children?

Back 25

flexing head

Front 26

*Larynx/epiglottis/vocal cords in pediatrics are different in what ways from an adult?

Back 26

cephalad (C3-5), omega-shaped; slanted up and more anterior

Front 27

*What is the smallest part of a pediatric airway?

Back 27

cricoid cartilage

Front 28

(circle) Chest wall moves easier/harder. Lungs are more pliable/stiffer.

Back 28

chest easier; lungs stiffer (more difficult to distend)

Front 29

Distance from vocal cords to carina is __ in neonates.

Back 29

4 cm

Front 30

Distance from vocal cords to carina is __ to __ cm infants up to 1 years old.

Back 30

5 to 9

Front 31

*What laryngoscope blade is preferred for use in children? Up to what age?

Back 31

Miller; 4

Front 32

*What is the calculation for estimating the size of a breathing bag for children?

Back 32

50cc/kg

Front 33

Calculation for tube depth? Calculation for uncuffed/cuffed tubes? What is the 7-8-9 rule?

Back 33

age/2 +12; uncuffed: age/4+4; cuffed: age/4 +3. 234 (kg), 789cm depth (small/medium/full)

Front 34

*What drugs should you always have drawn up and ready on your table top?

Back 34

atropine (0.02mg/kg - min 0.1mg or 0.25cc);

succinylcholine (2mg/kg);

epinephrine (0.01mg/kg 1:10,000 -- calculated)

Front 35

What is the standard IV size for pediatrics?

Back 35

22 gauge

Front 36

What is an important standard of care in relation to monitoring of pediatrics?

Back 36

temperature

Front 37

What is the general goal of preoperative assessment?

Back 37

anticipate potential complications, avert them when possible, minimize risks to the patient

Front 38

Why is accurate weight of pediatric patients imperative?

Back 38

drug doses are based on weight

Front 39

*What are the ASA NPO guidelines?

Back 39

2 h = clear liquids; 4h = breastmilk; 6h = solids

Front 40

What are the doses for oral and intranasal administration of midazolam?

Back 40

0.5-0.75 mg/kg; 0.2-0.3 mg/kg

Front 41

Dosage range for ketamine IM?

Back 41

low dose 1-2 mg/kg; up to 5 mg/kg

Front 42

At what age does MAC begin to decline?

Back 42

3 months

Front 43

Propofol doses are larger in which – infants or children?

Back 43

infants

Front 44

*What is the primary inhalational agent used during inhalation inductions?

Back 44

sevoflurane

Front 45

Which stage of anesthesia is most associated with agitation/difficult behavior? What are potential complications with this stage and what considerations should you have regarding this?

Back 45

Stage 2; keep stimulation to a minimum, don't start IV, don't insert oral airway; may cause laryngospasm: 100% O2, positive pressure, sux

Front 46

What are four things you should do to maintain the airway during induction?

Back 46

extend neck, jaws in sniffing position (thrust forward), airtight seal with mask, moderate CPAP (10-15 mmHg)

Front 47

*What are the mg/kg doses of succinylcholine for neonates/infants? Older children/adults?

Back 47

2 mg/kg; 1 mg/kg

Front 48

*What are the side effects of succinylcholine? What are its indications?

Back 48

masseter muscle rigidity (impeding MH possibility); cardiac arrest (hyperkalemia); rapid airway control, laryngospasm, RSIV to prevent aspiration

Front 49

An increase or decrease in what changes fluid requirements for a child?

Back 49

metabolic rate

Front 50

How many hours of fluid should you have at one time in your volutrol?

Back 50

at most 2 hours

Front 51

*What is the most common block in pediatrics? What are the main indications? What are the contraindications?

Back 51

Caudal;

Indications: below T10 such as circumcision, inguinal hernia repair, hydrocelectomy, orchiopexy.

Contraindications: sacral dimple, meningomyelocele, meningitis, sepsis, hydrocephalus, progressive degenerative neuropathy carries medicolegal implications

Front 52

What is the calculation for how much local anesthetic mixed in with epinephrine? What concentration is the epinephrine? How do you know if you are in the right space if your patient is asleep?

Back 52

1 ml/kg of LA with 1:200,000 epinephrine

You will see an increase in HR because of epi if placed correctly

Front 53

*What is the dose of emergency epinephrine?

Back 53

0.01 mg/kg

Front 54

*When suctioning the larynx, the time spent suctioning should be limited to?

Back 54

5 seconds