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112 Cards in this Set
- Front
- Back
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Where does the spinal cord end in a baby?
Adult? |
L3 for baby, L1 for adult. Gets there by 1 yr old
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Three major causes of neonatal bradycardia?
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1. hypoxia
2. hypovolemia 3. hypoglycemia |
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Why are neonates given atropine prior to induction?
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need anticholinergic because they have increased vagal tone: SNS not fully developed at birth but PSNS is
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Cervical level of preterm neonate?
term neonate? adult? |
C3
C4 C5-6 |
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Neonates lung compliance is ( more or less) compared to adult?
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less
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Is infant FRC greater or less than adults?
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less
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Closing capacity in infant? Adult?
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35 ml/kg
23 ml/kg |
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resting O2 consumption of infant?
Adult? |
8 ml/kg/min
4 ml/kg/min |
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High O2 concentrations
A. Stimulate B. depress infant respirations? |
depress
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AVG BLOOD VOLUMES (ML/KG)
preemie: 90-100 Term: 80-90 3 mo-3 yrs: 75-80 3-6 years: 70-75 over 6: 65-70 |
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Hgb F shiftst the oxyhemoglobin dissociation curve to the
A. right B. left |
B
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P50 of newborn?
Adult? |
19
27 |
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fetal circulation has (high or low) PVR? SVR?
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High PVR, low SVR
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what causes the shift in circulation in a newborn?
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closing of FO and PDA
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When speaking of intracardiac shunts, what dictates flow?
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pressure gradient across lesion
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Which of the following are left to right shunts?
A. VSD/ASD B. PDA C. tetrology of Fallot |
A, B
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Which type of cardiac lesions are cyanotic lesions?
A. left to right shunts B. right to left |
B (unoxygenated blood gets shunted to LV and pumped out
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Which of the following are right to left shunts?
A. PFO B. tetrology of Fallot C. truncus arteriosus D. transposition of great vessels |
B, C, D
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L>R shunts (increase or decrease) speed of inhalational uptake?
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increases
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R>L shunts (increase or decrease) speed of inhalational induction>?
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decrease
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IV agents enter heart on right or left?
Inhalational agents? |
IV: right
Inhalational: left |
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R>L shunting (increases or decreases) uptake of inhalational agents? IV agents?
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decreases inhalational
increases IV |
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Continuous systolic and diastolic murmur heard at 1st or 2nd ICS at LSB is hallmark of?
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PDA
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4 Defects of tetrology of fallot?
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pulmonary stenosis
VSD hypertrophic LV Overriding aorta |
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Which kind of lesions are cyanotic: L>R
R>L |
R>L
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Is preductal or postductal coarctation of aorta more common in neonates? Adults?
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preductal in babies
postductal in adults |
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Whys is normal resp rate higher the younger you are?
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increased metabolic demands of kids...demand goes down as age increases
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NORMAL RESP RATES:
< 1 yr: 30-60 1-3 yr: 24-40 4-5 yrs: 22-34 6-16 yrs: 18-30 Adolescent: 12-16 |
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Greatest mechanism for heat loss in kids in OR?
A. evaporation B. conduction C. radiation D. convection |
C
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Most accurate core temp?
A. TM B. skin C. esophageal D. rectal |
A
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For water soluble drugs, do kinds have a (larger or smaller) Vd?
What does this mean for dosing? |
larger
they have higher ECF relative to adults, so need larger dose (SCh) |
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For lipid soluble drugs, do kids have ( larger or smaller) Vd?
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smaller
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Induction dose of propofol?
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3-3.5 mg/kg for infnats
2.5-3 mg/kg for child |
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Induction dose of ketamine?
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2 mg/kg IV
5-6 mg/kg IM |
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PO dose of versed?
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0.5-0.75 mg/kg
NOT TO EXCEED 20 mg |
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orbicularis oculi is indicator of (laryngeal or diaphragm) muscle?
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laryngeal
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adductor pollicis is indicator of ( laryngeal or diaphragm) muscle?
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diaphragm
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Which NMB can cause bradycardia in kids with repeated dose?
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Sch
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Which NMB is vagolytic? ( causing ^ in HR and BP)
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pavulon
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What is the primary reason kids go to sleep faster?
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They suck agent in rapidly due to ^ minute ventilation
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Kids with URI have how much ^ risk of bronchospasm or laryngospasm?
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2-10 fold
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How long should elective case be postponed for uncomplicated URI?
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2 weeks
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How long should elective case be postponed for lower airway involvement?
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4-6 weeks
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If intubating a kid with recent URI, name 2 considerations:
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1. deep plane of anesthesia preior to ETT
2. Use ETT one size smaller than caluclated |
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For a kid with RAD, what 2 induction agents are preferred?
What should be avoided? |
PF propofol, ketamine
histamine releasing agents |
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ROP is most common in?
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babies weighing < 1500 grams or born < 35 weeks
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Which of the following can cause ROP?
A. hypoxia B. hyperoxia C |
Both are correct
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Which of the followng are correct in anesthetic management of kid with epiglotitis?
A. Use ETT 1-2 sizes smaller tahn calculated B. Be prepared for emergent cricothyrotomy of trach C. Use sux for intubation D. give atropine to block vagal stim |
all are correct BUT C: Never use NMBs
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What is racemic epi?
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equal mix of levo and dex isomers
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What is the most common cause of postextubationcroup?
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tight fitting ETT without air leak of <30
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Kids with URI have how much ^ risk of bronchospasm or laryngospasm?
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2-10 fold
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How long should elective case be postponed for uncomplicated URI?
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2 weeks
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How long should elective case be postponed for lower airway involvement?
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4-6 weeks
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If intubating a kid with recent URI, name 2 considerations:
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1. deep plane of anesthesia preior to ETT
2. Use ETT one size smaller than caluclated |
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For a kid with RAD, what 2 induction agents are preferred?
What should be avoided? |
PF propofol, ketamine
histamine releasing agents |
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ROP is most common in?
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babies weighing < 1500 grams or born < 35 weeks
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Which of the following can cause ROP?
A. hypoxia B. hyperoxia C |
Both are correct
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Which of the followng are correct in anesthetic management of kid with epiglotitis?
A. Use ETT 1-2 sizes smaller tahn calculated B. Be prepared for emergent cricothyrotomy of trach C. Use sux for intubation D. give atropine to block vagal stim |
all are correct BUT C: Never use NMBs
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What is racemic epi?
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equal mix of levo and dex isomers
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What is the most common cause of postextubationcroup?
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tight fitting ETT without air leak of <30
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Which location of foreign body is likely to cause total airway obstruction?
A. larynx B. mainstem bronchus |
A
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What is the most common block used in peds?
A. spinal B. epidural C. caudal |
C
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Where is the caudal space?
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continuation of epidural space in sacral area
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What level does caudal get you?
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anything below T10 is covered
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caudal dose of morphine?
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30 mcg/kg
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caudal dose of fentanyl?
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1 mcg/kg
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How does surgical stress induce hypovolemia?
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stress ^ plasma glucose levels, which induces osmotic induced renal loss of free water
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Total Body Water:
Preemie: 80 % total body wt term infnat: 70-75% adult: 55-60% |
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#rd space fluid loss in kids:
Minor: 3-4 ml/kg moderate: 5-6 Major: 7-10 ml/kg |
.
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Estimated blood volumes:
preemie: 90-100 ml/kg term: 80-90 3 mo- 1 yr: 75-80 3-6 yrs: 70-75 >6: 65-70 |
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what is the most effective intervention for facilitating induction and reducing postop complications?
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premedication with Versed
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Which of the following are at increased risk of SBE and need prophylaxis?
A. unrepaired cyanotic lesion B. prosthetic repair C. MVP D. repair with residual defect remaining |
A, B, D
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How long should a surgery be delayed if it is determined that a child has had breast milk?
Water? formula? |
4 hours
2 hours 4 hours(if younger than 3 mo) 6 hours ( > 6mo) |
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What is the most common "recipe" for inhalation induction in kids?
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N2O ( 70/30 or 50/50) with 8% Sevo
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What nerve does N2O blunt?
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olfactory
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First sign of induction in inhalation induction?
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nystagmus
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Order of s/sx for inhalation induction?
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nystagmus
eyes close limbs relax resp slow |
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Which of the following are reason to use N2O in kids?
A. decrease MAC of sevo B. second gas effect- speeds induction C. analgesia D. reduces PONV |
A, B, C
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What enzyme does N2O inhibit?
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methionine synthetase
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How does N2O provide analgesic effects?
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works on grey matter to cause release of endogenous endorphins
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What pateint population often has B12 deficiency?
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Autistic kids
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What is the agents of choice in peds?
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Sevo
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MAC of sevo in kids?
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3.3 in neonates,
2.5 6 mo-5 yrs 2 in adults |
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Which of the following have active metabolites?
A. Morphine B. versed C. demerol D. ketamine |
A( morphine 6 glucoronic acid)
C. normeperidine |
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Which adjuvant agent can caue neuronal apoptosis?
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Ketamine
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Where does the dural sac end in kids?
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S3
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Which of the followin are contraindications for caudal blocks?
A. infection B. sepsis C. hypovolemia D. coagulopathies |
all are
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1 ml/kg of 0.25% bupiv will cover how many spinal segments?
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10
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What is the max volume for caudal blocks?
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20 ml
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Criteria for emergence in preverbal kids include which of the following?
A. grimace using forehead/eyebrows B. purposeful movement C. spontaneous eye opening |
All are correct
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Criteria for adequate recovery from NMB in preverbal kids include which of the following?
A. NIF -30 B. head lift/coughing forcefully C. nonparadoxical breathing D. sustained tetany at 50 Hz |
All are
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Deep extubation might be warranted in what populations?
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kids with RAD
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What is most common complication in kids?
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PONV
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Zofran dose?
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.1 mg/kg
with decadron 0.2 mg/kg |
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Which of the following are "at risk" surgeries for PONV?
A. strabismus surgery B. orchiopexy C. tympanoplasty D. adenotonsillectomy E. repair of congenital heart defects |
A, B, C, D
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Risk factors for emergence delirium include:
A. <5 B. opioid use C. anxious parents D. rapid emergence E. isoflurane use |
All are correct
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Principal site of temp regulation?
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hypothalamus
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Which is most accurate method of measuring temp?
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Tympanic membrane
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What is most common method of temp monitoring?
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skin
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Which nerve fibers transmit cold temp data?
Warm? |
A delta
C |
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Why do infants lose heat faster than adults?
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Higher skin surface area compared to body mass
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4 ways body can generate heat?
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1. nonshivering thermogensis
2. shivering 3. voluntary muscle activity 4. dietary thermogenesis |
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What is burned as fuel in nonshivering thermogenesis?
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brown fat-lots of mitochondria with lots of christae,
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Where does shivering begin?
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upper body-masseter
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GA (increases or decreases) the threshhold at which the body initiates a response to cold stress?
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decreases
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Three thermal compartments?
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1. central
2. peripheral 3. skin |
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Why does temp decrease rapidly after induction?
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peripheral vasodilation>increases size of central comp>forcing it to redistribute its heat to larger area
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How does hypothermia affect MAC?
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decreases it-5.1% per degree drop
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Which of the following does hypothermia reduce dosage requirements of?
A. muscle relaxants B. Narcotics C. propofol D. barbiturates |
A, B, D
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OR room temp should be:
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27 for term
29 for preemies |
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What is the #1 COD in TEF kids?
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aspiration
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What is the classic triad of CDH?
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1. cyanosis
2. dyspnea 3. dextrocardia |
