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119 Cards in this Set
- Front
- Back
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What is the normal systolic BP in neonates, infants, and children(1-10)?
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neonates 65
infants 75-95 children 75-95 |
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What is the normal heart rate in neonates, infants, and children(1-10)?
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neonates 130-160
infants 120 children 80-100 |
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What is the normal RR in neonates, infants, and children(1-10)?
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neonates 40
infants 30-35 children 20-25 |
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What is the P50 of fetal hemoglobin?
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19
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What is the oxygen consumption for neonates?
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6cc/kg/min
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Between what age in an infant does hemoglobin drop to 11 and what is considered low?
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3-6months; 10
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What is suggested in an acutely ill neonate if the HR is normal but the blood pressure is decreased?
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hypovolemia
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Why is atelectasis more likely to occur in infants?
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decreased alveoli, decreased FRC, (FRC/TLC is normal)
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What lung parameters are increased in neonates?
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minute ventilation, respiratory rate and alveolar ventilation, chest wall compliance is also increased predisposing to atelectasis
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What is the minute ventilation of a neonate compared to an adult?
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neonate: 1 L , adult 6.5L
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What is the FRC, VC of a neonate compared to an adult?
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FRC: neonate 25cc/kg, adult 40cc/kg
VC: neoate 35, adult 50-70 PaO2: neonate 60-90, adult 75-100 |
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What is larger in an infants airway compared to adults?
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large tongue, tonsils, adenoids and epiglottis(also large occiput creates a more natural sniffing position)
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What is the difference in the glottis in infants versus adults?
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location: infants C3-4; adults C5-6
narrower, more anterior, nearly perpendicular to the plane of the trachea |
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How do neonates, infants, children create and maintain body heat?
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they cannot shiver; use nonshivering thermogenesis(when newborn is stressed O2 consumption increases which leads to release of norepi, norepi activates lipase in brown fat to break down fat to triglycerides which is then broken down to glycerol and nonesterified fatty acids which is then broken down to H2O, CO2, and heat
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Where is brown fat located?
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around scapula, clavicle, kidneys, and adrenals
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How long does it take for GFR to reach adult levels in an infant?
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by age 1
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How is renal function affected in neonates?
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decreased GFR, decreased urine concentrating ability because of immature renal tubular function, decreased ability to handle large solute loads
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Why are glucose containing IV solutions given to neonates?
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high metabolic rates and low glycogen stores
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Why should you be careful about giving an infant to much fluid?
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prone to overhydration and can develop cerebral edema and seizures
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How is total body water and blood volume different in infants versus adults?
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both are higher in infants(TBW 80% v 60%)
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Why is induction with inhalational agents faster in infants versus adults
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increased MV/FRC ratio
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How and why are the properties of nondelolarizing NMBDs different in infants versus adults?
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infants are more sensitive to nondepolarizers than adults, but because Vd is greater dosing is similar. elimination half time is prolonged due to decreased GFR
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What is different about SCh in neonates and infants verus adults?
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infants are less sensitive to SCh(even though pseudocholinesterase levels are decreased); neonates do not develop a phase 2 block(infants and children can)
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What is different about ECF volume in infants verses adults?
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40% in infants versus 20% in adults
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What are the doses of common induction agents in infants?
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propofol 3mg/kg; thiopental 3-5mg/kg; SCh 1-2mg/kg, ketamine IM 4-6mg/kg
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When should you get worried about decreased UO in a child?
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<0.5cc/kg/hr
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What is hypoglycemia in a neonate and what is tx?
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blood sugar of 20-30mg/dl, treatment is 1-3cc/kg of 20% glucose over 5min
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What is treatment of hypocalcemia in an infant?
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100mg/kg cagluconate
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When and why should uncuffed ETT be used in kids?
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age<8, due to cricoid being smallest part of airway increased pressure from cuff in this area can lead to tracheal stenosis and postextubation difficulty
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When would you do a exchange transfusion in an infant?
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Hct>65%
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Why should you be more cautious about the use of arterial catheters in pediatrics?
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higher incidence of ischemic complications
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What are advantages and disadvantages of the pediatric circuit system?
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conservation of heat and humidity, economy of anesthetic use, protection against pollution, relatively small fresh gas flows; disadv: higher resistance and more dead space
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What are advantages and disadvantages of the pediatric nonrebreathing system?
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low resistance, little dead space, rapid control of anesthetic concentration, low weight and ease of assembly; disadv: loss of heat and humidity, less economy in the use of volatile anesthetics, more operating room pollution, higher requirement for fresh gas inflow
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What are common premedications in children?
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versed and morphine(both 0.1mg/kg IV), versed PO(0.25-1mg/kg), atropine(0.15+0.01mg/kg)
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When should you avoid using halothane in children?
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when epinephrine is being used
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What factors relate to retinopathy of prematurity?
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low birth weight, PaCO2, O2 toxicity
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What are ventilation goals for sick children?
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low flows, small tidal volume, and high frequency
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What are advantages of nasotracheal intubation?
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less risk of accidental extubation, more comfortable, less secretions, less arytenoid ulceration
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How does IM administration of SCh differ than IV dosing in kids
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IV 2mg/kg, IM 4mg/kg; dysrhythmias are less common with IM dosing or continuous infusions
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What should you do if masseter spasm develops in a pediatric patient with use of SCh?
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can continue surgery unless others signs of MH are apparent but switch to a nontriggering anesthetic, patient should later have workup with a muscle biopsy
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When should you consider proceeding with an anesthetic when a child has had a recent URI?
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if the child is afebrile and the chest is clear of wheezes, and rhonchi
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When should you not tranfuse sickle cell patients prior to surgery?
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don't transfuse for minor surgery(myringotomy), in general transfuse until HbSS<40%
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What are causes of respiratory distress and failure in children?
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choanal atresia: pass 3.5 catheter through the nares; upper airway obstruction or laryngospasm; extrinsic airway compression from mass, goiter, vascualr anomaly( do barium swallow); subglottic edema; intrapulmonary problems such as RDS, PTX, PE, pulm edema, bronchospasm
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What are complications of bicarb administration in neonates?
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cerebral edema and hemorrhage, hypernatremia, hypercarbia
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What are signs of TEF?
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regurg of the first feeding; cyanosis, absence of bowel gas on XRAY, fetus cannot swallow amniotic fluid so polyhydramnios frequently develops, frothing around mouth and nose, failure to pass suction catheter,
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What are type A, B, C, D and E TEF?
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A: EA no fistula; B EA with proximal fistula; C EA with distal fistula; D EA with proximal and distal fistula; E no EA but fistual between trachea and esophagus
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How can you intubate a infant with TEF?
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usually want them awake spontaneously ventilating, can advance tube into mainstem bronchus, pull back until air is heard in the stomach and then advance slightly so the breath sounds are bilateral and no air is heard in the stomach
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If a patient with a TEF is about to undergo surgery for repair and already has a gastrostomy what should be done prior to induction?
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clamp gastrostomy tube to prevent slowing in the rate of rise of alveolar concentration and thus induction
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When should you consider paralyzing a patient with a TEF?
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after fistula is ligated
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When should you consider placing an umbilical artery catheter in a newborn?
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if response to ventilation and stimulation is not rapid
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When should you consider giving epinephrine or atropine/isoproterenol in newborns?
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epi: no cardiac electrical activity(10mcg/kg); atropine/isoproterenol: severe bradycardia(atropine 20mcg/kg, isoproterenol 50mcg/kg/min)
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What should you consider as a possible cause of severe hypoxia in a newborn?
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CDH, hypoplastic left heart syndrome, PTX, pneumomediastinium(emergency chest Xray in all persistently hypotensive patients)
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Why can neonates be hypoglycemic?
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glucose crosses placenta while insulin does not, after birth glucose no longer crosses placenta but the pancreas is still making insulin; also neonates have rapid metabolism and limited glycogen stores
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What acid base abn is present with an APGAR score of 0-2
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combined metabolic and resp acidosis
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What acid base abn is present with an APGAR score of 3-7?
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respiratory acidosis with slight depression of buffer base
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What should you do to eval and treat acid base status in a newborn with an APGAR of 3-7?
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obtain a sample from the umbilical cord, if pH is low obtain a heel sample, if that is low give bicarb
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What are signs of choanal atresia?
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cyclic cry, newborn becomes hypoxic and cries, once mouth is opened for crying, hypoxia is relieved which leads to more mouth closing and hypoxia
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What is the initial resuscitation of a newborn at one minute with bradycardia?
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oxygenate and ventilate the child
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What are causes of persistent fetal circulation?
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hypoxia and acidosis: examples TEF, CDH, choanal atresia, meconium aspiration,
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What is the immediate treatment of meconium staining?
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laryngoscopy and suctioning, if the glottis is stained with meconium intubation and suctioning should be carried out, if hypoxia or hypercapnea are present the ETT should be left in place and the patient mechanically ventilated; make sure to suction before ventilation through an ETT occurs; if significant staining is present patient should be obsevered for at least 24 hrs
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What does the pH of meconium tell you?
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if the pH is 5.5-7 the meconium is nonirritable to the lungs
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What factors are assoc with meconium aspiration?
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PTX, pneumomediastinum
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In a left to right intracardaic shunt what is the typical difference in pulmonary blood flow to systemic blood flow?
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3x greater pulmonary flow to systemic flow
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What is the goal in patients with a left to right intracardiac shunt?
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moderately increased PVR, moderately decreased SVR(positive pressure breathing by increasing PVR decreases shunt)
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Where should an arterial catheter be placed in a patient with a PDA?
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preductal: right upper extremity
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What is a important complication of PDA repair?
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injury to the left recurrent laryngeal nerve(hoarseness)
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What are the right to left intracardiac shunts?
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tetralogy of fallot(VSD, pulm stenosis, RVH, overridering aorta), transposition of great vessels, pulm stenosis with ASD, eisenmenger syndrome
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what should try to be avoided in patients with right to left intracardiac shunts?
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decrease in SVR or increase in PVR(this occurs with crying)
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How does a right to left intracardiac shunt affect the rate of induction of inhaled or IV anesthetics?
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inhaled-slows induction
IV-speeds induction |
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How does a left to right intracardiac shunt affect the rate of induction of inhaled or IV anesthetics?
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IV-slows rate(dilutes agent)
inhaled: if normal CO no effect, if decreased CO speeds rate |
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If bile is present in the vomit of a infant what does it tell you?
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obstruction is below the ampulla of vater: duodenal obstruction, jejunal and ileal atresia, and meckels diverticulum
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If bile is absent in the vomit of a infant what does it tell you?
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obstruction above the ampulla: pyloric stenosis, GERD
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What does it tell you if abdominal distention is present in a patient that is vomitting?
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obstruction is below the proximal jejunum
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What are the electrolyte abn present with pyloric stenosis?
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hypochloremia, hypokalemia, hyponatremia, metabolic acidosis
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What should you do prior to intubation of a infant with pyloric stenosis?
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insertion of an NG tube
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What patient's are more prone to pyloric stenosis?
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males between 3-6 weeks of age
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What are signs of dehydration in an infant?
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poor skin turgor, dry mucous membranes, sunken fontanelles, poor peripheral pulses, low temperature, urine SG>1.009(in adults its around 1.025)
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What are signs of overhydration in infants?
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weight gain, disappearance of tiny creases on eyelids, venous distention, HTN, bradycardia, low urine osmolality
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How does weight relate to the amount of water lost or gained?
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if child was 3kg and now is 4kg he's gained 1000mL of fluid; 1000mL water=1kg
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How do you calculate Na deficit?
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140-current Na level x kg x 0.4
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When should surgery to repair cleft lip or palate be attempted?
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cleft lip-1month of age(rule of 10s, Hgb 10, weight 10lbs, age 10weeks)
cleft palate-1year of age |
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what are preop problems assoc with cleft lip or palate?
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feeding difficulty, regurgitation of gastric contents
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What are complications of cleft lip or palate surgery?
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kinking or dislodgement of ETT, hemorrhage, hypothermia
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In an infant when postconceptual age is <than 60weeks and develops postop apnea how long should they remain in the hospital prior to discharge?
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at least 24 hrs with at least the last 12 being apnea free
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What is the typical hx of a newborn with RDS?
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nml resp fxn at birth and then progressive resp distress over one week
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What are complications of Respiratory Distress Syndrome?
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PTX, pneumomediastinum, bronchopulm dysplasia, intraventricular hemorrhage
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What are important problems with both gastroschisis and ompalocele?
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hypothermia, acidosis, dehydration, depression of respiration and consciousness
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What's the common induction sequence in gastroschisis or omphalocele?
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awake or rapid sequence
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If there is evidence of vital sign compormise after surgery for omphalocele or gastroschisis what should be done?
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reopen abdomen and staged closure
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When should you extubate a patient after surgery for omphalocele or gastroschisis?
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postop extubation is dangerous due to increased intraabdominal pressure after reduction of the hernia
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What is the dose of bicarb to treat acidosis<7?
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kg x dev of HCO3 from 24 x 0.2(0.2 for adults, 0.4 for infants)
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What is the difference between a meninocele and a meningomyelocele?
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meningocele: herniation of meninges through the defect in skull or vertebral column; meningomyelocele: herniation of meninges and spinal cord
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How do you replace spinal fluid lost during surgery for myelomeningocele?
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it is ECF, replace with balanced salt solution
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Why should you be careful with positioning during surgery for myelomeningocele?
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the sac may rupture; supine intubation requires careful padding
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What does apnea and htn during surgery on a infant with arnold chiari particularly concerning for?
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caudal displacement of brainstem and blockade of CSF from the 4th ventricle leading to increased ICP
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Where does CDH typically occur?
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left posterior foramen of bochdalek
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What are common associated problems with CDH?
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cardiac anomalies, polyhydramnios, pulmonary hypoplasia, pulm htn, GI problems
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Should you extubate a patient after repair of CDH?
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no, hypoplastic lung makes oxygenation tenuous and pulm shunting continues after surgery
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Where should you place IV catheters for CDH repair?
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upper extremity(increased abdominal pressure after repair can occlude the IVC)
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What are symptoms of acute epiglottitis?
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inspiratory stridor, high fever, painful sore throat, difficulty swallowing, and dehydration, often sitting up, leaning forward, drooling,
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How should you manage a patient with acute epiglottitis?
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Take to the OR for intubation, pretreat with atropine to bronchodilate, decrease secretions, mask induction with patient in the sitting position
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What is the difference in the primary location between acute epiglottitis and croup?
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acute epiglottitis supraglottic(thumb print sign, age 2-6)
croup subglottic(steeple sign, 3 months -3years) |
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What are the symptoms of croup?
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inspiratory stridor, barking cough, hoarseness, airway obstruction(rare)
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How do you treat croup?
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O2, cool mist, racemic epi, decadron(1.5mg/kg), if these all fail than intubation is indicated
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What are the best mapelson circuits for spontaneous ventilation?
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A>D>C>B(all do continue breathing)
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What are the best mapelson circuits for controlled ventilation?
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D>B>C>A(dead babies can't assist)
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How can rebreathing be prevented with mapelson breathing system?
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MV >200cc/kg
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What is the Pierre-Robin sequence?
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micrognathia, congenital heart disease, cleft palate, glossoptosis(not present with treacher collins syndrome)
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What is treacher collins syndrome?
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micrognathia, congenital heart disease, choanal atresia, aplastic zygomatic arches, microsomia(less severe airway management than pierre robin)
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How should you intubate a patient with pierre-robin or treacher collins?
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inhalational induction with spontaneous ventilation with either an oral intubation attempt or fiberoptic scope, should have ENT surgeon on standby
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What is bronchopulmonary dysplasia? What are the causes and symptoms?
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chonic lung disease seen in patients who survive neonatal lung disease, arises from O2 toxicity, barotrauma, infection, sx: hypoxia, hypercarbia, pulm htn, cor pulmonale, decreased lung compliance and hyperreactive airways
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How do you ventilate a patient with BPD?
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small rapid tidal volumes and PEEP
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What are airway problems associated with downs?
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narrow nasopharynx, large tongue, tonsils, and adenoids, which leads to chronic airway obstruction and hypoxia and pulm htn, atlantoaxial instability
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What is considered hypoglycemia for a preterm, term and 3day old neonate?
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preterm 25, term 35, 3days 45
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What are signs of hypocalcemia in children?
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irritability, seizures, apnea, bradycardia
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How is hypocalcemia defined in newborn?
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<3.5mEq/L
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What are predisposing factors to apnea following GETA?
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hypoxemia, hypothermia, hypoglycemia
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What are the benefits of doing a caudal?
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reduced postop agitation and opioid requirement, reduced volatile
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When do you use caudal for anesthesia in infants?
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perineal and lower abdominal procedures
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