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Apex Review > Neonatal A&P 4 > Flashcards

Neonatal A&P 4 Flashcards

1
Q

Infants and children at risk for developing hypoglycemia include

A

prematurity
less than 48 hours of age
small for gestational age
newborns of diabetic mothers
children with diabetes who received insulin on the day of surgery
children who receive glucose-based parenteral nutrition

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2
Q

Treatment of hypoglycemia in the infant or child includes

A

IV 10% dextrose at 2 ml/kg

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3
Q

If seizures are present in the setting of hypoglycemia, then

A

the dose is doubled to 4 mL/kg and then an infusion of 8 mg/kg/min of d10 is titrated

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4
Q

A 2 week old neonate will be expected to demonstrate all of the following EXCEPT a/an:
a. increased free fraction of highly protein bound drugs
b. faster circulation time
c. large volume of distribution for water-soluble drugs
d. shorter duration of action for lipid-soluble drugs

A

d. shorter duration of action for lipid soluble drugs

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5
Q

Describe the hepatic and renal function of the neonate

A

immature so it alters the pharmacokinetics and pharmacodynamics of drugs

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6
Q

Is MAC lower or higher in the infant?

A

higher

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7
Q

Describe the blood brain barrier of the infant.

A

immature

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8
Q

Describe cardiac output of the infant

A

higher

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9
Q

Describe the volume of distribution of drugs in the neonate.

A

volume of distribution of water-soluble drugs is higher

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10
Q

What is plasma protein concentration like for neonates?

A

lower

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11
Q

Neonates require higher doses of _____________ to achieve a given plasma concentration

A

water-soluble drugs

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12
Q

For drugs that are highly protein bound, the neonate will

A

experience increased free drug levels and have a higher risk of toxicity because they have lower concentrations of albumin and alpha-1 acid glycoprotein

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13
Q

In the neonate, drugs that require fat for redistribution and termination of effect

A

will have a longer duration of action

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14
Q

The neonate cannot conjugate bilirubin due to a reduction in _______________. this is the same enzyme that metabolizes _____________

A

glucuronyl transferase; acetaminophen

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15
Q

What is the MAC value for the neonate (0-30 days):

A

lower than the infant

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16
Q

What is the MAC value for the premature?

A

lower than the neonate

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17
Q

What is the MAC value for the 1-6 month old infant?

A

MAC is higher than the adult

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18
Q

What is the MAC value for the 2-3 month infant?

A

MAC peaks at its highest level

19
Q

The MAC requirement pattern for __________ is different

A

sevoflurane

20
Q

What is the MAC requirement of sevoflurane for 0 days to 6 months

A

MAC is higher (3.2%)

21
Q

What is the MAC requirement for sevoflurane for 6 months to 12 years.

A

MAC is lower but still higher than the adult (2.5%)

22
Q

Anesthetic considerations for the administration of neuromuscular blockers in the neonate include:
a. avoidance of succinylcholine
b. a longer duration of action of succinylcholine
c. larger dose of succinylcholine
d. a larger dose of succinylcholine and nondepolarizing neuromuscular blockers

A

c. a larger dose of succinylcholine

23
Q

What neuromuscular drugs can be administered intramuscularly?

A

succinylcholine and rocuronium

24
Q

What is the recommended dose of succinylcholine in the neonate?

A

2 mg/kg

25
Q

Why do neonates need a higher dose of succinylcholine?

A

increased ECF
normal sensitivity to succinylcholine

26
Q

What is the duration of succinylcholine in the neonate?

A

same as the adult

27
Q

What is the dose of nondepolarizers for neonates?

A

combination of an increased ECF and increased sensitivity is assumed to be a wash so dose stays the same

28
Q

What is the duration of action of nondepolarizers in the neonate?

A

immature metabolic and clearance mechanisms may prolong the duration of action

29
Q

What are subjective signs of adequate recovery of NMBDs?

A

grimacing
elbow and hip flexion
bringing the news to the chest

30
Q

Objective data suggests recovery from neuromuscular blockade includes a

A

TOF ratio >90% & a maximum inspiratory force less than 25 cmH2O

31
Q

The FDA black box warning on succinylcholine warns of

A

hyperkalemia associated with undiagnosed muscular dystrophy in children under 8 years old

32
Q

Although a head lift >5 seconds is appropriate for an adult, a neonate

A

does not have the muscle strength to raise his head

33
Q

What is the dose of edrophonium for reversal?

A

1 mg/kg and is associated with less muscarinic side effects

34
Q

Which NMDBs are useful in the neonates?

A

Atracurium and cisatricurium due to their organ-independent elimination

35
Q

Concerns with using pancuronium in the neonate include

A

stronger vagolytic effect and may cause HTN which an increase EBL and lead to intracerebral hemorrhage

36
Q

Pancuronium and vecuronium dosing is

A

0.1-0.15 mg/kg

37
Q

What is the onset of IM dose of rocuronium?

A

3-4 minutes

38
Q

What is the IM dose of rocuronium for children <1 year of age?

A

1 mg/kg

39
Q

What is the IM dose of rocuronium for children >1 year of age?

A

1.8 mg/kg

40
Q

The IM dose of succinylcholine for neonates and infants is

A

5 mg/kg

41
Q

The IM dose of succinylcholine for older children is

A

4 mg/kg

42
Q

When compared to administration into peripheral skeletal muscle _______________- administration of succinylcholine likely has the fastest onset

A

intralingual administration via the submental approach

43
Q

In children less than 5 years of age, succinylcholine can cause _______ and _____________________ can be used as pretreatment

A

bradycardia or asystole; atropine (0.02 mg/kg IV)

Apex Review (224 decks)

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