Neonatal emergencies

Question 1

The most common congenital defect of the esophagus is

Answer 1

esophageal atresia

Question 2

A key diagnostic indicator tor tracheoesophageal fistula is

Answer 2

maternal polyhydramnios

Question 3

The most common type of tracheoesophageal fistula is

Answer 3

type C (90%)

Question 4

Tracheoesophageal fistula may occur as part of

Answer 4

the VACTERL association

Question 5

Approximately 20% of neonates with esophageal atresia have

Answer 5

a significant cardiac defect

Question 6

Anesthetic considerations for esophageal atresia & tracheoesophageal fistula include

Answer 6

head up position and frequent suctioning minimizes the risk of gastric aspiration
maintain spontaneous ventilation during induction (PPV can cause gastric distension)
a precordial stethoscope placed on the left chest will immediately detect a right mainstem intubation

Question 7

Where should the ETT be placed for a tracheoesophageal fistula?

Answer 7

place it below the fistula but above the carina

Question 8

Most kids with esophageal atresia will have

Answer 8

a tracheoesophageal fistula

Question 9

Diagnosis of esophageal atresia is confirmed by

Answer 9

the inability to pass a gastric tube into the stomach

Question 10

Other symptoms of esophageal atresia include

Answer 10

choking
coughing
cyanosis during oral feeding

Question 11

What is VACTERL association?

Answer 11

vertebral defects
imperforated anus
cardiac anomalies
tracheoesophageal fistula
esophageal atresia
renal dysplasia
limb anomalies

Question 12

If an ETT is placed too high with tracheoesophageal fistula then

Answer 12

respiratory gas is delivered to the stomach

Question 13

If an ETT is placed too low with tracheoesophageal fistula then

Answer 13

endobronchial intubation is likely

Question 14

Placement of a g-tube with tracheoesophageal fistula allows for

Answer 14

gastric decompression with induction

Question 15

Which lecithin/sphingomyelin ratio suggests fetal lung maturity?
a. 0.5
b. 1.0
c. 1.5
d. 2.0

Answer 15

d. 2.0

Question 16

Type 2 pneumocytes begin producing surfactant between ___________ with peak production occurring at _______________

Answer 16

22-26 weeks; 35-36 weeks

Question 17

Neonates who do not produce enough surfactant are at risk for

Answer 17

respiratory distress syndrome

Question 18

Patients with respiratory distress syndrome are at high risk for

Answer 18

hypoxemia
hypercarbia
mixed acidosis
hemodynamic instability
death

Question 19

Positive pressure ventilation in the patient with poor lung compliance

Answer 19

increases the risk of pneumothorax

Question 20

Before delivery, treatment for respiratory distress syndrome includes

Answer 20

maternal corticosteroids to hasten fetal lung maturity

Question 21

After delivery, treatment for respiratory distress syndrome includes

Answer 21

CPAP
mechanical ventilation
exogenous surfactant

Question 22

Preductal and postductal oxygen saturation monitoring should be used to assess for

Answer 22

pulmonary hypertension
a right-to-left cardiac shunt and the return to fetal circulation via the PDA

Question 23

The tendency of an alveolus to collapse is directly proportional to

Answer 23

surface tension

Question 24

The tendency of an alveolus to collapse is inversely proportional to

Answer 24

alveolar radius (smaller radius= more likely to collapse)

Question 25

The steroid used to hasten lung maturity is

Answer 25

betamethasone

Question 26

Risk factors for respiratory distress syndrome include

Answer 26

low birth weight
low gestational age
barotrauma from positive pressure ventilation
oxygen toxicity
endotracheal intubation
maternal diabetes

Question 27

Anesthetic considerations for respiratory distress syndrome include that SpO2 should be

Answer 27

maintained while keeping in mind that hyperoxia can contribute to retinopathy of prematurity and poor lung development

Question 28

Where should an arterial line be placed in the neonate with RDS?

Answer 28

preductal artery preferred

Question 29

Where should the preductal and postductal pulse oximetry be placed?

Answer 29

preductal: right upper extremity
postductal: lower extremity

Question 30

What cells produce surfactant?

Answer 30

type 2 pneumocytes

Question 31

________________ allows the abdominal contents to enter the thoracic cavity

Answer 31

Congenital diaphragmatic hernia

Question 32

The most common site of herniation is

Answer 32

the foramen of Bochdalek (usually on the left)

Question 33

The mass effect of the abdominal contents within the chest

Answer 33

impairs lung development leading to pulmonary hypoplasia

Question 34

Consequences of poor lung development related to CDH include

Answer 34

poor pulmonary vascular development
increased pulmonary vascular resistance
pulmonary hypertension
impaired airway development
airway reactivity

Question 35

What should be avoided in terms of anesthetic management for the patient with congenital diaphragmatic hernia?

Answer 35

keep PIP <25-30 cm H2O to minimize barotrauma and the risk of pneumothorax in the “good” lung
avoid conditions that increase PVR (hypoxia, acidosis, hypothermia)

Question 36

When is surgery performed for congenital diaphragmatic hernia?

Answer 36

delayed 5-15 days to allow for stabilization of pulmonary, cardiac, and metabolic status

Question 37

What is necessary for anesthetic management of the patient with a congenital diaphragmatic hernia?

Answer 37

monitor preductal oxygen saturation
one-lung ventilation with a single lumen ETT advanced into the good lung may be required

Question 38

Other sites of herniation for a congenital diaphragmatic hernia include

Answer 38

foramen of Morgagni and around the esophagus

Question 39

CDH is usually diagnosed

Answer 39

at birth

Question 40

The newborn with CDH will experience

Answer 40

respiratory distress
scaphoid abdomen (sunken in)
barrel chest
cardiac displacement
fluid-filled GI segments in the thorax

Question 41

With CDH, a pulse oximeter placed on a lower extremity can

Answer 41

warn of increased intra-abdominal pressure

Question 42

With CDH, preductal SpO2 should be

Answer 42

> 90%