Ch 7 Pediatric Anesthesiology

Question 1

What are risk factors for sickling in sickle cell anemia patients?

Answer 1

hypoxia, acidosis, hypothermia, deyhdration, poor perfusion

Question 2

What is the predominant hemoglobin type in infants at birth to 1 month of age?

Answer 2

Hemoglobin F (80% of Hgb)

Question 3

Where is the glottis located in a premature newborn?

Answer 3

C3 level

Question 4

Where is the glottis located in a full term newborn?

Answer 4

C4 level

Question 5

Where is the glottis located in an adult?

Answer 5

C5 level

Question 6

The ________ (higher/lower) glottis makes intubation more difficult in the newborn.

Answer 6

Higher

Question 7

Which initial signs are associated with a total spinal block in an infant?

Answer 7

Apnea, decrease in oxygen saturation associated with bradycardia

Question 8

Which sign is common in adults but rarely seen in children under 5 after spinal anesthesia?

Answer 8

Hypotension

Question 9

What is normal total body water by age?

Answer 9

80% preterm infants
75% term infants
60% 6 months old to adults

Question 10

In which age group does succinylcholine require a larger initial dose per kg?

Answer 10

Newborns, because it is more water soluble

Question 11

At what age does retinopathy of prematurity typically occur?

Answer 11

Newborns born at less than 35 weeks gestational age

Question 12

At what weight is the risk of ROP higher?

Answer 12

Infants weighing less than 1500 g

Question 13

When is retinal development completed?

Answer 13

40 to 44 weeks post menstrual age (thus risk of ROP is negligible after 44 weeks PMA)

Question 14

Where should monitoring of the oxygen saturation be in infants less than 44 weeks PMA?

Answer 14

right arm (pre-ductal)

Question 15

What is the typical presentation of infantile hypertrophic pyloric stenosis?

Answer 15

nonbilious vomiting soon after feeding between the 3rd and 5th weeks of age

Question 16

What is the most common type of tracheoesophageal fistula or esophageal fistula?

Answer 16

Type C TEF (EA with distal TEF), 85-90% of cases

Question 17

Estimated Blood Volume (EBV) by age- premature infants and infants?

Answer 17

90-100 mL/kg premature infants
80-90 mL/kg term infants
75-80 mL/kg infants < 1 year
70-75 mL/kg children

Question 18

Estimated Blood Volume (EBV) by age - infants less than 1 and children?

Answer 18

90-100 mL/kg premature infants
80-90 mL/kg term infants
75-80 mL/kg infants < 1 year
70-75 mL/kg children

Question 19

What is the maximum allowable blood loss equation?

Answer 19

MABL= EBV x (Hi-Hp)/Hi
EBV is estimated blood volume
Hi is initial hct
Hp is lowest permissible Hct or target Hct

Question 20

What is the hematocrit of pRBCs?

Answer 20

60%

Question 21

How do you calculated the number of pRBCs to be transfused?

Answer 21

Volume of RBCs = EBV x (desired Hct-present Hct)/Hct of pRBCs

Question 22

What is the benefit of an uncuffed ETT compared to a cuffed ETT?

Answer 22

spontaneous breathing is easier

Question 23

What are the benefits of a cuffed ETT compared to uncuffed ETT?

Answer 23

Fewer intubations needed to to select the correct tube size
can use lower gas flows
less chance of airway fire

Question 24

What are normal systolic BP by age?

Answer 24

60-75 neonate
70-90 12 month old
80-100 5-year-old
100-125 adult

Question 25

What is a urinary sign of malignant hyperthermia?

Answer 25

dark brown or cola colored urine (myoglobinemia), which may be caused by rhabdomyolysis

Question 26

At what pressure would you expect an air leak around the ETT in a pediatric patient?

Answer 26

At peak inspiratory pressures of 15 to 25 cm H20.

Question 27

How do you perform an air leak test?

Answer 27

Listen over the larynx with a stethoscope at airway pressures of 15 to 20 cm H20. With a cuffed ETT, the cuff is slowly inflated until the air leak ceases.

Question 28

What is the most common cause of postintubation croup?

Answer 28

A tight-fitting ETT without an air leak at 30 to 40 cm H20.

Question 29

What is a common cause of sudden desaturation in a CDH patient receiving positive pressure ventilation?

Answer 29

Tension pneumothorax

Question 30

At what level of blood loss do children maintain a stable blood pressure?

Answer 30

Less than 25-35% loss of circulating blood volume

Question 31

What is the typical depth of an ETT for a newborn by weight?

Answer 31

7 cm for 1 kg 8 cm for 2 kg 9 cm for 3 kg 10 cm for 3.5 kg

Question 32

What is the 421 rule of fluids?

Answer 32

4 mL/kg for first 10 kg + 2 mL/kg for second 10 kg + 1 x mL/kg for any weight after 20 kg

Question 33

How do you correct hyperglycemia with insulin for a diabetic patient?

Answer 33

Divide 1500 by child's daily insulin. Ex. Child on 30 units per day, 1500/30 = 50. So every one unit of subcutaneous insulin will decrease BG by 50 mg/dL

Question 34

What is the dose for pediatric defibrillation?

Answer 34

first dose: 2 to 4 J/kg subsequent doses max of 10 J/kg

Question 35

Where does the spinal cord end in newborns and adults?

Answer 35

newborn: L2-L3 adults: L1

Question 36

Where does the dural sac of adults and newborns end?

Answer 36

newborn: S3-S4 adults: S1-S2

Question 37

What is the most common glycemia seen in Beckwith-Wiedemann syndrome?

Answer 37

hypoglycemia

Question 38

At what age does pulmonary vascular resistance reach adult levels?

Answer 38

1-2 months of life

Question 39

Which disease results in central postoperative depression of the newborn?

Answer 39

Pyloric stenosis; due to CSF alkalosis

Question 40

At what age is MAC the greatest?

Answer 40

age 1 to 6 months

Question 41

What is the Parkland formula?

Answer 41

4 ml/kg x weight in kg x % BSA burned (give over first 24 hrs) 2/3 give in first 8 hours 1/3 give over remaining 16 hours

Question 42

Which fluids should you give a child with severe dehydration?

Answer 42

isotonic saline solution or colloid solution; do not replace electrolytes like potassium if urine output is low

Question 43

What is EMLA comprised of?

Answer 43

Lidocaine 2.5% and prilocaine 2.5%

Question 44

Which umbilical vessel is easier to cannulate?

Answer 44

umbilical vein

Question 45

How do infants less than 3 months regulate thermogenesis?

Answer 45

metabolism of brown fat

Question 46

What are the primary signs of neurogenic shock?

Answer 46

hypotension with wide pulse pressure normal HR hypothermia

Question 47

How does oxygenation and ventilation affect the oculocardiac reflex?

Answer 47

Hypercarbia and hypoxemia decrease the threshold to elicit the OCR

Question 48

When is postop bleeding most common after tonsillectomy?

Answer 48

within first 6 hours of surgery