Exam 1: growth&development, preop eval, gen approach Flashcards
(250 cards)
1
Q
what is a question we always ask about baby in preop
A
-term/how many weeks it was born
-troubles after birth
-problems with pregnancy
2
Q
what is definition of pre-term infant
A
<37 weeks
3
Q
what is definition of term infant
A
37-40 wks
4
Q
what is definition of post term infant
A
> 42 weeks
5
Q
what is considered extremely low birth weight
A
<1000g
6
Q
what is considered very low birth weight
A
<1500 g
7
Q
what is considered low birth weight
A
<2500 g
8
Q
what is premature
A
<37 weeks
9
Q
what are anesthesia concerns with premature babies
A
airway control
fluid management
temperature regulation
retinopathy of prematurity
apnea of prematurity
<60 weeks PCA highest incidence of post anesthetic complications
10
Q
what patient has the highest incidence of post anesthetic complications
A
<60 weeks PCA
11
Q
what is definition of small for gestational age
A
<10% for gestational age at birth
12
Q
what is a cause of small for gestational age
A
chronic placental insufficiency
chromosomal abnormalities
mother:
-smoking
-DM
-chronic disease
13
Q
how can we prep the OR for small for gestational age/ all pediatric patient
A
warm room, warm them throughout case
14
Q
what is a common hematology issue with small for gestational age
A
polycythemia leading to hyperviscosity syndrome
15
Q
how do we manage hyper-viscosity syndrome intraop
A
maintain or slightly elevate BP
16
Q
SGA/LGA issues
A
17
Q
what is definition of LGA infant
A
> 90% for gestational age
18
Q
what are common issues with LGA infants
A
birth injuries
hypoglycemia
hypocalcemia
difficult intubation/IV sticks
19
Q
what are issues with SGA infants (chart)
A
congenital anomalies
chromosomal abnormalities
chronic intrauterine infection
heat loss
asphyxia
metabolic abnormalities
hypoglycemia
hypocalcemia
polycythemia
hyperbilirubinemia
20
Q
what are issues with LGA infants (chart)
A
birth injuries
asphyxia
meconium aspiration
metabolic abnormalities
hypoglycemia
hypocalcemia
polycythemia
hyperbilirubinemia
21
Q
what are common birth injuries with LGA infant
A
brachial
phrenic nerve
fractured clavicle
22
Q
what is the most sensitive indicators of a babies well being
A
weight
23
Q
what issues can cause changes in babies weight
A
CHF
endocrine
malignancy
infection
malabsorption
24
Q
what issues can we find through head circumfrence
A
severe malnutrition
hydrocephalus
25
what can cause a sunken fontanelle
fluid status changes
hemorrhage, fluid loss, dehydration
26
what three measurements do we use to assess baby
weight
length
head circumference
27
how does newborn weight change in first week after birth
decrease by 10%
28
how do you calculate length in cm using age
(age in years x 6) + 77
29
by 6 month an infants weight is _______x
2
30
by 1 year an infants weight is __x
3
31
when does a baby regain its weight after its initial loss
2nd week
30g/day then
12g/day 1st year
32
what is the rule of 10s for males
10 lbs per year until 16
33
what is the rule of 10s for females
10 lbs a year until 12
34
how much weight does a preterm infant lose in first week
15% then gain it back slower than term
35
T/F SGA infants lose more weight than others
F, dont lose weight, gain weight in first week
36
preop screening chart
37
what are preop of screenings for airway
history of difficult airway, adjuncts for ventilation and intubation
38
what are preop of screenings for cardiovascular: murmur with pathologic findings
preop echo
39
what are preop of screenings for History of syncope or poor functional capacity:
preop ECG, consider preop echo and cardiology eval
40
what are preop of screenings for asthma
preop albuterol if not well controlled
delay elective for poorly controlled
stress dose steroid if prolonged steroid exposure (>7 days) in last 12 months
41
what are preop of screenings for cystic fibrosis
V/Q mismatch common,
preop oxygen sat,
bronchial hyper reactivity,
evaluate recent CXR and PFTs,
Echo if pulm htn suspected\may have liver disease,
total bili,
INR,
albumin
may have renal insufficiency from aminoglycosides
42
what are preop of screenings for severe OSA
overnight observation
43
what are preop of screenings for seizures
continue meds day of sx
AED (antiepileptic drug) interactions with NMB blockade
AED induced metabolic acidosis
44
what are preop of screenings for ADHD
continue meds day of sx, consider alpha 2 agonist premedication
45
what are preop of screenings for CP?
constinue seizure and reflux medications day of sx
consider preop warming giving airway hypotonia
consider ICU or step down for recovery
46
what are preop of screenings for muscular dystrophy
preop ECG, ECHO, CPK, room air O2 sat, FVC
47
what are preop of screenings for gastointestinal
continue reflux medications preop
48
what are preop of screenings for renal
check K
anemia may be present: preop HCT
continue HTN meds preop
assess most recent dialysis
volume status
49
what are preop of screenings for sickle cell
preop admission
IV hydration
tranfuse if hb<10 g/dl
consider echo for pulm htn
50
what are preop of screenings for oncology
evaluate for lesion location
evaluate end organ dysfunction from chemo
51
what are preop of screenings for mitochondrial myopathy
avoid prolonged fasting,
use dextrose containing IVF at maintenence rate,
consider peop echo and ECG
consider anxiolytic premedications midazolam, dexmetomidine, or ketamine
52
what are preop of screenings for type 1 diabetes
HbA1C prior to day of sx
continue long acting insulin (glargine)
continue insulin pump without reduction
reduce evening NPH by 50%
check awakening and preop BS
53
what are preop of screenings for trauma/emergency
full stomach precautions
preop HCT
coagulation studies
C-spine films/precautions
54
what are preop of screenings for apnea of prematurity
require apnea-bradycardia monitoring post op (44-54 weeks PCA)
55
what are preop of screenings for prematurity, bronchopulmonary dysplasia, OLD
inflammation, smooth muscle hypertrophy, fibroproliferation
56
what are preop of screenings for prematurity, bronchopulmonary dysplasia, NEW
O2 dependence, >28 days old and disruption of lung growth
57
what are preop of screenings for prematurity, subglottic stenosis
prolonged intubation, stridor may be present
58
what are preop of screenings for prematurity, airway
predict difficult airway
mucopolysaccharoidosis
pierre robin
treachear collins
goldernhar
59
what are preop of screenings for prematurity, others
intraventricular hmmg, hypoglycemia
60
how do we calculate age for premature infants
Post-Conceptual Age = gestational age + post-maternal age
61
u: How do we differentiate a benign murmur vs congenital pathology?
Functional capacity history
-can they play/run
-cyanosis/poor activity
62
what congenital issues require cardiac consult
williams
noonan
trisomy 21
turner
marfan
63
how can the CRNA prevent subacute bacterial endocarditis
preop abx
amoxicillin or clindamycin 60 min before dental case
64
how can we distinguish an innocent murmur
*Still’s: left lower sternal border and may radiate to the base of the heart. Heard supine and diminished when sitting
65
how can we distinguish a pathological murmur
*Congenital Disease: pansystolic, Grade 3 or above, Left upper sternal border, harsh, abnormal 2nd heart sound, early or midsystolic click
*Diastolic murmur
66
what volatile do we avoid in asthma
des
67
if a patients asthma is not well controlled and asymptomatic, what do we do
proceed with anesthetic after short- acting beat agonists
68
T/F a patient with asthma can have surgery with minimal risk
T
69
if a patients asthma is well controlled and they have an expiratory wheese what do we do
if expiratory wheeze is resolved with SABA, proceed with sx
70
if a patient has poorly controlled asthma what do we do
consider reschedule
71
preop asthma care
72
controlled vs not well controlled vs poorly controlled chart
73
what are risk factors for URI
intubation < 5 years
reactive airway disease
paternal smoking
premature
airway sx
copious secretions
nasal congestions
74
a patient has moderat to severe URI with additional URI risk factors, what do you do
postpone for 2 weeks
75
what can happen when a patient with URI is anesthetized
laryngospasm
bronchospasm
oxygen desaturation
severe coughing
76
how do we manage autism patient
minimize stimulation
maximize routine
preop oral precedex, clonidine, ketamine, versed- mix with juice
77
how do we manage ADHD patient
premedicate with versed or alpha 2 agonist
continue meds
stimulants can cause more tachy with ephedrine
78
how do we manage seizures
ID baseline sz
continue AEDs day of surgery
oral or IV midazolam
79
what medication do we avoid in Cerebral palsy
Versed-airway obstruction
80
what are cerebral palsy patients at risk for
seizures
reflux
visual dysfunction
cognitive dysfunction
hypo/hyperthemia
airway obstruction
81
what are s/s cerebral palsy
spasticity, dystonia, ataxia
82
what heart issue is common with duchene and becker muscular dystrophy
cardiomyopathy (do preop TTE, EKG)
83
what muscular dystrophy may be difficult to intubate
duchenne
84
what resp test might be done preop for duchene and becker muscular dystrophy
proep PFC (FVC)
85
if FVC is <50% what is risk
increased risk of respiratory complications
86
if FVC is <30% what is risk
severe risk of postop resp complications
87
what do we treat hemophilia A with
recombinant factor 8
88
what do we treat hemophilia B with
recombinant factor 9
89
what do we treat von willebrands with
DDAVP
Humate
90
what do stressors induce in mitochondrial myopathy
metabolic acidosis
91
what are triggers for mitochondrial myopathy
prolonged fasting
hypoglycemia
hypothermia
prolonged tourniquets
hypovolemia
NV
92
what do we premedicate mitochondrial myopathy patients with
versed and alpha 2 agonists
93
what do we do preop of mitochondrial myopathy patients
EKG
echo
94
what medications are okay to take day of sx
AntiEpileptic Drugs
asthma medications
GERD meds
95
what medications do we hold for sx
anticoagulants, ACEI, ARB
96
T/F stop BB intra op
F, continue
97
what are most common cause of anaphylaxis intraop
abx and NMBs
98
how do we pretreat allergies
benadryl
pepcin
decadron
99
how do we treat anaphylaxis
benedryl
pepcin
decadron
epinephrine
100
who is at risk for latex allergy
Children with spina bifida
He of multiple surgeries
meningomyelocele
101
what are s/s allergic response
rash
pruritis
facial swelling
anaphylaxis
102
what is the most common inherited disease
von willebrand
103
what gender is more at risk for hemophilia
males, X-linked recessive
104
risk of PONV
105
what are pediatric predictors of difficult airway
craniofacial syndromes
facial asymeetry
micrognathia
cleft pallate
large tonsil size
loose teeth
airway/tongue masses
high arched pallate
106
what can large tonsil size lead to
OSA
difficult mask
airway obstruction
107
when do we chart dentition in peds
pre and post op
airway in and out
108
what is normal HR BP for preterm
120-180 BPM
45-60/30
109
what is normal HR BP for term
100-180 bpm
55-70/40
110
what is normal HR BP for 1 year
100-140 bpm
70-100/60
111
what is normal HR BP for 3 years
85-115
75-110/70
112
what is normal HR BP for 5 years
80-100
80-120/70
113
how do we find high systolic in peds
low systolic
age in years x2 +90
age in years x2 +70
114
pediatric VS chart
115
NPO chart
116
what is NPO for clear liquids
2 hrs
117
what is NPO for breast milk
4 hrs
118
what is NPO for formula
6 hrs
119
what is NPO for light meal
6 hrs
120
what is NPO for heavy meal
8 hrs
121
what are clear liquids for pediatric
water,
Pedialyte,
carbonated beverages,
clear tea,
plain gelatin,
and fruit juices without pulp
122
when does seperation anxiety in children peak
1 year
123
what are the high risk patients for preoperative anxiety
1-5 years
parents with poor coping skills
124
risk for preop anxiety chart
125
premeds pediatric doses
126
what is oral dose of midazolam
0.25-1 mg/kg
127
what is IV dose of midazolam
0.05-0.1 mg/kg
128
what is transmucosal (nasal) dose of midazolam
0.2-0.3 mg/kg
129
what is the IM dose for midazolam
0.1-0.15 mg/kg
130
what is the IV dose for fentanyl
0.5-1 mcg/kg
131
what is the transmucosal (oral) dose for fentanyl
10 mcg/kg
132
what is the oral dose of ketamine
6-10 mg/kg
133
what is the IV dose of ketamine
1-2mg/kg
134
what is the transmucosal dose for ketamine
5-10 mg/kg
135
what is the IM dose for ketamine
3-7 mg/kg
136
what is the oral dose for clonidine
2.5-5 mcg/kg
137
what is the IV dose for clonidine
1-2 mcg/kg
138
what is the IV dose for precedex
0.25-1 mcg/kg
139
what is the transmucosal (nasal) dose for precedex
1-2 mcg/kg
140
what is the IM dose for precedex
1-2 mcg/kg
141
what are complications with down syndrome
large tongue, increased secretions
142
what do we do special for set up in peds
2 sizes up and down of ett
warm the OR
emergency drugs: atropine and anectine on IM needles in bag
143
how do we decide if parent should be there for induction
parent in good mindset not freaking
not parent if they will freak out in OR or are anxious
parents of 1 YO patient
144
how do we prepare parent for taking patient in OR
tell them what to expect
tell them their role
145
what are contraindications for inhalation inductions
MH, muscular dystrophies, central core disease, full stomach
146
what is preferred inhaled induction
nitrous oxygen mix 2:1 for 2 min then
sevo 2, 4, 6, 8
nitrous oxygen blend 7:3
147
what patients can you do single breathe induction on
older children >9
148
how do you do single breathe induction
prime with 8% sevo and take VC breathe
149
when do we start IV in peds after inhalation induction
after 2 minutes of loss of eyelash reflex
150
what is induction steps of inhaled anesthetic
nystagmus
eyes close
limbs relax
slow/deep breaths
fast/shallow breaths
excitatory/uncontrolled movements
snoring/upper airway obstruction
eyelash reflex gone
151
when do we let go of ETT in peds
only after taped
152
when can peds patient be moved after inhalation induction
after IV and meds in
153
when do we do IV induction
older children 6-7 years and up
obese child
154
what is the induction dose of propofol for peds
2.5-3.0 mg/kg (unpremedicated ages 3-12)
155
what is the induction dose of etomidate for peds
0.3 mg/kg
156
what is the induction dose of ketamine for peds
2 mg/kg
157
what is the robinol dose for peds with ketamine
0.1 mg/kg
158
what is the versed dose for peds with ketamine
0.5 mg/kg
159
what weird effects does lidocaine cause
ears ringing
lips tingle
taste in mouth
160
what induction drug is good for asthmatics
ketamine, bronchodilates
161
how do we treat pediatric laryngospasm
avoid vigorous PPV
moderate continuous PPV with 100% O2
prop 0.5 mg/kg
severe hypoxemia and bradycardia
IV succs 2 mg/kg and atropine 0.02 mg/kg
IM succs 4 mg/kg
162
do children/infants have a higher or lower MAC%
higher
163
what are contraindications of Nitrous oxide
pulmonary htn
pneumothorax
pneumocephalus
middle ear surgery
small bowel obstruction
severe anemia
decreased Cerebral blood flow
shock
164
where is nitrous oxide metabolized
in gut? aerobic bacteria
165
what is MAC of iso in infant
1.7
166
what is Mac of iso in child (3-10)
1.6
167
what is mac of des in infant
9.4
168
what is mac of des in child (3-10)
8.0
169
what is mac of sevo in infant
3.3
170
what is mac of sevo in child (3-10)
2.5
171
what is the volatile of choice in peds
sevo
172
how does sevo effect heart
little effect
173
how does sevo affect QTC
prolongs
174
how does sevo affect MV/RR
decreases
175
how does Sevo affect lungs
bronchodilator
176
what does sevo compare with emergence
prolonged
177
what gas do you avoid in asthma
des
178
what are cardiovascular effects of des
decreased SVR
decreased BP
increased HR
no change CO
179
how is emergence with des
rapid
180
what is morphine dose for peds
0.05 to 0.1 mg/kg/hr
181
what is fent dose for peds
1-3 mcg/kg/hr
182
what is sufentanil dose for peds
0.1-0.3 mcg/kg/hr
183
what is alfentanil dose for peds
1-3 mcg/kg/min
184
what is remifentanil dose for peds
0.1-0.4 mcg/kg/min
185
what is hydromorphone dose for peds
3-5 mcg/kg/hr
186
What opioids cause histamine release?
morphine
Dilaudid
-also increased risk NV-
187
what are side effects of fentanyl
chest wall rigidity/bradycardia
188
what is best opioid for neonates
fentanyl
189
what are side effects of morphine
urticaria
histamine release
resp depression (especially in kidney failure)
PONV
190
what is DOA of fentanyl
1 hr
191
what is the metabolite of morphine
morpine-6-glucuronide
192
what is the IV dose of succs
1-2 mg/kg
193
what is IM dose of Succs
4 mg/kg
194
what cardiac complications are possible with succs
bradycardia, asystole
195
what patients do you avoid succs in do to high K
NM disorders
burns
dysrhythmias
muscle rigidity
masseter spasm
postop myalgias
196
what is dose of roc
0.6 mg/kg,
197
what is onset of roc
2 min
198
what is DOA of roc
30 min
199
what is RSI dose of roc
1.2 mg/kg
200
how do you know you pass from stage 2 to stage 1
grimacing
spontaneous eye opening
purposeful movement (reach for tube)
201
when do we not wake kids up
stage 2
202
what is NMB reversal doses in peds
robinol 0.01 mg/kg
neostigmine 0.06 mg/kg
203
what are signs of adequate reversal
nonparadoxic breathing
NIP >30 cm H2O
hip flexion with leg elevation for 10 sec
head lift for 10 seconds
204
T/F move patient during stage 2
no, can cause spasm
205
how do you extubate peds
deep (unless difficult airway and full stomach)
206
when do laryngospasms occur
stage2
207
T/F use 100% O2 with kids
F, prevent absorption atelectasis
208
what do you take to travel with peds patient
jackson reece, mask, O2, emergency drugs (atropine, anectine drawn up)
209
what is the ranking of desaturation time in infants children, adults
longer in infants than children than adults
210
what do we treat post op delirium with
versed
211
what can help with emergence delirium
precedex
212
what drug increases risk of emergence delierium
ketamine
213
what factors increase risk of emergence delirium
young age
previous surgeries
type of procedures
type of anesthetic
214
What are S/S of Emergence Delirium?
Restless
Agitated
Disoriented
Thrashing
moaning
crying
215
parameters for PACU discharge
216
what is definition of neonate
first 28 days of full term birth
217
what temp to we raise OR to for neonatal sx
80-85*
218
what do we use to warm OR and neonate in OR
radiant warmer
bair hugger
warmed/humidified circuit
warmed fluid/blood
insulate head
219
what Spo2 for neonatal sx
83-95%
220
how long can we have umbilical lines for
5-7 days
221
what are considerations for IVF for neonates
free of bubbles
drugs proximal to patient
minimize flushes
buritrol to limit flow
222
equipment for neonatal anesthesia
223
do males or females have more choanal atresia
females
224
what syndome is choanal atresia often associated with
CHARGE
Treacher Collins
Pfeiffer & Vater
225
what is CHARGE syndrome
Coloboma
Heart disease
Atresia choanae
Retarded growth
Genital anomalies
226
Pfeiffer & Pfeiffer
Veterbral defects
Anal atresia
Tracheoesophageal fistula with Esophageal atresia
Radial and renal anomalies
227
what type of choanal atresia is an emergency
bilaateral, surgery within 1st days of life
228
what are s/s of bilateral choanal atresia
resp distress and cyanosis with feeds, relieved with crying
229
what airway intervention do we do early on in induction for choanal atresia
OA
230
what kind of choanal atresia is diagnosed in later childhood and adulthood
unilateral
231
what are causes of laryngeal and upper tracheal obstruction
webs
congenital subglottic stenosis
subglottic hemangioma
tracheoesophageal fistula/esophageal atresia
232
what is the procedure for laryngeal web identified intrautero
EXIT procedure
233
what symptoms present with laryngeal or tracheal web
resp distress
stridor
234
what complication can accompany anterior webs
subglottic stenosis
235
what is the most common indication for neonatal tracheostomy
congenital subglottic stenosis
236
what are treatments for subglottic stenosis
trache
endoscopic steroids and dilators
cricotracheal resection and laryngotracheoplasty
237
what is the most common infantile vascular tumor
hemangiomas
238
what should we suspect iwth V3 beard distribution on the face
subglottic hemangioma
239
when do subglottic hmeangioma patients have resp distress and stridor
6 and 12 weeks of life
240
what syndrome is subglottic hemangioma associated with
PHACES
*Posterior fossa malformation, Hemangioma, Arterial lesions of head and neck, Cardiac abnormalities, Eye abnormalities, Sternal cleft, or Supraumbilical hernia
241
what is treatment of subglottic hemanagioma
propranolol and steroids
surgery with laser or open
graft with rib or thyroid cartilage
242
what do we anticipate when intubating subglottic hemangioma patient
bleeding
243
what is an error in the separation of the trachea from the floor of the foregut
*TRACHEOESOPHAGEAL FISTULA/ ESOPHAGEAL ATRESIA
244
what syndrome is associate with *TRACHEOESOPHAGEAL FISTULA/ ESOPHAGEAL ATRESIA
*VACTERL Vertebral anomalies, Anus imperforate, Congenital heart disease, Tracheoesophageal fistula, Renal abnormalities, Limb abnormalities
245
what is themost common type of *TRACHEOESOPHAGEAL FISTULA/ ESOPHAGEAL ATRESIA
dilated proximal esophageal pouch and a fistula between the distal trachea and distal esophagus
246
what are signs symptoms of *TRACHEOESOPHAGEAL FISTULA/ ESOPHAGEAL ATRESIA in newborn
excessive secretions
spits up during initial feedings
cant pass NGT
247
how do we optimize *TRACHEOESOPHAGEAL FISTULA/ ESOPHAGEAL ATRESIA patient for surgery
anemia
lytes
T &C
anomaly eval
G-tube
248
how do we intubate *TRACHEOESOPHAGEAL FISTULA/ ESOPHAGEAL ATRESIA
awake intubation with videoscope
maintain SV
ETT above carina but distal to fistula
249
Calculation for internal diameter of ETT
(Age in years/4)+4
250
Calculation to advance the ETT
3x the internal diameter
(Age in years/2)+12
