Neonatal A&P 4

Question 1

Infants and children at risk for developing hypoglycemia include

Answer 1

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

Question 2

Treatment of hypoglycemia in the infant or child includes

Answer 2

IV 10% dextrose at 2 ml/kg

Question 3

If seizures are present in the setting of hypoglycemia, then

Answer 3

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

Question 4

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

Answer 4

d. shorter duration of action for lipid soluble drugs

Question 5

Describe the hepatic and renal function of the neonate

Answer 5

immature so it alters the pharmacokinetics and pharmacodynamics of drugs

Question 6

Is MAC lower or higher in the infant?

Answer 6

higher

Question 7

Describe the blood brain barrier of the infant.

Answer 7

immature

Question 8

Describe cardiac output of the infant

Answer 8

higher

Question 9

Describe the volume of distribution of drugs in the neonate.

Answer 9

volume of distribution of water-soluble drugs is higher

Question 10

What is plasma protein concentration like for neonates?

Answer 10

lower

Question 11

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

Answer 11

water-soluble drugs

Question 12

For drugs that are highly protein bound, the neonate will

Answer 12

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

Question 13

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

Answer 13

will have a longer duration of action

Question 14

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

Answer 14

glucuronyl transferase; acetaminophen

Question 15

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

Answer 15

lower than the infant

Question 16

What is the MAC value for the premature?

Answer 16

lower than the neonate

Question 17

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

Answer 17

MAC is higher than the adult

Question 18

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

Answer 18

MAC peaks at its highest level

Question 19

The MAC requirement pattern for __________ is different

Answer 19

sevoflurane

Question 20

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

Answer 20

MAC is higher (3.2%)

Question 21

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

Answer 21

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

Question 22

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

Answer 22

c. a larger dose of succinylcholine

Question 23

What neuromuscular drugs can be administered intramuscularly?

Answer 23

succinylcholine and rocuronium

Question 24

What is the recommended dose of succinylcholine in the neonate?

Answer 24

2 mg/kg

Question 25

Why do neonates need a higher dose of succinylcholine?

Answer 25

increased ECF normal sensitivity to succinylcholine

Question 26

What is the duration of succinylcholine in the neonate?

Answer 26

same as the adult

Question 27

What is the dose of nondepolarizers for neonates?

Answer 27

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

Question 28

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

Answer 28

immature metabolic and clearance mechanisms may prolong the duration of action

Question 29

What are subjective signs of adequate recovery of NMBDs?

Answer 29

grimacing elbow and hip flexion bringing the news to the chest

Question 30

Objective data suggests recovery from neuromuscular blockade includes a

Answer 30

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

Question 31

The FDA black box warning on succinylcholine warns of

Answer 31

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

Question 32

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

Answer 32

does not have the muscle strength to raise his head

Question 33

What is the dose of edrophonium for reversal?

Answer 33

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

Question 34

Which NMDBs are useful in the neonates?

Answer 34

Atracurium and cisatricurium due to their organ-independent elimination

Question 35

Concerns with using pancuronium in the neonate include

Answer 35

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

Question 36

Pancuronium and vecuronium dosing is

Answer 36

0.1-0.15 mg/kg

Question 37

What is the onset of IM dose of rocuronium?

Answer 37

3-4 minutes

Question 38

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

Answer 38

1 mg/kg

Question 39

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

Answer 39

1.8 mg/kg

Question 40

The IM dose of succinylcholine for neonates and infants is

Answer 40

5 mg/kg

Question 41

The IM dose of succinylcholine for older children is

Answer 41

4 mg/kg

Question 42

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

Answer 42

intralingual administration via the submental approach

Question 43

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

Answer 43

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