Neonatal and Geriatric Anesthesia Flashcards
Why is neonatal respiratory rate 2-3 times higher than in adults? What effect will this have on induction with inhalant anesthetics?
Vt is the same as an adult (10-15 ml/kg) so the respiratory rate must be 2-3 times greater for minute volume to meet oxygen demand
High alveolar vent increases gas exchange
What happens to cardiac output if bradycardia occurs in a neonate?
Cardiac output decreases
Is an 8 week old puppy or kitten a neonate?
No, it is considered pediatric
Neonatal: birth to 2 weeks
Pediatric: 8-2 weeks
Beyond 8 weeks, they are considered miniature adults for anesthesia
An 8 week-old puppy has a mean arterial blood pressure of 55 mmHg during anesthesia. Is this puppy hypotensive?
No. This is normal for a puppy that is 8 weeks old. Puppies tend to have a lower MAP than adults.
Why are alpha-2 agonists such as xylazine or medetomidine not a particularly good agents in neonatal and pediatric patients?
Because these cause vasoconstriction, there will be an increased afterload and inability to deal with it at this age
Under what conditions should glucose-containing fluids be administered to young animals during anesthesia? Which glucose-containing solution would be least likely to result in water overload, diuresis, and dehydration?
They will only get glucose-containing fluids if they truly need glucose
½ strength LRS with 2.5% dextrose
Can injectable anesthetics be used in 6-8 week-old puppies and kittens? Why or why not?
Yes. They are now pediatrics rather than neonates and their neurological system is more developed
Do older animals generally require more or less anesthetic agent?
Less
Is the anesthesia duration for older animals generally longer or shorter for a specific anesthetic dose?
Longer
Does age by itself increase anesthetic risk? Why or why not?
No, biological and physiological age are more important than chronological age
Why might recovery from lipophilic anesthetics be prolonged in the older patient?
There is an increase in adipose tissue and an increase in total distribution volume for lipophilic drugs
Older animals are often borderline hypoxic (PaO2 60-80 mmHg) when awake. Why?
They have an increase in alveolar deadspace
Describe an easy, inexpensive physical method that you can use in a practice setting to determine whether an older animal has adequate cardiac reserve to undergo anesthesia.
Exercise challenge: take them out and run them around. If you get tired before the dog gets tired, they’re probably fine. If they have a hard time, then they have cardiac problems and should not undergo anesthesia
Why would drugs that cause the heart to beat faster (i.e. antimuscarinics, ketamine) not be good drugs for the older patient?
This will make them tachycardic and increase myocardial consumption causing arrhythmias
What is the O2 rate for neonates and pediatrics?
2-3 times greater than adults
What is respiratory control like at birth?
Immature
What are respiratory considerations for neonates and peds?
Increase risk of pulmonary shunting
Greater risk of airway obstruction
What are circulatory considerations for neonates and peds?
Neonatal circulatory system is low pressure, low volume, low peripheral resistance Reduced myocardial contractility Immature ANS Resting CO near maximal Reduced ventricular compliance
