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Pathophys II > Pathophys final review part 4 > Flashcards

Pathophys final review part 4 Flashcards

1
Q

Infants are at risk for postoperative apnea up to

A

60 weeks postconceptual age

-type of anesthetic is not a risk factor

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2
Q

Postconceptual age is

A

age in weeks plus gestational age

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3
Q

A vagotomy is

A

an operation when one or more branches of the vagus nerve are cut
this is done to treat patients with excessive gastric acid production & peptic ulcer disease

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4
Q

If a patient is vomiting, we may see

A

metabolic alkalosis

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5
Q

If a patient is having diarrhea, we may see

A

metabolic acidosis

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6
Q

Gastroschisis is

A

herniated viscera exposed to air

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7
Q

Omphalocele is

A

herniated viscera covered in a membranous sac & is often associated with other congenital anomalies

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8
Q

The BTT shunt is

A

a systemic to pulmonary shunt
it commonly involves connecting the subclavian artery to the pulmonary artery
risks include shunt blockage (possibly from low flow states), infection, and excessive flow to the lungs

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9
Q

The infant’s retina continues to develop until

A

44 weeks post-conceptual age

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10
Q

Known factors to increase pulmonary vascular tone include

A 
hypoxemia & use of <30% fiO2
hypercarbia/acidosis
hypothermia
atelectasis
transmitted positive pressure & PEEP
stress response/stimulation/light anesthesia
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11
Q

Known factors to decrease pulmonary vascular tone include

A

increasing inspired oxygen to 100%
hyperventilation
potent inhalation agents reduce SVR more than PVR
nitric oxide

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12
Q

Chronic Fontan complications include

A

dysrhythmias
protein losing enteropathy
thrombosis

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13
Q

The PDA can be kept open with

A

prostaglandins

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14
Q

HLHS is a term used to

A

describe a spectrum of defects with the common denominator being under development of the heart’s left side
-aorta, aortic valve, LV, & MV

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15
Q

Describe the Norwood with shunt

A

connection between systemic to pulmonary circulation
anticipate oxygen saturation 75-80%
RV ejects into the systemic circulation

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16
Q

Describe the Bidirectional Glenn

A

requires low PVR & blood flow is passive
expected arterial oxygen saturation is 75-85%
direct anastomosis between the SVC & pulmonary artery branch

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17
Q

Describe the Fontan procedure

A

the inferior vena cava is connected to the pulmonary vasculature
allows for passive blood flow from the IVC to lungs while bypassing the heart
completes the separation of the pulmonary & systemic circulations
expected arterial oxygen saturation is 88-93%

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18
Q

TOF includes

A

VSD, RVOT, RVH, & overriding aorta

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19
Q

_____ may be used to treat pulmonary hypertension

A

Nitric oxide

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20
Q

The patent ductus arteriosus can be closed

A

medically via indomethacin or ibuprofen or surgical therapy

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21
Q

Describe where preductal and postductal measurement takes places

A

preductal- right arm

postductal- lower limb

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22
Q

Necrotizing enterocolitis anesthetic management includes

A

aspiration risk may necessitate RSI
inhalation agents poorly tolerated–> narcotic technique & avoid nitrous oxide
vasopressors required typically
large fluid loss & blood loss

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23
Q

Inguinal hernia repair, be prepared to see

A

laryngospasm when the surgeon pulls on the hernia sac if there is inadequate depth of anesthesia

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24
Q

Infants with _____ type hernia are more likely to have concurrent birth defects including CHD & chromosomal abnormalities

A

Bochdalek-type

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25
CDH is a potentially lethal anomaly due to
pHTN, pulmonary hypoplasia, & associated cardiac or congenital defects
26
Anesthetic management for CDH repair includes
``` avoid mask ventilation place NG tube Pre & post ductal monitoring reactive pulmonary vasculature give paralysis and narcotics while avoiding nitrous oxide ```
27
Omphalocele is typically
associated with genetic, cardiac, urologic, & metabolic abnormalities
28
High intra-abdominal pressures >_____ are poorly tolerated with omphalocele & gastrochisis
20 | c
29
Criteria for aborting primary closure of omphalocele & gastrochisis includes
end-tidal CO2 >50 max ventilatory pressure >35 intra-gastric pressure & intravesical pressure >20
30
Describe VATER & VACTERL
vertebral abnormalities, imperforated anus, congenital heart disease, tracheo-esophageal fistula, renal abnormalities, and limb abnormalities associated with tracheoesophageal fistula
31
When inducing a neonate for tracheoesophageal repair,
maintain spontaneous ventilation place ETT between fistula & carina avoid nitrous
32
Crohn's disease vs. ulcerative colitis.
Crohn's disease will affect anywhere in the tract UC targets the colon both have an autoimmune component
33
Gastrin stimulates
parietal cells to release HCl | gastrin is released from G cells
34
Cholecystokinin is released from
I cells as a result of protein, fat, & acid
35
Proton pump inhibitors work by
inhibiting the parietal cell H+/K+ exchanger ATPase pump | PPIs are more effective than H2 antagonists
36
H2 receptor antagonists work by
selective, reversible inhibition of H2 receptor mediated secretion of H+ ions
37
Sympathetic response of the GI tract
will cause decrease gastric motility
38
Water absorption occurs in
small intestine (ileum)
39
Risk factors for apnea include
low birth weight, anemia, hypothermia, sepsis, neurological abnormalities, & type of surgical procedure apnea is inversely related to postconceptual age
40
For retinopathy of prematurity, the anesthesia saturation goal is
90-94%
41
Normoglycemia for infants is
45-90 mg/dL
42
Four routes of heat loss in the infant include
radiation (39%), >convention> evaporation> conduction
43
At birth the liver is
somewhat incomplete cytochrome P450 reaches ~50% adult values at birth phase II are impaired until 1 year
44
The ductus arteriosus remains patent in utero due to
hypoxia, mild acidosis, & placental prostaglandins
45
Describe blue vs. pink lesions.
pink lesions- L to R shunts- connects arterial and venous circulation resulting in increased pulmonary blood flow blue lesions- R to L shunts- venous blood is ejected systemically; there is decreased pulmonary blood flow & patients are cyanotic
46
Eisenmenger's syndrome is
when the shunt reverses direction when the PVR is high enough
47
Coarctation presents with
upper extremity hypertension | decreased lower extremity pulses & LVH
48
The Ross procedure is where
the diseased aortic root is resected the patient's own pulmonary valve root is excised & implanted into the aortic position advantages: free from long-term anticoagulation & the valve grows as the patient grows disadvantage: single valve disease is treated with 2 valve procedure
49
Describe class vs. modified BTS
classic- subclavian artery is divided & directly anastomosed to the ipsilateral pulmonary artery modified- synthetic shunt between the subclavian artery & PA; hypotension leads to sluggish flow & possibly thrombosis
50
SBE prophylaxis dose is
50 mg/kg of cefazolin | doxycycline if allergy exists
51
TET spell is a
acute dynamic increase in the pulmonary outflow tract obstruction that may result in a cyanotic episode due to right to left shunting
52
Intraoperative treatment of a TET spell includes
``` 100% oxygen knees to chest fluid bolus hyperventilation sedation esmolol phenylephrine ```
53
Anesthetic considerations for the elderly include
decrease induction agents by 50%
54
Two major structural effects in blood vessels of the elderly include
stiffening & atherosclerosis
55
Additional CV considerations for the elderly include
systolic function is abnormal (increases) and diastolic does not so see widened pulse pressure increased incidence of dysrhythmias Decreased sensitivity to beta-adrenergic modulation***
56
The most common complication and leading cause of death in the postoperative period for the elderly is
myocardial infarction
57
The respiratory system of the elderly has
FRC increases with age closing volume exceeds FRC in supine position at 45 and exceeds FRC in upright position at 65 more prone to respiratory failure reduced oxygen exchange at alveolar level more prone to atelectasis because increased tendency for airways to close residual volume increases
58
Elderly individuals have an
increased risk of aspiration** | due to decreased ability to clear secretions & attenuated protective cough mechanisms
59
The aging kidney is
more susceptible to injury
60
Hepatic function in the elderly
decreased metabolism prolonged half-life phase 1 drug metabolism is variable phase 2 drug metabolism is not significantly affected serum albumin decreases while alpha 1 acid glycoprotein increases
61
A major risk factor for CV disease is
diabetes
62
____ is more pronounced and lasts longer in the elderly
hypothermia
63
Frailty is
an independent predictor of in-hospital mortality | a state of reduced physiologic reserve
64
Diminishing cognitive performance over any time interval is
predictive of an earlier death
65
______ is the norm in the elderly patient
polypharmacy
66
Drug dosages in the elderly should be adjusted for
smaller lean body mass
67
The ideal induction agent for the elderly is
etomidate
68
Primary risk of opioids in the elderly is
respiratory depression | -reduce dose
69
_____ is not recommended in the elderly
meperidine
70
The NMBD of choice in the elderly is
cisatricurium
71
Poor functional status is a risk factor for
SSI & postoperative complications
72
Additional drugs that should be avoided in the elderly include
``` metoclopramide meperidine NSAIDs transdermal fentanyl agonist-antagonist opioids methadone ```
73
______ has worse outcomes than ______ surgery in the elderly.
emergent; elective
74
The most common postoperative complications for the elderly include
cardiac, pulmonary or neurologic complications
75
Increased number of clinical risk factors leads to
increased risk of surgical procedure & overall poor outcomes
76
The two most important factors for perioperative outcomes include:
surgical risk of the procedure | number of defined clinical risk factors in patient
77
____ is common after major surgery
delirium
78
The leading cause of morbidity is
pulmonary insufficiency or infection

Pathophys II (43 decks)

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