Pediatric Anesthesia Quiz#1 Flashcards
(108 cards)
1
Q
1 kg = ? gm
A
1kg = 1000g
2
Q
1 gm = ? mg and ? mcg
A
1 gm = 1000 mg = 1000000 mcg
3
Q
Epi 1:200000 = ? mcg/ml
A
Epi 1:200000 = 5mcg/ml
4
Q
What is the pediatric PO dose of midazolam?
A
0.5 - 0.7 mg/kg(max 20 mg)
5
Q
What is the pediatric dose of IV cefazolin?
A
25 mg/kg
6
Q
What is the pediatric dose of IV succinylcholine?
A
1.5 - 2 mg/kg
7
Q
What is the pediatric dose of IV atropine?
A
- 01 - 0.02 mg/kg(no less than 0.1 mg)
* 10-20 mcg/kg IV or 20-40 mcg/kg IM*
8
Q
What is the pediatric dose of IV propofol?
A
2-4 mg/kg
9
Q
What is the pediatric dose of IV vecuronium?
A
0.1 mg/kg
10
Q
What is the pediatric dose of IV fentanyl?
A
1-2 mg/kg
11
Q
What is the pediatric dose of IV hydromorphone?
A
10-20 mcg/kg
12
Q
What is the pediatric dose of IV neostigmine?
A
0.07 mg/kg(max 5 mg)
13
Q
What is the pediatric dose of IV glycopyrrolate?
A
- 01 mg/kg(10 mcg/kg)
* Give at least 100 mcg*
14
Q
What is the pediatric dose of IV ondansetron?
A
0.1 mg/kg
15
Q
The major importance to the pediatric anesthesia provider are the physiologic differences related to ?(2)
A
- general metabolism
- immature function of the various organ systems
16
Q
Prematurity has conventionally been applied to infants weighing ________ at birth.
A
less than 2500 grams
17
Q
A preterm infant is one who is born ________ weeks of gestation.
A
born before 37 weeks of gestation
18
Q
A term infant is one who is born after ___ weeks and before ____ completed weeks of gestation.
A
- 37 wks
- 42 completed weeks of gestation
19
Q
A post term infant is one who is born after ___ completed weeks of gestation.
A
42 weeks
20
Q
An infant is considered premature if born before what gestational age and has what weight?
A
- less than 37 weeks of gestation
- less than 2500 gram at birth
21
Q
In what five ways is the premature infant different from the full-term neonate?
A
As compared to the term infant, the premature infant is less able to:
- suck
- maintain body temp
- swallow
- eat
- sustain ventilation
22
Q
Define the pediatric definition of an infant?
A
1 - 12 months of age
23
Q
Define the pediatric definition of an adolescent?
A
13 - 19 years of age
24
Q
Define the pediatric definition of a child?
A
1 - 12 years of age
25
Define the pediatric definition of a neonate?
Less than 30 days old
26
Define the pediatric definition of low birth weight?
less than 2.5 kg
27
Define the pediatric definition of very low birth weight?
less than 1.5 kg
28
Define the pediatric definition of extremely low birth weight?
less than 1 kg
29
Define the pediatric definition of a micro-preemie?
less than 750 grams
30
The duration of gestation and weight of an infant have an important relationship...deviations from this relationship may be associated with:
- inadequate maternal nutrition
- significant maternal disease
- maternal toxins
- fetal infections
- genetic abnormalities
- fetal congenital malformations
31
____ is a more sensitive index of well-being, illness, or poor nutrition than length or head circumference and is the most commonly used measurement of growth.
Weight
32
At full-term birth, the infant has a SHORT NECK and a CHIN that often meets the chest a the level of the _____; these infants are prone to ________ during sleep.
- level of the 2nd rib
| - upper airway obstruction
33
In addition, infants are more prone to upper airway obstruction under GETA because upper airway muscles, which normally support the airway potency, are ___________, resulting in pharyngeal airway collapse and obstruction.
disproportionally sensitive to the depressant effect of GETA
34
What are two major differences between the neonatal and the adult airway?
- tongue: relatively large in proportion to the rest of the oral cavity--->easily obstructs the airway
- position of the larynx: infant's larynx is more cephalic(C2-3) vs and adult's(C4-5)
35
An infants epiglottis is ___ & ____ and angled into the lumen of the airway, making it more difficult to displace anteriorly during laryngoscopy.
- narrower
| - omega shaped
36
20 primary teeth begin to erupt during the first year of life and are shed at the age of ______ years.
How many permanent teeth begin to appear at the time the primary teeth are shed?
- 6 to 12 years
| - 32 permanent teeth
37
To improve airflow during upper-airway obstruction what 3 things should be done immediately?
- give chin lift
- jaw thrust
- apply some CPAP(5-15 cm H20) at the APL valve
38
Positive pressure ventilation by bag and mask has been instituted on the neonate during resuscitate. When is endotracheal intubation indicated?
During neonatal resuscitation, prompt endotracheal intubation is indicated if there is no immediate(
39
When should immediate endotracheal intubation be considered during neonatal resuscitation?
Immediate endotracheal intubation of the neonate should be considered for situations in which bag and mask ventilation is likely to be ineffective, for example extreme prematurity with low pulmonary compliance secondary to surfactant deficiency.
40
In what situations should a nasal trumpet be avoided in the pediatric patient?
- coagulopathy/thrombocytopenia patients
| - suspicion of a traumatic basilar skull fracture(think trauma)
41
What weight would a size 1 LMA be appropriate for?
42
What weight would a size 1.5 LMA be appropriate for?
5- 10 kg
43
What weight would a size 2 LMA be appropriate for?
10 - 20 kg
44
What weight would a size 2.5 LMA be appropriate for?
20 - 30 kg
45
What weight would a size 3 LMA be appropriate for?
30 - 50 kg
46
What weight would a size 4 LMA be appropriate for?
50 - 70 kg
47
What is the formula for correct ETT in the pediatric population?
> 2 years of age:
UNCUFFED: age + 16/4
CUFFED: [age + 16/4]--->go down a 1/2 size
48
Where should the ETT be taped at in a term infant?
10 cm
49
Where should the ETT be taped at in a 1 year old?
11 cm
50
Where should the ETT be taped at in a 2 year old?
12 cm
51
Where should the ETT be taped at in a 6 year old?
14 - 15 cm
52
Where should the ETT be taped at in a 10 year old?
16 - 17 cm
53
Where should the ETT be taped at in a 16 year old?
18 - 19 cm
54
Where should the ETT be taped at in a 20 year old?
20 - 21 cm
55
Identify the narrowest portion of the pediatric airway. What is the shape of the narrowest region of the pediatric airway?
- the cricoid cartilage is functionally the narrowest portion of the pediatric upper airway.
- "funnel-shaped"
56
List 5 ways the neonatal airway differs from the adult airway and one anesthetic implication for each difference?
- the tongue is larger--->increased the likelihood of obstruction and technical difficulties during laryngoscopy
- the larynx is higher(more cephalic) in the neck--->straight blades are more useful than curved blades
- the epiglottis is stubby, short, omega-shaped and angled over the laryngeal inlet--->control of the laryngoscopy blade is more difficult
- the vocal cords are angled--->a "blindly" passed ETT may lodge in the anterior commissure rather than slide into the trachea
- the infant larynx is "funnel-shaped", the narrowest portion occurring at the cricoid cartilage--->uncuffed ETT were generally preferred in children younger than 6 years
57
What is the does for IV lidocaine?
1mg/kg
58
What is the dose for IV versed?
0.05 mg/kg
59
What is the distance from the teeth(alveolar ridge) to the mid trachea in the newborn? In the infant who is six months to 1 year-old? In the 2 year-old, 3 year and 4 year-old?
- newborn = 10 cm
- 6 months to 1 year = 11-12 cm
- 2 year = 12 cm
- 3 year = 13-14 cm
- 4 year = 15 cm
- 5 year = 15-16 cm
60
Laryngospasm is elicited by stimulation of the ____ fibers contained in the _______ of the _________.
- afferent fibers
- internal branch
- of the superior laryngeal nerve
*A-I-SLN*
61
What is a sign of a partial laryngospasm?
inspiratory stridor
62
What is a sign of complete laryngospasm?
- no air movement
- tracheal tug
- paradoxical movement of the chest/abdomen
- desaturation
- bradycardia
63
What are some anesthesia-related factors related to laryngospasm?
-insufficient depth of anesthesia during induction/emergence/intubation/extubation/saliva/blood/mucus or airway manipulation/volatiles(pungent DES/ISO)
64
What are some patient related factors associated with laryngospasm?
younger children = greater risk, upper resp infection, active asthma, airway hyperactivity after rest infection, smoking exposure, GERD, h/o elongated uvula of choking during sleep
65
What are some surgery-related factors contributing to laryngospasm?
T&A, Lap appendectomy, thyroid surgery(injury to SLN), inatrogenic removal of parathyroid glands, espophageal procedure
66
What are some ways to prevent laryngospasm?
- deepen anesthesia during airway manipulation and IV placement
- awake vs. deep extubation
- positive inflation of lungs before extubation
- reduced salivation with small amounts of antisialogogue(glycol)
67
What are the treatments for laryngospasm?
- identify and remove the offending stimulus
- apply jaw thrust
- insert oral/nasal airway
- apply positive pressure w/ 100% O2
- deepen anesthesia with Sevo or 0.5 mg/kg propofol
- 0.1 mg/kg succ IV or up to 4 mg/kg IM(with atropine)
- continue to mask ventilate or intubate
- assess for gastric distention
68
Laryngospasm occurs during induction of a pediatric patient; an intravenous line has not been placed yet. Which two muscles relaxants can be given IM to break the laryngospasm in this pediatric patient?
- IM succinylcholine or rocuronium may resolve laryngospasm if an IV catheter has not yet been placed.
- 3 mg/kg of succinylcholine IM will provide satisfactory relaxation in 85% of patients
- 4 mg/kg in the deltoid muscle will provide skeletal muscle relaxation in all, with duration of up to 20 minutes
69
What is the limit of viability and why?
The limit of viability is around 24 weeks, when the lungs develop a gas-exchanging surface and surfactant production begins.
70
At what conceptual age is surfactant developed?
Surfactant appears initially between 23 and 24 weeks gestational age and increases in concentration during the last 10 weeks of gestational life.
71
How many breaths per minute should be produced by the ventilator for the neonate? for the adult?
- 30 to 50 breaths per minute for the neonate
| - 12 to 16 breaths per minute for the adult
72
How do infants react to hypoxia?
infants react to hypoxia with BRADYCARDIA progressing to cardiac arrest
73
What is the appropriate internal diameter of the ETT for the premature newborn? For the full-term newborn?
- preemie ---> 2.5 to 3.0 mm
| - full term newborn ---> 3.0 to 3.5 mm
74
What ETT size(U/C) and length are required for the neonate, 2 year old, 6 year old and 10 year old?
- neonate = 3.0 to 3.5 and 10 cm
- 2 years old = 4.5 and 13 cm
- 6 years old = 5.5 and 15 cm
- 10 years old = 6.5 and 17 cm
75
What is the formula for determine the length of the ETT from the mouth?
10+age(yrs)/2
76
Why are infants more prone to airway obstruction?
-infants have a proportionately larger tongue than adults
77
How does chest wall compliance and pulmonary compliance differ in the neonate compared with the young, healthy adult?
- In the neonate, chest wall compliance is increased and pulmonary compliances is decreased.
- This means the chest wall is easier to distend(its less rigid), but the lung is more difficult to distend(it is more rigid)
78
In newborns, the closing capacity is higher than the FRC. What does this mean?
Some airways close during the expiratory phase of normal tidal breathing.
79
Why is subglottic stenosis potentially more sever in the pediatric patient than in the adult?
- the pediatric airway has a relatively small cross-sectional area in the normal pediatric patient
- with the presence of a subglottic stenosis, which may be congenital or acquired, even a small amount of swelling can rapidly occlude the opening
80
What intrapleural pressure is generated during the first breath of neonatal life?
- the first breath of neonatal life is a gap that generates a transpulmonary distending pressure of 40 to 80 cm H20
- another way to state "a transpulmonary distending pressure of 40 to 80 cm H20" is a pressure of -40 to -80 cm H20
81
The adult lungs comprise some 300 to 480 million alveoli; how many alveoli comprise the neonatal lungs?
- the neonatal lungs comprise about 30 million alveoli approximately 1/10th the number in the adult lungs.
- most alveoli formed by 18 months
82
What are the angles of the left and right bronchi in a child less than 3 years of age?
- left bronchi = 55 degrees
| - right bronchi = 25 - 70 degrees
83
What factors contribute to the decreased FRC in the neonate and infant during general anesthesia?
- the chest wall in infants is less rigid(more compliant) because ribs are cartilaginous and not bony
- the boxlike configuration of an infant's thorax permits less elastic recoil than the dorsoventrally flattened thoracic cage of the adult does
- an infant is more vulnerable to muscle fatigue, which may further decrease the stability of the chest wall
- as a result of all these factors, an infant's chest wall is extremely compliant. The net effect of the compliant chest wall and the poorly complaint lungs is a REDUCTION IN FRC
84
How is the headspace in children calculated? What is the headspace of a 30 kg child?
- deadspace is 2.0 - 2.5 ml/kg
| - the headspace of a 30 kg child is 60 - 75 ml
85
What is the tidal volume of a neonate in ml/kg?
-a neonate should have a ventilator setting for tidal volume of 7 ml/kg(6-8 mg/kg is the normal range)
86
What is the minute volume per kg for a neonate?
- Vt in a neonate is 7 ml/kg and RR is 30-50 bpm.
- minute ventilation = Vt x RR
- an estimate of Ve in the neonate is: ~250 ml/kg
87
Calculate the minute volume of the neonate who weights 3 kg and has a rest rate of 40.
Ve= Vt x RR
(7ml x 3) x 40
Ve=840 ml/min
88
What is the length of the infant trachea from the cords to the carina?
the length of the trachea(VC to carina) in infants and neonates and children up to one year of age varies from 5 to 9 cm.
89
Is the infants larynx higher, at the same, or at a lower level in the neck compared to the adult larynx? Identify the level of the infant larynx.
- the thyroid cartilage is located at C3-4 in infants as compared to C4-5 in adults.
- the infant larynx is located higher in the neck, at the level of C3-4 than in the adult, where the larynx is located at the level of C4-5.
90
At what age does the pediatric laryngeal cartilages reach adult proportions?
at age 10-12 years the cricoid and thyroid cartilages reach adult proportions
91
What PaO2 is desirable when ventilating a premature infant for surgery?
60-80 mmHg
92
Where should PaCO2 be maintained during intracranial surgery in children?
-for children, PaCO2 may be reduced to 20-25mmHg
***Katrin's comment: "more recent literature states to keep the pediatric patients undergoing near surgery normocapneic***
93
At what rate do infants consume oxygen? How does this compare with the adult?
resting O2 consumption in a healthy infant is 7 ml/kg/min(twice that of an adult)
94
How does the tongue differ in the child compared with the adult?
a child's tongue is relatively larger in proportion to the rest of the oral cavity, compared to the adult tongue.
95
How id the French size of the ETT determined for a child? What ETT size is required for a 6-year-old?
- the french size for a child is age(years) = 18
| - a 6 year old will require a 24 french ETT
96
What size(french) suction catheter should be used to clear the ETT of the intubated neonate?, The intubated 2-year-old? The intubated 6-year-old?
- Neonate: 8 french
- 6 month to 2 years: 10 french
- 2 to 12 years: 14 fr
97
What are some treatments for intro bronchospasm?
- deepen anesthesia/analgesia
- increase FiO2
- increase expiratory time(1:2.5)
- repeat Beta 2 agonist
- if severe small doses of Epi 10 - 20 mcg IV/ETT
98
Asthma is a ___ airway disease.
LOWER
Not a resp infection
99
Elective surgery should be postponed for children with more severe symptoms such as:
- mucopurulent secretions
- productive cough
- pyrexia > 38 degrees
- pulmonary involvement
100
For a child with URI symptoms who is afebrile with clear secretions and who is otherwise healthy should surgery be performed?
yes
101
Would a formerly premature infant be a candidate for outpatient surgery? What are the anesthetic concerns for the formerly premature infant?
- No, the formerly premature infant is not an appropriate candidate for outpatient surgery.
- Formerly premature infants(
102
How many days post gestation is it safe for surgery in the full-term infant? For the peter infant, surgery should be delayed how long post-conception?
- Surgery is safe from the 15th through 56th day post gestation in the full-term infant.
- Elective or outpatient procedures should be deferred until the preterm infant reaches the age of at least 60 weeks post-conception.
103
What are the recommendations for as related to preterm infants and discharge from the PACU?
- it is recommended that former preterm infants who are 55 to 60 weeks PCA and who are not anemic and not experiencing apnea be observed for an extended period of time and if stable later discharged.
- However, infants younger than 55 weeks PCA those who are anemic(hct
104
A 5 month old infant with h/o prematurity comes from MRI under GETA. Is the infant going home after recovery or is the infant going to be admitted for further observation? Gestational age:32 weeks/Chronological age:5 months(20 weeks)
So PCA = 52 weeks
32 + 20 = 52
so the infant would be staying for observation
105
How is post conceptual age determined in the infant?
PCA=sume of gestational age and the chronological age
106
The infant patient is high-risk for postoperative apnea, what agent may be given prophylactically to decrease the risk of apnea?
-caffeine loading dose 10 mg/kg
107
What is considered periodic breathing?
pauses in ventilation lasting no more than 5 to 10 seconds
108
In the infant, under GETA the muscle tension is abolished so this causes?
FRC collapse--->airway closure and atelectasis occurs unless CPAP or PEEP is maintain.
