Pediatrics Flashcards
(32 cards)
Acid-base disturbance and electrolytes in pyloric stenosis?
hyponatremic hypokalemic hypochloremic metabolic alkalosis
Management goal in single ventricle physiology like hypoplastic left heart syndrome?
Balanced circulation between pulmonary and systemic sides (Qp:Qs=1)
These patients need higher pulmonary vascular resistance to “squeeze” circulation to systemic side via PDA – this is why they are maintained at lower oxygen saturations because they rely on hypoxic pulmonary vasoconstriction (as well as probably hypercarbic pulmonary vasoconstriction).
Also anything that increases systemic vascular resistance will make things worse because pulmonary “squeeze”through PDA will be ineffective.
Associated defects with tetralogy of Fallot?
PROVe:
pulmonary stenosis
RVH
overarching aorta
VSD
Goals of anesthetic management in TOF?
maintain SVR & reduce HR and contractility: think same as HOCM
-plus-
normocarbia
adequate oxygenation
Drug that keeps the ductus arteriosus open? drug that closes the ductus arteriosus?
Prostaglandin E1 keeps it oPen; in”door”methacin closes the “door”
Common side effect of prostaglandin E1 (PGE1)?
APNEA, CNS irritability, hypotension and fevers.
Infant diaphragms have a higher percentage of type I or type II muscle fibers?
Type II fast-twitch muscle fibers making them more prone to respiratory fatigue
The most common syndromes associated with Pierre Robin sequence?
Stickler
Velocardiofacial
Treacher-Collins
fetal alcohol syndrome
Classic triad of congenital diaphragmatic hernias?
dyspnea, cyanosis and dextrocardia
Key points to the anesthetic management of newborns with congenital diaphragmatic hernia?
permissive hypercapnia to avoid volutrauma – lung injury can increase inflammatory mediators and lead to pulmonary vasoconstriction (more than the likelihood of mildly increased PaCO2 causing PHTN)
AVOID:
- pulmonary hypertension
- hypothermia
- venous access in LE’s because the inferior vena cava may become compressed after the reduction of the hernia
- nitrous oxide as it can diffuse into the viscera residing within the thoracic field causing further lung compression
thumbprint sign is associated with?
acute epiglottitis (as seen on lateral radiograph)
Steeple sign is associated with?
Laryngotracheobronchitis (croup) - seen on frontal radiograph - indicates tracheal mucosal edema causing tracheal narrowing
Best initial treatment for hypotension in the euvolemic neonate?
Atropine for three reasons:
cardiac output is determined primarily by HR
Cardiac myocytes are relatively insensitive to catecholamines
neonatal myocytes have poor lusitropy and cannot respond with increased stroke volume to increased preload (volume bolus)
How does PGE2 affect ductal patency?
Maintains ductal patency in utero
A decrease in PGE2 plus oxygenated blood closes ductus arteriosus after birth
neonatal PaO2 5 minutes after birth? 1 hour after birth? and PaO2 in utero?
5 minutes: 35-40 mmHg
1 hour: 60-65 mmHg
in utero: 20 mmHg
Risk factors for postop respiratory events following adenotonsillecomy?
age < 2
apnea-hypopnea index greater than 10
BMI greater than 95 percentile
history of craniofascial syndromes (Down’s)
comorbid conditions (mod to severe asthma, congenital heart disease)
Risk factors for retinopathy of prematurity?
prematurity
low birth weight
LOW serum IGF-1
hyperoxia
HIGH neonatal glucose
(Thought to be caused by the disorganized growth of retinal blood vessels)
When is the risk for post-tonsillectomy hemorrhage the greatest?
75% within first 6 hours
25% within first 24 hours
Pathogen usually responsible for epiglottitis?
vaccinated: polymicrobial including staph, strep pyogenes, strep pneumoniae, and NON-typeable haemophilus
non-vaccinated: haemophilus influenza type b (Hib)
Klippel-Feil Syndrome and its common associations?
congenital fusion of cervical spine, low hairline, and short neck
difficult intubation
commonly associated with scoliosis, strabismus and scapular defects
When does surfactant production begin? by which pneumocytes?
Week 32; type II pneumocytes
lecithin and sphingomyelin ratio in early pregnancy?
lecithin does not begin to be secreted by the developing fetal lung until 24-26 weeks
lecithin and sphingomyelin ratio at 32 weeks?
approximately equal amounts
lecithin and sphingomyelin ratio at lung maturity?
L/S ratio > 2 or more
In diabetic mothers, L/S ratio should be > 3.5
