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Flashcards in Pediatrics Deck (42)
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1

Define the oculocardiac reflex. What are the nerves involved? How do you treat it?

Decrease in heart rate of 10% following pressure on the globe or manipulation of the eye muscles.
Afferent limb: ophthalmic division of the Trigeminal nerve, efferent: Vagus nerve
Treatment: ask surgeon to stop stimulus, make sure patient is deep enough, turn up FiO2, if bradycardia doesn't resolve, consider atropine 20mcg/kg

2

What are the blood volumes assigned to each age group?

Adult female: 60-75 ml/kg
Adult male: 65-70 ml/kg
Child 1-12 years: 70-75
Child 3-12 months: 70-80
Full term newborn: 80-90
Pre-mature: 90-100

3

What is the anesthetic management of CDH?

1. pre-ductal sats 90-95
2. PIP < 25, with low TV

4

For pediatric heart cases, what two types of medications should you be careful about mixing, and why?

1. opiods and benzos
2. These kids have decreased CP reserve due to heart defects. Anything that would cause vasodilation will worsen perfusion to the rest of the body

5

What are the side effects of PGE1?

apnea, bradycardia, fever, flushing, gastric outlet obstruction, and CNS irritability

6

What is the difference in codeine and morphine metabolism in neonates and school aged children?

Neonates: Decreased CYP2D6 activity, so less codeine is converted to morphine, therefore they are less sensitive
Morphine: two other enzymes that convert opioids to inactive metabolites and morphine to its two metabolites are low at birth, leading to increased sensitivity of the drug in neonates

7

What is the main way that babies keep warm? What factors increase this heat production? What inhibits heat production?

1. non shivering thermogenesis: breakdown of brown fat into TG
2. NE, thyroxine, glucocorticoids
3. inhaled anesthetics and B blockers

8

How would you describe the trend of DM 1 and 2 in children? increasing? or decreasing?

Both are increasing

9

What abnormalities are associated with Trisomy 21?

1. heart defects: AVSD > VSD > TOF > PDA
2. Duodenal atresia
3. Pulmonary HTN
4. Difficult IV access, difficult airway
5. Subglottic stenosis

10

What causes persistent fetal circulation?

Increased pulmonary pressures (I.e. hypoxia, acidosis, and hypothermia

11

What are the criteria for starting a newborn on PPV? When do you start CPR?

1. persistent cyanosis, HR < 100
2. HR < 60

12

How do you treat mild post-intubation croup vs. moderate to severe?

1. mild: cold, humidified air
2. mod-severe: racemic epinephrine and monitoring for at least 4 hours following extubation

13

What is the first surgical correction step for pulmonary atresia?

1. BT shunt placement: This is a shunt between the R subclavian artery and the pulmonary artery. Therefore blood goes from the aorta --> R subclavian --> pulmonary artery --> lungs
"what will not flow will not grow"

14

What are the optimal leak pressures for a cuffed vs. uncuffed tube?

1. Cuffed: 20 cm H20
2. Uncuffed: 20-30 cm H20
- if the leak pressure is >20-30 then the cuff is TOO BIG

15

What agent should be avoided in patients with the MHTFR mutation?

N20

16

How do you induce a patient with congenital emphysema? What should you avoid?

1. use spontaneous ventilation with minimal PIP
2. avoid n20

17

What are the early signs of MH?

1. masseter muscle spasm
2. Increased EtCO2
3. Hyperthermia
4. Tachycardia
5. Tachypnea

18

What are the symptoms of propofol infusion syndrome? What is the one organ NOT effected?

1. Cardiac abnormalities
2. Renal failure (hyperkalemia, rhabdo)
3. Liver problems
4. metabolic acidosis

BUT pulmonary edema is NOT see

19

What does VACTERL stand for?

1. vertebral
2. Anal atresia
3. cardiac
4. TEF
5. Renal
6. limb

20

True or false: high cognitive ability is associated with increased risk for peri-operative anxiety

true

21

What is the youngest age of a child that would benefit from midazolam? Why?

9 months. That's when separation anxiety begins

22

Define Klippel-Feil syndrome

congenital fusion of the cervical spine

23

What are the risk factors for post op apnea in kiddos?

1. prematurity
2. anemia
3. GA or local w/ sedation
4. hx of apnea

24

Why do infants have an increased WOB?

1. Highly compliant chest wall and poorly supported airway structures leads to functional airway closure with each breath
2. increased metabolic demand
3. smaller diameter of airways = increased R

25

What is the first sign of total spine anesthesia in a neonate?

1. respiratory distress and apnea
2. hemodynamic changes and autonomic effects are minimal

26

In comparing gastroschisis and omphalocele:
1. which is more common?
2. which is associated with chromosomal abnormalities?
3. which has an encasing?
4. which is associated with increased rates of infection and heat loss?

1. Omphalocele
2. Omphalocele
3. Omphalocele
4. Gastroschisis

27

What is the most efficacious treatment of PONV in kiddos?

Zofran, NOT the use of propofol

28

What are the risk factors for PONV in kids?

1. Older than 3
2. Surgery > 30 minutes
3. strabismus surgery
4. FMH of PONV

29

Explain the factors that lead to a faster induction of anesthetic in kids.

1. Greater MV compared to FRC (most important)
2. Greater blood flow to vessel rich organs in kids (i.e. the brain)
3. Kids have lower blood:gas partition coefficients
4. Gas is LESS soluble in tissue, meaning that there is an increase in blood concentration of gas and therefore an increase in speed of induction

30

What drug is specifically CI following tonsillectomy and why?

Codeine. Some kids are rapid metabolizers, while others are not! That means that you cannot predict the anesthetic effect, whereas you can predict the effect of morphine since it is not a pro-drug.
REMEMBER: codeine ..> morphine via CYP2D6