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Peds Anesthesia > Peds Anesthesia and Perioperative Considerations > Flashcards

Peds Anesthesia and Perioperative Considerations Flashcards

(67 cards)

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1
Q

Pre-Term, Neonate, Infant and Child (days-years)

A

Pre-Term = prior to 37 weeks gestation
Neonate = 1-28 days
Infant = 28 days - 1 year
Child = > 1 year

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2
Q

Most significant part of transition occurs
within…….

A

first 24-72 hours after birth

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3
Q

4 Adaptive Changes

A

Establish FRC
Convert Circulation
Recover from birth asphyxia
Maintain core temperature

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4
Q

Where does fetal gas exchange occur?

A

PLACENTA

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5
Q

Fetal Hgb shifts oxyhemoglobin dissociation curve to the …..

A

LEFT!

-Increased O2 loading in the lungs/placenta, decreased O2 unloading at tissues]

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6
Q

O2 transport is accomplished by ______which totals _______.

A

fetal Hgb
70-90%

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7
Q

Hgb. full term neonate

A

18-20g/dl

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8
Q

Hgb does not go below …….

A

10!
0-30 days

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9
Q

4 Weeks fetal lung

A

primitive lung buds develop from foregut

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10
Q

Branching of bronchial tree complete to 28 divisions, no further formation of cartilaginous airways

A

16 weeks

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11
Q

primitive alveoli (saccules) and type II cells present; surfactant detectable; survival possible with artificial ventilation

A

24 weeks

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12
Q

capillary network surrounds saccules; unsupported survival

A

28-30 Weeks

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13
Q

true alveoli present, roughly 20 million at birth

A

36-40 Weeks

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14
Q

PaO2 rises as R to L mechanical shunts close

A

Birth-3 months

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15
Q

“Guppy Breathing in Utero” starts when?

A

From 30 weeks gestation, present 30% of the time at a rate of 60 breaths/min.

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16
Q

What are responsible for the decrease in neonatal PVR?

A

Changes in PO2, PCO2, and pH
-Increase in PO2, Decrease in CO2, Decrease in Pulmonary Vascular Resistance

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17
Q

The primary event of the respiratory system transition is ________.

A

INITIATION OF VENTILATION!

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18
Q

Infant must generate _____ negative pressure,
_____ cm H2O, to inflate the lungs

A

high
-70 cm H20

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19
Q

Established to act as a buffer against cyclical alterations in PO2 and PCO2 between breaths

A

FRC of approx. 25-30ml/kg

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20
Q

Why are neonate and infant lungs prone to collapse?

A

-Weak elastic recoil
-Weak intercostal muscles
-Intra-thoracic airways collapse during exhalation

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21
Q

What can help maintain FRC/lung inflation in the neonate during anesthesia?

A

PEEP of 5cm H2O

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22
Q

Infants terminate the expiratory phase of breathing before reaching their true FRC which results in ________.

A

intrinsic PEEP and a higher FRC.

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23
Q

Initial hyperapneic response is abolished by ______ and ______.

A

hypothermia and low levels of anesthetic gases

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24
Q

What causes profound bradycardia in babies?

A

HYPOXIA!

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25
Contributing factors for apnea in infancy
-Increased O2 consumption 6ml/kg -Decreased FRC (non-functional residual capacity) -Increased closing volume
26
Why do intra and extra cardiac shunts exist?
to minimize blood flow to the lungs while maximizing flow/O2 delivery to organ systems
27
3 shunts of CV system in babies
Ductus Venosus Foramen ovale Ductus Arteriosus
28
Deoxygenated blood travels through the _______ to the _______ to the __________. (very low resistance to flow)
descending aorta umbilical arteries placenta
29
Oxygenated blood returns via _______
the umbilical vein (PO2 35 mm Hg)
30
_________ diverts approx. 50% of blood away from the liver into the IVC then to the RA
Ductus venosus
31
This causes O2 rich blood to be directed across the foramen ovale which connects the right and left atrium
Preferential streaming
32
This process feeds the coronary and cerebral circulations
O2 rich blood fed to the LV and ejected into the aorta
33
PVR is _____ in fetal circulation.
HIGH
34
RV output is delivered across the __________ which connects the _______ to the ________
-Ductus Arteriosus -PA -Descending Aorta
35
Blood entering the _________returns to the placenta and feeds__________. (PO2 22mmHg)
-descending aorta - the lower body
36
Umbilical cord cut =
Increases SVR, reversal of shunts
37
Decrease PVR and reversal of shunts =
Onset of breathing
38
Initiation of ventilation does what to PVR?
decreases drastically blood flow increase 450%
39
Effect of LA and RA upon birth
LA pressure increases RA pressure decreases
40
Ductus Arteriosus: _________ closure in 10-15 hours. _________ closures in 2-3 weeks.
Physiologic Anatomic
41
_________,_________,_________ are the shunts needed for effective fetal circulation that must close after birth to allow effective newborn circulation
foramen ovale, ductus arteriosus, and ductus venosus
42
pulmonary vascular resistance high, systemic vascular resistance low
in Utero
43
SVR high, PVR low, shunts functionally close
Born
44
flow through FO and DA becomes left to right, shunts close, and circulation becomes like that of an adult
Increased SVR, decreased PVR
45
Consequences of PPHN (acidosis and hypoxia)
Increased PVR Decreased PBF RAP > LAP Increased ductal flow This can open the foramen ovale
46
S/S of PPHN
Marked cyanosis Tachypnea Acidosis Right to left shunt across FO and DA = marked cyanosis (right to left = cyanotic shunt)
47
Treatment of PPHN
ADEQUATE VENTILATION AND OXYGENATION IS KEY Hyperventilation – maintain alkalosis Pulmonary vasodilators – prostaglandin Minimal handling Avoidance of stress
48
Major of function of the fetal renal system
passive production of urine which contributes to the formation of amniotic fluid
49
Function of amniotic fluid
is important for normal development of the fetal lung and acts as a shock absorber for the fetus
50
Characteristics of the fetal kidney
Low renal blood flow Low GFR
51
Sodium excretion in neonate
the neonate will continue to excrete Na even in the presence of a severe Na deficit
52
The neonate is considered an _______ (Renal)
“obligate sodium loser”
53
The primary compensatory mechanism for the reabsorption of the Na and H2O losses of plasma, blood, GI tract fluid, and third space fluid during surgery
the RAAS
54
Best fluid for all neonates and premies?
D5 .2% Na Fluids must contain Na!
55
The neonate’s limited thermal range is a function of their _____,______,______.
Small size Increased surface area to volume ratio Increased thermal conductance
56
2 stages of heat loss
-Transfer of heat from body core to skin surface -Dissipation of heat from skin surface to the environment (Both stages governed by the laws of conduction, convection, radiation, and evaporation )
57
electromagnetic energy from the body to colder objects in the room (highest % of loss)
Radiation
58
Heat production is achieved by ........
Voluntary muscle activity Involuntary muscle activity Non-shivering thermogenesis-major component in the neonate
59
Major component of thermal regulation
Non-shivering thermogenesis
60
Cold stress potential consequence in baby
Reopening of fetal circulation (foramen vale and ductus arteriosus)
61
Lowest acceptable Hgb/Hct
35% because of high O2 demand with limited ability to increase CO
62
If not crying? If crying?
If not crying? = monitors first then mask If crying? = mask first then monitors FIRST MONITOR IS ALWAYS PULSE OX
63
Pediatric Airway characteristics
-smaller larynx -narrowest portion is cricoid cartilage -epiglottis is longer and narrower -tongue is proportionally larger -neck is much shorter -LARYNX IS MORE ANTERIOR ANDC CEPHALAD
64
Risk of mainstem intubation is much higher in peds d/t _______.
short teachea and bronchus
65
Cold infants will be ______,_______,and ______.
bradycardic, hypotensive, and slow to awaken -remember infants can not shiver to increase their own body heat
66
Laryngospasm highest risk during which stage of anesthesia
Stage 2 If extubated deep or LMA removed deep and brought straight to PACU – patient will go through Stage 2 while in PACU DO NOT STIMULATE THE CHILD UNTIL AWAKE
67
Newborn vitals
Systolic = 70 Diastolic = 40 HR = 140 RR = 40-60

Peds Anesthesia (3 decks)

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