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Pediatrics > peds deck 9 > Flashcards

peds deck 9 Flashcards

1
Q

cerebral palsy is a disorder of _____________ & ______________

A

motor ability; muscle tone.

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2
Q

80% of cases of CP are _________________; while 6% come from ____________, and can also be acquired after neurologic injury, most commonly from ______________

A

prenatally acquired; hypoxic injury at birth; meningitis

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3
Q

anesthesia implications for pt with cerebral palsy

A
  1. can be spastic –> difficulty with positioning 2. poor muscle tone (consider diaphragm and heart) 3. poor vascular tone 4. poor temperature regulation 5. commonly have seizures/epilepsy - AVOID MEPERIDINE 6. scoliosis common
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4
Q

anesthesia considerations for the pt with Autism spectrum d/o

A
  1. be careful of preoperative medications 2. discuss preop medications/distraction techniques with caregivers (i.e. find out what works for the child)
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5
Q

anesthesia considerations for the pt with epilsepsy

A
  1. consider their at home medications 2. careful with preop medications 3. want them to take seizure meds DOS 4. metabolize medications (may need to redose NMBA more frequently) 5. NO MEPERIDINE
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6
Q

there are _________ types of spinal muscular atrophy and are classified by _____________

A

5; onset of sx

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7
Q

why do pts with spinal muscular atrophy commonly present for surgery?

A
  1. G-tubes 2. eventually need trach and become vent depedent
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8
Q

T/F: pts with spinal muscular atrophy are NOT neurologically intact

A

FALSE

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9
Q

pt presents for surgery and has Duchenne’s MD, what is the risk you should be concerned about

A

MD, specifically Duchennes can trigger MH crisis; plan for non-triggering anesthetic

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10
Q

pt comes in with Muscular dystrophy, but does not know they type, and it is not indicated in the chart, what should you plan for?

A

non-triggering anesthetic

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11
Q

how would you do a non-triggering anesthetic for the pt at risk for MH? (duchennes MD)

A
  1. flush machine according to manufacturers recommendation 2. utilize charcoal filters 3. ensure no succinylcholine is out 4. tape volatile agents
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12
Q

_______________ is the absence of parasympathetic ganglionic cells in the bowel –> may result in needing bowel resection

A

Hirschsprungs

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13
Q

Risk factors for the development of persistent pulmonary htn of the newborn

A
  1. birth asphyxia (most common) 2. maternal use of prostaglandin inhibitors near term (NSAID, ASA) 3. Diaphragmatic hernia 4. microthrombus
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14
Q

_________________ is associated with increased muscularization of pulmonary arterial vessels, sepsis, and aspiration syndromes

A

persistent pulmonary htn of the newborn

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15
Q

diagnosing persistent pulmonary htn of the newborn

A
  1. echo = shunting across PDA; tricuspid regurg 2. holosystolic murmur 3. hx by interview that indicates: meconium aspiration, abnormal FHR monitor 4. sx: cyanosis, respiratory distress with tachypnea but minimal retractions 5. lg shunt: PAO2 gradient > 20 mmHg
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16
Q

goals in treating persistent pulmonary htn of the newborn

A
  1. decrease PVR 2. improve oxygenation 3. correct acidosis 4. correct myocardial dysfunction
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17
Q

tx for persistent pulmonary htn of the newborn

A
  1. tx underlying cause 2. high frequency jet ventilation (HFJV) 3. Nitric Oxide (mainstay of therapy) 4. sildenafil (pulmonary VD) 5. inotropes 6. if HFJV & NO fail = ECMO
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18
Q

what is the only therapy/tx for severe combined immunodeficieny d/o (SCID)

A

stem cell transplant

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19
Q

__________________ is where both T cell and B cells are very low or absent causing infants to have recurrent and severe infections

A

severe combined immunodeficiency (SCID)

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20
Q

which pediatric d/o are autosomal recessive

A
  1. Hurlers 2. Cystic Fibrosis 3. Spinal muscular atrophy
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21
Q

which pediatric D/o’s are autosomal dominant

A
  1. Crouzons 2. Apert 3. Treacher Collins (40% - less common)
22
Q

new mutation is the most common presentation of __________________ & ________________

A

apert syndrome; Treacher Collins (60%)

23
Q

______________ blood flow = parallel circuit with both LV and RV sending oxygenated and deoxygenated blood, mixing with shortcuts

A

prenatal (in-utero)

24
Q

_______________ blood flow = serial circuit with two pumps (LV and RV) and two different systems (cardiac and pulmonary)

A

postnatal

25
Q

the ductus arteriosus closes in 98% of term infants by day ____________

A

4

26
Q

after birth the foramen ovale is _____________ closed due to increased pressures in the left side of the heart; however, remains _____________ open in 50% of children < 5 and in 25-30% of adults

A

functionally; anatomically

27
Q

CO in the neonate is ____________ dependent

A

HR

28
Q

T/F: SV in the neonate is fixed

A

TRUE

29
Q

PVR _____________ after birth until around 6 mo of age - where it reaches adult levels

A

decreases

30
Q

what increases PVR

A
  1. PEEP 2. high airway pressures 3. atelectasis 4. low FiO2 5. respiratory & metabolic acidosis 6. increased hct 7. SNS stimulation 8. direct surgical manipulation 9. vasoconstrictors: phenylephrine
31
Q

what decreases PVR

A
  1. no PEEP 2. low airway pressures 3. lung expansion to FRC 4. high FiO2 5. respiratory & metabolic alkalosis 6. low hct 7. blunted stress response (deep anesthesia) 8. Nitric Oxide 9. Vasodilators: milrinone, prostacyclin
32
Q

_______________ shunt is when deoxygenated blood from systemic veins flows directly into aorta –> recirculation of deoxygenated blood in systemic circulation

A

right to left

33
Q

_____________ shunt is when oxygenated blood from pulmonary veins –> PA –> recirculation of oxygenated blood within the pulmonary circulation

A

left - to - right

34
Q

interventions to decrease shunt

A
  1. decrease stress 2. keep them warm 3. keep them appropriately hydrated (according to comorbidities/heart pathology)
35
Q

what are some examples of single ventricle d/o

A
  1. hypoplastic left heart syndrome 2. pulmonary atresia with intact ventricular septum 3. tetralogy of fallot with pulmonary atresia 4. interrupted aortic arch
36
Q

_______________ will cause mixing of systemic and pulmonary blood causing mixed blood to go into both systemic and pulmonary circulations

A

single ventricle

37
Q

EKG considerations in the pediatric pt

A
  1. no change in P wave 2. PRI increases with age 3. QRS-interval increases with age 4. shift from R-axis to L-axis QRS 5. t-wave inversion in V4R, V-V4 from 1 week-adolescents
38
Q

CO in the infant is __________x that of the adult at rest

A

2

39
Q

what is a normal CO in the child

A

200 ml/kg/min - 325 ml/kg/min

40
Q

the increased CO in the child reflects higher __________ and ____________

A

BMR; O2 consumption

41
Q

__________________ is when the SVC and IVC are surgically connected directly to the pulmonary artery without a pumping chamber

A

fontan

42
Q

Fontan procedure is commonly performed for what disorders

A
  1. single ventricle (originally developed for this) 2. tricuspid atresia 3. HLHS
43
Q

with fontan circulation, pulmonary blood is driven by _______________ pressure gradient, thus need adequate ___________ and decreased ____________

A

nonpulsatile; preload (volume); PVR

44
Q

anesthesia implications for fontan

A
  1. adequate preload 2. decreased PVR
45
Q

what medications can you use in the transplanted heart if the pt is hypotensive

A
  1. epinephrine 2. isoproterenol 3. dobutamine
46
Q

caution the use of ______________ in the transplanted heart due to risk that heart may not start back; also caution ____________ due to risk of severe bradycardia

A

adenosine; neostigmine.

47
Q

anesthetic considerations for the pt with hypertrophic cardiomyopathy

A

ensure they are adequately hydrated (i.e. increase preload)

48
Q

anesthesia considerations in the pt with kawasaki dz

A

careful consideration and balance between myocardial oxygen supply and demand

49
Q

which pediatric patients DEFINITELY get endocarditis abx prophylaxis

A
  1. prosthetic valves 2. hx of infective endocarditis 3. unrepaired cyanotic congential heart disease (incl palliative shunts and conduits) 4. completely repaired defects repaired with prosthetic material for 6 months after procedure 5. cardiac transplant pts with valve regurg)
50
Q

if child is recieving endocarditis abx prophylaxis the dose will be __________x their normal dose; however it should NOT exceed ____________ dose

A

2; adult

Pediatrics (15 decks)

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