Flashcards in Peds II Part I Deck (109)
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1
What is considered an ex premature infant?
<37 weeks and <60 weeks postconceptional age
2
How long should expremature patients be monitored after general surgery?
12-24 hours for apnea and O2 desaturation
3
what are the factors that increase risk of periop apnea
< 60 weeks postconceptual
anemia <12 gm Hgb
secondary diagnoses (intraventricular hemorrhage)
4
should you avoid opioids in expremature infants in genral?
yes
5
what caffeine dose can be used to decrease the frequency of apnea in expremature infants?
10mg/kg
6
when can an expremature infant be discharged after general?
12 hrs free of apnea
7
does regional increase risk of periop apnea?
no
8
what valve is involved in Ebstein's anomaly?
tricuspid
9
what portions of the tricuspid valve leaflets are displaced into the RV?
septal and posterior
10
is the anterior valve leaflet of the Tricuspid abnormal in Ebsteins anomaly?
yes
11
describe the anterior valve of the tricuspid in Ebsteins anomaly
elongated and sail like with chordal attachments to the RV free wall
12
is there an RV outflow tract obstruction in ebsteins?
maybe
13
is the tricuspid valve regurgitant or stenotic in ebsteins?
usually regurgitant (may be stenotic)
14
what type of interatrial communication is present in ebsteins?
R to L shunting
15
what happens to the RA in Ebsteins?
dilated
16
what happens to the RV in Ebsteins?
atrialized and reduced cavity
17
neonatal clinical presentation of Ebsteins
systemic venous congestion
cyanosis
worsens after ductus arteriosis closes
18
older children clinical presentation of Ebsteins
incidental murmur
19
adolescent and adult presentation of Ebsteins
SVT to CHF
worsening cyanosis
occasional syncope
20
what are the risks for Ebsteins?
paradoxical embolizaiton
brain abcess
CHF
sudden death
21
What are the signs and symptoms of Ebsteins anomaly? (thats right...there is more)
cyanosis (depends on R to L shunt)
systolic murmur (left lower sternal border)
hepatomegaly
tall broad P waves, 1st degree block
PST and VT
WPW (20%)
22
treatment options of ebsteins
tricuspid valve repair to fontan procedure to transplant
23
associated complications after Ebsteins anomaly repair
infective endocarditis
CHF
SVT
24
what are the surgical goals of Ebstein anomaly repair?
repair or replace tricuspid valve
repair atrial defect
25
complications after ebsteins anomaly repair
3rd degree AV block
SVTs
residual tricuspid regurg
prosthetic valve dysfunction
26
is the effect of IV anesthetics effected in Ebsteins?
yes; usually delayed effect of IV anesthetics
27
what are the major anesthetic hazards associated with ebsteins?
depressed RV function
increases in R to L shunt
SVTs
28
Other goals of anesthetic management of Ebsteins
minimize mechanical metabolic affects of ventilation
maintain RV contractility
29
3 most common cardiac anomalies related to trisomy 21
complete atrioventricular canal defect (40%)
ventricular septal defect (25%)
atrial septal defect (10-15%)
30
