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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

other associated cardiac anomalies with DS

tetralogy of Fallot and PDA
(all have propensity for increased pulmonary blood flow)