Peds Summary Flashcards
(33 cards)
SBE propylaxis
- Should be given 30-60 minutes prior
- Cefazolin 50 mg/kg or amoxicillin or if true penicillin allergy- doxycycline
- Patients should get it for following risk factors & procedure type: previous endocarditis, CHD repair within 6 months or no previous repair, cardiac transplants with valvopathy, synthetic valve repair
- procedure type: dental exam with abscess, tooth extraction or moving gingiva, respiratory procedure where incision is made, cardiac procedure, infectious skin or neuromuscular procedure
- Not given with bronchoscopy without biopsies, GI or GU procedure (if infectious treat with normal abx.), routine dental cleaning
Apnea of prematurity
- inversely proportional to postconceptual age (= conceptual age + postnatal age)
- apnea >15 seconds is both central and obstructive
- may see bradycardia & desaturations
- Risk factors: low birth weight, anemia, hypothermia, sepsis, neurological abnormalities, & type of surgery
- Risk reduction occurs after 44 weeks PCA (but still exists)
- Can continue to occur for 48 hours postop (even with regional!)
- Management includes: in house admission for all premature infants <60 weeks PCA, deferment of elective surgery until >44-50 weeks PCA, IV caffeine, Nasal CPAP or intubation
Maximum allowable blood loss is:
EBV (100 mg/kg for infants) x (Starting Hct- allowable Hct)/ Starting Hct
NPO guidelines for peds:
2 hours- clear liquids
4 hours- breast milk
6 hours- nonhuman milk, formula
Fetal circulation is characterized by:
high PVR secondary to fluid filled lungs
low SVR secondary to large surface area of placenta
most oxygenated blood from the umbilical vein perfuses the brain & heart by shunting across the liver via the ductus venosus and shunting across the right heart via the foramen ovale
The effect of _________* and __________ produce an oxygen carrying capacity in the fetus that is nearly equal to adults
left shifted Hgb F & polycythemia
Fetal circulation path:
2 arteries bring blood to placenta
1 umbilical vein brings blood (mostly to IVC) as it bypasses the liver via the venosus ductus
right atrium through foramen ovale to left atrium to left ventricle through aorta
also have deoxygenated blood returning from brain through SVC to right atrium and then right ventricle, goes through PA and bypasses lungs through the ductus arteriosus
Circulatory changes at birth include:
lungs fill with gas & pulmonary vascular decreases
decreased PVR so blood flows to lungs & pressure in LA increases over RA pressure closing the atrial septum over the foramen ovale
Placental clamp increases systemic vascular resistance Increase in SVR & aortic pressure > pulmonary artery pressure results in reverse flow through ductus arteriosus
A _________ causes closure of the ductus arteriosus
decrease in prostaglandins
Permanent anatomic closure of the ductus arteriosus is usually complete in
5-7 days
A patent ductus arteriosus results in
congestive heart failure & low diastolic pressure
Preductal versus postductal monitoring.
Preductal- right hand (oxygenated)
postductal- lower limb (may be less oxygenated)
if you see a drop in the postductal sat this means you have a change in your pHTN and should deepen your anesthetic
Describe the difference between the pediatric & adult airway.
tongue- bigger
position of larynx- higher
epiglottis- omega shaped, more difficult to lift
subglottic- smaller & oblong shaped**
vocal cords- lower (caudad) anterior attachment (aka a sharper diagonal line)
trachea- shorter
easier with a straight blade!
Subglottic stenosis:
90% of acquired subglottic stenosis are the result of ETT & prolonged intubation
often requires placement of a smaller ETT
Production of surfactant begins between
23 to 24 weeks of gestation**
_____ remains constant throughout development.
Vt/kg****
Babies have lower numbers of (chest wall tips)
type 1 muscle fibers
chest wall is more horizontal & pliable
more prone to fatigue & apnea for these reasons
Anytime a baby experiences bradycardia & apnea
think airway!
Subglottic stenosis is
90% the result of prolonged intubation with too large of an ETT
often requires placement of smaller ETT
Bronchopulmonary dysplasia is
a form of chronic lung disease that occurs in patients who have survived severe neonatal lung disease
similar to emphysema for adults
cause is uncertain but may be related to frequent collapse & reopening of alveoli
-infants may require supplemental O2, develop lower airway obstruction & air trapping, Co2 retention, atelectasis, bronchiolitis, & bronchopneumonia
-ventilation strategies include small tidal volumes (4-6 mL/kg), greater respiratory rates, PEEP, and minimized inspired oxygen concentration
Retinopathy of prematurity is:
the arrest of normal retinal vascular development in exchange for neovascularization and fibrous tissue formation in the retina
-can lead to retinal detachment & fibrosis
-associated with low birth weight, oxygen exposure, prematurity, apnea, blood transfusions, sepsis, & CO2
Anesthesia saturation goal is 90-94%**
fluctuating oxygen levels may be more damaging than high oxygen tensions
Normoglycemia for infants is
45 to 90 mg/dL**
should be maintained on IV dextrose when NPO & must closely watch
predisposed to hypoglycemia during stress (surgery)
Four routes of heat loss include
radiation > convection > evaporation > conduction
pediatric patients have increased risk for heat loss
utilize non-shivering thermogenesis during the first 3 months of life
Prematurity and the renal system:
significantly reduced ability to compensate for large swings in volume
glomeruli continue to form postnatally until approximately 40 days
renal clearance of drugs is reduced- ability to handle free water & solute loads may be impaired in neonates; half-life of medications will be prolonged
reduced proximal tubular reabsorption of sodium & water