Test 1 Flashcards
(172 cards)
1
Q
1kg = _____g
A
1kg = 1000g
2
Q
1g = ______ mg =______mcg
A
1g = 1000mg = 1,000,000mcg
3
Q
PO Midazolam
A
0.5-0.7 mg/kg
MAX 20 mg
4
Q
Propofol IV
A
2-4 mg/kg
5
Q
Succinylcholine
A
1.5-2 mg/kg
6
Q
Atropine
IV
IM
A
IV 10-20mcg/kg (min 0.1mg)
IM 20-40 mcg/kg
7
Q
Cefazolin
A
30mg/kg
8
Q
Vecuronium
A
0.1mg/kg
9
Q
Fentanyl
A
1-2 mcg/kg
10
Q
Hydromorphone
A
10-20 mcg/kg
11
Q
Morphine
A
0.1 mg/kg
12
Q
Suggamadex
A
2-4 mg/kg
13
Q
Glycopyrrolate
A
10 mcg/kg
14
Q
Neostigmine
A
0.07 mg/kg
MAX 5 mg
15
Q
Ondansetron
A
0.1 mg/kg
MAX 4 mg
16
Q
Ketorolac
A
0.5 mg/kg
MAX 30 mg
17
Q
Infants weighing less than 2500gm at birth known as
A
Prematurity
18
Q
Infant born before 37 weeks
A
Preterm
19
Q
Infant born between 37 and 42 weeks
A
Term infant
20
Q
Infant born after 42 weeks
A
Post-term
21
Q
5 ways premature infant different from full term neonate
A
Less able to:
- suck
- maintain body temp
- swallow
- eat
- sustain ventilation
22
Q
Definition of neonate
A
<30 days
23
Q
Definition of infant
A
1-12 months
24
Q
Definition of child
A
1-12 years
25
Definition of adolescent
13-19 years
26
Low birth weight
Less than 2.5 kg
27
Extremely low birth weight
Less than 1 kg
28
Very low birth weight
Less than 1.5 kg
29
Micro-preemie
Less than 750 gm
30
Deviation in relationship between duration of gestation and weight of infant may be associated with
- inadequate maternal nutrition
- significant maternal disease
- maternal toxins
- fetal infections
- genetic abnormalities
- fetal congenital malformations
31
___________ is more sensitive index of well-being, illness, or poor nutrition than length or head circumference
Weight
Most commonly used measurement of growth
32
Full term birth, infant has _______ and _______ that meet the chest at level of _____ rib.
Causes to be more prone to
Short neck and chin
2nd rib
Upper airway obstruction during sleep
33
Infants are more prone to upper airway upstruction under GETA because
Upper airway muscles are disproportionally sensitive to depressant effects of GETA
34
Major differences between neonatal and adult airway (2)
Tongue relatively large in proportion to rest of oral cavity = easily obstructs
Larynx is more cephalad in infants (C2-3 vs C4-5)
35
____ primary teeth. Begin to shed at _____ years
20
6-12 years
36
Many infants have some degree of ________ which renders supraglottic structure prone to collapse with inspiration
Laryngomalacia
37
To improve airflow during upper airway obstruction in pediatric airway
Chin lift
Jaw thrust
CPAP 5-15 cm H20 on APL
38
Avoid nasal trumpets in children with
Coagulopathy and/or thrombocytopenia
Suspicion of traumatic basilar skull fracture
39
LMA for <5kg
1
40
LMA for 5-10 kg
1.5
41
LMA for 10-20kg
2
42
LMA for 20-30kg
2.5
43
LMA for 30-50kg
3
44
LMA for 50-70 kg
4
45
Formula for selecting correct ETT
Uncuffed
(Age (yrs) + 16) / 4
46
Formula for selecting cuffed ETT
(Age (yrs) + 16) / 4
Go down at least 1/2 size
47
ETT depth 1-12 months
10cm
48
ETT depth 6 year old
14-15cm
49
ETT depth 10 years old
16-17cm
50
ETT depth for 16 years old
18-19cm
51
Black line marking at ETT should rest
Right at vocal cords
Will put tip of ETT between carina and cords
52
Narrowest part of infants larynx
Cricoid cartilage
53
5 ways neonatal airway differs from adult airway
- larger tongue
- larynx more cephalad
- epiglottis short, stubby, omega shaped, angled over laryngeal inlet
- angled vocal cords
- infant larynx more funnel shaped,
54
Purpose of leak test
Prevent airway edema and post intubation stridor
55
Pattern for depth of ETT
10 + age in years
56
Laryngospasm elicited by stimulation of _____________
Afferent fibers of internal branch of superior laryngeal nerve
57
Inspiratory stridor
Partial laryngospasm
58
No air movement, tracheal tug, paradoxical chest movement, bradycardia, desaturation
Complete laryngospasm
59
Laryngospasm treatment
- identify and remove stimulus
- jaw thrust
- oral or nasal airway
- positive pressure ventilation 100% 02
- deepen anesthesia with Sevo or 0.5mg/kg Propofol
- 0.1-1mg/kg Succ IV or 4 mg/kg IM
W/ atropine 10-20mcg IV, 20-40mcg IM
60
Laryngospasm occurs during induction of pediatric patient. IV hasn’t been placed. Which 2 muscle relaxants can be given IM to break laryngospasm in this patient
Succinylcholine or Rocuronium
61
Succinylcholine dose IM peds
4 mg/kg
62
2 year old develops laryngospasm postoperatively and becomes bradycardic. Should atropine be given prior, concurrently, or after succinylcholine
Atropine then succinylcholine
Succinylcholine mimics effect of Ach at cardiac muscarinic receptors, which can precipitate more severe bradycardia, junction alone rhythms, or sinus arrest
63
Limit of viability is
Around 24th week
64
At limit of viability the lungs develop what (2)
Gas-exchanging surface
Surfactant production begins
65
Surfactant produced by
Type II pneumocytes
66
Clinically useful indicator on lung maturity
Lecithin-Sphingomyelin (L/S) ratio
Surfactant secretion increases
67
Inspiration in infants occurs almost entirely as a result of
Diaphragmatic descent
68
In awake state of infant what maintains FRC
Sustained inspiratory muscle tension
69
Under GETA in infants what occurs in relation of airway
Inspiratory muscle tension abolished and FRC collapses -> airway closure and atelectasis unless CPAP or PEEP maintained
70
Recurrent pauses in ventilation lasting _________ with alternating bursts of respiratory activity is normal
5-10 seconds
71
Surgery in neonates poses a major concern- development of apnea in post-op period. Which neonates at highest risk? (4)
- prematurely born
- multiple congenital anomalies
- hx of apnea and bradycardia
- chronic lung disease
72
Risk of postanesthetic respiratory depression is inversely related to
Gestational age and post conceptual age(PCA)
73
PCA is
Sum of gestational age and chronological age
74
Criteria for discharge from PACU
Should be admitted
< 55 weeks PCA
Anemic (HCt <30%)
Ongoing apnea
75
Criteria to discharge from PACE
Observed for extended time and later discharged if stable
Former preterm infants 55-60 weeks PCA
Not anemic
No apnea
76
URI may
Increase airway sensitive, cause desaturation, laryngospasm, bronchospasm, breath holding, severe coughing
77
When should elective surgery be postponed r/t URI
Mucopurulent secretions
Productive cough
Fever >100.4
Pulmonary involvement
78
Asthma is characterized by
Variable and recurring symptoms
Airway obstruction
Inflammation
Hyperresponsiveness of airways
79
Should be given shortly after induction to pt with asthma
B2 agonist
Corticosteroids
80
Tx of intra-op bronchospasm
Deepen anesthesia/analgesia
Increase Fi02
Increase expiratory time (1:2.5)
Repeat Beta 2 agonist
If severe epi 10-20 mcg IV or ETT
81
At what conceptual age is surfactant developed
23-34 weeks and increases in concentration during last 10 weeks of gestation
82
Infant patient is high-risk for post-op apnea. What agent may be given prophylactically to decrease risk of apnea?
Caffeine 10mg/kg
83
Would a formerly premature infant be a candidate for outpatient surgery?
What are anesthetic concerns?
No.
<55 weeks PCA increased risk of post-op apnea and bradycardia
Formerly premature infants should have cardiorespiratory monitoring for minimum of 24 hours
84
How many breaths per minute should be produced by ventilator for neonate? Adult?
30-50 for infant
12-16 for adult
85
How do infants react to hypoxia?
Bradycardia progressing to cardiac arrest
86
What is appropriate internal diameter of ETT for premature newborn? Full term newborn?
2. 5-3.0 mm for premature (uncuffed)
| 3. 0-3.5 full term (uncuffed)
87
What size ETT and length for neonat, 2yo, 6yo, and 10yo?
Neonate- 3.0-3.5. 10 cm
2yo- 4.5 and 13 cm
6yo- 5.5 and 15cm
10yo- 6.5 and 17cm
88
Why are infants more prone to airway obstruction than adults?
Proportionally larger tongue than adults
89
How does chest wall compliance and pulmonary compliance differ in neonate compared with adult?
Increased chest wall compliance and decreased pulmonary compliance
Chest wall easer to dissent bu lung is more difficult to distend
90
In newborn closing capacity is higher than FRC. This means
Some airways close during expiratory phase of normal tidal breathing
91
Why is subglottic stereos is more severe in peds patient than adult
Relatively small cross-sectional area in peds
Small amount of swelling can rapidly occlude airway
92
What is tidal volume of neonate in ml/kg?
6-8 ml/kg
93
What is minute volume per kg for neonate?
Minute ventilation = TV X RR
94
Foramen Ovale allows flow where
RA to LA
95
Ductus arteriosus allows flow where
PA to Aorta
96
Fetal circulation:
of umbilical veins and arteries
1 umbilical vein
2 umbilical arteries
97
What allows flow to bypass liver
Ductus venous
98
Fetal circulation
Which is higher PVR or SVR
high PVR
Low SVR
99
What causes closure of foramen ovale
As breathe lungs inflate reducing PVR. SVR increases after umbilical cord cut.
As LA pressure increases over RA pressure the flap closes shutting the foramen ovale
100
What causes closure of ductus arteriosus
Reduced levels of prostaglandins causes closure of DA and FO within days after birth
101
Blood shunt through what two structures in the neonate with persistent fetal circulation
Blood shunt through ductus arteriosus and foramen ovale
102
During early neonatal period hypoxia causes what
Reversion to fetal circulation.
PVR increases and reopens foramen ovale and/or ductus arteriosus
103
Hypoxia causes (4)
Pulmonary vasoconstriction (increased PVR)
Systemic vasodilation (decreased SVR)
Bradycardia
Decreased cardiac output
104
ANS in neonates is predominately
PNS
Slowly improving SNS
105
Cardiac output in neonates is largely dependent on what?
Why?
CO is rate dependent
Fixed stroke volume
106
Less compliant LV in neonate is dependent on
Rate and adequate filling
107
Hypovolemia in neonate is followed by
Fall in cardiac output
108
2 ways physiology of CV system of neonate differed from that of the adult
CO is heart rate dependent
LV compliance is decreased
109
Appropriate heart rate range for term infant
When do you do CPR
120-180
Rate <100 CPR
110
Infants systolic arterial BP is closely r/t
Circulating blood volume
111
Neonate H/H
Hct 60%. Hgb 18-19
112
Most Hgb in neonate is what type? Impact
Fetal Hgb
Higher affinity for O2. Shifts oxyhemoglobin curve to LEFT
113
During the first few months of life what occurs with Hgb
H/H decline steadily and HgbF replaced by HgbA
O2 delivery to tissues not compromised and curve shifts to the RIGHT
114
Hgb concentration at 2 weeks, 2-3 months, and 2 years
2 weeks- 13-19
2-3 months 10-11
2 weeks <12.5
115
4 ways children pharmacokinetics differ from adults
Altered protein binding
Larger volume of distribution
Smaller proportion of fat and muscle stores
Immature renal and hepatic function
116
When do liver enzymes become completely functional in the neonate
Cytochrome P450 enzyme is fully functional at 1 month of age
117
Physiologic jaundice is due to
Breakdown of RBCs release bilirubin and the newborn liver is immature and cannot conjugate
118
Grave form of jaundice of newborn characterized by
High levels of unconjugated bilirubin in blood
Degenerative lesions in cerebral gray matter
Kernicterus (bilirubin encephalopathy)
119
What drugs may cause kernicterus in the neonate
Furosemide
Sulfonamides
Diazepam
120
What causes kernicterus
Toxic effects of unconjugated bilirubin on CNS
121
S/S of kernicterus
Hypertonicity
Opisthotonos
Spasticity
122
Number one condition associated with apnea and bradycardia in preterm infants
GERD
123
Fetal pancreas secretes insulin from when
11th week of fetal life
124
Uncontrolled maternal hyperglycemia results in
Hypertrophy and hyperplasia of fetal islets of Langerhans
Increased levels of insulin in fetus
125
Increased levels of insulin in fetus results in
Affects lipid metabolism giving rise to large, overweight infants
126
Hyperinsulemia of fetus persists after birth and may lead to
Serious hypoglycemia which can lead to irreversible CNS damage
127
To prevent hyperglycemia during GETA in neonates
dextrose free IVF (LR) should replace small blood loss, third spacing, and deficit fluid losses
128
Insensible fluid losses in infancy
Relatively high due to high respiratory rate and thin skin of LBW infants
129
Infants have limited ability to do what which leads to dehydration developing rapidly
Limited ability to concentrate urine and conserve water
130
2 limitations of kidney function in newborn and significance
GFR 15-30% of normal adult- decreased ability to concentrate urine
Tolerate water and salt loads poorly
131
Pre op NPO recommendations
Clears
Gum
Breast milk
Formula/light meals
Solids (fatty)
Clears and gum 2 hours
Breast milk 4 hours
Formula/light meals. 6 hours
Solids (fatty) 8 hours
132
Infants are predisposed to hypothermia due to what
Large skin surface compared to body mass ratio
Evaporative heat loss greater
Reduced keratin content
Diminished efficacy of thermoregulatory response
133
Impact of volatile and regional anesthetics in infants in relation to thermoregulation
Cause vasodilation = greater blood flow to surface of bodies
Disrupt thermoregulatory mechanism
134
Most perioperative heat loss is due to
Environment
135
First hour heat loss during surgery is due to
Core-to-peripheral redistribution of body heat
136
4 primary processes of heat loss in patients
Radiation
Convection
Conduction
Evaporation
137
Most significant mechanism of heat loss by out bodies
Radiation
138
Transfer of energy between 2 objects that are not in direct contact but differ in temperature
Radiation
139
What part of bodies lose greatest amount of heat
Heads
140
Process of creating air currents by heat
Convection
141
Convection MOA in bodies
Transfer kinetic energy to air molecules on surface of skin. Heated air molecules replaced by colder air molecules
142
What percent of total heat loss from body occurs from radiation and convection
Radiation 40%
Convection 30%
Total 70%
143
Moisture evaporated from the patients skin as well as through the respiratory tract
Evaporation
144
Which route does a burn patient lose the highest percentage of body heat
Evaporation
145
Transfer of heat by physically in direct contact with less warm object
Conduction
146
Rank routes of heat loss
Radiation
Convection
Evaporation
Conduction
147
5 ways to prevent heat loss in OR
Using forced warm air devices
Lower FGF
Humidification systems
Warming the OR
Covering and insulating patients
148
Infants rely primarily on what to generate heat
Non-shivering thermogenesis
149
Brown adipose tissue is located where
Scapulae, axillary, mediastinum, around kidneys/adrenal glands
150
Physiology of brown fat temperature homeostasis
Brown color caused by abundance of mitochondria that are able to uncouple oxidative phosphorylation, resulting in heat production
151
Non shivering thermogenesis may persist up to age of
2
152
What reduces nonshivering thermogenesis in infants (anesthetics)
Inhalation agents
Propofol
Fentanyl
153
Cold stress and hypothermia affects
Recovery from anesthetic and relaxant drugs
Impairs coagulation
Depress ventilation
Dysrhythmia
Increased post-op 02 consumption
154
Significance of brown fat?
Cold stress resulting in increased NE production, enhances metabolism of brown fat and increased body heat
155
Body responses during hyperthermia stress are limited to
Active vasodilation and sweating
156
Posterior fontanelle closes when
4 months
157
Anterior fontanelle closes when
9-18 months
158
Autoregulation of CBF is dependent on what
Pressure dependent
159
Predisposing factors for intracranial hemorrhage
Hypoxia
Hypercapnia
Hypernatremia
Functuations in arterial/venous pressure or CBF
Low Hct
Overtransfusion
Rapid administration of hypertonic fluids (dextrose/bicarb)
160
Retinopathy of prematurity occurs in
50% of extremely low birth weight infants
161
During anesthesia for premature and term neonates do what to prevent retinopathy of prematurity
02 saturations between 90%-95% and avoid significant fluctuations in 02 sat
162
At what gestation age does the risk of retinopathy of prematurity become negligible
After 44 weeks postconception age
163
Neonatal retrolental fibroplasia is a result of oxygen toxicity above what % Fi02
Above 40% oxygen
164
Ophthalmology cases
If eye looks upward do what
Increase anesthesia depth
165
Ophthalmology cases
Eye rotates down
Decrease anesthesia depth
166
Most common cause for liver transplantation in children
Cholestatic liver disease secondary to biliary atresia
167
Pediatric fluid replacement for blood loss is best determined by which method of monitoring
Hct
168
4 reasons why difficult to keep newborns warm
Large surface area to body weight ratio
Cannot compensate by shivering
Limited to subcutaneous fat for insulation
Limited stores of brown fat and unstable thermoregulatory systems
169
What route do infants lose most of body heat
Radiation
170
Newborns produce heat primarily by what mechanism
Non-shivering thermogenesis of metabolism of brown fat
171
What controls non-shivering thermogenesis in infants
Autonomic nervous system
172
Best way to maintain infants body heat
Maintain high ambient termperature
