Week 6 - Neonatal Anesthesia Flashcards

Question

What are considerations of benzodiazepine use in neonates?

Answer 1

Increased duration due to liver immaturity Respiratory depression and severe hypotension can occur after bolus administration

Answer 2

- Used with caution in neonates, may cause significant hypotension, low cardiac output - Delayed clearance and recovery in neonate - Many providers avoid its use in very preterm infants (29-32 weeks due to hypotension) - Reports exist of cardio respiratory collapse in neonates after single induction dose - Not routinely used for prolonged infusions such as ICU setting (propofol infusion syndrome) *Common to use in sedation of full-term infants for diagnostic scans/procedures --- 1-3 mg/kg

Answer 3

PO: 10-15 mg/kg (given preop -- not common to give in neonate prior to anesthesia) PR: 35-40 mg/kg for 1st dose 20mg/kg Q6H for 24 hours (give after induction) IV (Ofirmev): dosing is based on child's size Max Dose = 75 mg/kg per day

Answer 4

Nasobuccal membrane blocks communication between nasal cavity and nasopharynx Oral airway usually needed after induction *associated with CHARGE syndrome

Answer 5

Webs: membranes that partially or completely cover larynx or trachea Subglottic Stenosis: most common need for neonatal tracheostomy

Answer 6

most common vascular tumor in infants - related to PHACES syndrome - medical therapy attempted first (propranolol - bradycardia/hypotension) - surgical therapy

Answer 7

- Patients may be slowly induced with Sevofluane if no IV present, but always kept spontaneously breathing (IV placed prior to induction if airway compromise expected) - Prior to surgical intervention -- anesthetic transitioned to TIVA with possible agents: propofol, dexmedetomidine, ketamine, remifentanil - Glycopyrrolate usually given early in anesthetic - Specific combination of anesthetic very provider dependent – NARROW margin of error in keeping patient spontaneously breathing, adequately anesthetized, yet NOT apneic

Answer 8

-Usually babies can be optimized: IV access, labs (including type and screen), correct anemia and electrolyte imbalances, evaluate for congenital anomalies, echo (?!) -Know what type of defect exists!! -- Preop imaging, rigid bronchoscopy while spontaneous breathing immediately prior to surgical correction to view fistula -Special Equipment: Fiberoptic scope at appropriate size, CMAC with appropriate blade -In-depth discussion of anesthetic plan with all members of care team may be necessary

Answer 9

- Mostly done via thoracoscopy, with lung isolation not necessary -- tip of ETT placed above carina, but distal to the fistula. (Purposely right-main stem, then withdraw ETT until bilateral breath sounds heard) - Verify with fiber optic - Usually baby kept spontaneously breathing until fistula is isolated & ligated -- if stomach becomes inflated, surgeon may have to needle decompress - Gastrostomy may be performed -- allow for Fogarty catheter to be placed through stomach to occlude fistula from below

Answer 10

Neonates are stabilized prior to surgical intervention: including jet ventilation, measures to reduce PVR, iNO, and ECMO NG should always be in place Small TV (high RR), limited peak inspiration pressures, NO, N2O, may need 1 lung ventilation

Answer 11

- Anesthetic planned around location of cyst - May require spontaneous respiration during intubation or bronchial blocker in case of cyst rupture (so contents don’t fall into lung tissue) *rupture may cause hemorrhage or bronchopulmonary fistula formation

Answer 12

- No N2O - If positive pressure is needed, low peak airway pressures/IVs - Single lung ventilation may be needed - Epidural catheter threaded up from caudal space may be useful for pain control

Answer 13

Considered FULL STOMACH -- empty the stomach with OG placed in various positions prior while awake, then modified RSI No opioid used - only LA and acetaminophen

Answer 14

Continue volume resuscitation Prevent hypothermia

Answer 15

Huge volume losses: need large IV access -- hopefully time for CVC -albumin 5%, massive transfusion Hyperkalemia and renal failure common Inotropic support usually needed (epi, dopamine, milrinone)

Answer 16

- Usually patient can be induced supine with donut padding around defect – (may have to be lateral if very large defect) - Prepare for transfusion, may not be needed - Large IV access critical (anticipate possibility of large blood loss) - Usually extubate to ICU afterward - Treat as latex allergy as increased sensitivity has been reported with this diagnosis - +/- muscle relaxants: discuss with surgical team prior to administration

Answer 17

- ETT sizes 2.0 to 3.5 (size 2.0 and 2.5 are uncuffed, micropremie) - Miller 0 (nice to have CMAC) - Neonatal circuit with neonatal HME - Size 1 or 2 mask - Shoulder roll - Percordial or Esophageal stethoscope

Answer 18

EBV x (Child's Hct - Minimum acceptable Hct) / Child's Hct

Answer 19

(Desired Hct - Present Hct) x EBV (70mL/kg x 10kg) / Hct of PRBCs

Answer 20

Preterm = 90-100 mL/kg Term = 80-90 mL/kg 3 months - 1 year = 70-80 mL/kg *preterm neonates can be up to 90% water -- term neonate 75%

Answer 21

- Gestational Age - Any known prenatal concerns (including no prenatal care) - Any maternal factors that would influence baby (gestational diabetes, hypertension, drug abuse) - Any suspected syndromes or anomalies - Is patient being fed (NPO guidelines still apply) -- If not, how are they receiving glucose (and other nutrients) - Any apnea/brady (sometimes documented as “spells” by NICU) - Airway and Oxygen use - Any existing IV access – Labs! - Consent can be tricky and time consuming

Week 6 - Neonatal Anesthesia Flashcards

(45 cards)