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1

Neonatal temp regulation Hypothermia causes

Low body fat content, thin skin, increased BSA, inability to shiver

2

Nenatal temp regulation Causes of hyperthermia

Malignant

3

Infant time to cool down and heat up compared to children and adults

cool down and heat up faster. slope changes with age

4

Rate of resp complications in PACU

1/10/2014

5

Resp comp in PACU

apnea, bronchospasm,
laryngospasm, severe persistent
coughing, and stridor/postextubation
croup. Bradycardia often
accompanies event.

6

Peds airway anatomical differences

– Large head, tounge, tonsils and adenoids
– Anterior and cephalad larynx
– Long, floppy, epiglottis
– Funnel-shaped larynx – cricoid ring is
the narrowest point
– Loose teeth? (5-8 year olds)

7

Age for obligate nasal breathing

subsides at 3-5mos

8

Preferred blade for peds

straight

9

vocal chord angle compared to adults

more angled attachment to trachea

10

Peds nasal intubation

more difficult, blind intub may lodge in anterior commissure.

11

Infant epiglottis

omega-shaped (Ω) and angled away from the axis of the trachea

12

infant or adult ipiglottis is broader

adult

13

ETT tube size

(Age/4)+4

14

ETT depth

(Age/2)+12

15

Uncuffed vs cuffed

Uncuffed<8y/o to avoid post ext stridor and subglottic stenosis

16

Why not cuffed?

smaller ID=more work of breathing, cuff poorly designed for peds and need pressure<25cmH20

17

Why not uncuffed?

more tube changes for long term intubation, leak of gas, more gas flow, higher risk of aspiration

18

If radius is halved, resistance is

16. Resist=1/radius^4

19

Law for resistance

Poiseuille's law

20

Poiseuille's law

R=8nl/pir^4

21

When does cuff not matter?

short cases with ETT sz>4.0

22

Cuffed preferable when

high risk of aspiration, low lung copliance, precise control of vent and CO2

23

Post int croup incidence

1%

24

post int croup risk factors

arge ETT, change in pt position
intraop, multiple attempts at intubation,
traumatic intubation, pts < 4 y/o, surgery > 1
hr, coughing on ETT

25

Post int croup treatment

humidified air, nebulizer treatment, steroid

26

Larygotracheal stenosis incidence

90% prolonged int

27

Peds FRC

28-30cc/kg

28

O2 consuption of infant

6ml/kg. 2x adult

29

Ratio of alveolar minute ventilation to FRC

2x adult

30

Chemorecoptors of term newborn

developed in the
term newborn → hypercarbia WILL
stimulate ventilation