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Anesthesia 101 > ITE Peds 1 > Flashcards

ITE Peds 1 Flashcards

1
Q

Preterm Infants who ingest cow milk (not formula or breast) before the age of ____ are at increased risk of _____.

A

12 months

Iron deficiency anemia

*infants age 6 mo - 3 yrs have high iron requirements d/t increased growth

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2
Q

Progress for treatment of iron deficiency can be tracked with ______

A

reticulocyte count

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3
Q

If a pt has a patent ductus arteriosus (PDA) and low pulmonary vascular resistance, blood will preferentially travel to the ____, and overtime, result in ______

A

lungs
- large diastolic run off from aorta to pulmonary artery

Congestive heart failure

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4
Q

Blood enters the fetus via the ______, then passes ____, unless it bypasses it via the _____ to the IVC

A

single umbilical vein

through the liver

ductus venosus

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5
Q

In the fetus, pulmonary vascular resistance is (higher/lower) than systemic vascular resistance.

A

higher

- very small fraction of blood flow enters the pulmonary tree, and majority enters the aorta via ductus arteriosus

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6
Q

Both the ________ and _______ are present in the fetus to shunt blood systemically away from the pulmonary bed since the lungs serve no major function.

A

Ductus arteriosus (PDA) and foramen ovale

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7
Q

_____% of adults have a patent foramen ovale

A

25-30%

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8
Q
  1. Decrease in PVR
  2. Increase in SVR
  3. Increase in PaO2 > 50 mmHg
  4. Normocarbia

All result in (Opening/Closure) of the ductus arteriosus

A

Closure

  • PaO2 >50 mmHg causes arterial sm of the ductus to contract)
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9
Q

Indomethacin is a ______ inhibitor and therefore inhibit prostaglandin synthesis.

A

nonselective cyclooxygenase (COX) inhibitor

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10
Q

In certain cyanotic heart lesions, ________ can help keep PDA open for survival and prevent hypoxemia

A

PGE1, alprostadil

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11
Q

Examples of cyanotic heart lesions leading to impaired pulmonary blood flow

  1. Pulmonary atresia
  2. Critical pulmonary stenosis
  3. Transposition of the great arteries
  4. Severe subpulmonic stenosis with VSD
  5. TOF

These are special and require__________

A

keep PDA open with PGE1 for survival and prevent hypoxemia

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12
Q

Congenital heart disease pearl:

A

What does not see flow, will not grow

  • inadequate or absent blood flow = impaired growth of heart structures
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13
Q

Physiological anemia of the newborn typically occurs at age ____ at a value of ___ g/dL.

A

8-12 weeks of age

11 g/dL

Does not require treatment!

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14
Q

Anemia occuring at 4-8 weeks of age is most likely d/t _______

A

anemia of prematurity or hemolytic anemias

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15
Q

Anemia occuring at 12-16 weeks of age is most likely _______

A

not physiologic and needs to be further evaluated.

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16
Q 
Spinal anesthesia (subsarachnoid space) in infants.
- How is the onset of action and duration of action different?
A

More rapid onset
Shorter duration of action

d/t higher Cardiac output, highly vascular pia matter, and loose myelination that provides little barrier for drug diffusion across spinal cord

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17
Q

How does the intrathecal space and CSF pressure differ in infants vs adults?

A

narrower intrathecal space

decreased CSF pressure

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18
Q

Spinal cord infants terminate at ____ until 2 years of age

A

L3

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19
Q

How common is hypotension and bradycardia infants during spinal?

A

Rare

  • d/t compensatory vagal responses
  • Immature SNS
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20
Q

CSF volume in:

  • Neonates
  • Infants
  • Children
  • Adults
A
  • Neonates: 10 mL/kg
  • Infants: 4 mL/kg
  • Children: 3 mL/kg
  • Adults: 2 mL/kg
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21
Q

How does a high spinal manifest in infants?

A

Apnea
- lack of thoracic kyphosis leads to increased cephalad spread of LA

*NOT CV collapse

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22
Q 
Estimated blood volume:
Premature infant
Full term newborn
Infant (3-12mo)
Child (1-12 yrs)
Adult male
Adult female
A 
Premature infant: 100 ml/kg
Full term newborn: 90 mL/kg
Infant (3-12mo): 80 mL/kg
Child (1-12 yrs): 75 mL/kg
Adult male: 70 mL/kg
Adult female: 65 mL/kg
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23
Q

Which congenital heart disorder is common in pts with pectus excavatum?

A

Mitral valve prolapse

- RV outflow tract obstruction

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24
Q

Most common side effect of succinylcholine in pediatric pt that it should be expected?

A

Bradycardia

  • succ is 2 ACh molecules chemically linked, and can activate muscarinic receptors in sinus node
  • pretreat with atropine (muscarinic antagonist) if pt < 1 y.o
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25
Q

K is expected to rise in serum by ___ mEq/dL after admin of Succinylcholine

A
  1. 5 mEq/dL

* K release can be profound (huge surge) if pt has dmged or denervated muscle fibers –> fatal arrhythmia

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26
Q

Cole formula for internal diameter of uncuffed ETT

A

(Age/4) + 4

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27
Q

Ideal local anesthetic for ureteral procedures should cover ____ somatic and visceral distributions

A

T10-L2

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28
Q

Epidurals usually have sacral sparing d/t:

A
  • tendency of epidural boluses to travel upwards
  • thicker nerve root sheaths
  • larger diameters of sacral root fibers
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29
Q

_________ techniques are superior in achieving reduced bladder spasms and incisional pain control after open surgery for VUR

A

Caudal catheter

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30
Q

Approximately __% of omphaloceles are associated with congenital cardiac anomalies.

A

20%

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31
Q

Infants with cyanotic heart disease do not usually experience postnatal fall in hgb [ ] since _______

A

continued hypoxemia maintains erythropoiesis

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32
Q

The fetus uses ____ mL/kg/min of oxygen, compared to adult oxygen requirement of ____ mL/kg/min.

A

fetus: 8 mL/kg/min
adult: 3 mL/kg/min

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33
Q

The placenta uses __% of oxygen delivered to it, leaving __% of the oxygen to be transferred to the growing fetus

A

40%

60%

*the more the placenta consumes, the less the fetus gets

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34
Q

Fetal hgb has a greater oxygen affinity (Right/Left) shift than maternal hgb

A

Left shift

- hgb “sink” promotes transfer of oxygen

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35
Q

During alkalotic conditions, oxygen has a (greater/lesser) affinity for hgb

A

greater

*in the lung, oxygen binds to hgb with greater affinity

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36
Q

physiologic effect that describes hgb’s affinity for oxygen at different conditions

A

Bohr effect

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37
Q

Condition in the placenta where the maternal bohr effect and the fetal bohr effect occur in opposite binding conditions. Accounts for 2-8% of oxygen transfer across placenta

A

double bohr effect

  • maternal side: hgb is in an acidic environment = promote oxygen offloading
  • fetal side: hgb is in alkalotic state, promotes oxygen uptake
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38
Q
  1. Higher fetal hgb [ ]
  2. Bohr effect
  3. Double Bohr effect
    - help promote oxygen transfer from ____ to ____
A

mother to fetus

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39
Q

Dosing for caudal epidural block using 0.2% ropivacaine is ___ mL/kg.
This will provide coverage from _____ to ____ dermatomes

A

1 mL/kg
- sacral to low thoracic dermatomes

  1. 5 mL/kg
    - only cover sacral dermatomes
  2. 25 mL/kg
    - cover up to mid thoracic
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40
Q

4 T’s of a mediastinal mass

A
  1. Thymoma
  2. Teratoma (other germ cell tumors)
  3. Thyroid neoplasm
  4. Terrible Lymphoma
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41
Q

Which mediastinal mass is the most common anterior mediastinal mass in children?

A

thymomas

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42
Q

The ______ is the central space of the thoracic cavity located behind the sternum and between the two lungs and their respective pleura.

A

mediastinum

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43
Q

In newborns, the dural sac typically ends at __, and the conus medullaris at __

A

S3

L3

*adults its S1-2 and L1-2

44
Q

How does increased intraabdominal pressure (ie: insufflation) affect a CSF shunt?

A

hinders output

45
Q

What questions can the anesthesiologist ask to assess ventriculoperitoneal shunt function?

A

Nausea
Headache
blurred vision

46
Q

How does increased intraabdominal pressure (ie: insufflation) affect a Cerebral venous return?

A

decreased

47
Q

(True/False) males are at the same risk for PONV as females until puberty

A

true

  • kids are also 2x more likely to develop PONV than adults
  • increased risk of dehydration, postop bleeding, aspiration, wound dehiscence
48
Q

What is the MOA of emend?

A

it is aprepitant, a NK-1 receptor antagonist w/ similar efficacy to zofran at preventing PONV, especially at 24-48 hours post op

49
Q

Why is respiration less efficient in children when they have a more compliant chest wall than adults?

A

Highly compliant chest wall, but poorly supported by surrounding structures (ie pliable ribs).

Functional airway closure accompanies each breath, thus increasing work of breathing.

50
Q

Why does the smaller diameter of infant airways relative to adults cause increased resistance to airflow?

A

Poiseuille (poi_se’) Law

- resistance is inversely proportiinal to radius raised to 4th power

51
Q

_________ is also known as mandibulofacial dysostosis.

  • Underdeveloped supraorbital ridges
  • Hypoplastic zygomas
  • Ear deformities
  • Cleft palate
  • Midface hypoplasia
  • OSA
  • Hearing loss (50%)
A

Treacher collins syndrome

52
Q

(True/False) In Treacher collins syndrome, airway difficulty decreases with age

A

False. it Increases in difficulty!

- supraglottic devices as conduit for fiberoptic intubation successful

53
Q

Apgar scores should not be used to ______ outcomes or direct termination of care. Lower Apgar scores are simply _____ with worse outcomes.

A

predict

correlated

54
Q

If a newborn has a HR < 100 bpm and is not responding, add ______.

If HR is < 60 bpm, add _____

A

positive pressure ventilation

chest compressions in a 3:1 ratio

55
Q

Why are neonates less SENSITIVE to codeine compaired to school-age children?

A

decreased CYP2D6
- *cytochrome that converts prodrug to morphine (active drug)

*effects of opioids in children are not by opioid receptors, but by drug metabolism

56
Q

CYP2D6 is (High/Low) at birth and (Increases/Decreases) with age. Especially in the first 2 weeks.

A

low

increase

**cytochrome that converts prodrug to morphine (active drug)

57
Q

CYP3A is (High/Low) at birth and (Increases/Decreases) with age. Especially in the first year of life.

This mechanism makes pts more susceptible to oversedation and respiratory depression.

A

Low

Increases

*cytochrome that converts opioids to inactive metabolites (fentanyl to norfentanyl, and tramadol to nortramadol)

58
Q

UGT2B7 converts _____ to ______, which are then renally excreted. Levels are low after birth until 10 days of age.

A

morphine to metabolites (M3G and M6G)

- Reduce morphine by 50% to achieve same analgesic effect on kg/body weight

59
Q

Neonates are more (sensitive/resistant) to hydrophilic opioids (morphine) d/t receptor immaturity and decreased excretion despite the increased volume of distribution.

A

Sensitive

60
Q
  • ASA 3 or >
  • Age < 3 mo
  • Airway related procedures (i.e bronch)
  • mult drug combo

Are all risk factors for ______ during pediatric sedation

A

Laryngospasm

61
Q

Heat loss during anesthesia is most likely ______. But heat loss through the breathing circuit is by _______

A

radiation ( pt and surrounding)

Evaporation (water to gas, hence the humidified air to minimize loss)

62
Q

_____, _____, and _____ are the primary triggers for nonshivering thermogenesis in neonates and infants

A

Norepi, glucocorticoids, thyroxine

63
Q

What type of shivering thermogenesis is most important in neonates and infants?

  • Voluntary muscle
  • Shivering
  • Dietary thermogenesis
  • Nonshivering thermogenesis
A

Nonshivering thermogenesis

- Major source of metabolic heat production, not produced from muscle activity

64
Q

Down syndrome is associated with cervical (instability/rigidity)

A

Instability

65
Q

50% of pts w/ Down syndrome have CV defects like ____

A

Endocardial cushion defect, ASD, VSD, TOF, PDA

- most to least common

66
Q

Why are children with Down syndrome a challenge to intubate? (6)

A
  1. Fusion of teeth
  2. Cleft lip/palate
  3. Mandibular hypoplasia
  4. hypertrophic tonsillar tissue
  5. Cervical instability
  6. Subglottic stenosis
67
Q

Klippel-Feil syndrome is associated with cervical (instability/rigidity)

A

rigidity

68
Q

How common is bradycardia following admin of succinylcholine?

A

Common

- can pre-treat with atropine, but not recommended

69
Q

MRI is located in zone ____

A

IV

70
Q

Treatment of laryngospasm

A
  1. continuous positive airway pressure with 100% oxygen
  2. Deepen anesthetic with propofol
  3. Succinylcholine 1-2 mg/kg
    - co-treatment with atropine to prevent bradycardia
71
Q

Other methods succinylcholine can be administered

A

IM 5 mg/kg

Intralingual

Submental

Interosseous

72
Q

How does rocuronium and neostigmine potency affect infants? How does it affect the dose?

A

potency is greater d/t immature receptors

- dose should be reduced for both

73
Q

How does succinylcholine dose affect infants?

A

Infants are more resistant to it, bc they have a higher volume of distribution.
- Dose can be increased

74
Q

Earliest sign of inadequate gas exchange in OR

A

loss of continuous waveform during ETCO2 capnography monitoring

75
Q

Postop bowel hypomotility is more common in pts with (gastroschisis/omphalocele)

A

gastroschisis

*usually smaller than omphalocele

76
Q

(gastroschisis/omphalocele) involves abd wall defect to the R of the umbilical cord

A

gastroschisis

77
Q

Water soluble drugs (most abx) require (higher/lower) initial dose to achieve same clinical fx in neonates compared to children

A

higher

78
Q

Lipid-soluble agents have (longer/shorter) DOA d/t decreased fat content of neonates

A

longer

- not rapidly redistributed into fatty compartments

79
Q

Protein binding in neonates and infants are (increased/decreased) and require a LOWER dose of a highly protein bound drug to achieve similar fx

A

decreased

80
Q

The HIGHER amt of total body water in neonates means that water-soluble drugs will require a (higher/lower) dose to achieve the same fx

A

higher

81
Q

Why is venous access difficult in pts with down syndrome? (3)

A
  1. xerodermia
  2. atopic dermatitis
  3. obesity
82
Q

3 conditions associated with atlantoaxial instability

A
  1. Down syndrome
  2. RA
  3. achrondroplasia
83
Q

What happens if a loose tooth is accidently swallowed?

A

does not routinely need to be retrieved unless it is in the tracheobronchial tree

84
Q

_____ has more emergence delirium than any other volatile anesthetic.

A

sevoflurane
- low blood:gas solubility

Desflurane comes in second

85
Q

5 min myringotomy and tympanoplasty procedure. Best medication for post op analgesia?

A

Intranasal fentanyl

  • works rapidly w/in 7-8 min
  • 1-2 hour duration
  • rapidly absorbed into bloodstream but quickly reaches steady therapeutic state
86
Q

Maintenance fluid is using the 4-2-1 rule and the deficit is replaced as ________

A

half in the first hour and second half over the next 2 hours

87
Q

Administration of ______ w/in __hrs postpartum to a neonate with NRDS is associated with improvement in oxygenation

A

surfactant, 2hrs

- can be administered endotracheal

88
Q

in neonates with NRDS what do you titrate FiO2 to target SaO2 of __%.

A

90%

- (100% will increase risk for complications like bronchopulmonary dysplasia)

89
Q

NRDS is self limited and typically improves by 3-4 days, treatment typically starts with CPAP and PEEP setting of ___ mmHg

A

3-8 mmHg

90
Q

____ is a chronic lung disease often found in preterm infants w/ underdeveloped lungs who are exposed to mechanical ventilation, high oxygen [ ], or infection

A

bronchopulmonary dysplasia

91
Q

risk factors for PONV in pediatric pts

A
  1. prolong surgery time >30 min
  2. age > 3 yrs
  3. h.o PONV
  4. strabismus surgery
92
Q

children presenting for elective surgery with suspected URI should be rescheduled at least __ weeks later

A

4

93
Q

Vital signs in a moderate sedation pediatric case must be recorded at least every _ min, and every _ min for deep sedation and GA

A

10 min

5 min

94
Q

Osteogenesis imperfecta cognitive/intelligence level

A

normal

95
Q 
Osteogenesis imperfecta 
problems for anesthesiologists:
respiratory problems
meds
other
A
  • restrictive lung disease
  • fasciculations from succinylcholine can cause bone fx
  • hearing loss/deaf
96
Q 
Blood volume
Preterm infant
Full-term infant
3-12 mo infant
> 1 y.o
A

Preterm infant: 100 mL/kg
Full-term infant: 90 mL/kg
3-12 mo infant: 80 mL/kg
> 1 y.o: 70 mL/kg

97
Q

Who mandates each healthcare organization to approve a plan outlining the credentialing process for practitioners providing pediatric procedural sedation

A

The Joint Commission

All other societies can only provide guidelines, not mandates

98
Q

Noonan syndrome is most commonly assoc w/ which congenital heart abnlty?

A

Pulmonary stenosis

99
Q

Noonan syndrome is most commonly assoc w/ which congenital heart abnlty?

A

Pulmonary stenosis

100
Q

Turner syndrome is most commonly assoc w/ which congenital heart abnlty?

A

bicuspid aortic valve

coarctation of aorta

101
Q

What happens if sufficient air enters the pulmonary circulation during venous air embolism?

A
  • Trigger bronchoconstriction (lead to shunting)
  • Respiratory distress
  • Increase dead space ventilation
102
Q

What happens if sufficient air enters the L sided systemic circulation via R to L shunt during venous air embolism?

A
  • cause MI
  • arrhythmias
  • cerebrovascular compromise
103
Q

Why are children more likely to become symptomatic from a VAE?

A

smaller circulatory volume

smaller heart size easily overwhelmed by smaller volumes of entrained air

104
Q

How effective is aspiration of air from a central line in a pt with a massive VAE?

A

rarely successful

  • instead, flood the field with saline
  • compress jugular veins
  • increase PEEP (increases central venous pressure, make it more diff for air to enter vasculature)
105
Q

______ presents with low grade fever, inspiratory stridor, hoarseness, “barking” cough, steeple sign

A

laryngotracheobronchitis

- croup

Anesthesia 101 (38 decks)

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