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Anesthesia Principles III
Pediatric Anesthesia- Congenital Heart Disease
22
Medical
Graduate
07/29/2010

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Cards

Term
How is myocardial function in the neonate unique?
Definition

*Neonatal myocardium is less compliant to volume shifts

*CO is greatly affected by changes in HR

Term
How is ventricular performance influnced?
Definition

*Preload

*Afteroad

*Contractility

Term
What is the "rule of 5's"?
Definition

*RA-5mmHg

*RV 25 (52)/5

*LA 10mmHg

*RV 100(102)/10

 

PA~ 25/15

Ao~ 100/50

Term
What are the four general categories of CHD and examples of each?
Definition

*Obstructive Lesions

-AS

-MS

*Regurgitant lesions

-MR

-AR

*Shunt Lesions

-ASD

-VSD

-PDA

*Mixing Lesions

-TV

-TA PVR

-Pa w/ VSD single ventricle

-Single atrium

Term
What are three factors that affect shunting?
Definition

*Shunt orifice size

*Outflow resistance

*These factors make the flow balance of SVR/PVR so important

Term
What is the formula for PVR?
Definition
*PVR= 80 x (MPAP-PCWP)/CO
Term
What are factors that increase PVR?
Definition

*Hypoxia

*Hypercarbia

*Acidosis

*Hyperinflation (increased PEEP, Increased PIP)

*Sympathetic Stimulation

*High HCT

*Atelectasis (Decreased FRC)

*Surgical constriction (retraction)

*Anesthetics (ketamine, N2O)

*Hypovolemia

*Alpha-adrenergic agonists

Term
What are factors that decrease PVR?
Definition

*Oxygen

*Hypocarbia

*Alkalosis

*Normal FRC

*Block sympathetic stimulation (Narcotics)

*Low Hct

*PGE1

*Alpha adrenergic antagonists

*Vasodilators

Term
What are interventional cardiology procedures that can be done in peds?
Definition

*Diagnostic

*Coil Embolization

*Trans-catheter device closure

*Balloon and stent dilatation

*Balloon atrial septectomy- TGA-IVS, MS, MA

*Radiofrequency mapping and ablation

*Myocardial biopsy

 

**Associated risks- Dysrhythmias, perforation, damage to leaflets and chordae, CVA, Air embolism, IVP dye reactions.

Term
What are the types of atrial septal defects?
Definition

*F>M

*Different from a PFO

*Ostium secundum- 70%, located over or near IVC (good kind to have)

*Ostium primum- located at or near PFO- usually Down's kids

*Sinus Venosus- at the SVC associated with pulm veins draining into the RA.

 

***Problem?? L to right shunt causing pulmonary overload

Term
What are the four types of ventricular septal defects?
Definition

*Supracristal

*Membranous (75%)

*Inlet

*Muscular

 

**Problem is left to right shunt and pulmonary overload

Term
In what children are atrioventricular canal defects most common?
Definition
*Downs syndrome patients
Term
What are some anesthetic implications for repair of atrioventricular canal defect?
Definition

*-2 types: partial and complete

*Repair normally for Qp:Qs>3

 

*Avoid high FIO2

*Avoid low EtCO2

*Avoid high SVR

**Avoid Air emboli

*Deep hypothermic arrest for case- 18 degrees room temp 45-50

Term
What are associated findings with Patent Ductus Arteriosus Patients?
Definition

*Common in premature infants

*Causes left to right shunt= pulmonary congestion

*Widened pulse pressure

*Machinery mumur

*Feeding difficulties

*Medical treatment first then surgical

Term
What are some OR specific implications for PDA?
Definition

*2 IV's, A-line not necessary, if only a PICC present, need PIV to give blood through

*Left thoracotomy

*2 Pulse ox's

*Fentanyl, pavulon, may not tolerate forane

*May need atropine

*Maintain volume, consider PRBC's right away

*Review neonatal anesthesia

Term
What two heart conditions are linked to Sudden Cardiac Death in children?
Definition

*Hypertrophic CM

*Dilated CM

Term
What are symptoms of Coarctation of the Aorta?
Definition

*Chest Pain

*Upper limb HTN

*Diminished Femoral pulses

*Bounding carotid pulses

*CHF

Term
What are the 4 defects in a Tetrology of Fallot?
Definition

*VSD

*Pulmonary stenosis

*Hypertrophy of R ventricle

*Overriding Aorta

Term
What is the treatement for a "Tet spell"?
Definition

*Volume- Give 10-12mL/kg

*Neosynephrine

*100% FIO2

*Clamp Aorta

*Morphine

*Knees to chest

*Keep PVR Low

Term
What should be done to manage normal surgery for patients who have lesions with increased pulmonary blood flow? (ie: ASD, VSD, PDA's)?
Definition

*Maintain a high PVR and low SVR

*Low FiO2, normal CO2

*Lower SVR w/ anesthetic agents (forane)

*Vasodilators

Term
What should be done to manage normal surgery for patients who have lesions decreased pulmonary blood flow? (TOF, TA, PA)
Definition

*Must have some sort of shunt from R to L

*Keep PVR low

 

Term
What are results of chronic hypoxemia?
Definition

*Pressure of volume overload

*Polycythemia Hct>65%

*Alveolar hyperentilation

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