Term
| A connective surgery that realigns the divergent visual axes of the eyes by detaching and reattaching extraocular muscles to the globe? |
|
Definition
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Term
| Anesthesia will include, type of anesthesia, meds and which med do you avoid for strabismus repair? |
|
Definition
| IV or inhalded induction with muscle relaxant; OCR - may pretreat with atropine or glycopyrrolate; Avoid succs it can alter the repair / make the MD aware if you use it; LMA: OK; table turned; ETT away from surgical site. |
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Term
| Why do patients need nasolacrimal duct probing? |
|
Definition
| For nasolacrimal duct stenosis |
|
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Term
| What may trigger a laryngospasm when you are doing a nasolacrimal duct probing? |
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Definition
| Flourescein and blood may accumulate in the airway and trigger a laryngospasm. Suction*** before emergence. |
|
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Term
| What other measures can you do to help decrease the risk of laryngospasm triggered by secretions after a nasolacriminal surgery? |
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Definition
| Trendelenburg or a shoulder roll to pool secretions in the nasopharyngeal airway. |
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Term
| Protein binding is ____ in the preterm and term infants than older children and adults |
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Definition
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Term
| Drugs that are highly protein bound in adults have more or less affinity in neonates? |
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Definition
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|
Term
| Alpha acid glycoprotein is reduced in preterm and term infants. It affects the meds that are acidic or basic? |
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Definition
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Term
| Volume of Distribution is greater for the child. You will need an _____ loading dodse to achieve a clinical response |
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Definition
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Term
| With an increased volume of distribution in the child it is important to ________ drugs. |
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Definition
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Term
| Do children have a smaller or larger proportion of body weight in the form of fat and muscle? |
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Definition
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Term
| Drugs that redistribute to fat and muscle have a large initial _______ in blood concentration. |
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Definition
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Term
| Do you need more or less muscle relaxant in the child to achieve neuromuscular blockade? |
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Definition
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|
Term
| Neonates have a reduced total quantity of ______ enzymes? |
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Definition
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|
Term
| What metabolic process is decreased in the neonate and affects Morphine's metabolism? |
|
Definition
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Term
| Half lives of medications that are eliminated by the liver are ______ in the neonates, _________ in children 4-10 years of age and reach adult values in _________. |
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Definition
| prolonged, decreased, adolescents |
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Term
| Healthy term neonates have normal renal drug clearance by what age? |
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Definition
|
|
Term
| GFR and tubular function are fully mature by age? |
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Definition
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Term
| Aminoglycosides or cephalosporins are excreted by? hence, they have a prolonged elimination half life in neonates |
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Definition
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Term
| Why are neonates sensative to sedatives, hypnotics and narcotics because of an? |
|
Definition
| increased brain permeability |
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Term
| Dosage of drugs need to be carefully titrated in order to allow the? |
|
Definition
| lowest dose that provides a response |
|
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Term
| Neonates have a more rapid rate of increase of Fa/Fi than adults? |
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Definition
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Term
| Inhalation anesthetics in the neonate are rapidly taken up in the lungs. Name 4 reasons why? |
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Definition
| 1. Greater alveolar ventilation to FRC ratio; 2. Greater portion of the CO distributed to the vessel rich group; 3. Reduced tissue / blood solubility; and 4. reduced blood gas solubility. |
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Term
The solubility of halothane, isoflurane, enflurane, and
methoxyflurane is ___ less in neonates than adults |
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Definition
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|
Term
The solubility of sevoflurane is similar in neonates and
adults? True or false. |
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Definition
|
|
Term
| In neonates the __________________ speeds the rate of Fa/Fi compared with adults |
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Definition
| reduced tissue solubilities of IA |
|
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Term
The decrease of the fat and muscle group in neonates
causes the Fa/Fi to equilibrate more? |
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Definition
|
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Term
| It is difficult to achieve a deep level of anesthesia in children with Sevoflurane? True or false. |
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Definition
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Term
| What may help to deepen anesthesia with sevoflourane in the neonate? |
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Definition
Inserting an IV or performing laryngoscopy after induction may result in physiologic and motor response, even when the inspired concentration is
8% with SEVO -- thus, Use of Supplemental IV anesthetics may be required to deepen level of anesthesia |
|
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Term
Left-to right shunts do not affect the
pharmacokinetics of? |
|
Definition
|
|
Term
| How do Right-to-left shunts delay equilibration of Fa/Fi? |
|
Definition
1. The wash-in of less soluble IA is more delayed
2. IV anesthetics are needed to deepen the level of anesthesia in these children |
|
|
Term
| The MAC of halothane ______as age decreases, reaching maximal value in infants 1-6 months of age and then decreases by 30% in full-term neonates. Similar in isoflurane and desflurane. |
|
Definition
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|
Term
| The MAC of _________ in neonates and infants younger than 6 months of age is 3.3%, in older infants and children it is 2.5% |
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Definition
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Term
| What drives the need to deliver enough oxygen to maintain the high metabolic rate of neonates? |
|
Definition
| The cardiopulmonary system |
|
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Term
| This high rate of oxygen consumption leads to a _______ in blood oxygen levels in the neonate during periods of hypoventilation |
|
Definition
|
|
Term
| The Induction agent of choice of neonates is? |
|
Definition
| Sevoflurane is the induction agent of choice, it does not irritate the upper airway and its well tolerated by children |
|
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Term
| Inhalation indution: x 4 steps |
|
Definition
1. Premedicate child (Pre-op)
2. Encourage child to breath through the face mask with 70% N2O,
with th pop-off valve open for 1-2 minutes 3. Once the child seems silly or has lost contro, 8% Sevoflurane is
administered ( Increase concentration quickly to avoid the excitement phase)
4. Maintain spontaneous ventilations with the maximum inspired
concentration of Sevo until IV access is achieved (Avoid
awareness |
|
|
Term
|
Definition
| A dissociated state of consciousness in which children are inconsolable, irritable, uncompromising, and uncooperative |
|
|
Term
| With emergence delerium the mechanism is? most kids want what off? and will they listen to parents? and how long will it last? ( Feels like a lifetime..) |
|
Definition
Most often children want all monitors IV’s and monitors, IV’s, bandages removed; Many fail to respond appropriately to their parents;
Highest incidence occurs in children 1-5 years of age; It last 10-20 minutes
and The mechanism is unknown |
|
|
Term
| What is central apnea and how do you treat it? |
|
Definition
due to immaturity or depression of
the respiratory drive
*Treatment- Caffeine or Theophylline |
|
|
Term
| Obstructive apnea is and how do you treat it? |
|
Definition
Obstructive apnea due to the infant’s inability to maintan a patent airway
Due to the immature airway; Reposition head etc. |
|
|
Term
| Mixed apnea- a combo of both _____ & ____ apnea? |
|
Definition
|
|
Term
| The number of neonates having apnea in the post op period is? |
|
Definition
|
|
Term
| A chronic lung disease in infants who have been born prematurely? |
|
Definition
|
|
Term
| Diagnosis of BPD is made by an? and seen in infants whom? and these kids may have problems in? |
|
Definition
an abnormal chest x-ray in infants who
required oxygen before 36 weeks postconceptual age; Seen in infants who required high levels of oxygen
and ventilation; and These infants have abnormalities in lung compliance and resistance |
|
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Term
|
Definition
| Prolonged expiratory to avoid air trapping; Bronchodilators to reduce airway resistance; Diuretics; and steroids |
|
|
Term
| Parasympathetic control of heart rate matures earlier in gestation than ? |
|
Definition
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Term
| Neonates do not respond to hypovolemia or inadeq. anesthesia with? and vagotonic responses from what drugs may lead to bradycardia? |
|
Definition
Neonates do not respond to hypovolemia or an inadequate depth of anesthesia with tachycardia
Vagotonic response caused by succinylcholine and opioids may lead to bradycardia |
|
|
Term
| Choanal Atresia/ Stenosis can manifest as? be caused by? and be part of _____congenital abnormalities and develop ______ during induction. So use an oral airway. |
|
Definition
Manifest as cyanosis at rest that resolves with crying or placement of an oral airway
*Caused by failure of the bone in the nasopharynx to develop
�� Can be part of a constellation of congenital abnormalities: CHARGE
* They develop airway obstruction during induction |
|
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Term
| What is: An emergency during delivery of the fetus and Will need a tracheostomy? |
|
Definition
|
|
Term
| Congenital subglottic stenosis: severity is dependent on? for severe cases a ____ is placed. Induction - how? |
|
Definition
Severity dependent on airway closure;
* For severe cases a tracheostomy is placed and a series of dilations are attempted; Induction- Inhalation with a facemask while maintaining spontaneous ventilations; Place an ETT small enough to pass the level of obstruction |
|
|
Term
Esophageal Atresia and
Tracheoesophageal Fistula are associated with? |
|
Definition
other anomalies
VATER
More recently VACTERL |
|
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Term
| Symptoms and Diagnosis of Esophageal atresia and tracheoesophageal fistuala? |
|
Definition
Symptoms
* Excessive oral secretions
* Regurgitation of feedings
* Respiratory distress exacerbated by feedings
Dx- Inability to pass an OGT into the stomach or by radiographic studies |
|
|
Term
| TEF should be fed how? and what position? central or peripheral IV? what vents the stomache? |
|
Definition
They should be nursed prone or in the lateral position in a head up position
OGT in the upper esophageal pouch to suction to avoid accumulation of saliva and aspiration; A gastrostomy tube is placed to vent the stomach; and a central line is placed for parenteral nutrition |
|
|
Term
| TEF - General Anesthesia? Awake or asleep; ETT secured where? Stethoscope where? |
|
Definition
Awake intubation
Tube position is very important
The ETT is secured with the tip distal to the fistula; should be carefully secured, if it moves up to the
fistula opening you may not be able to ventilate
the infant
�� Stethescope over the left chest may detect
improper placement |
|
|
Term
| Congenital diaphragmatic hernia is? and many have? |
|
Definition
| An anatomic defect that allows intrusion of the abdominal contents into the thoracic cavity and Many have other congenital defects |
|
|
Term
| Congenital Diaph. Hernia Ventilation: Goal is to: with settings that allow? and avoid? What pH disturbance increases pulm. blood flow? |
|
Definition
Goal is to avoid barotrauma and conditions known to increase pulmonary vascular resistance.
Utilize settings that allow rapid low tidal volumes and limit peak inspiratory pressures will avoid
barotrauma
* Alkalosis increases pulmonary blood flow |
|
|
Term
| Name 4 treatments utilized for congenital diaphragmatic hernia? |
|
Definition
1.Opioid and benzodiazepine used for
sedation; 2. Volume replacement and inotropic support for cardiovascular compromise; Inhaled NO has been used to treat pulmonary hypertension; 4. ECMO |
|
|
Term
| What is the hallmark of congenital diaphragmatic hernia? |
|
Definition
| the abnormal compression of pulmonary structures |
|
|
Term
With Cong. Diaphrag. Hernia: You have: Lung growth that is severely ________; Pulmonary hypertension; ____to ___ shunting via the PFO and PDA which
causes severe hypoxemia
�� The intrathoracic contents may cause caval
compression which reduces preload and CO |
|
Definition
|
|
Term
| The intrathoracic contents in congenit. diaphr. hernia may cause caval compression which? |
|
Definition
|
|
Term
| Initial mngement for cong. diaphr. hernia include: list 7 things |
|
Definition
�� Improving oxygenation and ventilation
�� Airway control is a priority
�� Do not mask ventilate infant
�� After the airway is secured insert a NGT to decompress intestinal contents
�� ABG, chest x-ray, Echo, and cranial U/S �� IV access �� A-line |
|
|
Term
| With congenital diaph hernia surgical repair is? anesthesia focuses on: 4 things and avoid N20. |
|
Definition
Surgical Repair is delayed until the infant is optimized
*Anesthetic management focuses on supportive care with: High dose opioid technique; Adequate central access; Mimic vent settings used in the NICU
ABG- to guide respiratory management
and IA in low doses
NO N2O- limits oxygen and intestinal diffusion may worsen lung compression |
|
|
Term
| Gastrointestinal Problems - Lesions that are obstructive an Infant may present with? |
|
Definition
vomiting, abdominal distention, and late
passage of meconium |
|
|
Term
| Treat obstructive GI lesions if not life threatening by? |
|
Definition
| If not life-threatening, focus is to establish euvolemia and a stable metabolic state before surgery |
|
|
Term
| Obstructive GI lesions / anesthesia should consist of? |
|
Definition
Induction- awake if you anticipate airway problems or a RSI if
the airway is normal
*If the surgery is an emergency and the volume status is tenuous ketamine may be used for induction * GA with either IA or opioid technique and muscle relaxant and Avoid N2O |
|
|
Term
Gastrointestinal Problems
specifically: Conditions that compromise blood supply |
|
Definition
These infants are very ill; they May present with abdominal distention, bloody stools, vomiting, hypotension, metabolic abnormalities, anemia, and
thrombocytopenia; Emergency surgery is required to remove necrotic tissue and close perforations |
|
|
Term
| Anesthesia for GI conditions that compromise blood supply include? |
|
Definition
| Anesthesia: Adequate IV access; T&C- have blood products immediately available; A-line; Optimize volume status and Dopamine may be used to increase blood supply to the gut |
|
|
Term
| Hypertrophic Pyloric Stenosis? feels like an? presents how? and manifests when? |
|
Definition
Manifest within the 2nd to 6th week of life with nonbilious vomiting; Presents as hypertrophy of the muscularis layer of the pylorus and can be palpated as an olive-shaped mass
between the middle and right upper quadrant (olive) |
|
|
Term
| Pyloric Stenosis is not a? the priority is? and these infants become? |
|
Definition
Is Not a surgical emergency; Intravascular volume and metabolic
stabilization is the priority; These infants become hypokalemic,
hpoychloremic, and alkalotic |
|
|
Term
| Anesthesia with pyloric stenosis? |
|
Definition
| Prior to induction the stomach is emptied with an OGT; RSI- pulmonary aspiration is a risk; IA or balanced for maintenance; The infant should be extubated fully awake; Local at the incision site for analgesia; May need to be monitored for apnea |
|
|
Term
| These infants have defects in the abdominal wall that manifest with impaired blood supply to the herniated organs, intestinal obstruction, and major ntravascular fluid deficits? |
|
Definition
| Omphalocele and Gastochisis |
|
|
Term
This defect presents with: Failure of the gut to migrate from the yolk
sac into the abdomen during gestation;
may have associated genetic cardiac
urologic and metabolic abormalities
and The herniated viscera are covered with a membranous sac |
|
Definition
|
|
Term
| Congenital anomoly that develops as a result of occlusion of the omesenteric artery during gestation; is Not associated with other genetic anomalies and the herniated viscera and intestines are exposed to air after delivery, which results in edema, dilated, foreshortened, and functionally abnormal bowel |
|
Definition
|
|
Term
| Management of Omphalocele and Gastochisis is directed at: |
|
Definition
reduction of fluid loss from the exposed visceral surfaces; On arrival to the NICU fluid resuscitation is
instituted: Multiple boluses of LR and 5% Albumin given at 20mL/kg |
|
|
Term
| Anesthesia for ampalocele and gastochicas? |
|
Definition
Volume replacement and prevent
hypothermia; Awake intubation or RSI; Muscle relaxation; Abdominal closure may increase intraabdominal pressure;�� A staged closure is done if infant becomes unstable |
|
|
Term
Physiology of the EYE:
Intraocular pressure is:
Greater than ___ is abnormal |
|
Definition
NL- 12-15mmHg
Greater than 20mmHg is abnormal |
|
|
Term
| Aqueous humor is made by the? released into the? transverses the? into the? |
|
Definition
| a clear fluid produced by the ciliary body that is released into the anterior chamber of the globe, it traverses the canal of Schlemm into the episceral veins;If the flow is altered it results in an increased IOP; Increased central venous pressure can attenuate the drainage of humor from the eye |
|
|
Term
| With a noncompliant globe any increase in choroidal blood volume will? |
|
Definition
|
|
Term
| Must avoid increases in IOP during induction with a noncompliant globe by: |
|
Definition
Avoid hypercarbia and hypoxia and Avoid agents that increase IOP (succinylcholine and ketamine);
Reducing childs apprehension and crying |
|
|
Term
Succinylcholine
�� Increases IOP?
�� Can last from? |
|
Definition
|
|
Term
| Name the 4 possible causes of Succs and increased IOP |
|
Definition
Four possible causes:
�� Cyclopegia- obstructs outflow of the aqueous humor
�� Tonic contraction of the extraocular muscles
�� Increased choroidal blood volume
�� Relaxation of orbital muscles |
|
|
Term
Traction of the eye muscles or external pressure on the globe initiates an afferent signal via the trigeminal nerve that evokes a parasympathetic
output via the vagus nerve which causes
multiple dysrhythmias termed the? |
|
Definition
|
|
Term
| Anticholinergic meds are routinely given prior to induction (with eye sx)? |
|
Definition
| Atropine- 20mcg/kg; Glycopyrrolate 10- 20mcg/kg |
|
|
Term
| Open Globe Injury: Anesthesia includes: |
|
Definition
IV access is essential
Pre-oxygenate the child
IV induction with propofol and rocuronium
Intubate as quickly to avoid aspiration and OGT to decompress stomach
Surgeon should be available to physically protect the eye with a shield |
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