Term
| Urine concentrating ability is ______ in neonates. Urine Osmolality is ___ - ___ mEQ |
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Definition
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Term
| Neonates have decreased renal response to ______ |
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Definition
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Term
| Renal Plasma flow and GFR are ____ that of the adult values. |
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Definition
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Term
| A microdrip IV set should be used on children less than _______ kg. |
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Definition
| 50 kg. The volume in the fluid container should not exceed the child's estimated fluid deficit. |
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Term
| What type of mask is designed to minimize dead space? |
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Definition
| Rendell-Baker/ Soucek; however the most commonly used mask have a soft inflatable cuff |
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Term
| What type of mask is designed to minimize dead space? |
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Definition
| Rendell-Baker/ Soucek; however the most commonly used mask have a soft inflatable cuff |
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Term
| What type of airway is usually not used in children? |
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Definition
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Term
| After intubation with ETT assess for leak at ____ cm H20. |
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Definition
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Term
| Advantage to mapelson circuit is? |
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Definition
| Decreased resistance b/c no valves or soda lime restriction |
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Term
| Disadvantage to Mapleson circuits: |
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Definition
| need for high flows to eliminate rebreathing; pollution of the OR environment; loss of patient heat and humidity. |
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Term
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Definition
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Term
| In premies small airways predispose them to? |
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Definition
| Obstruction and difficulty with ventilation. ETT increases WOB greater than infant. |
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Term
| In premies loss of muscle control caused by anesthesia increases the? |
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Definition
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Term
| Premies are more prone to what kind of tracheal problems? |
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Definition
| subglottic stenosis; tracheal stenosis, and tracheobronchomalacia |
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Term
| The premies immature lung predisposes them to hypoxia. Low lung volumes and compliance leads to an increased ______? |
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Definition
| intrapulmonary shunt and V/Q mismatch |
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Term
| PEEP is used during anestheisa to maintain? |
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Definition
| lung volume and prevent hypoxia and VQ mismatch |
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Term
| Premies are susceptible to what kind of respiratory problems? |
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Definition
| O2 toxicity, barotrauma and development of BPD |
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Term
| Premies have a ______ ventilatory response to CO2 and further blunts this response |
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Definition
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Term
| Premies have a biphasic ventialtory response? |
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Definition
| true; increased RR then apnea |
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Term
| Premmie often have cognitive impairment d/t brain injury most commonly in ? |
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Definition
| periventricular white matter |
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Term
| IVH occurs in what percent of premies |
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Definition
| 1/3 or 33%; IVH grades I - IV, IV being the worst |
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Term
| Inguinal hernia repair avoid which medication? |
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Definition
| Fentanyl; use tylenol; surgeons use local for pain control. Need stimulus to breath.... otherwise they stay vented. |
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Term
| Preterm infants with BPD will have compensated _____ ______ and elevated _____. |
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Definition
| respiratory acidosis and elevated ETCo2 |
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Term
| Inguinal hernia repair. RA is common; Caudal block with _____ caine ____ % with epi 1:200,000 _____ml / kg |
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Definition
| Bupivicaine .375%; epi .75ml /kg; works for 1-2 hrs. Excellent for premies with BPD. |
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Term
| Fetal heart is less compliant, it has less contractile tissue and more fibrous tissue and more dependent on? |
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Definition
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Term
| Premie CO is dependent on |
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Definition
| HR; small absolute blood volume; little autoregulation predisposes the premie to CV collapse |
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Term
| Open PDA predisposes the premie to |
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Definition
| pulmonary htn and CHF; PDA = R to L shunt |
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Term
| Preemies are less sensitive to ____ and are increased risk for CV _____ |
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Definition
| catecholamines; and CV collapse |
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Term
| ROP occurs in ___% of low birth wt infants. Thought to be caused by? |
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Definition
| 50%; vatiations in arterial oxygen and exposure to bright lights, free oxygen radicals may be another cause. |
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Term
| Preemies are susceptible to hypothermia, the epidermis has less _____, this causes an increase in evaporative heat loss and insensible fluid loss |
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Definition
| keratin. In addition they have littl efat and a large surface area to mass ratio....keep them warm. |
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Term
| Preemies have a reduced kidney function, plasma creatine levels are ___ and are at risk for? |
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Definition
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Term
| Preemies are at risk for hypo and hyperglycemia. Decreased ____ and ____ stores. |
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Definition
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Term
| Preemies may be insulin resistant and may require ____ to maintain normoglycemic? |
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Definition
| insulin; monitor glucose close.... |
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Term
| Liver has reduced hepatic proteins at risk for spontaneous liver? |
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Definition
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Term
| Tissue O2 delivery is maximized by maintaing a HCT between ___ - ____% |
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Definition
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Term
| Explain why n20 is not routinely used on preemies. Note that the MAC is less than the term infant |
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Definition
| N2O d/t decreased 02 = desat quickly; also distension of airfilled spaces (gut) |
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Term
| Premmies immature liver yield hgher 1/ 2 times for opiods and benzos |
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Definition
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Term
| NEC is caused by_______ and is life threatening. |
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Definition
| intenstinal mucosa ischemia |
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Term
| Early signs of NEC = feeding intolerance and name 3 more: |
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Definition
| lethargy, temp. instability and increased WOB. |
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Term
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Definition
| hypotension; abd distension, apnea, coagulopathy and multiorgan failure. NEC is a SURGICAL EMERGENCY..... |
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Term
| Preparation for NEC sx: albumin, FFP, platelets, PRBCs epinephrine, dopamione and calcium gluconate... What is calcium gluconate for ? |
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Definition
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Term
| NEC emergency preop assessment should include: |
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Definition
| current meds, IV, dextrose infusion rates, H& H, electolytes and BG level.l |
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Term
| What are the intubation considerations for NEC emergencies? |
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Definition
| RSI or awake d/t full stomache |
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Term
| NEC need vascular access. What else is needed to surgery? |
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Definition
| 2 large bore IVs (22 gauge), a-line, CVP, foley, NG tube. |
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Term
| Anesthesia technique most commonly used for NEC? |
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Definition
| High dose ketamine or opioids, fentanyl 20- 50 mcg/ kg, muscle relaxant, small or NO inhalational gas |
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Term
| Preemie treatment of hypotension, bolus of fluid____-___ ml/kg. Run your Dopa at ___-___mcq/kg/min. What other 2 considerations? |
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Definition
| 10-20ml/ kg; 5- 20 mcg/kg/min; give Ca++ if giving blood think stress dose of glucocorticoids |
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Term
| During NEC replace blood loss with? |
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Definition
| PRBCs; givbe platelets to maintain count >100,000. |
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Term
| During NEC replace fluids viligently; not uncommon for premie to receive ___ of fluid during the case? |
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Definition
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Term
| Ligation of PDA d/t failure of closure is common in premmies. the PDA incures a severe __-___ shunt. |
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Definition
| left to right.With overload or pulmonary HTN shunting may be right to left producing cyanosis. |
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Term
| PDA is ligated thru a left? |
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Definition
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Term
| PDA ligation monitors: BP cuff on right upper arm. ETCo2 , pulse ox digits of right arm and lower extremity. what does it mean if you lose signal in the lower extremity? |
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Definition
| ligated the AO. If you lose both you ligated the PA and there will be no ETCO2. |
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Term
| PCA anesthesia: Fentanyl 20-50 mcg/kg (the whole case ) ; Pancuronium .2 mg/kg, albumin 10 ml/kg before induction is often given to avoid hypotension. The sx is about ____ long the patient should be extubated when? |
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Definition
| 20 minutes; extubate the next day. |
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Term
| Inguinal hernia repair; common ijn preemies use GA or RA. May need to give ____ to prevent post op apnea? |
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Definition
| caffience. 10 mg/kg prior to extubation |
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Term
| A cuffed tube is ____ mm larger? |
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Definition
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Term
| In mapelson circuits what prevents rebreathing? |
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Definition
| High fresh gas flows venting exhaled gas thru the APl valve before next inspiration |
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Term
| The efficiency of mapelson circuit is measure by the fresh gas flow required to ? |
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Definition
| eliminate Co2 rebreathing |
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Term
| Advantages to mapelsoncircuit is |
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Definition
| decreased resistance b/c no valves or soda lime restriction |
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Term
| Disadvantage of mapelson: |
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Definition
| pollution; need for high flows and loss of pt heat and humidity. |
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