Term
| The airways are formed to the terminal bronchi by the ___ week of gestation |
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Definition
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Term
| Full term infants have approximately __ _____ alveoli |
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Definition
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Term
| The alveoli increase in number until age __ |
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Definition
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Term
| When do children develop full smooth muscle tone in the pulmonary vasculature |
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Definition
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Term
| Growth of the pulmonary vascular bed can be inhibited by many conditions that include: |
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Definition
| lung hypoplasia associated with diaphragmatic hernia. |
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Term
| Type I fibers at 37 weeks ___; term ___ ; adult ___ |
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Definition
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Term
| Surfactant is produced by what cells? |
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Definition
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Term
| When does surfactant production begin? |
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Definition
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Term
| Release of surfactant into amniotic fluid occurs |
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Definition
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Term
| Production of surfactant is effected by |
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Definition
| acidosis, hypoxia, hyperoxia, temperature, inhalation agents |
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Term
| Surfactant is destroyed by |
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Definition
| 100% FiO2, aspiration, aggressive ventilation |
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Term
| Surfactant is increased by |
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Definition
| steroids, thyroxine, cortisone, and heroin |
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Term
| Compare the oxygen consumption rate of an infant at _______ to that of an adult _________. |
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Definition
| 5-8 ml/kg/min, 2-3ml/kg/min |
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Term
| What is the primary mode of changing your oxygen intake and CO2 elimination for an infant? |
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Definition
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Term
| Rapid desaturation is caused by... |
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Definition
| Their high rate of oxygen consumption combined with a reduced FRC |
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Term
| High concentrations of oxygen _____ the newborn’s respiration, low concentrations _____ it |
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Definition
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Term
| What should your goal O2 saturation be? |
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Definition
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Term
| Central apnea is exacerbated by? |
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Definition
| hypothermia, hypoglycemia, sepsis and hypocalcemia |
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Term
| Postoperatively, __% of former premature infants may have postoperative apnea |
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Definition
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Term
| Are infant's lungs more/less compliant |
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Definition
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Term
| Is an infant's chest wall more/less compliant |
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Definition
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Term
| Fetal Hgb has a ______ affinity for 2,3 DPG and thus a ______ affinity for oxygen |
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Definition
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Term
| RBCs with Fetal Hgb have a ½ life of... |
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Definition
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Term
| What is the major and secondary determinant of cardiac output in the infant? secondary? |
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Definition
Major is heart rate
Secondary is preload |
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Term
| The first sign that a child is hypovolemic is a... |
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Definition
| Reduction in blood pressure, b/c while the PNS is developed, the SNS is not, so the normal response of tachycardia to hypovolemia does not occur. |
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Term
| Umbilical cord has how many veins and arteries |
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Definition
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Term
| Clamping the umbilical vein _______ systemic vascular resistance |
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Definition
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Term
| If there is sufficient increases in RA pressure (as would occur with pulmonary hypertension), the ____ ____ can be forced open |
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Definition
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Term
| The DA closes due to an ______ in systemic vascular resistance and ______ in pulmonary resistance |
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Definition
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Term
Persitent Pulmonary Hypertension (PPHN)
Precipitating Factors |
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Definition
Hypothermia
Hypoxemia
Acidosis
Pneumonia
Meconium aspiration
Congenital diaphragmatic
hernia |
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Term
| Persitent Pulmonary Hypertension (PPHN) treatment |
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Definition
Nitric Oxide (NO) is a potent pulmonary vasodilator that may be beneficial.
Oral sildenafil (viagra) is also a useful pulmonary vasodilator.
ECMO (extracorporeal membrane oxygenation) may be required to provide adequate oxygenation until severe PPHN resolves. |
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Term
| Choanal Atresia and Stenosis Implications |
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Definition
-easy to obstruct
-manifests as cyanosis at rest that resolves with crying or oral airway
-early placement of oral airway is helpful during induction |
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Term
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Definition
| downward displacement of aryepiglotic fold producing obstruction with inspiration |
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Term
| Laryngomalacia anesthetic implications |
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Definition
It is helpful to provide positive pressure immediately prior to intubation.
downsize your ETT! Have several sizes available |
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Term
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Definition
-forms 2-3 mm below the true cords
-from prolonged intubation
-were they in NICU at birth? |
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Term
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Definition
| Vertebral anomalies, imperforate Anus, TEF, Radial aplasia/Renal abnormalities, and Limb abnormalities |
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Term
| True or false: Esophageal atresia and tracheoesophageal fistulas (TEF) are often associated with other congenital abnormalities |
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Definition
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Term
| symptoms of Esophageal atresia/TEF |
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Definition
-excessive secretions
-regurgitation of the first feeding and -occasionally respiratory distress exacerbated by feedings
-recurrent pneumonia is usually diagnosed later. |
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Term
| What is the most common type of tracheoesophageal fistula |
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Definition
| The most common is type C where the esophagus ends in a blind pouch from above and there is a single fistula from the lower end of the esophagus to the trachea. |
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Term
| Anesthesia considerations for TEF: |
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Definition
SG RRAPP!
Suction the pouch
G-tube to vent stomach
Right main stem on purpose
RSIV
Atropine, pre-treatment
Position
Precordial |
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Term
| Congenital Diaphragmatic Hernia (CDH) accounts for ___% of all major congenital anomalies and occurs 1 in roughly ______ live births |
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Definition
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Term
| Perioperative mortality for CDH is ____% |
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Definition
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Term
| __% of children with CDH also have concurrent cardiac anomalies |
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Definition
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Term
| Most common area of herniation in CDH |
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Definition
| Left foramen of Bochdalek (80%) |
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Term
| Most common areas of herniation in CDH are: |
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Definition
1. Left foramen of Bochdaleck (accounts for 80% of all CDH). The left foramen closes after the right which is probably why the left side is most affected.
2. Right foramen of Bochdaleck
3. Foramen of Morgagni |
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Term
| In CDH, what problem results in thelungs due to having abdominal contents in the thoracic cavity? |
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Definition
| IPSILATERAL LUNG HYPOPLASISA |
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Term
| The symptoms of CDH include: |
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Definition
Scaphoid abdomen
Barrel shaped chest
Respiratory distress
Bowel sounds auscultated over chest
Arterial hypoxemia and cyanosis |
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Term
| What kind of shunt do you see in congenital diaphragmatic hernia? |
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Definition
| A right to left shunt, and persistent fetal circulation (PDA, PFO |
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Term
| Treatment for kids with CDH |
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Definition
| These kids frequently require inhaled NO (nitric oxide), high frequency ventilation and/or ECMO. |
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Term
| Anesthesia Considerations of CDH |
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Definition
NG or OG tube is placed to decompress the stomach
immediately intubated (generally awake intubation)
Ventilation is accomplished with low volume and high rates.
Preductal oxygen saturation
Preductal radial arterial line should also be placed in RIGHT radial artery.
AVOID NITROUS OXIDE
Frequent ABGs
sodium bicarbonate 1mEq/kg for acidosis
Hyperventilate to keep CO2 around 25-30 torr and pH7.5!
MAINTAIN NORMAL BODY TEMPERATURE! |
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Term
| In CDH repair, If the infant’s lungs respond to hyperventilation with a ______ in PaCO2, they often times do well |
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Definition
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Term
| 6 Factors that Worsen Pulmonary Hypertension |
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Definition
Hypoxia
Hypercarbia
Acidosis
Hypothermia
Pain
Noxious stimuli |
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Term
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Definition
| Use D5.45 or D5.9NS as maintenance on pump at 4ml/kg/hr |
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Term
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Definition
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Term
| After CDH repair are infants extbated? |
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Definition
| No, sent to NICU on a vent |
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Term
| What labs should be monitored in a CDH repair |
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Definition
| Ionized Calcium and glucose |
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Term
| Why do you avoid 100% SpO2 in a neonate? |
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Definition
| Due to retinopathy of prematurity. Too much O2 can cause blood vessels to grow abnormally, resulting in abnormal vessel growth causing retinopathy of prematurity. |
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