Term
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Definition
activation of nociceptos in peripheral tissues. C & A fibers transmit pain sensation.
Described as well-licalized aching or gnawing pain. i.e. bone pain muscle pain, postoperative pain. |
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Term
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Definition
| visceral structures are stretched, compressed, invaded or distended. Poorly localized. Described as squeezing, cramp, colicky. |
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Definition
| type of visceral pain also known as verceral somatic reflex. Vague pain often w/ N&V |
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Definition
| direct injury to neural tissue from tumor inflitration, erosion, or from cancer therapies. Associated w/ sensory, motor, and autonomic deficits accompany the symptoms of burning, squeezing, and sharp pain. i.e. brachial and lumbar plexopathies and post thoracotomy pain syndrome. |
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Term
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Definition
| Affect CNS, involving 2nd and 3rd order neurons typified by abnormal sensibility to both pain and temp. i.e. neoplastic lesions along the spinothalamic tract or cerebral cortex projections, postherpetic neuralgia, and phantom limb pain. |
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Term
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Definition
| pain can occur after fractures, thrombosis, lymphedema, dysautonomia including burning, allodynic pain, w/ sudomotor and vasomotor changes, edema, and coldness of area. Sympathetic nervous system changes affecting the area |
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Term
| Nociceptors activated by only one type of stimulus |
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Definition
| high-threshold mechanoreceptors |
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Term
| A-delta afferent nerve fibers |
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Definition
| small, rapid, myelinated = sharp & prickling pain |
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Term
| C-afferent nociceptive neurons |
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Definition
| small, slowly, unmyelinated plymodal receptors activated by wide variety of high-intensity stimuli, mechanical, chemical, temperature |
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Term
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Definition
| exaggerated pain response usually b/c of imprinting |
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Term
| Urine concentrating ability is_______in neonates. Urine Osmolality is ____-_____mEq/L |
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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
| Reanl plasma flow and GFR are _____that of the adult values. |
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Definition
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Term
| Maturational differences make it very difficult for the infant to handle fluctuations in fluid and solute loads. Hemostatic mechanisms are fully developed after _______yr(s) of life. |
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Definition
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Term
| The excretion of a fluid bolus is d/t the limited______ |
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Definition
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Term
| Normal neonate losses ______% of its body weight in the first few days of life due to loss of______&_______ |
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Definition
| 5-15%; isotonic salt and water |
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Term
| Pematurity increases neonatal fluid requirements. Fluid requirement is bases on what three factors? |
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Definition
| weight, U/O, and serum sodium |
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Term
| On day one neonate fluid requirements are _______(high or low)? |
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Definition
| low; increasing over the next few days |
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Term
| Glucose levels must be maintained. What happens to the levels in the first few hours of life? What should it not go below? |
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Definition
| decreases; should not go below 45mg/dL |
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Term
| What is given to replace glucose levels and what is the bolus and continuous infusion doses? |
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Definition
| D10W; bolus 2-4mL/kg; Continuous infusion 4-6mg/kg/min |
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Term
| D/t fluid and salt losses during first few days of life, the neonate is prone to hyper or hypo natremia? |
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Definition
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Term
| What type of fluids are preferred in the OR? |
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Definition
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Term
| Glucose containing solutions are not used in the OR because? |
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Definition
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Term
| When critically ill children arrive in the OR w/ hyperalimentation the infusion should be______? |
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Definition
continued on a separate line;
deduct volume from isotonic operative fluids. |
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Term
| Age related norms for HR & BP see pf 18 of textbook. |
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Definition
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Term
| If you suspect hypovolemia, how much fluid bolus should be give? |
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Definition
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Term
| A normal healthy child should not be transfused until the Hct. is____ |
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Definition
| 20-25%; A child w/ sever pulmonary disease requires a higher Hct. than a healthy child. |
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Term
| If significant blood loss is expected the use of what 3 things may be necessary? |
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Definition
| foley, central line, and art line |
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Term
| Most of the heat loss form the baby is lost by? |
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Definition
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Term
| The child should be considered poikilothermic which means? |
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Definition
| cold blooded; use radiant warmers, warm air mattress, heat moisture exchangers and fluid warmers, but avoid hyperthermia |
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Term
| A microdrip IV set should be used on children less than___kg. |
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Definition
| 50kg. 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 minimized 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 w/ ETT assess for a leak at _______cmH2O |
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Definition
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Term
| A cuffed tube is ______mm larger? |
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Definition
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Term
| In Mapleson circuits what prevents rebreathing? |
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Definition
| high fresh gas flows venting exhaled gas thru the APL valve before next inspriation. |
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Term
| The efficiency of mapleson 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 mapleson circuit is: |
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Definition
| decreases resistance b/c no valves or soda lime restriction. |
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Term
| Disadvantage to Mapleson circuits is: |
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Definition
| the need for high flows to eliminate rebreathing; pollution of the OR environment; loss of patient heat and humidity. |
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Term
| Make sure read Dorsch chapter 8 |
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Definition
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Term
| Define low birth weigh, very low, and extremely low. |
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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 w/ ventilation. ETT INCREASES WOB greater than the infant |
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Term
| In premies loss of muscle control caused by anesthesia increase_____? |
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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 premie's immature lung predisposes them to hypoxia. Low lung voulmes 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 anesthesia to maintain? |
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Definition
| lung volume and prevent hypoxia and V/Q mismatch |
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Term
| Premies are suceptible to what kind of respiratory problems? |
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Definition
| Oxygen toxicity, barotrauma, and development of BPD |
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Term
| Premies have a _______ventilatory response to carbon dioxide and ______further blunts this response |
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Definition
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Term
| premies have a biphasic ventilatory response |
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Definition
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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 Cardiac output is dependent on? |
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Definition
| HR; small absolute blood volume; little autoregulation prediposes the preemie to CV collapse |
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Term
| Open patent ductus arteriosus predisposes the preemie to? |
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Definition
| pumonary HTN and CHF; PDA = right to left 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
| Preemie often have cognitive impairment d/t brain injury most commonly in the? |
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Definition
| perventricular white matter |
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Term
| IVH occurs in what percentage of preemies? |
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Definition
| 1/3 or 33%; IVH grades 1-4, 4 being the worst. |
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Term
| Retinopathy of prematurity occurs in _____% of low birth wt. infants. Thought to be caused by what? |
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Definition
| 50%; variations in arterial oxygen and eposure to bright lights, free oxygen radicals may be another cause. |
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Term
| preemies are susceptible to hypthermia, 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 little fat and a large surface area to mass ratio...KEEP THEM WARM!! |
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Term
| Preemies...Reduced kidney function, plasma creatinine levels 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 closely! |
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Term
| Liver has reduced hepatic proteins, at risk for spontaineous 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 requirement is less than the term infant. |
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Definition
| N20 d/t decreases O2= desat quickly; also distension of airfilled spaces (gut) |
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Term
| Preemies immature liver yield higher 1/2 times for opioids and benzos |
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Definition
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Term
| Necrotizing Entercocolitis NEC, is a life threatening situation caused by? |
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Definition
| intestinal mucosa ischemia |
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Term
| Early signs of NEC= feeding intolerance, name 3 more. |
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Definition
| lethargy, temperature instability, and increased WOB |
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Term
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Definition
| hypotension; abdominal distension, apnea, coagulopathy, and multiorgan failure. NEC IS A SURGICAL EMERGENCY |
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Term
| Preparation for NEC surgery: albumin, FFP, platelets, PRBC'S, Epinephrine, Dopamine, and calcium gluconate...what's the Ca gluconate for? |
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Definition
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Term
| NEC emergency Pre-op assessment should include: |
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Definition
| current meds, IV access, Dextrose infusion rates, H&H, electrolytes, and BG level. |
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Term
| What are the intubation considerations for NEC emergencies? |
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Definition
| RSI or awake d/t full stomach |
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Term
| NEC need vascular access. What else is needed to surgery? |
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Definition
| 2 large bore IV's (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 20-50mcg/kg, muscle relaxant, small or NO inhalational gas. |
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Term
| Preemie treatment of hypotension, bolus of fluid ___-___ml/kg. Run Dopa at ___-____mcq/kg/min. What other two considerations? |
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Definition
| 10-20 ml/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
| PRBC's. Give platelets to maintain count >100,000. |
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Term
| During NEC replace fluids villigently; not uncommon for a preemie to receive______of fluid during the case? |
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Definition
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Term
| Ligation of patent Ductus Arteriosus d/t failure of closure is common in preemies. The PDA incures a severe ____-_____ shunt |
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Definition
| left to right. With overload or pulmonary HTN shuting 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 20-50mcg/kg (the whole case) Pacuronium 0.2mg/kg, albumin 10ml/kg before induction to avoide hypotension. The surgery is about _____long the patient should be extubated when? |
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Definition
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Term
| Inguinal hernia repair; common in preemies, use GA or RA. May need to give _____to prevent post op apnea? |
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Definition
| caffeine. 10mg/kg prior to extubation |
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Term
| INGUINAL HERNIA REPAIR avoid which medication? |
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Definition
| fentanly; use tylenol; surgeons use local for pain control. Need stimulus to breath...otherwise stays vented. |
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Term
| Pertem infants with BPD will have compensated ______ ______ and elevatied ______ |
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Definition
| respiratory acidosis and elevated ETCO2 |
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Term
| Inguinal hernia repair. RA is common; cuadal blockagde with ______caine _____% with epi 1:200,000 ______ml/kg |
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Definition
| bupivicain 0.375%; epi 0.75ml/kg; works for 1-2 hrs. Excellent for preemies w/ BPD. |
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