Hypotensive effects of citrate-induced hypocalcemia can be minimized by administering how much calcium gluconate for each milliliter of blood transfused??
(1 to 2 mg IV) / for each mL of blood transfused
CDH - The most common findings include displacement of the
heart and fluid-filled gastrointestinal segments into the thorax - both stomach and bowel are often present
CDH - These infants can have profound hypoxemia, which reflects the
RIGHT -TO-LEFT shunting through the ductus arteriosus; the cause is persistent fetal circulation resulting from lung parenchymal and vascular hypoplasia with resultant high pulmonary vascular resistance.
For patients with CDH, Adequate sedation is achieved in an effort to minimize increases in
pulmonary vascular resistance
Apnea of Prematurity is diagnosed if an infant exhibits
•apnea of longer than 15 to 20 seconds, -apnea associated with a heart rate of less than 80 to 100 beats per minute, or -apnea associated with significant decreases in oxygen saturation
Intraoperative oxygen saturation goals for preterm infants undergoing surgery have well established guidelines, True or false?
False there are no established guidelines for specific intraoperative oxygen saturation goals
For CDH - Venous access should be avoided in the
lower extremities, because venous return may be impaired as a result of compression of the inferior vena cava following reduction of the hernia ***
with CDH is N2O okay to use?
Nitrous oxide should be avoided, because its diffusion into loops of intestine present in the chest may result in distention with subsequent compression of functional lung tissue (we don’t want NO to expand in a closed space)
the most frequent congenital anomaly of the esophagus ***
Esophageal atresia (EA) is
For EA - what should be avoided?
Endotracheal intubation is avoided, if possible, because of the potential to worsen distention of the stomach, which can lead to gastric rupture
For EA - Awake intubation with spontaneous ventilation allows
optimal positioning of the endotracheal tube while minimizing the risk of ventilatory impairment associated with gastric distention resulting from positive pressure ventilation and passage of gases through the fistula
with EA - Proper placement of the tracheal tube is critical; it should be above the carina but below
the TEF (fistula)***
EA - Intraoperative insensible and third-space fluid losses should be replaced with crystalloid at a rate of
6 to 8 mL/kg/hr
EA - Blood loss may be replaced with 5% albumin and packed red cells to maintain a hematocrit of higher
Gastroschisis requires urgent
If inspiratory pressures are greater than _______ primary closure is not recommended
25 to 30 cm H2O or intravesical or intragastric pressures are greater than 20 cm H2O,
In Hirschsprung's Disease Anesthesia can be maintained with a mixture of
air, oxygen, volatile agent, and muscle relaxant.
In Hirschsprung's Disease Anesthesia Extra care should be taken in positioning, since these operations can be
In Hirschsprung's Disease Extubation at the end of surgery is
in Anorectal Anomolies, Intravenous catheters should be placed in upper extremities, because
surgical positioning of the legs may impede venous flow or limit access to the intravenous catheter insertion sites
for an anorectal anomolies with significant abd distention, what type of intubation should be employed?
one of the most common gastrointestinal abnormalities appearing in the first 6 months of life
Initial tx of Pyloric Stenosis is aimed at repletion of IV Volume, electrolyte correction and Acid/Base abnormalities. Further resuscitation is given as
5% dextrose in 0.45% NaCl at 1.5 times the maintenance rate
for patients with pyloric stenosis, what is the preferred induction plan?
-awake intubation or by use of -RSI after administration of hypnotic and succinylcholine
Early signs and symptoms of this disease are often nonspecific and include recurrent apnea, lethargy, temperature instability, and glucose level instability.
Necrotizing Enterocolitis (NEC)
NEC - Surgery is reserved for neonates for whom medical management fails, as evidenced by
bowel perforation, sepsis (peritonitis), and progressive metabolic acidosis indicating bowel necrosis
Intraoperative care of a critically ill newborn w/NEC is often more a resuscitation effort than management of
general anesthesia ***
for the infant with NEC, if not already intubated, induction should proceed with full-stomach precautions and awareness of the infant's
depleted intravascular volume and possible impaired contractility
For NEC - Maintenance of anesthesia is generally limited to the use of
short-acting iv opioids (fentanyl) as tolerated, muscle relaxation, and replenishment of intravascular volume as needed
cornerstone TX for biliary atresia is a Kasai's operation (portoenterostomy) and what?