Pediatric Anesthesia

Question 1

< 30 days of age?

Answer 1

neonate

Question 2

1-12 mos of age

Answer 2

infant

Question 3

1-12 yrs of age

Answer 3

children

Question 4

Cardiac output of neonates and infants is dependent on _______, b\c _______ is relatively fixed by a noncompliant and poorly developed left ventricle.

Answer 4

heart rate; stroke volume

Question 5

Describe the airway in the neonate and infant.

Answer 5

1) large head and tongue
2) narrow nasal passages
3) anterior and cephalad larynx
4) long epiglottis
5) short trachea and neck
6) prominent tonsils and adenoids

Question 6

What is the formula to calculate pediatric ETT size for >1yr old?

Answer 6

Age (yr) divided by 4, plus 4

ex) 4yr old= 4/4=1 plus 4= 5mm ETT size

Question 7

What is the best size ETT for a neonate <3kg?

Answer 7

3.0-3.5

Question 8

What is the best size ETT for an infant 6mos-1yr old?

Answer 8

3.5-4.0

Question 9

What is the best size ETT for a 1-2 yr old?

Answer 9

4.0-4.5

Question 10

What is the formula to estimate tube length at mouth in pediatrics

Answer 10

Weight (kg) divided by 5, plus 12

ex) 5kg neonate= 5/5=1 plus 12= 13cm at lip

Question 11

%TBW of preterms?

Answer 11

90%

Question 12

%TBW of terms?

Answer 12

80%

Question 13

%TBW of 6-12mos olds?

Answer 13

60%

Question 14

Why are infants of diabetic mothers prone to hypoglycemia?

Answer 14

infant produces insulin in response to maternal blood sugar to control its own glucose levels—> after delivery, the cord is clamped eliminating maternal blood sugar level—> stored insulin decrease’s the newborn’s blood sugar

Question 15

What is the most commonly used local anesthetic in North American?

Answer 15

Bupivacaine

Question 16

What is the preferred concentration of local anesthetic for peripheral nerve blocks in the neonate?

Answer 16

0.25% bupivacaine or 0.20% ropivacaine

Question 17

What is the suggested maximum dosage for bolus injection in the caudal space or epidural space for older children and neonates? For infants?

Answer 17

4mg/kg; 2mg/kg

Question 18

What is the normal gestation period?

Answer 18

40 weeks

Question 19

What is the definition of prematurity?

Answer 19

<37 weeks

Question 20

Is right or left sided diaphragmatic herniation more common?

Answer 20

70-90% of defects are on the left side

Question 21

How do you confirm a diaphragmatic hernia?

Answer 21

US or ultrafast fetal MRI

Question 22

What percent of newborns with a diaphragmatic hernia will have congenital heart disease?

Answer 22

40-60%

*also high incidence of intestinal malrotation

Question 23

What are the hallmark signs of a congenital diaphragmatic hernia?

Answer 23

1) arterial hypoxia (R–>L shunt from persistant fetal circulation)
2) barrel-shaped chest–> bowel is in the thorax
3) severe retractions (working hard to breath)
* s/s: dyspnea, tachypnea, cyanosis

Question 24

Why is the avoidance of hypothermia, hypoxia, and acidosis a concern with diaphragmatic hernias?

Answer 24

ALL increase pulmonary vascular resistance

Question 25

What is the most common form of tracheoesophageal fistulas?

Answer 25

85%: form that ends in a blind pouch and a lower esophagus that connects to the trachea

Question 26

What are the 3 signs of tracheoesophageal fistula that can be noted when attempting to feed an infant?

Answer 26

1) choking
2) coughing
3) cyanosis
s/s: hypoxia and bradycardia, gastric distention with respirations, aspiration pneumonia, dehydration

Question 27

How is the diagnosis of a TEF made?

Answer 27

by failure to pass a catheter into the stomach and confirmed by coiling of the catheter in a blind pouch

Question 28

_____ % of infants with TEF have associated congenital anomalies, approximately ____% involve the cardiovascular system.

Answer 28

50%; 15-25%

Question 29

What is VACTERL syndrome? (associated congenital anomalies with TEF)

Answer 29

vater plus cardiac and limb abnormalities
Vertebral defect
Anal atresia
Cardiac anomalies
Tracheoesophageal fistula
Esophageal atresia
Renal dysplasia
Limb anomalies

Question 30

What are some anesthetic concerns for TEF?

Answer 30

1) copious pharyngeal secretions
2) no positive pressure ventilation prior to intubation
3) awake intubation without muscle relaxants
4) neonates are dehydrated and malnourished
5) no neck extension
6) avoid instrumentation of the esophagus
7) extubate after repair is done (30% reintubation occurence)

Question 31

What is pyloric stenosis?

Answer 31

idiopathic hypertrophy of the circular smooth muscle of the pylorus, which results in compression and narrowing of the pyloric channel
*there is narrowing or stenosis in the pylorus causing pressure to build–> build–> build–> POP–> out it goes!