Term
| What causes the ductus arteriosus to close? |
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Definition
| Increase in SVR and decrease in PVR |
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Term
During what time period does the ductus arteriosus functionally close?
Anatomically close? |
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Definition
Functionally: day 1-8
Anatomically (fibrosis): 1-4 months |
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Term
| What maintains the patency of the ductus arteriosus in utero? |
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Definition
| Prostaglandins (the uterus provides a constant supply) |
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Term
| How can the ductus arteriosus become lifesaving for very young kids? |
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Definition
| A decreased PaO2 can cause the ductus arteriosus to reopen |
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Term
| If all (or even some) fetal shunts remained open - what condition is created? |
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Definition
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Term
| What is the mechanism of pulmonary hypertension and subsequent hypoxia in an infant? |
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Definition
| An increase in PVR creates pulmonary hypertension; this produces a rise in RAP which opens the foramen ovale and ductus arteriosus; this opening leads to deoxygenated blood mixing with oxygenated blood, leading to a drop in PaO2 and cyanosis |
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Term
| What factors precipitate persistant pulmonary hypertension |
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Definition
| hypothermia, hypoxemia, acidosis, pneumonia, meconium aspiration, congenital diaphragmatic hernia |
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Term
| Name 2 treatments for persistent pulmonary hypertension |
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Definition
| nitric oxide (pulmonary vasodilator) and ECMO (for oxygenation) |
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Term
| You are caring for a kid with bilateral choanal atresia. Do you want them to be quiet or cry and why? |
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Definition
| Cry because will switch from nose breathing to mouth breathing and be able to take in larger, more adequate TV |
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Term
| What is choanal atresia? Why is it a problem? |
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Definition
| Conditon where the nasal pharyngeal bone does not regress and can create a nasal obstruction (infants are nose breathers) |
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Term
| You have a kid with choanal atresia on the table - what problem may occur on induction and what can you do to prevent this problem? |
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Definition
| Development of airway obstruction; awake placement of oral airway may work to preserve patency (use lidocaine viscous to localize the tongue to prevent gagging) |
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Term
| Define laryngomalacia and the anatomical structures it involves |
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Definition
| (Soft larynx) = Downward displacement of the aryepiglottic fold during inspiration producing obstruction. Involves: small glottis, long narrow epiglottis, floppy aryepiglottic fold |
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Term
| What are 2 anesthetic implications with laryngomalacia? |
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Definition
| PPV before intubation (supports structures) and down size the ETT |
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Term
| What factors clue you to think about subglottic stenosis? |
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Definition
| prolonged intubation (early gestation, spent time in NICU, intubated/vented, etc); other anomalies (ex: Down's syndrome is associated wtih this) |
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Term
| Where does subglottic stenosis form (anatomically) |
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Definition
| 2-3mm below the true cords |
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Term
| I feel resistance when attempting to pass the ETT through the cords. Why could this be occuring? What should I do? |
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Definition
| Resistance could be due to hitting the cricoid cartilage or subglottic stenosis - DO NOT force tube; downsize ETT |
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Term
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Definition
| A set of anomalies that includes vertebral abnormalities, imperforate anus, tracheoesophageal fistulas, radial aplasia and renal abnormalities, limb abnormalities |
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Term
| What are symptoms of esophageal atresia and tracheoesophageal fistulas? |
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Definition
| excessive secretions, regurgitation of first feeding, occasionally respiratory distress worsened by feedings, recurrent pneumonia |
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Term
| How do you intubate a pediatric with esophageal atresia/tracheoesophageal fistula? |
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Definition
| Intentional right (or left) mainstem - slowly withdraw ETT just until breathsounds are heard. |
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Term
| What are other intubation implications for the pediatric with esophageal atresia/TEF? |
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Definition
| Place precordial in left axilla, goal of cuff location is just distal to fistula, if gastrostomy tube present = CAN do inhalation induction |
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