Term
| Describe the characteristics of a PDA murmur |
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Definition
| impinges on diastole, heard over mid to left sternal border, hard to hear if neonate is on ventilator |
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Term
| What is the most common approach for PDA repair? |
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Definition
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Term
| What are your fluid/blood replacement priorities with PDA closure? |
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Definition
| T&C 1 unit PRBC (have unit in room at start), fluid warmers, T&C 1 unit plsma, albumin 5% in room, preservative free o.9NS |
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Term
| Where is preductal and postductal pressures monitored? |
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Definition
| Preductal - right arm, postductal - left arm |
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Term
| How should monitors be placed in PDA repair? |
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Definition
| BP on right arm, sat monitor on right arm, sat monitor also on left arm or lower extremities, esophageal stethoscope/temperature probe |
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Term
| What are the pulse pressures like in PDA? What does PDA ligation do to the diastolic pressure and pulses? |
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Definition
| Widened, improves disastolic pressure and pulse strength |
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Term
| What is the preferred method of anesthesia to repair the PDA? What is an alternative anesthetic plan? |
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Definition
| High dose fentanyl (10-50mcg/kg) and pancuronium 0.1mg/kg. Alternatively, sevo can be used in moderate amounts, unless the EF is poor. |
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Term
| How is bradycardia handled intraoperatively when repairing a PDA? |
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Definition
| the surgeon must immediately stop and allow lung re-expansion. |
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Term
| What are causes of hypotension in PDA repair? |
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Definition
| loss of circulating volume (blood loss or evaporation) or due to chest compression that causes decreased venous return |
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Term
| what are potential complications of PDA repair? |
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Definition
| recurrent laryngeal nerve injury, tearing the PDA, clamping of the aorta, destruction of the thoracic duct, clamping of the pulmonary artery, clamping the carotid artery, clamping of a bronchus |
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Term
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Definition
| Albumin is a colloid and is therefore dosed based on the 1:1 rule (1ml fluid loss is replaced with 1ml colloid) |
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