Incidence of CHD is growing by what percentage a year?

Is the  true incidence known?

1) 5% a year

2) True incidence is masked d/t large number of infants will die in utero.

Basic Things we are concernced with in Anesthesia regarding CHD repair:

1) What are you prepared for when a kid is coming for a CHD repair? 

2) How about the asymptomatic repaired CHD patient?

1) Symptoms of cyanosis, dysrhythmias, or CHF.  Also we are prepared for basic instability

2) Repaired CHD pt. appears well but the stress of surgery can unmask subtle physiology in these pts.

Stages and Goals of CHD repair:

1) What is definitive repair and what is the goal?

2) What is palliative repair?

1) Definitive means the CHD is completely repaired to the extent it can be.  The goal is to eliminate cyanosis and the body's compensatory response of polycythemia.

2) Palliative means the repair is being done in stages.

Fill in the blanks regarding CHD:

The newborn heart or preterm heart contains a lot of ___1___ tissue and few ___2_____ producing a ____3_____ contraction.   ____4____% of the neonates myocardial mass comprises contractile tissue (compared with 60% in the mature myocardium)

1) connective

2) myocytes

3) nonsynchronous

4) 30%

True or False:

Neonates have a higher velocity of shortening, an increased length-tension relationship and a reduced ability to respond to afterload stress.

False

Neonates have a LOWER velocity of shortening, a DIMINISHED length-tension relationship and a reduced ability to respond to afterload stress.

We know that an infant's cardiac output will respond to an increase in preload, However stroke volume is relatively fixed. 

So, Overall- the most important parameter that drives cardiac output (and therefore Oxygen delivery) is:

The newborn Myocardium derives a relatively high fraction of activator Calcium from the extracellular pool to initiate and sustain contraction.  

SO:

1) Why is the neonatal heart so darned dependent on extracellular Calcium?

2) What drugs should we be concerned with?

1) cytoplasmic reticulum and T-tubular system are underdeveloped

2) Calcium Channel  Blockers

Flashcard Deja Vu:

What should you suspect if you have a BP drop in a kid?

True or False:

1) Preterm infant heart is less sensitive to the depressant effects of inhaled agents.

2) A relatively high pulmonary vascular resistance persists in the preterm infant

1) false- more sensitive to effects of inhaled agents

2) True

The preterm infant pulmonary vasculature is more sensitive to vasoconstriction by  4 main things.  What are they?

1) Hypoxia

2) Acidosis

3) Hypercarbia

4) Hypothermia

There is always one big GAY slide during this assignment.  For me this is the one. 

Slide 8 of CHD

Almost any anesthetic technique may be used in any CHD patient if the anesthetist understands what?:

1) The pathophysiology of the lesion

2) the pharmacology of the drugs employed.

Cardiopulmonary changes at birth:

Tell me about what happens when that baby gets it's first smack on the ass and expands those lungs.

1) Functional closure of the foramen ovale as a result of increased LAP in excesss of RAP

2) The LAP increases as a result of the inc. in pulmonary blood flow and inc. pulmonary venous return to the left atrium.

3) RAP falls as a result of closure of the ductus venosus

4) PDA closes d/t inc. aterial oxygen saturation