Term
| How is myocardial function in the neonate unique? |
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Definition
*Neonatal myocardium is less compliant to volume shifts
*CO is greatly affected by changes in HR |
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Term
| How is ventricular performance influnced? |
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Definition
*Preload
*Afteroad
*Contractility |
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Term
| What is the "rule of 5's"? |
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Definition
*RA-5mmHg
*RV 25 (52)/5
*LA 10mmHg
*RV 100(102)/10
PA~ 25/15
Ao~ 100/50 |
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Term
| What are the four general categories of CHD and examples of each? |
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Definition
*Obstructive Lesions
-AS
-MS
*Regurgitant lesions
-MR
-AR
*Shunt Lesions
-ASD
-VSD
-PDA
*Mixing Lesions
-TV
-TA PVR
-Pa w/ VSD single ventricle
-Single atrium |
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Term
| What are three factors that affect shunting? |
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Definition
*Shunt orifice size
*Outflow resistance
*These factors make the flow balance of SVR/PVR so important |
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Term
| What is the formula for PVR? |
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Definition
| *PVR= 80 x (MPAP-PCWP)/CO |
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Term
| What are factors that increase PVR? |
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Definition
*Hypoxia
*Hypercarbia
*Acidosis
*Hyperinflation (increased PEEP, Increased PIP)
*Sympathetic Stimulation
*High HCT
*Atelectasis (Decreased FRC)
*Surgical constriction (retraction)
*Anesthetics (ketamine, N2O)
*Hypovolemia
*Alpha-adrenergic agonists |
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Term
| What are factors that decrease PVR? |
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Definition
*Oxygen
*Hypocarbia
*Alkalosis
*Normal FRC
*Block sympathetic stimulation (Narcotics)
*Low Hct
*PGE1
*Alpha adrenergic antagonists
*Vasodilators |
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Term
| What are interventional cardiology procedures that can be done in peds? |
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Definition
*Diagnostic
*Coil Embolization
*Trans-catheter device closure
*Balloon and stent dilatation
*Balloon atrial septectomy- TGA-IVS, MS, MA
*Radiofrequency mapping and ablation
*Myocardial biopsy
**Associated risks- Dysrhythmias, perforation, damage to leaflets and chordae, CVA, Air embolism, IVP dye reactions. |
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Term
| What are the types of atrial septal defects? |
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Definition
*F>M
*Different from a PFO
*Ostium secundum- 70%, located over or near IVC (good kind to have)
*Ostium primum- located at or near PFO- usually Down's kids
*Sinus Venosus- at the SVC associated with pulm veins draining into the RA.
***Problem?? L to right shunt causing pulmonary overload |
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Term
| What are the four types of ventricular septal defects? |
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Definition
*Supracristal
*Membranous (75%)
*Inlet
*Muscular
**Problem is left to right shunt and pulmonary overload |
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Term
| In what children are atrioventricular canal defects most common? |
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Definition
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Term
| What are some anesthetic implications for repair of atrioventricular canal defect? |
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Definition
*-2 types: partial and complete
*Repair normally for Qp:Qs>3
*Avoid high FIO2
*Avoid low EtCO2
*Avoid high SVR
**Avoid Air emboli
*Deep hypothermic arrest for case- 18 degrees room temp 45-50 |
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Term
| What are associated findings with Patent Ductus Arteriosus Patients? |
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Definition
*Common in premature infants
*Causes left to right shunt= pulmonary congestion
*Widened pulse pressure
*Machinery mumur
*Feeding difficulties
*Medical treatment first then surgical |
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Term
| What are some OR specific implications for PDA? |
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Definition
*2 IV's, A-line not necessary, if only a PICC present, need PIV to give blood through
*Left thoracotomy
*2 Pulse ox's
*Fentanyl, pavulon, may not tolerate forane
*May need atropine
*Maintain volume, consider PRBC's right away
*Review neonatal anesthesia |
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Term
| What two heart conditions are linked to Sudden Cardiac Death in children? |
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Definition
*Hypertrophic CM
*Dilated CM |
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Term
| What are symptoms of Coarctation of the Aorta? |
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Definition
*Chest Pain
*Upper limb HTN
*Diminished Femoral pulses
*Bounding carotid pulses
*CHF |
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Term
| What are the 4 defects in a Tetrology of Fallot? |
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Definition
*VSD
*Pulmonary stenosis
*Hypertrophy of R ventricle
*Overriding Aorta |
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Term
| What is the treatement for a "Tet spell"? |
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Definition
*Volume- Give 10-12mL/kg
*Neosynephrine
*100% FIO2
*Clamp Aorta
*Morphine
*Knees to chest
*Keep PVR Low |
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Term
| What should be done to manage normal surgery for patients who have lesions with increased pulmonary blood flow? (ie: ASD, VSD, PDA's)? |
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Definition
*Maintain a high PVR and low SVR
*Low FiO2, normal CO2
*Lower SVR w/ anesthetic agents (forane)
*Vasodilators |
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Term
| What should be done to manage normal surgery for patients who have lesions decreased pulmonary blood flow? (TOF, TA, PA) |
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Definition
*Must have some sort of shunt from R to L
*Keep PVR low
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Term
| What are results of chronic hypoxemia? |
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Definition
*Pressure of volume overload
*Polycythemia Hct>65%
*Alveolar hyperentilation |
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