pediatricAnesthesia - PresentedMay2003 PediatricAnesthesia...

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Pediatric Anesthesia Darko J Vodopich MD Resident @ CWRU–MHMC Revised by: Greg  Gordon MD, and Susan Sweda MD Presented May 2003
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Development:  Organogenesis - 1 st  8 weeks  Organ function - 2 nd  trimester  Body mass - 3 rd  trimester
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Changes in cardiovascular system:  Removal of placenta from circulation  Increasing of systemic vascular resistance  Decreasing of pulmonary vascular resistance  True closure of PDA ~ 2-3 weeks   critical  transitional circulation  Myocardial cell mass less developed   prone to  biventricular failure, volume loading,  poor  tolerance to afterload, heart rate- dependent CO* * True for young infants
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Changes in pulmonary system:  Small airway diameter - increased resistance  Little support from the ribs  VO 2  2x > adults  Diaphragm and intercostal muscles do not achieve  type-1 adult muscle fibers until age 2  Obligate nasal breathers
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Airway difference:  Large tongue  Higher located larynx  Epiglottis short and stubby, angled over the inlet  Angled vocal cords   we must rotate ETT to  correct  lodging at anterior comissure  Narrowest portion is cricoid cartilage
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Chest wall/Respiratory difference:  Ribs are horizontal in neonates (vertical in adults)  Ribs and cartilages are more pliable  Chest wall collapse more with increased negative  intrathoracic pressure  Atelectasis is more common     FRC    number of alveoli  Alveolar ventilation/FRC:  Adults = 1.5:1  Infants = 5:1 (  respiratory rate)
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Kidney and liver difference: Low renal perfusion pressure, immature GF,  TF, obligate Na loser in the 1 st  month of life Complete maturation @ 2 years of age  Impaired liver enzymes, including conjugation  react.  Lower levels of albumen and proteins - prone  to  neonatal coagulopathy, and less drug  bound    higher drug levels
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GI system and thermoregulation:  Full coordination of swallowing ~ 4-5 months    increased risk for GE reflux  Large body surface area/weight  Limited ability to cope stress  Minimal ability to shiver in 1 st  3 months  Heat whole body  including the head
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Pharmacology/dynamics:   Increased total body water:  Large initial dose required  Less fat   longer clinical drugs effect  Redistribution of the drug into muscle will  increase duration of clinical effect (fentanyl)  Consider liver and kidney immaturity
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Volatile anesthetics Isoflurane:  Less myocardial depression than Halothane  Preservation of heart rate  CMRO 2  reduction rate Desflurane:
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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pediatricAnesthesia - PresentedMay2003 PediatricAnesthesia...

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