Anesthesia Tutorial of the Week Quiz

1) There is complete obstruction to systemic blood flow in hypoplastic left heart syndrome (HLHS).

2) At birth, an increase in arterial carbon dioxide concentration (PaCO2) causes pulmonary vascular resistance (PVR) to fall.

3) The ductus arteriosus is usually fully closed by 24-48h of life.

4) In children with single ventricle heart defects, an intracardiac and systemic-to-pulmonary shunt are both required to allow the single ventricle to perfuse both systemic and pulmonary vascular beds.

5) Oxygen causes a rise in PVR.

6) A ratio of pulmonary blood flow to systemic blood flow (Qp:Qs) of 1 represents a balanced circulation.

7) Peripheral oxygen saturations (SpO2) of 100% are the ideal target for a neonate with HLHS.

8) Congestive cardiac failure, pulmonary oedema and pulmonary hypertension can result from an unbalanced circulation with a Qp:Qs >1.

9) Prostaglandin E1 can be used to close the ductus arteriosus.

10) Phosphodiesterase inhibitors such as milrinone increase cardiac output as well as lower systemic vascular resistance (SVR).

11) Stage 1 palliation with a Norwood procedure is usually carried out at day 3-5 of life.

12) Non-invasive ventilation (NIV) increases cardiac output by reducing afterload.

13) A bidirectional Glenn procedure involves anastomosis of the inferior vena cava (IVC) to the right pulmonary artery.

14) Positive pressure ventilation increases SVC flow to the pulmonary arteries in children post bidirectional Glenn procedure.

15) In children post-Glenn, SVC or pulmonary artery thrombosis can cause persistent hypoxia not responsive to volume replacement or adequate ventilation.

16) In children post-Fontan, pulmonary blood flow and cardiac output are entirely dependent on passive venous filling.

17) Target SpO2 in a child post Fontan is 75-85%.

18) Children with a Fontan circulation poorly tolerate hypovolaemia and large volume IV fluid resuscitation is often needed to prevent shock.

19) Intubation with Propofol is safe in children with a Fontan circulation?

20) Complications from a Fontan circulation include cardiac failure, thrombosis, arrhythmias and liver failure.