Anesthesia For Non-Ob Surgery Flashcards
What population is more predisposed to anomalies
DM 4-12%
Vs 3%
When is fetus most voluntarable and why
Between 15-90 days - organogenesis
After this mostly functional defects or growth retardation
What group of meds is associated with congenital anomalies
Tranquilizers
Minor BZDP
Major Psych meds
Cleft lip/palate is associate with
Tranquilizers, salicylates, opiates
Valium: most common
No studies suggest that a single dose is ass with congenital defects
Why not to use N2O
- Teratogenic effects
- Adverse effects on DNA synthesis
- Inactivates B12:
- essential cofactor for enzyme methionine synthetase
- interferes with folate metabolism
- conversion of uridine to thymidine - Increase uterine adrenergic tone- vc to uterine blood flow
Propofol
B: Ok to use, rapidly crosses placenta
Ketamine
Not classified
Can depress Apgar score
Which med group to avoid during all trimesters
BZDP
D
Narcotics
Muscle relaxant
Narcotic safe
Droperidol and Zofran ok to use
Ketorolac
Not used, avoid after 1st trimester
May constrict or close fetal DA
Muscle relaxant don’t cross placenta
What is #1 cause of non OB maternal mortality
Homicide #1
Trauma is most common
What are the 3 H’s that decrease uterine perfusion
Hypoxia
Hypocarbia
Hypotension
When to start aspiration prophylaxis
14 weeks: bicitra, Pepcid, Reglan
Most likely need to be GETA : RSI
Narcotic and antisialagogue OK
When to start fetal heart monitoring
After 16 - 18 weeks
What does hypocarbia do
Decreased umbilical blood flow because of direct vasoconstriction
OxyHgb curve shifts to left: fetal hypoxia, metabolic acidosis
Induction
Preoxygentation (not concern when in uterus), RSI
Ketamine 14 weeks
Anticolinesterase agents can increase uterine tone due to release of Ach; don’t need the full reversal
Cervical cerclage
When and what anesthesia plan
14-26 weeks
SAB without sedation
Post op for OB surgery
Need to stay 24 hrs after surgery for FHR
Cardiac arrest
LUD key, cricoid pressure until airway secured
Chest compression mid point of sternum
Fetal delivery
What is the 4 min rule
C/S delivery within 4 min of cardiac arrest
Baby out
Most common fetal surgery
Obstructive uropathy
Congenital diaphragmatic hernia
Repair of myomeningocele (31-37 gestational weeks)
Tetragenesis
Dysgenesis of fetal organs as evidenced either structurally or functionally
Avoid benzo
