Anesthesia For Non-Ob Surgery

Question 1

What population is more predisposed to anomalies

Answer 1

DM 4-12%

Vs 3%

Question 2

When is fetus most voluntarable and why

Answer 2

Between 15-90 days - organogenesis

After this mostly functional defects or growth retardation

Question 3

What group of meds is associated with congenital anomalies

Answer 3

Tranquilizers
Minor BZDP
Major Psych meds

Question 4

Cleft lip/palate is associate with

Answer 4

Tranquilizers, salicylates, opiates
Valium: most common
No studies suggest that a single dose is ass with congenital defects

Question 5

Why not to use N2O

Answer 5

1. Teratogenic effects
2. Adverse effects on DNA synthesis
3. Inactivates B12:
   - essential cofactor for enzyme methionine synthetase
   - interferes with folate metabolism
   - conversion of uridine to thymidine
4. Increase uterine adrenergic tone- vc to uterine blood flow

Question 6

Propofol

Answer 6

B: Ok to use, rapidly crosses placenta

Question 7

Ketamine

Answer 7

Not classified

Can depress Apgar score

Question 8

Which med group to avoid during all trimesters

Answer 8

BZDP

D

Question 9

Narcotics

Muscle relaxant

Answer 9

Narcotic safe

Droperidol and Zofran ok to use

Question 10

Ketorolac

Answer 10

Not used, avoid after 1st trimester
May constrict or close fetal DA

Muscle relaxant don’t cross placenta

Question 11

What is #1 cause of non OB maternal mortality

Answer 11

Homicide #1

Trauma is most common

Question 12

What are the 3 H’s that decrease uterine perfusion

Answer 12

Hypoxia
Hypocarbia
Hypotension

Question 13

When to start aspiration prophylaxis

Answer 13

14 weeks: bicitra, Pepcid, Reglan
Most likely need to be GETA : RSI

Narcotic and antisialagogue OK

Question 14

When to start fetal heart monitoring

Answer 14

After 16 - 18 weeks

Question 15

What does hypocarbia do

Answer 15

Decreased umbilical blood flow because of direct vasoconstriction

OxyHgb curve shifts to left: fetal hypoxia, metabolic acidosis

Question 16

Induction

Answer 16

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

Question 17

Cervical cerclage

When and what anesthesia plan

Answer 17

14-26 weeks

SAB without sedation

Question 18

Post op for OB surgery

Answer 18

Need to stay 24 hrs after surgery for FHR

Question 19

Cardiac arrest

Answer 19

LUD key, cricoid pressure until airway secured
Chest compression mid point of sternum
Fetal delivery

Question 20

What is the 4 min rule

Answer 20

C/S delivery within 4 min of cardiac arrest

Baby out

Question 21

Most common fetal surgery

Answer 21

Obstructive uropathy
Congenital diaphragmatic hernia
Repair of myomeningocele (31-37 gestational weeks)

Question 22

Tetragenesis

Answer 22

Dysgenesis of fetal organs as evidenced either structurally or functionally

Avoid benzo