anesthesia for pregnancy

Question 1

perinatal considerations

Answer 1

postpone elective and/or non-emergency procedures (wait until 2nd trimester)

avoid teratogenic drugs

balanced anesthesia

reversible agents

local anesthetics

minimize stress and pain

maximize oxygenation

rapid recovery

if C-section, work quickly and have help

Question 2

maternal physiology-CV

Answer 2

increased oxygen consumptions

increased cardiac output

increased blood volume (>40%)-dilutional anemia

decrease blood pressure-vasodilation

increased platelet count, and coag factors

Question 3

maternal physiology-pulmonary

Answer 3

Decreased FRC-uterus impinging diaphragm, aggravating factors

increased RR and TV-liminted compensation, hyperoxygenation

mild respiratory alkalosis-normal response, decreased CO₂

Question 4

maternal physiology-CNS

Answer 4

increased endogenous enodorphins & progesterone-increased pain threshold, reduced MAC values by 40%, reduced opioid requirements

vascular engorgement of epidural space-reduced local anesthetic doses, increased spread of epidural drugs

Question 5

maternal physiology-GI

Answer 5

increased risk of reflux and aspiration-prolonged gastric emptying, decreased esophageal sphincter tone, decreased gastric motility, increased acidity

pretreat-metoclopramide, H2 blockers

hepatic function tests increased

Question 6

materanl physiology-renal

Answer 6

increased blood flow 80%

increased GFR-50%

increased bicarbonate excretion-compensatory metabolic acidosis

post partum diuresis-plasma volume normal

Question 7

fetal physiologic considerations

Answer 7

adequate placental blood flow-maternal hypotension

avoid fetal hypoxia-maternal ventilation-hypotension, anemia, acid-base

avoid teratogensis-first trimester, injectables and inhalants

protects against abortion-xylazine-uterine pressure changes, N2O, halothane

Question 8

prenaesthetic peroid

Answer 8

tranquilization-nacrotics preferables-reversible

IV catheter and fluids-dehydration

Clip before induction

preoxygenate

avoid placing in dorsal recumbency

rapid technique-minimize hypoxia

support ventilation-compression on diaphragm

balanced anesthesia-minimize side effects

Question 9

maintenance

Answer 9

work quickly

remember reduced MAC

monitor blood loss

avoid hypotension

Question 10

neonatal resuscitation-ABCD’s

Answer 10

airway-suction, intubate/mask

breathing-stimulate-rub briskly, doxapram

cardiac/circulation-check heart rate, atropine epinephrine

drugs-reversal agents-naloxone

ligate umbilical cord

warmth

Question 11

recovery of Mum

Answer 11

reverse nacrotics-use locals for analgesia

alert-avoid harm to the babies

clean mammary area