Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia III > Caring for Pregnant Patients > Flashcards

Caring for Pregnant Patients Flashcards

1
Q

Most physiologic changes occur in the ___ trimester, and most anatomic changes occur in ____

A

Physiologic = 1st trimester

Anatomic = 2nd and 3rd trimesters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Are the physiologic and anatomic changes in pregnancy good or bad?

A

Mostly good.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Respiratory changes in pregnancy

A

1) Increase in ventilation
- D/t increased metabolic demand
- Increase 40% TV and 15% RR
- Increase 50% MV overall
- High ventilation will decrease CO2 levels (goes into resp alkalosis pH = 7.44)

2) Decrease in airway resistance
- d/t increased progesterone
- Lung compliance unchanged

3) Increase in O2 Consumption
- Increase by 20%
- Curve shifts to the right (P50 increases from 26-28mmHg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Anatomic respiratory changes in pregnancy

A

1) Cephalad diaphragm displacement
2) Weight gain and breast enlargement (pressure on the chest and boobs might get in the way of airway)

3) Vascular engorgement of the respiratory tract mucosa
- Mucus membranes fragile

4) Edema of nasopharynx, oropharynx, and the cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is edema of the nasopharynx, oropharynx, and the cords most common?

A

During pre-eclampsia

Remember there is HTN and loss of plasma proteins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Effect of pregnancy on the FRC

A

Decrease by 20%

Less safe apnea time!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why can pregnant ladies desat quickly?

A

Low FRC and high O2 consumption rate (20% higher than normal).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

We can expect induction during pregnancy to be (faster/slower) than the non-pregnant patient. MAC should be (increased/decreased) by ____.

A

Faster induction

Decreased MAC by 25-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Effects of maternal hyperventilation

A

Alkalosis

  • Shift to the left (will decreased O2 release to the fetus)
  • Constriction of the umbilical and uterine blood vessels

This is only a problem with prolonged hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Effects of elevating the diaphragm

A

Decreased FRC and displacement of the heart (look at EKG, listen for murmur, possible dysrhythmia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pregnancy and coagulation

A

Overall, it is a hypercoagulable state
Increased clotting factors (fibrinogen and factors 5-8)
Platelets remain unchanged or may decrease slightly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CO will be (increased/decreased) during pregnancy

A

Increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens to BP and SVR in pregnancy

A

SVR will decreased by 20%
- vessels lose their SNS tone

BP will decrease slightly

  • ADH is cleared more rapidly
  • BP maintenance depends on RAAS b/c vessels have lost their SNS tone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Your pregnant patient is lying supine and starts to drop their BP. What is this and how is it treated?

A

Supine Hypotensive Syndrome
- It’s possible compression of vena cava or aorta.

Treatment:

  • Left or right uterine displacement (depending on which vessel is compressed)
  • Hydrate before induction
  • Treat hypotension with ephedrine or phenylephrine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Supine hypotension syndrome is a risk > ____ weeks and can decrease CO by up to ___%

A

20 weeks

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Plasma volume increases by ___% but RBC volume only increases by ___%.

A

Plasma 50%

RBC 20%
Causes a dilutional anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Normal blood loss during vaginal birth

A

500cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Normal blood loss during a c-section

A

500-1,000cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

GI changes in pregnancy

A

As a result of physiologic and hormonal changes:

  • Delayed gastric emptying
  • Everything in the GI tract slowed overall
  • Secretions are more acidic
  • Stomach is displaced upward and at 45 degree angle to the right. This displaces the intra-abdominal portion of the esophagus into the thorax, decreasing tone to the lower esophageal sphincter, causing reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

All parturients greater than ___ weeks are considered full stomachs

A

12 weeks

Aspiration risk continues into the post-partum period, until the body has time to normalize hormonally, physiologically, and anatomically.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Aspiration prophylaxis in pregnancy

A

Give non-particulate antacids, H2 blockers, and/or reglan.

Consider doing regional instead.

If doing GA, do RSI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Renal Changes in Pregnancy

A

High CO and large blood volume cause an increase in GFR by 60%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hepatic Changes in Pregnancy

A

Slight increases in AST and ALT

Bigger changes will be seen in HELLP syndrome (part of pre-eclampsia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Neuromuscular Changes in Pregnancy

A

1) Increase in endorphins!
- Allows us to decrease MAC by 40%

2) Increased sensitivity to opioids, LAs, and catecholamines

25
Q

Why is MAC decreased in pregnancy?

A

1) Faster induction

2) Higher endorphins potentiates the effects of the VA

26
Q

Formula for uterine blood flow and normal values for UBF

A

(uterine arterial pressure - uterine venous pressure) / Uterine vascular resistance

UBF during pregnancy: 500-700mL/min
UBF when not pregnant: 50-100mL/min

27
Q

There is a direct correlation between uterine blood flow and

A

fetal umbilical venous O2

28
Q

When will uterine blood flow decrease?

A

1) Decrease in perfusion pressure (maternal hypotension SBP < 100)

2) Increase in uterine vascular resistance
- Maternal HTN and uterine contraction
- Vasoconstrictors

29
Q

Is the uterine vascular bed able to autoregulate?

A

NO! This is why BP management in parturients is critical

30
Q

We are most worried about fetal ion trapping with these drugs

A

LAs

31
Q

Generally all of our anesthetics will cross the placenta except

A

NMBs

32
Q

What is a protective mechanism that the fetus has against drug OD?

A

Blood from the umbilical vein first goes to the liver

33
Q

What is the baseline fetal HR?

A

120-160

May vary by 5-10bpm and variations are a good and normal thing.

34
Q

Causes of fetal tachycardia

A

Maternal fever or infection
Atropine administration
Late sign of fetal hypoxia

35
Q

LATE decelerations may be from

A

Compromised blood flow to the fetus (maternal hypotension, cord compression, etc)

36
Q

SEVERE decelerations will go below __bpm and last longer than ___

A

70

1 minute

Fetus is in distress! We need to deliver!

37
Q

Treatment for shitty fetal heart rate patterns

A

1) LUD (left uterine displacement)
- Compression could be decreasing CO by 30%

2) O2
3) Correct any contributing factors (treat hypotension, stop oxytocin, check for prolapsed cord in her vajay, assess for vaginal bleeding that could be from the placenta)

38
Q

Stages of Labor

A

1st Stage

  • From beginning of regular painful contractions to full cervical dilation
  • Longest stage of labor and divided into two phases
  • This is mostly visceral pain (Block T10-L1)
    • -> Latent Phase: 1st and longest part. Contractions start and are getting stronger and cervix is thinning
    • -> Ative Phase: Second and shorter phase. The cervix is actively dilating to 10cm

2nd Stage

  • From full cervical dilation to delivery
  • This is the most painful stage***
  • This is somatic, stretching pain (Block S2-4)

3rd Stage
- From delivery of neonate to delivery of the placenta

39
Q

Staging and neuraxial block requirements

A 
1st Stage (T10-L1)
2nd Stage (T10-S4)
3rd Stage (T10 b/c it involves the vag and uterus)
40
Q

Risks for intense pain during pregnancy

A 
Young maternal age (ya so tight)
Increased maternal weight (excess tissue in the way)
Occiput posterior presentation
Increased fetal weight (fat baby)
Use of tocolytics
41
Q

Opioids popular in pregnancy

A

Fentanyl and meperidine (Demerol)

Sufentanil not as popular because it can cause fetal bradycardia

42
Q

Common analgesic interventions in parturients

A 
Opioids
Ketamine
Agonist/Antagonists (Nubain & Stadol)
Intrathecal Opioids
Epidurals
CSE
43
Q

Can epidurals prolong labor?

A

Yes, it can prolong Stage 1

44
Q

Relative contraindications for regional anesthesia

A 
Primary herpes
Obstructive cardiac lesions
R or L intracardiac shunts
Active CNS disease
PIH (pregnancy induced HTN)
MG (possible respiratory compromise)
45
Q

Epidurals should be placed below this level

A

Below L2

46
Q

Does the level of epidural block depend on baracity of the LA?

A

NO.

It would matter in spinals. NOT epidurals!

47
Q

Most common LAs in pregnancy

A

Amides:
Lidocaine, bupivacaine, and ropivacaine

Esters:
Chlorprocaine, tetracaine, and mepivacaine

48
Q

Epidural concentrations used for bupivacaine

A

.0625% - .25%

Used with or without an opioid

49
Q

Epidural concentrations used for ropivacaine

A

.125% - .5%

50
Q

Benefits of having a continuous laboring epidural (CLE)

A 
More constant level of analgesia
More even block
More stable VS
Greater safety
Able to use if need to give surgical block for emergent c-section
51
Q

Procedure for continuous epidural infusion

A

1) Give test dose with epi. Wait 3-5 min before initiation of bolus
(may be difficult to detect b/c mother is probs already tachy from pain)

2) Give bolus injection
3) Start continuous infusion once adequate block obtained (at LEAST T10 level)

52
Q

Block above this level will start to affect cardiac accelerators

A

T4

53
Q

Sometimes the first sign of a sympathectomy may be

A

N/V

If your patient starts having N/V after epidural placement - check BP for hypotension.
We don’t want SBP < 100 in parturients!

54
Q

Effects of epidural on labor

A 
Slows Stage 1
Can halt labor if cervix dilated < 3-4cm
Hypotension
Fetal hypocia
Somnolence
N/V
55
Q

Caudal Block

A

Type of epidural not common in OB. Needs high volumes. May be ok in Stage II

56
Q

Paracervical block

A

Usually done by OBGYN - LA injected submucosally in the vagina on either side of the cervix. May be used for Stage I (while cervix is dilating), but there is high risk of fetal bradycardia from LA injection.

57
Q

Pudendal block

A

Good block for Stage II (delivery)

Inject LA on both sides of vagina into the sacrospinous ligament. Good perineal anesthesia.

58
Q

Parturients are most likely easy or difficult airway?

A

Difficult

Edema of oropharynx and cords

59
Q

If doing a spinal block for c-section, you should block at this level

A

T4-6

Anesthesia III (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions