Cesarean Section Flashcards

1
Q

What does anesthesia for patients undergoing cesarean section focus on?

A

1) Providing adequate analgesia for the mother with the least amount of cardiovascular depression
2) delivering viable neonates while minimizing negative effects of the drug

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2
Q

What physiological changes are seen in the mother that we have to take note of when choosing anesthetic drugs?

A
  • Increase in blood vol. to meet increase metabolic demands
  • Relative anemia from larger increase in plasma volume compared to red cell mass
  • Increased heart rate and stroke volume to meet oxygen demands
  • More susceptible to hypotension due to blunted response as a result of decreased baroreceptor activity
  • Displacement of diaphragm due to pregnant uterus decreases tidal volume and functional residual capacity (FRC)
  • More prone to hypoxemia
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3
Q

What drugs are considered safe in a patient having a C-section?

A
  • Opioids - reversible if newborns require it
  • Benzodiazepines - do not cause significant cardiovascular depression
  • Premedication with an anticholinergic - to counter related bradycardia or vagal stimulation
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4
Q

What anesthetic drug would you not use in a C-section patient?

A

Alpha-2 agonist

  • reduces cardiac output affecting placenta perfusion
  • has been observed to reduce survivability of newborns
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5
Q

Why is rapid induction and intubation favored in a c-section patient?

A
  • Pregnancy increases gastric acid secretion and prolonged gastric emptying
  • Higher chance of regurgitation and subsequent aspiration due to increased intragastric pressure from uterus and decreased lower oesophagus sphincter tone
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6
Q

Why is propofol often used in C-sections?

A
  • Rapid onset, short duration of action, minimal hepatic metabolism, rapid elimination, very little residual effect on neonates
  • Must be titrated carefully to avoid significant respiratory depression and hypoxemia
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7
Q

Etomidate

A

Good option for cardiovascular function, but should be given with benzodiazepine which may cause prolonged depression in the neonate

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8
Q

Ketamine

A
  • given as a combination with benzo or opioids
  • prolonged depression in neonates
  • reversible by flumazenil
  • doens’t affect neonatal survival
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9
Q

Inhalants

A
  • pregnancy lowers MAC by 25-40% = increases sensitive to inhalant
  • increased respiratory drive due to increased sensitivity to PaCO2 = higher minute volume
  • therefore requires less inhalant
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10
Q

What ventilator settings are recommended?

A

PEEP and IPPV

-reduction in lung expansion results in a larger degree of actelectasis

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11
Q

Why should you prevent hypocapnia to occur from hyperventilation?

A

Alkalosis reduces fetal oxygen delivery by reducing oxygen offloading (left shift in oxygen-hemoglobin dissociation curve) and reduces uterine blood flow

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