Chapter 37: The Obstetric Airway Flashcards
Overall obstetric mortality is:
1:10,000 live births
Anesthesia-related obstetric mortality occurs:
1: 1 million cases
Name six pregnancy + airway risk factors:
Failure to intubate Aspiration Hypoxemia Urgency for two patients Failure to prepare completely
Pregnant women have decreases gastric emptying primarily due to
Progesterone levels
Stress of Labor
(Narcotics)
Pregnant women have an increased gastric acidity due to:
gastrin
Does NPO status effect GI risk in pregnant patients?
No.
Pregnant women are more prone to aspiration because of decreased gastroesophageal sphincter tone due to:
Reflux
Anticholinergic use
Narcotics
Insertion + removal of NG tube (reduces integrity of GE junction)
Frequency of hiatial hernias in pregnant patients?
27%
Aspiration in pregnant patients; contributing factions include:
Increase in gastric pressure
Failure to intubate
What is the gastric pressure of a woman who is pregnant w/ a singleton?
+17 cmH2O
What is the gastric pressure of a woman who is pregnant with twins?
+40 cmH2O
What is the gastric pressure of a patient in lithotomy?
+24 cmH2O
Contributing factors to failure to intubate in pregnant patients:
Upper airway edema
Adiposity of head, neck and trunk
Breast enlargement
In what trimester does upper airway edema generally occur?
Third trimester
How much more likely is failure to intubate in the pregnant patient than the non-pregnant patient?
10 x more likely
Why are pregnant women more prone to hypoxia?
Their FRC decreases by 20%, but their VO2 increases by 20% a term–in labor, it increases by 60%.
What is Cimetidine?
A medication used to treat ulcers
Appropriate dose of Cimetidine to prep pregnant woman for surgery?
300 mg IV 60 min prior
Appropriate dose of metoclopramide to prep pregnant woman for surgery?
10 mg IV 30 min prior
In emergent situation, what is an appropriate medication for a pregnant women to prep for surgery?
Sodium citrate 30 ml PO immediately prior to surgery
Two stomach-attenuating medications to give pregnant women prior to elective surgery?
Cimetidine
Metoclopramide
What stomach-attenuating medication is appropriate to give pregnant woman prior to emergent surgery?
Sodium citrate
Which maneuver is important in managing airway of pregnant woman?
Sellick manuever
