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Obstetrics > Lecture 1 - Obstetric Anesthesia > Flashcards

Lecture 1 - Obstetric Anesthesia Flashcards

1
Q

What physiological changes occur during pregnancy?

A
  • Neurological
  • Respiratory
  • Cardiac
  • Hematological
  • Renal
  • Gastrointestinal
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2
Q

What are the neurological changes in pregnancy?

A
  • MAC is decreased
  • Epidural space becomes smaller
  • Cerebrospinal fluid volumes are decreased
  • Epidural veins are engorged
  • Increase to sensitivity to local anesthetics
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3
Q

What are the respiratory increases during pregnancy?

A
  • Tidal volume increased ~40% at term
  • RR increases ~15%
  • Minute ventilation increased ~ 50 %
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4
Q

T/F: During pregnancy compensatory metabolic acidosis takes place by excretion of bicarbonate.

A

TRUE (This is due to the respiratory alkalosis that occurs from pregnancy)

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5
Q

PaCO2 decreased to ________ mmHg secondary to hyperventilation creating respiratory _______..

A

28-32

alkalosis

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6
Q

How does the body correct for respiratory alkalosis?

A

Excretion of bicarbonate maintains normal pH.

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7
Q

What What are the respiratory changes that decrease during pregnancy?

A
  • FRC decreases by ~ 20%
  • Expanding uterus displaces diaphragm cephalad
  • Decrease dead space
  • Slight decrease in airway resistance
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8
Q

Decreased FRC, coupled with increased maternal oxygen _________, can rapidly lead to materna ______ during indction of general anesthesia

A
  • consumption

- hypoxia

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9
Q

T/F: Preoxygenation is NOT mandatory prior to anesthesia induction.

A

FALSE

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10
Q

P50 of hemoglobin increases from 27 to __ mmHG.

A

30

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11
Q

Why does P50 change during pregnancy?

A

Aids in oxygen delivery to fetus

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12
Q

What will hyperventilation do during pregnancy?

A
  • Decrease PaCO2
  • Uterine vasoconstriction
  • decrease placental blood flow
  • Oxygenhemoglobin curve will shift to the left
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13
Q

Why would you use a small ETT and avoid nasal intubation of instrumentation of an OB patient?

A

Mucosal venous engorgement/edema

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14
Q

The pregnant patient has an increased plasma and red cell mass by how much?

A

~ 45 % plasma

~ 20% RBC

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15
Q

How much does the cardiac output increase?

A

40%

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16
Q

How much does heart rate increase?

A

15-30 %

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17
Q

How much does stroke volume increase?

A

30 %

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18
Q

Progesterone _______ venous smooth muscle causing a decrease in the __________ vascular resistance of __%.

A
  • increases
  • peripheral
  • 15
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19
Q

Cardiac output changes during labor. Name the phase and the elevation of CO in percentage.

A

Latent phase - 15%
Active Phase - 30%
Second Stage - 45%
Postpartum - 80%

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20
Q

T/F: The OB patient’s response to adrenergic drugs is blunted.

A

TRUE

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21
Q

T/F: Cardiac atrophy can be seen on CXR in the OB patient.

A

FASLE (Cardiac HYPERTROPY …..)

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22
Q

T/F: There is a increase in plasma colloid osmotic pressure.

A

FALSE (DECLINE in plasma colloid….)

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23
Q

Give the description of Supine Hypotension Syndrome. (aortocaval compression)

A

~ 20% of term parturient will develop hypotension, pallor nausea and vomiting and diaphoresis when they lie flat

  • May be seen as early as 20 weeks gestation
  • Lateral uterine tilt position is best used
24
Q

What are the hematological changes in the OB patient.

A
  • Depressed cell mediated immunity
  • Hypercoagulable state (Increased risk for pulmonary embolism)
  • PT decreases 20 %
  • PTT decrease 20 %
25
Q

What coag factors increase in the OB patient?

A 
I
VII
VIII
IX
X
XII
26
Q

What coagulation factors decrease in the OB patient?

A

XI

XIII

27
Q

What coagulation factors are unchanged in the OB patient?

A

II

V

28
Q

What renal changes are seen in OB patients?

A
  • Increase in renal blood flow
  • Serum BUN and creatinine are MILD decreased
  • MILD glycosuria and proteinuria are common
29
Q

Renal blood flow and glomerularfiltration increased by about ____ % by __th week and remain elevated until delivery.

A

50

16

30
Q

T/F: Competence of gastroesophageal sphincter is reduced during pregnancy.

A

TRUE

31
Q

What decreases gastroesophageal sphincter tone?

A

Progesterone

32
Q

Placental gastrin secretion ______ acid scretion.

A

increases

33
Q

There is a 20% _________ in pseudocholinesterase levels but the ________ in volume of distribution counters any clinically significant __________ of NMB with succinylcholine.

A

Decrease
Increase
Prolongation

34
Q

What are the different methods of agents transferring across the placenta?

A
  • Diffusion
  • Bulk Flow
  • Active Transport
  • Pinocytosis
  • Breaks
35
Q

Fetal stores are __mL of O2 and consumption is __ mL/min.

A

42

21

36
Q

How long can a full term fetus survive without oxygenation?

A

10 minutes

37
Q

Describe the partial pressure of placental blood flow and how does fetus and mother circumvent this.

A
  • Placental Blood Flow is 40 mmHg PaO2
  • Fetal oxyhemoglobin dissociation curve is left shifted and mother curve is right shifted
  • Fetal hemoglobin is higher than mother’s
38
Q

T/F: Transfer of CO2 occurs by active transport of across the plecenta.

A

FALSE (….CO2 occurs by simple diffusion…)

39
Q

How much CO is directed toward the uterus in the parturient?

A

10% (about 600-700cc)

40
Q

How much CO is directed toward the uterus in a non pregnant woman?

A

50 CC

41
Q

Of uterine blood flow how much goes to the placenta and how much to the myometrium?

A

80% placenta

20 % myometrium

42
Q

What are three factors that influence uterine blood flow?

A
  • Systemic blood pressure
  • Uterine vasoconstriction
  • Uterine contraction
43
Q

T/F: Propofol and thiopental mildly reduce UBF via maternal hypotension.

A

True

44
Q

T/F: Ketamine has no net effect at doses < 1.5 mg/kg on the UBF.

A

TRUE

45
Q

T/F: Volatile agents increase UBF secondary to hypotension but at < 1 MAC the effect is minor.

A

FALSE (Volatile agents DECREASE UBF…)

46
Q

T/F: Nitrous oxide has negligible effects on UBF.

A

TRUE

47
Q

T/F: Opioids have major effect of UBF causing vasoconstriction.

A

FALSE (Opioids have little effect on UBF)

48
Q

T/F: Low serum local anesthetic levels can result in uterine vasoconstriction.

A

FALSE (HIGH serum local…..)

49
Q

Uterine blood flow may ______ With neuraxial analgesia as a ______ in maternal catechol levels _____ vasoconstriction, as long as _______ blood pressure is maintained.

A

Improve
reduction
reduces
normal

50
Q

T/F: Increased oxygen tension closes the DUCTUS.

A

TRUE

51
Q

What two factors will cause a R to L shunt through the ductus.

A
  • Hypoxia

- Acidosis

52
Q

What occurs during 1st stage of labor?

A

Onset of true labor until complete cervical dilatation.

53
Q

What occurs during latent phase of labor?

A

minor dilation 2-4 cm

infrequent contraction

54
Q

What occurs during active phase of labor?

A 
progressive dilation to 10 cm a
regular contraction (3 - 5 min)
55
Q

What occurs during 2nd stage of labor?

A

Time from complete dilation until infant delivered.

56
Q

What occurs during 3rd stage of labor?

A

Time from delivery of infant until placenta delivered.

Obstetrics (10 decks)

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