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OB > Maternal co-exisiting disease > Flashcards

Maternal co-exisiting disease Flashcards

1
Q

Anesthesthetic considerations for pregnant women with hyperthyroidism:

A

May be receiving propranolol
-Fetal goiter may occur
-myocardium more sensitive to catecholamines

-Propranolol may exacerbate HoTN following spinal anesthetic block - consider epidural for elective c-section

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2
Q

What is pheochromocytoma?

A

Neuroendocrine tumorof themedullaof theadrenal glands, or extra-adrenal chromaffin tissue that failed to involutethat secretes excessive catecholamines – norepinephrine and epinephrine.

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3
Q

What can pheochromocytoma mimic?

A

preeclampsia

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4
Q

what type of analgesia plan is preferred in someone with pheochromocytoma?

A

continuous epidural

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5
Q

What kind of treatment should someone with pheochromocytoma receive for an elective c-section?

A

-pre-op therapy with alpha-blockers, followed by beta blockers.

Avoid beta-blockade without prior alpha blockade d/t the risks of unopposed alpha stimulation (severe HTN)

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6
Q

What would the treatments for bronchial asthma during pregnancy be?

A

Methylxanthines
corticosteroids
Beta-adrenergics

May improve during pregnancy d/t bronchodilation

Pregnancy has no consistent effects of the course of asthma

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7
Q

What are the anesthetic considerations for someone who has asthma while pregnancy?

A

C-section:
-EPIDURAL preferred over spinal block (reports of bronchoconstriction)

Avoid general anesthesia if possible (ETT can trigger bronchospasm)

-Avoid H2 blockers (cimetidine, ranitidine) can increase sensitivity to histamine that causes spasm

-consider atropine of glycopyrrolate to decrease secretions

-use ketamine for induction= bronchial relaxation

-Avoid the use of desflurane

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8
Q

How can paraplegia affect labor?

A

Higher incidence of preterm labor

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9
Q

if the lesion is at what level should you consider autonomic hyperreflexia?

A

above T7

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10
Q

What are some signs and symptoms of autonomic hyperreflexia?

A

pilomotor erection, sweating, flushing, headache, severe HTN, BRADYCARDIA

Triggered by:
Stimulation of the skin, distension of the bladder/uterus

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11
Q

Is an epidural or a spinal preferred for someone with paraplegia?

A

Epidural

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12
Q

What drug should be avoided for induction in paraplegia?

A

Succinylcholine d/t risk of hyperkalemia

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13
Q

What is Multiple sclerosis?

A

Manifests as neurological defects that present as pyramidal cerebellar or brainstem symptoms

(Loss of myelin in CNS after possible viral exposure or autoimmune response)

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14
Q

What are some symptoms of MS?

A

-Motor weakness
-impaired vision
-ataxia
-bladder and bowel dysfunction
-labile emotions

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15
Q

How does pregnancy affect MS?

A

No effects on the progression of MS
-slight increased risk of relapse during pregnancy (most often in the postpartum period though)

-watch for pulm complications
-maintain normal body temp

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16
Q

What are some concerns about neuraxial anesthesia in the MS pt?

A

-potential neurotoxic exposure of demyelinated spinal cord.
-Do not exceed concentrations >0.25% bupivacaine infusions
(use lowest concentrations and volumes to achieve analgesia)
- Epidural tolerated better than spinal

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17
Q

What med should be avoided during induction for MS?

A

Succinylcholine should be avoided w severe musculoskeletal involvement

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18
Q

What is the main concern with someone who has a brain tumor?

A

Herniation and death following rapid CSF reduction w dural puncture.

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19
Q

What is myasthenia gravis?

A

Rare autoimmune disorder
-progressive muscle weakness
- destruction of ACTH receptors
-treat w anticholinergics (neostigmine or edrophonium)
-pregnancy can exacerbate symptoms = cholinergic crisis

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20
Q

What antibiotics are contraindicated in Myasthenia Gravis?

A

-Gentamycin
-Kanamycin
-Streptomycin
-Polymyxin
-Tetracycline
-Lincomycin

21
Q

What tocolytics are contraindicated in myasthenia gravis?

A

Magnesium sulfate

22
Q

What cardiac meds are contraindicated in myasthenia gravis?

A

-Quinidine
-Propranolol

23
Q

What Beta Adrenergics are contraindicated in myasthenia gravis?

A

-Ritodrine
-Terbutaline

24
Q

What other drugs are contraindicated in myasthenia gravis

A

quinine
penicillamine
lithium

25
Q

IV to oral dose of neostigmine ratio

A

30:1

26
Q

What meds are pts w myasthenia gravis highly sensitive to?

A

depolarizing and non-depolarizing NMB
-Intubation doses or usually 1/2-1/3 normal

27
Q

What are signs and symptoms of cholinergic crisis?

A

-Profound muscle weakness
-resp failure
-loss of bowel and bladder function
-disorientation
-diplopia

28
Q

What is the treatment for cholinergic crises?

A

IV/IM atropine

29
Q

What is sickle cell disease?

A

Autosomal recessive genetic blood disorder (mutation of hemoglobin gene)

-Affects African Americans more
-RBCs assume an abnormal rigid sickle shape decreasing the cells flexibility and increasing viscosity leading to pain, thrombosis and auto amputation

  • Life expectancy shortened (Males: 42, females: 48)
30
Q

How does sickle cell affect pregnancy?

A

HgbAS pts (heterozygous) usually have no problems w pregnancy

HgBSS (homozygous) and HgbSC have more severe anemia and higher incidence of preeclampsia

Avoid sickle cell crisis: avoid hypoxia, HoTN, dehydration, hypothermia, and acidosis.

Don’t use a tourniquet.

31
Q

Anesthetic considerations for sickle cell disease

A

Epidural (give WARMED fluids prior to block)

avoid hypothermia and hypoxia

32
Q

Why is an epidural preferred for a C-section?

A

decreased risk of hypotension- can be used post-op if pt has sickle cell crisis

33
Q

What is von Willebrand disease?

A

The most common hereditary coagulation abnormality.

Qualitative or quantitative deficiency of von Willebrand factor (vWF), a multimeric protein that is required for platelet adhesion

34
Q

What is the treatment for type 1 von Willebrand’s disease?

A

DDAVP 0.3 mg/kg

-Monitor vWF levels (possible tachyphylaxis > 48 hrs)

35
Q

In what type of vWF deficiency should DDAVP NOT be used?

A

type 3- can worsen bleeding

(neuraxial block is a relative contraindication too)

36
Q

What is Factor V Leiden?

A

Variant of human coagulation factor V that cannot be inactivated by protein C and thereby causes a HYPERCOAGUALBILITY disorder

37
Q

What is a patient typically on if they have Factor V disorder in pregnancy?

A

LMWH (lovenox) very early in pregnancy–> converted to heparin at 38 weeks to facilitate neuraxial blocks

38
Q

How long should LMWH be held before a block?

A

Prophylactic : hold >12 hrs before block

Therapeutic: hold > 24hrs before block and consider anti-Xa heparin assay

39
Q

What is Protein C and Protein S?

A

Hepatic enzymes that interact with coagulation factors Va (5a), VIIIa (8a) to inhibit fibrin formation= clot

Deficiency of C & S = HYPERcoagulability, recurrent DVT, PE

Hypercoagulability also seen with phospholipid and cardiolipin antibodies

Pts may be on heparin= careful assessment before block

40
Q

What is Rheumatoid Arthritis?

A

-Chronic, systemic inflammatory disorder that principally affects synovial joints

-Hyperplasia of synovial cells = excess synovial fluids

  • the destruction of articular cartilage= inflammation in lungs, pericardium, pleura, sclera, and subcutaneous nodular lesions
41
Q

Anesthetic considerations for those who have rheumatoid arthritis:

A
  • Alanto-axial instability= potentially difficult airway
  • difficult block placement

-possible pleura effusions

–motor and sensory deficits

-cardiac issues ( pericarditis, valvulitis, fibrosis, atherosclerosis, increased risk of CAD, MI, stroke, angina)

42
Q

What is Systemic Lupus erythematosus?

A

Multisystem inflammatory disease of unknown etiology that is characterized by the production of autoantibodies against cell membrane antigens

  • most common in women in childbearing years
43
Q

What are the cardiac considerations of Lupus?

A

-Pericarditis (check EKG for prolonged PR interval or non-specific T-wave changes

-Valvular disorders (thickening, vegetation, regurg, stenosis)

  • prophylactic antibiotics are only required if pt has high risk for endocarditis
44
Q

Why do you want to make sure you do a complete airway evaluation before GA in a pt with Lupus?

A

Vocal cord palsy

45
Q

What are the anesthetic considerations for maternal addiction?

A

-difficult IV access
-withdrawal symptoms
-fetal withdrawal, hyperactivity, hypoxia
-increase O2 consumption
-increased low birth weight/ very low birth weight
-increased maternal hypovolemia
- adrenal insufficiency

46
Q

Increased risk of an alcoholic:

A

Inc. risk of hemorrhage d/t esophageal varices, clotting abnormalities d/t hepatic disease, cardiomyopathy, neuropathy, inc. gastric volume, acidity.

47
Q

Amphetamines:

A

Limited response to ephedrine
- INCREASED MAC
- increased risk for uterine atony

48
Q

Cocaine:

A

vasoconstrictor= decreased uteroplacental blood flow
- HTN, tachycardia
- chronic= decreased MAC
-Acute= Increased MAC

49
Q

What drugs can cocaine increase the duration of?

A

2-chloroprocaine
Succinylcholine

OB (8 decks)

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