Non-OB sx for the OB pt ppt Flashcards
perioperative risk include what
fetal loss fetal asphyxia premature labor premature ROM difficult airway thromboembolism teratogens
_____ - _____% of pregnant women undrgo non-OB sx
0.5-2%
trauma complicates ___-___% of surgeries
6-7
the nonOB gets how many anesthetics a year?
80,000
Cerclage is usually done b/t what age of gestation
12-26 wks
contraindications to cerclage
active labor ROM dilation >4 cm intrauterine infection fetal abnormalities abrupto placenta
risk with ceclage
PROM
chorioaminonitis
cervical laceration
what is important to remember about Cardiac and valve sx
CPB is safe
** Circ arr not rec *** (don’t stop all circulation)
a rise any any lab will be alarming but he said one lab inparticular is ALWAYS alarming in prego’s what is it
creatinine
what does progesterone do?
reduce pressure at LES increase gastric acidity decreased GB motility decrease SVR resp alkolosis decreased MAC
are IV anesthetics Bad for uterine blood flow?
no, there is a small reduction in uterine flow that is dose dependent! only drops if you drop moms pressure
what do VAAs do to uterine blood flow
decrease BP=> lower UBF
Mild changes < 1 MAC
UTERINE RELAXATION
do local anesthetics cause a problem in the uterus?
no, unless you have very high levels
drugs crossing the placenta depend on what?
MW- large drugs don;t cross
Charge- non-ionized cross more than ionized
Protein binding- non protein bound cross easier
lipophilic- higher lipophilicity is advantageous
state 5 drugs that we use that DON’T cross placenta?
Sux's non-depol Glycopyrrolate Insulin Heparin
State 9 drugs that DO cross the placenta that we use?
VAA's Opiates Benzo's Propofol Thiopental LA Atropine BB Ephedrin Phenylephrine
what is ion trapping?
fetal blood is slightly more acidic than mothers
a distressed fetus becomes more acidic
weakly basic drugs (LA and Opiates) can cross the placenta
then in acidodic enviroment become ionized and can have trouble crossing back into mothers circulation
this can cause a build up of drug in the fetus
when is the best time for surgeries?
2nd trimester
elective sx usually is done when?
> 6 wks post partum
are VAA’s teratogens? and why or why not?
yes (potentially)
b/c unethical to test in prego
LA, VAAs, induction agents, opioids, and MR are all safe for the fetus when?
in clicical circumstances
Name14 teratogenic drugs?
ACEi's ETOH COCAINE COUMADIN androgens antithyroid chemo Diethystibesterol Lead Lithium Mercury Phenytoin Streptomycin Thalidomide Trimethadione Valproic acid
which teratogenic drug was given to girls to prevent excess hight
diesthylstilbestrol
what was big about Thalidomide and it’s teratoginicity
it was OTC in germany and used for morning sickness
gave kids phocomelia (flippers)
Pregnancy cat A
no risk identified in well controlled studies
Pregnancy Cat B
no adequate and well controlled studies in PREGNANT WOMEN, however animal studies have revealed no fetus harm
Pregnancy Cat C
no adequate and well controlled studies in PREGNANT WOMEN, however an adverse effect has been shown in animals
or
Adequate and well controlled studies in PREGNANT WOMENhave failed to show a risk to the fetus; but an adverse effect has been shown in an animal
Pregnancy Cat D
a risk to the fetus has been demonstrated in adequate, well controlled or observational studies in pregnant women; however the benefits of therapy may outweigh the potential risk
Pregnancy cat X
positive evidence of fetal abnormalities has been demonstrated in adequate well controlled studies or observational studies in pregnant woman or animals, the drug is contraindicated in women who are or may became pregnant
what are the effects of N2O in prego
affects B12 synthesis
increases adrenergic tone
may vosoconstrict uteine vessels (animals)
you want to deliver the fetus with in how long following mothers cardiac arrest?
5 min
is direct fetal death common?
no usually results from maternal shock
placental abruption
anesthethic management for prego
main goal
maintain uterine perfusion \+ adequate maternal oxygenation = preservation of fetal O2
when should non elective surgeries be performed?
2nd trimester
Intraop fetal monitoring
it is possiable at what weeks?
18 weeks gestation
Intraop fetal monitoring
it is only advised when? and what weeks is that?
if the fetus is considered viable
22-24 weeks
Intraop fetal monitoring
if the fetus is not viable what do you wanna do pre and post op
check fetal tones
Intraop fetal monitoring
who must monitor the fetus
trained personal OB RN
who’s decision is it to monitor fetus intraop
OB not anesthesia
complications of tocylitics?
pulm edema
arrythmias
hypokalemia
Virchow’s triad
hypercoaguability
stasis
endothelial injury
what is required and why during fetal surgery
high dose inhalation agents
to anesthetizing mother, fetus, and to provide uterine relaxation
