Non-OB sx for the OB pt ppt

Question 1

perioperative risk include what

Answer 1

fetal loss
fetal asphyxia
premature labor
premature ROM
difficult airway
thromboembolism
teratogens

Question 2

_____ - _____% of pregnant women undrgo non-OB sx

Answer 2

0.5-2%

Question 3

trauma complicates ___-___% of surgeries

Answer 3

6-7

Question 4

the nonOB gets how many anesthetics a year?

Answer 4

80,000

Question 5

Cerclage is usually done b/t what age of gestation

Answer 5

12-26 wks

Question 6

contraindications to cerclage

Answer 6

active labor
ROM
dilation >4 cm
intrauterine infection
fetal abnormalities
abrupto placenta

Question 7

risk with ceclage

Answer 7

PROM
chorioaminonitis
cervical laceration

Question 8

what is important to remember about Cardiac and valve sx

Answer 8

CPB is safe

** Circ arr not rec *** (don’t stop all circulation)

Question 9

a rise any any lab will be alarming but he said one lab inparticular is ALWAYS alarming in prego’s what is it

Answer 9

creatinine

Question 10

what does progesterone do?

Answer 10

reduce pressure at LES
increase gastric acidity
decreased GB motility
decrease SVR
resp alkolosis
decreased MAC

Question 11

are IV anesthetics Bad for uterine blood flow?

Answer 11

no, there is a small reduction in uterine flow that is dose dependent! only drops if you drop moms pressure

Question 12

what do VAAs do to uterine blood flow

Answer 12

decrease BP=> lower UBF
Mild changes < 1 MAC
UTERINE RELAXATION

Question 13

do local anesthetics cause a problem in the uterus?

Answer 13

no, unless you have very high levels

Question 14

drugs crossing the placenta depend on what?

Answer 14

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

Question 15

state 5 drugs that we use that DON’T cross placenta?

Answer 15

Sux's
non-depol
Glycopyrrolate
Insulin
Heparin

Question 16

State 9 drugs that DO cross the placenta that we use?

Answer 16

VAA's
Opiates
Benzo's
Propofol
Thiopental
LA
Atropine
BB
Ephedrin
Phenylephrine

Question 17

what is ion trapping?

Answer 17

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

Question 18

when is the best time for surgeries?

Answer 18

2nd trimester

Question 19

elective sx usually is done when?

Answer 19

> 6 wks post partum

Question 20

are VAA’s teratogens? and why or why not?

Answer 20

yes (potentially)

b/c unethical to test in prego

Question 21

LA, VAAs, induction agents, opioids, and MR are all safe for the fetus when?

Answer 21

in clicical circumstances

Question 22

Name14 teratogenic drugs?

Answer 22

ACEi's
ETOH
COCAINE
COUMADIN
androgens
antithyroid
chemo
Diethystibesterol
Lead
Lithium
Mercury
Phenytoin
Streptomycin
Thalidomide
Trimethadione
Valproic acid

Question 23

which teratogenic drug was given to girls to prevent excess hight

Answer 23

diesthylstilbestrol

Question 24

what was big about Thalidomide and it’s teratoginicity

Answer 24

it was OTC in germany and used for morning sickness

gave kids phocomelia (flippers)

Question 25

Pregnancy cat A

Answer 25

no risk identified in well controlled studies

Question 26

Pregnancy Cat B

Answer 26

no adequate and well controlled studies in PREGNANT WOMEN, however animal studies have revealed no fetus harm

Question 27

Pregnancy Cat C

Answer 27

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

Question 28

Pregnancy Cat D

Answer 28

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

Question 29

Pregnancy cat X

Answer 29

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

Question 30

what are the effects of N2O in prego

Answer 30

affects B12 synthesis
increases adrenergic tone
may vosoconstrict uteine vessels (animals)

Question 31

you want to deliver the fetus with in how long following mothers cardiac arrest?

Answer 31

5 min

Question 32

is direct fetal death common?

Answer 32

no usually results from maternal shock

placental abruption

Question 33

anesthethic management for prego
main goal

Answer 33

maintain uterine perfusion
\+
adequate maternal oxygenation
=
preservation of fetal O2

Question 34

when should non elective surgeries be performed?

Answer 34

2nd trimester

Question 35

Intraop fetal monitoring

it is possiable at what weeks?

Answer 35

18 weeks gestation

Question 36

Intraop fetal monitoring

it is only advised when? and what weeks is that?

Answer 36

if the fetus is considered viable

22-24 weeks

Question 37

Intraop fetal monitoring

if the fetus is not viable what do you wanna do pre and post op

Answer 37

check fetal tones

Question 38

Intraop fetal monitoring

who must monitor the fetus

Answer 38

trained personal OB RN

Question 39

who’s decision is it to monitor fetus intraop

Answer 39

OB not anesthesia

Question 40

complications of tocylitics?

Answer 40

pulm edema
arrythmias
hypokalemia

Question 41

Virchow’s triad

Answer 41

hypercoaguability
stasis
endothelial injury

Question 42

what is required and why during fetal surgery

Answer 42

high dose inhalation agents

to anesthetizing mother, fetus, and to provide uterine relaxation