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)
