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OB Test 2 > Non_OB Surgeries > Flashcards

Non_OB Surgeries Flashcards

1
Q

How many pregnant women undergo surgery while pregnant?

A

0.3-2.2% or 93,000 - 110,000 women

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2
Q

How many surgeries during pregnancy occur during the first trimester?

A

42%

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3
Q

When is surgery during pregnancy the most concerning for the fetus? Why?

A

During the first trimester, because this is the period of organogenesis
-avoid if possible

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4
Q

What is associated with general anesthetic exposure during the first trimester?

A

Hydrocephalus and eye defects

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5
Q

What are the most common procedures performed during the first trimester?

A

Torsion

Neoplasm or cysts of the ovary

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6
Q

What side effect do benzodiazepines have if used during the first trimester?

A

2x increase in cleft palate

9% increase in miscarriage

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7
Q

How many surgeries are done during the second trimester?

A

35%

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8
Q

What are the most commonly performed surgical procedures performed during the second trimester?

A

Appendectomies

Cholecystectomies

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9
Q

Why is it safer to have surgery during the second trimester than the first?

A

Risk for preterm deliver is lowest during the second trimester

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10
Q

How many surgical procedures are performed in the third trimester?

A

23%

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11
Q

What are the most common procedures performed during the third trimester?

A

Appendectomy

Cholecystectomy

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12
Q

When is fetal well being first monitored during surgery?

A

From the age of viability, 24 weeks gestation

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13
Q

If performing anesthesia for procedures before the first trimester, what drugs should you avoid and why?

A

Versed
IV lidocaine: fetal cardiac and CNS toxicity
Morphine: polyploidy, abnormal chromosome numbers
N2O

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14
Q

When is pregnancy testing occur (age wise)?

A

Ages 10-60 y

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15
Q

What percentage of women showing up for elective sterilization procedures have positive pregnancy test?

A

3%

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16
Q

When can a pregnancy test be excluded?

A

Hx Hysterectomy

Young w/o menstral cycle (?)

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17
Q

Are pregnancy tests needed if someone has had their tubes tied?

A

Yes, can have reconnection of the Fallopian tubes

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18
Q

What are the maternal complications with surgery during pregnancy? Rate?

A 
6%
Infection
Respiratory problems
VTE
Re-operation
Death
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19
Q

What are the overall risks of surgery during the first trimester?

A

Increased risk of miscarriage and fetal defects

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20
Q

What are the overall risks of surgery performed in the second and third trimester?

A

Triggering of labor and lower birth weight infants

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21
Q

Why is O2 reserve decreased in pregnant women?

A

FRC is reduced 20%

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22
Q

What positions make the risk of small airway closure higher in pregnant women?

A

Supine

Trendelenburg

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23
Q

What about a laparoscopic procedure also increases the risk of small airway closure?

A

Pneumoperitoneum

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24
Q

By how much is MAC reduced during pregnancy?

A

By 30-40%

25
Q

Why is MAC decreased during pregnancy?

A

Decreased FRC and increased minute ventilation

26
Q

What effect does pregnancy have on peripheral neural blockade?

A

Increases sensitivity to peripheral neural blockade

27
Q

What happens to plasma cholinesterase during pregnancy?

A

It decreases 25% in the first trimester and stay there till 1 week postpartum

28
Q

Does the increased sensitivity to LAs and decreased plasma cholinesterase prolong blockade during pregnancy?

A

It is uncommon due to the large volume of distribution

29
Q

Can toradol be used in the pregnant patient? Why or why not?

A

NO. Toradol can cause closure of the ductus arteriosis

30
Q

How much do NSAIDs increase the risk of closure of the ductus arteriosis?

A

15x

31
Q

What occurs if the ductus arteriosis closes prematurely?

A

Progressive right heart dysfunction
Tricuspid regurgitation
CHF
Intrauterine fetal death

32
Q

What concern does laparoscopic surgery present in the pregnant patient?

A

Uterine or fetal trauma
Fetal acidosis from absorbed CO2
Decreased maternal CO and uteroplacental perfusion d/t intra-abdominal pressure

33
Q

What affect does the pneumoperitoneum have on the airway pressures and compliance?

A

Pneumoperitoneum results in higher peak airway pressures and decreased compliance

34
Q

What happens with advancing gestation and the risks associated with laparoscopic surgery?

A

Changes are progressively greater

35
Q

Why are cholecystectomies the most common procedure seen in pregnancy?

A

Pregnant women are at an increased risk for gall bladder disease

36
Q

What procedures are worst for infant mortality?

A

Appendiceal abscess

Cervical incompetence

37
Q

By how much is the risk of premature deliver and LBW increased by appendiceal abscess and cervical incompetence?

A

9%

38
Q

Neural tube defects are worse in surgery done at how many weeks?

A

4-5

39
Q

Why are appendiceal abscesses more likely to have generalized peritonitis during pregnancy?

A

Increased steroid levels during pregnancy

-inhibits normal inflammatory response of walling off the appendiceal abscess by the omentum

40
Q

Why is appendiceal abscess misdiagnosed?

A

Abdominal pain may be mistaken for round ligament pain or uterine contraction pain

41
Q

Why are pregnant women at an increased risk for appendiceal abscess?

A

The appendix rotates counterclockwise as term approaches and the tip lies over the right kidney

42
Q

Why is white count possibly not diagnostic to help with Dx of appendiceal abscess?

A

WBC in pregnancy can be elevated to 15,000

-so marked elevation would be needed to be helpful

43
Q

What is the rate of misdiagnosis with appendiceal abscess?

A

36%

44
Q

When can ECTs be performed during pregnancy?

A

All 3 trimesters

45
Q

When is FHR and uterine contraction activity monitored with ECT?

A

Pre and post procedure

-if viable

46
Q

What are the guidelines for ECT during pregnancy?

A

Obtain preop OB consult
Monitor FHR and uterine contractions pre and post
Ensure hydration and denitrogenation
Left uterine displacement after 18-20 weeks
Aspiration prophylaxis
Observe for vaginal bleeding post

47
Q

What could be considered for ECT in pregnant women with symptoms of GERD?

A

ETT

-some providers say this should be done after 20 weeks gestation for ECTs

48
Q

What drugs are typically used for ECTs?

A

Brevitol

Succinylcholine

49
Q

Derangements of maternal physiology with surgery may result in what negative effects?

A

Hypoxia
Hypercapnia
Stress
Abnormal temperature

50
Q

What conditions enhance teratogenicity?

A

Hypoxia
Hypercapnia
Stress
Abnormal temperature

51
Q

Are anesthetic agents teratogens?

A

They are listed as unlikely

52
Q

Hyperthermia is teratogenic, what is it associated with?

A 
Increases:
Miscarriage
Neural tube defects
Cataracts
Teeth abnormalities
Heart defects
Craniofacial and skeletal defects
53
Q

What is Category A for drug safety in pregnancy?

A

No risk and find no evidence of harm

54
Q

What is Category B for drug safety in pregnancy?

A

Animal studies show no risks, but there are no controlled studies on pregnant women

55
Q

What is Category C for drug safety in pregnancy?

A

Animal studies have shown risk, but no human studies

56
Q

What is Category D for drug safety in pregnancy?

A

Positive evidence of human for fetal risk

-in life threatening situation might use

57
Q

What should be avoided during anesthesia during pregnancy?

A 
Long exposure
Repeated exposures
Pain
Stress
Hypotension
Hypoxia
Sepsis
Hyperventilation
58
Q

Maternal PaCO2 correlates directly with fetal PaCO2, severe acidosis can lead to what?

A

Fetal myocardial depression and hypotension

59
Q

What occurs with maternal hyperventilation?

A

Low PaCO2 and high pH adversely affects fetal oxygenation by causing uterine artery vasoconstriction

OB Test 2 (4 decks)

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