OB: Non-Obstetric Sx During Pregnancy Flashcards
Up to 1 in ___ parturients will require surgery during their pregnancy
_____/year in the US
50
80,000
Most are urgent or emergent surgeries
Trauma
Ovarian cysts
Appendicectomy
Cholecystectomy
Breast
Cervical incompetence
Craniotomy
CPB
Liver transplantation
Anesthetic Management
Maternal Physiology (4)
Respiratory
Cardiovascular
Gastrointestinal
CNS
Anesthetic Management
Maintenance of ____ _____
Fetal Oxygenation
Anesthetic Management
Prevention of _____ Labor
Preterm
Teratogenicity - what not to give
The usual suspects (2)
Nitrous Oxide
Benzodiazepines
Teratogenicity - what not to give
New issues
Neurotoxicity?
Apoptic neurodegeneration?
Anesthetic Management less than 24 wks gestation
Postpone if possible
Post op assessment by OB
Counsel preoperatively
Nonparticulate antacid
Maintain normal O2, CO2, BP, & Glucose
Regional when appropriate
Document FHT before & after
Anesthetic Management greater than 24 weeks
Postpone if possible
Counsel preoperatively
OB consult, prophylactic tocolytics?
Aspiration prophylaxis
Uterine displacement
Maintain normal O2, CO2, BP, & Glucose
Document FHT before & after, or continuous if feasible
Regional when possible
Tocolysis - PO/PR _____ few anesthesia implications
Indomethacin
Tocolysis - PO _____ contribute to hypotension
Nifidepine
Tocolysis - IV Mag Sulfate potentiates ______ and attenuates ______ responsiveness
nondepolarizers
vascular
Preoperative Pregnancy Testing
Minimum: date of ____
LMP
Preoperative Pregnancy Testing
_____ testing is controversial
mandatory
Intraoperative Management
No preference as to type of anesthesia maintenance, assuming maintenance of _______
normotension
One small study suggested general better than regional of ovarian mass, but not replicated in larger studies
Intraoperative Management
_____ monitoring
standard
Intraoperative Management
____ pre and post at minimum, intraoperatively either continuous or intermittent if it won’t interfere with surgery
FHT
Intraoperative Management
Loss of beat-to-beat is _____ (General or MAC), but not fetal ______
expected
bradycardia
Intraoperative Management
Decelerations: increase maternal _____, increase maternal ___, increase uterine _____, adjust surgical ______, begin tocolysis
oxygenation
BP
displacement
retraction
Intraoperative Management
Monitoring ____ ____ to improve fetal outcomes
hasn’t shown
General Anesthesia implications (7)
Full preoxygenation/denitrogenation
RSI
Avoid hypoxia
Difficult airway??
First trimester – high dose ketamine (>2mg/kg) can cause uterine hypertonus
MAC is decreased 20-40% in pregnancy
Muscle relaxants should be given slowly to prevent acute increases in acetylcholine
Regional Anesthesia implications (4)
Minimize drug exposure
No change in FHT variability
Adequate volume and ephedrine or phenylephrine to prevent hypotension
Decrease neuraxial dose by 1/3
Postoperative Care
Continue monitoring ____ & _____ activity
FHT & uterine
Postoperative Care
Treat preterm labor ____ & ____
early and aggressively
Postoperative Care
L&D unit or L&D RN in ____ area
recovery
Postoperative Care
Pain meds will _____ beat-to-beat variability
decrease
Postoperative Care
High risk for embolus, should ____ as early as possible
ambulate
Postoperative Care
Maintain oxygenation and ____ ____
uterine displacement