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Anesthesia > Obstetric Anesthesia > Flashcards

Obstetric Anesthesia Flashcards

1
Q

Highest change in CO levels during pregnancy

A

immediately postpartum: ~75% above pre-labor levels d/t autotransfusion during uterine contractions
*uterine blood flow increases to 600-700ml/min at term (~10% of CO)

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2
Q

Most dangerous time during pregnancy for patients with cardiac disease

A

During the increase in CO: life-threatening for those with pulmonary hypertension and stenotic valve disease

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3
Q

Which hormone potentiates volatile agents?

A

Progesterone

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4
Q

Dose adjustment for local anesthetics

A

~30% lower dose
- increase in plasma volume dilutes total protein & albumin concentration&raquo_space; higher free-fractions of protein-bound drugs

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5
Q

What are the cardiovascular changes observed in pregnancy?

A

INCREASE: CO, SV, HR
DECREASE: MAP, SVR, PVR

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6
Q

What are the respiratory changes observed in pregnancy?

A
  • cephalad displacement of the diaphragm, increase AP diameter
  • lower FRC
  • higher O2 consumption
  • higher MV, TV, RR
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7
Q

Which pulmonary parameters do not change in pregnancy?

A

dead space
lung compliance
vital capacity
FEV1

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8
Q

What causes a decrease in SVR?

A

progesterone INCREASES nitric oxide & prostacyclin = peripheral vasodilation

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9
Q

What causes dilutional anemia?

A

increase in plasma and RBC volume

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10
Q

Why are pregnant women prone to viral infection?

A

non-infectious leukocytosis
lower cell-mediated immunity
(to not ‘reject’ the fetus)

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11
Q

What is the normal arterial blood gas in a pregnant patient?

A

Respiratory alkalosis - secondary to increase in minute ventilation

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12
Q

What is the normal arterial blood gas in a pregnant patient?

A

Respiratory alkalosis - secondary to increase in minute ventilation

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13
Q

What is the effect of hyperventilation in a pregnant patient?

A

esp. in labor, further worsens the effects of respiratory alkalosis: uterine vasoconstriction&raquo_space; decrease placental perfusion

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14
Q

Why are pregnant patients considered a difficult intubation?

A

edematous mucosal surface - friable
(secondary to increase plasma volume&raquo_space; capillary engorgement)

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15
Q

Why are pregnant patients at risk for reflux?

A

Progesterone lowers GES pressure/tone

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16
Q

Describe aortocaval compression syndrome.

A

gravid uterus compresses the IVC and aorta&raquo_space; hypotension, tachycardia
* can decrease uteroplacental perfusion

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17
Q

Which drugs cross the placenta?

A

low molecular weight
non-ionized
lipid-soluble
(*those that also cross the BBB)

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18
Q

How do anesthetic agents cross the placenta?

A

simple diffusion (agents are lipid-soluble and have low molecular weight)

19
Q

Give examples of drugs NOT crossing the placenta

A

NMB (depolarizing & non-depolarizing)
heparin
insulin
glycopyrrolate

20
Q

What are the types of FHR decelerations?

A
  1. early - head compression
  2. variable - cord compression
  3. late - uteroplacental insufficiency
21
Q

What are the parameters measured by APGAR scoring?

A

HR
respiration
muscle tone
reflex
color

22
Q

What is the significance of an APGAR score?

A

evaluate need for resuscitation and success of resuscitation

23
Q

When is the best time to operate on a pregnant patient?

A

For non-emergent: avoid during time of organogenesis (as early as 5 weeks AOG)
‘Safest’ at 2nd trimester

24
Q

How to induce general anesthesia for an emergency CS for fetal distress?

A

preoxygenate while prepping the abdomen
RSI, verify ETT, cut
Gas: 50% N2O/O2 + 0.5 MAC

25
Q

Considerations for epidural placement

A

gravid uterus compresses the IVC&raquo_space; epidural venous distention&raquo_space; ‘smaller’ epidural space
1. check for IV/dural placement
2. higher block - adjust dose

26
Q

ephedrine vs phenylephrine for maternal hypotension

A

Ephedrine: 5-10mg (crosses placenta)
- beta-agonist: dose-dependent fetal metabolic acidosis
Phenylephrine: 50-100mcg
- alpha-agonist: peripheral vasoconstriction, increase uterine vascular resistance but no clinical significance on uteroplacental flow

27
Q

Which levels to block during labor analgesia?

A

During active labor: target T10-L1

28
Q

Conversion from analgesia to anesthesia for NSD should block which levels?

A

Target pudendal nerve S2-S4

29
Q

What are usual indications for emergency CS?

A

preeclampsia/eclampsia
non-reassuring fetal status

30
Q

When do you include fetal monitoring for non-obstetric surgery?

A

When fetus is deemed viable at 24 weeks AOG

31
Q

Leading cause of morbidity/mortality

A

hypertensive disorders: chronic, gestational, preeclampsia/eclampsia

32
Q

Pathologic features of preeclampsia

A

1) increased vascular permeability: peripheral edema, pulmonary edema, left-ventricular failure
2) coagulation problems sec to HELLP

33
Q

Describe HELLP

A
  • Hemolysis, elevated liver enzymes, low platelet count
  • Microangiopathic hemolytic anemia
  • Immediate delivery if with DIC
34
Q

Most common cause of mortality in pregnant w/ hypertensive disorder

A

cerebrovascular accident

35
Q

Antihypertensives used

A

labetalol - B>a-antagonist
hydralazine - vasodilator

36
Q

Anesthetic concerns for MgSO4

A
  • therapeutic range of 4-8 mEq/L
  • increased sensitivity to NDMB (even in therapeutic doses)
  • crosses placenta: WOF neonatal depression (respiratory & muscle)
37
Q

Most cardiac disease complicating pregnancy

A

congenital heart disease

38
Q

Commonly used tocolytics

A

indomethacin (NSAID)
MgSO4
terbutaline (b-agonist)
nicardipine (CCB)

39
Q

Commonly used uterotonics

A

oxytocin
methylergonovine (ergot alkaloid derivative)
carboprost (prostaglandin analog)

40
Q

Concerns with the use of uterotonics

A

Methergine: IV or IM
- CI: hypertension, IHD
Carboprost: IM only
- CI: asthma

41
Q

Anesthetic concerns in MS

A

Neuraxial technique is safe

42
Q

Anesthetic concerns in MG

A
  1. resistant to DMB, sensitive to NDMB
  2. caution w/ opioids, sedatives
  3. MgSO4 & CCB are not recommended for eclampsia
  4. epidural analgesia
  5. vaginal delivery is preferred
43
Q

Anesthetic concerns in SLE

A
  1. preeclampsia vs lupus nephritis as a diagnostic dilemma
  2. review coagulation profile if for neuraxial technique
  3. blood crossmatching may be a problem d/t antibodies

Anesthesia (8 decks)

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