Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AP: Summer Exam 3 > Obstetric Anesthesia: Hertz cont. > Flashcards

Obstetric Anesthesia: Hertz cont. Flashcards

1
Q

How is chronic HTN defined?

What drug is safe for mom to treat it?

A

BP > 140/90 before 20 weeks gestation

Labetolol (mixed alpha, beta blocker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the triad of symptoms of preeclampsia?

A

HTN >140/90 or > 20% of baseline

Proteinuria > 300mg /24 hrs AND/OR
Edema (hand, face)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors of preeclampsia? (5)

A

Primarily primigravidas
Primipaternity
Previous Hx
Obesity
Multiple gestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the etiology of preeclampsia? (4)

A
  • Not definitely known
  • Abnormal fetal trophoblastic cell migration through placenta resulting in increased BP
  • Changes in placental/abnormal vascular endothelium
  • Platelet adhesion occurs resulting in release of seratonin, thromboxane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What vasoconstrictors are more prevalent in preeclampsia? (4)

A
  • Thromboxane (AT1, AT2 platelet aggregation)
  • Endothelin (causes pulmonary HTN)
  • Angiotensin II
  • Serotonin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is severe preeclampsia defined?

A

One of the following:

  • BP > 160/110
  • Proteinuria > 5 Grams/24 hrs
  • Symptoms such as headache, blurred vision, oliguria, pulmonary edema, myocardial dysfunction, RUQ pain (liver congestion), platelets < 100k, HELLP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Severe preeclampsia contributes to ___ - ___% of maternal deaths and ____% perinatal deaths.

A

20-40

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What turns preeclampsia into severe eclampsia?

A

HELLP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is contraindicated in HELLP syndrome?

A

REGIONAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Can seizures occur with preeclampsia?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment of preeclampsia?(5)

A
  • Bedrest
  • Sedation
  • Labetalol, Hydralazine
  • Magnesium sulfate
  • Delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are antihypertensives safe for mom? (5)

A
  • Labetolol 5-10 mg IV
  • Hydralazine 5mg IV
  • Methyldopa 250-500 mg PO (alpha 2 agonist)
  • Magnesium sulfate
  • Nitroprusside (arterioles, venules)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are attributes of magnesium sulfate? (3)

A

Treats hyperreflexia and prevents seizures

Direct vasodilating action on smooth muscle of arterioles and uterus

Potentiates sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Excessive magnesium sulfate can cause what? (6)

A
  • prolonged PR interval, widened QRS (5-10 mEq)
  • muscle weakness (10 mEq)
  • loss of DTRs
  • respiratory depression
  • SA, AV block (15 mEq)
  • cardiac arrest (25 mEq)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SNP in doses > _____mcg/kg/min or prolonged period can increase risk of what?

A

10 mcg/kg/min

cyanide toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What drugs do you NOT use in pregnant women?

A

ESMOLOL –adverse fetal effects

Calcium channel blockers–tocolytic action and potentiate circulatory depression induced by magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the anesthetic management of severe preeclampsia?

A

Pts are critically ill and need to be stabilized prior to any type of anesthesia.

Need a-line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are antihypertensives needed in OR?

A

Labetalol
Hydrazaline
NTG
Nitroprusside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are signs of magnesium toxicity? (3)

A

Oversedation
Loss of reflexes
DROPPING SATURATIONS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do we manage a preeclamptic patient? (3)

A

Monitor UO

Hypovolemia treated with no more than 500ml LR

Check platelets and coags prior to regional anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Avoid regional if platelets < _____, but lowest is _____.

A

100k

70k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is ideal anethesia for preeclamptic pt?

A

Epidural or spinal

Vaginal

C/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is controversial regarding regional in the preeclamptic pt?

A

EPI contained in test dose

24
Q

What drugs/doses are appropriate for hypotension in pregnant patients, specifically preeclamptic pts that become hypotensive during epidural placement?

A

Ephedrine 5mg

Phenylephrine 50 mcg

Note: Pregnant women are more sensitive to meds.

25
Q

What are anesthetic considerations for general anesthesia in preeclamptic pts? (4)

A
  • Difficult airways so be prepared!
  • Limit IV fluid to avoid pulmonary edema
  • Doses of non-depolarizing relaxants are reduced in patients on magnesium since it potentiates NMB.
  • A-line for severe preeclampsia
26
Q

What is usually better tolerated, regurgitant or stenotic lesions in the pregnant woman?

A

regurgitant

27
Q

What is the 2nd most common valve defect in pregnant pts?

A

mitral regurge

28
Q

What should you avoid in mitral regurge? (3)

A

Increases in SVR

Decreases inHR and contractility

Maintain sinus rhythm

29
Q

What should you avoid in aortic regurge? (2)

A

Increases in SVR

Decreases in HR and contractility

Note: consider afterload reduction

30
Q

What should be avoided in mitral stenosis? (3)

A

Avoid tachycardia

Atrial fibrillation–perfusion depends on atrial kick

Increases in blood volume because may precipitate pulmonary edema

Note: Maintain SVR

31
Q

What should you avoid in aortic stenosis? (3)

A

Decreases in SVR

Avoid bradycardia

Avoid hypovolemia

32
Q

What is the dose of mg sulfate?

A

Loading dose: 4 GRAMS then 1-3 gram/hr

Plasma level: 1.5 -2 mEq/L

Therapeutic level: 4-6 mEq/L

33
Q

What are congenital heart diseases? (3)

A

left to right shunt

right to left shunt

cardiomyopathy

34
Q

What are left to right shunts? (3)

A

ASD–atrial septal defect

VSD–ventricular septal defect

PDA–patent ductus arteriosus

35
Q

What should you avoid in left to right shunt? (3)

A

Avoid excess fluids

Avoid trendelenberg position

Avoid increases in SVR

36
Q

What is tetrology of fallot?

A

RV hypertrophy

Pulmonary valve stenosis

Ventricular septal defect

Overriding aorta

37
Q

What should you avoid in right to left shunt (ie. tetralogy of fallot for example)? (3)

A

Decrease in SVR b/c enhances shunt leading to cyanosis. Use phenylephrine

Decrease in blood volume because preload is necessary to eject blood past the outflow obstruction

Avoid myocardial depressants to avoid decrease to pulmonary circulation

38
Q

Cardiomyopathy can present at any point of pregnancy. True or false?

A

True

39
Q

What are risk factors for cardiomyopathy? (5)

A
  • multiple gestation
  • preeclampsia
  • obesity
  • advanced age
  • breastfeeding
40
Q

What are anesthetic considerations for cardiomyopathy? (4)

A

Invasive monitoring

Intubation, ventilation

inotropic support

IABP

41
Q

What are risk factors for gestational diabetes? (4)

A
  • Advanced age
  • Obesity
  • Family hx of diabetes
  • Hx of stillbirth, neonate death, etc.
42
Q

What effects does gestational diabetes have on mom? (4)

A

HTN
Polyhydramnios
C-section more likely
Preterm labor more likely

43
Q

What are the effects of gestational diabetes on baby? (5)

A

Macrosomia (large baby)
Structural malformations
Intrauterine death
Respiratory distress syndrome
Neonatal HYPOglycemia

44
Q

What are structual malformations that can occur in baby with diabetic mom? (6)

A
  • CNS: anencephaly (brainless), spina bifida, encephalocele
  • Transposition of great vessels, situs inversus, single ventricle
  • Caudal regression–dolphin like features
  • Renal agenesis
  • Anal/rectal atresia–hole not present
  • Lack of pulmonary development
45
Q

Critical organogenesis before ____th week.

A

7th

46
Q

What are anesthetic considerations for gestational diabetic pts? (3)

A

Autonomic dysfunction leads to increased risk of hypotension

Gastroparesis–give reglan

Strict sugar control

47
Q

How may asthma change during pregnancy?

A

May improve, worsen, or stay the same

48
Q

How will ABG change for pregnant women?

A

pH increases

CO2 decreases

pO2 decreases

49
Q

What are anesthetic concerns for pregant asthmatic? (3)

A
  • Prevent hypocarbia
  • Prevent hypercarbia –> vasoconstriction–>decreased UBF–> fetal distress
  • Avoid high thoracic block
50
Q

What type of anesthesia is preferred for asthmatic?

A

Regional, spinal or epidural

51
Q

What meds do you avoid in asthmatics? (3)

A

Hemabate–prostaglandin F2alpha increases smooth muscle tone–>constricts a/w

**Methergine **

Labetolol–use hydrazaline, snp

52
Q

What is BMI for obesity?

A

30 kg/m2

53
Q

What are obese pts at increased risk of? (4)

A
  • HTN
  • Aspiration
  • Diabetes
  • Increased risk of DVTs
54
Q

What is a risk factor for c/s for obese pt? (4)

A

Increased risk of fetal distress

Increased risk for abnormal labor (arrest of descent)

Increased risk of shoulder distocia

Increased risk of maternal death

55
Q

Do people recover from cardiomyopathy?

What do you do if it occurs antepartum?

A

50% do not fully recover and some require transplant

Promptly deliver the baby

AP: Summer Exam 3 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions