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OB Anesthesia > Physiology > Flashcards

Physiology Flashcards

1
Q

MAC during pregnancy

A

decreases by 40%, returns to normal by 3-4 day postpartum

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2
Q

Sensitivity to local anesthesitcs?

A

Increased sensitivity to local anesthetics during pregnancy (30%)

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3
Q

epidural blood volume?

A

Obstructing IVC –> enlarges epidural venous plexus –> increases epidural blood volume –> more uptake of epidural anesthetics

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4
Q

CSF volume?

A

lower CSF due to increased girth in abdomen –> pushes CSF cephalad as well as epidural fluid –> more spread with injection

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5
Q

Oxygen consumption?

A

increased oxygen consumption in pregnancy –> 20% of CO goes to uterus and fetus that are very metabolically active

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6
Q

Minute ventilation

A

Large increase in minute ventilation –> respiratory alkalosis during pregnancy

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7
Q

Respiratory mechanics during pregnancy

A

Elevated diaphragm, increased AP chest diameter, Vt and RR increased

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8
Q

Rapid desaturation?

A

Decreased FRC + increased O2 consumption

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9
Q

Inhalational induction during pregnancy?

A

Accelerated due to increased MV and lower MAC

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10
Q

Airway during pregnancy

A

Treat all as difficult and full stomach!

  • rapid desaturation
  • edema from fluid retention
  • friable tissue due to capillary engorgement
  • full-stomach (RSI)
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11
Q

Hgb-O2 dissociation curve

A
  • Alkalosis shifts to left

- 2,3-DPG shifts back right

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12
Q

Anemia during pregnancy?

A

dilutional anemia due to increased plasma circulating volume (55%)
- reduced blood viscosity as well

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13
Q

Estimated blood volume

A

in pregnancy it increased 90 cc/kg

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14
Q

DO2 during pregnancy?

A

reduction in Hgb is offset by the increase in CO

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15
Q

BP in pregnancy?

A

reduced SVR so normotensive

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16
Q

increased CO?

A

due to HR and SV increases

  • greatest increase is immediately after delivery (autotransfusion)
  • CO should return to normal in 2 weeks postpartum
17
Q

Aortocaval compression?

A

supine hypotension syndrome

  • can also see bradycardia
  • enlarged uterus compresses IVC and aorta –> SOB and edema
18
Q

Heart changes due to increased blood volume

A
  • Stretching of ventricles –> common regurgitant lesions
  • S3 heart sound
  • accentuated S2 heart sound
  • systolic ejection murmur
  • slight cardiomegaly
19
Q

GFR in pregnancy?

A

GFR increases thus making BUN and Cr lower!

- a Cr of 1 is abnormal in pregnancy!

20
Q

Full stomach precautions?

A

cephalad displacement of stomach due to uterus = promotes LES incompetence
- progesterone contributes!

21
Q

Hepatic changes

A

liver flow unchanged, slight elevation in ALK

- decreased pseudocholinesterase

22
Q

Coagulation state

A

pregnancy is HYPERcoagulable state

23
Q

Increased coagulant factors

A
  • Factors VII, VIII, IX, X, XII

- Fibrinogen

24
Q

Decreased coagulant factors

A
  • Factor XI

- Platelets

25
Q

Metabolic state

A
  • diabetogenic state = high FFA, ketones, TGA

- hPL creates insulin resistance

26
Q

CO immediately postpartum

A

Drastic increases in CO immediately postpartum –> venous constriction due to sympathetic surge and contraction of the uterus (venous reservoir)

27
Q

when does aortocaval compression start?

A

around 20th week gestation

28
Q

Difficult airway in pregnancy?

A 
10x more common to have a failed intubation
- can have changes in mallampati class during course
29
Q

ACid base during pregnancy

A

Increased RR –> resp alkalosis

- renal compensation by HCO3 excretion

30
Q

Succinylcholine metabolism

A

plasma cholinesterase activity decreased by 25% –> back to normal 2-6 week postpartum
not clinically relevant

31
Q

Gastric emptying during pregnancy

A

gastric emptying doesn’t change –> but decreases during active labor

OB Anesthesia (4 decks)

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