Pre-Eclampsia

Question 1

What is Pre-eclampsia?

Answer 1

Widespread arteriolar vasoconstriction causes hypertension, tissue hypoxia, and endothelial damage

Question 2

Mild pre-ecl vs severe

Answer 2

BP > 140/90 two elevated BPs taken four hours apart
Proteinuria: > 300 mg over 24 hours
Non pedal edema

Severe:
160/110
Severe proteinuria >5 gm over 24 hours
Evidence of severe end organ damage

Question 3

If a patient seizes with eclampsia-what are you doing?

Answer 3

50-100 mg sodium thiopental, bolus of IV mag 4-6 gm followed by an infusion of 2 gm/hr
Establish airway, monitor BP, pulse ox, and EKG
Cure: delivery of fetus and placenta

Question 4

Which assay could you use to assess platelets in pregnant women?

Answer 4

PFA 100-most rapid and simple assessment of platelet aggregation. uses epinephrine and ADP

Question 5

With pts on Magnesium, KIM what about their baby?

Mg also causes what with sensitivity to muscle relaxants and why?

Answer 5

Could have weakness and decreased muscle tone
Also causes increased maternal sensitivity to both depolarizing and non-depolarizing muscle relaxants. It does this because it inhibits release of ACh at NM junction and decreases sensitivity of motor endplate to aCH.

Question 6

What are therapeutic levels of Mg? When do you lose deep tendon reflexes? When do you get SA and AV nodal block? Cardiac arrest when?

Answer 6

4-6
You lose deep tendon reflexes at 10
SA and AV block at 15
Cardiac arrest at 20

Question 7

What can you give to counteract Mag? How much?

Answer 7

Calcium gluconate counteracts the cardiac effects, but both gluconate or chloride could help overall.
Calcium gluconate: 1 gm
Calcium chloride 300 mg

Question 8

Pre-op in pts with pre-ec?

Answer 8

Assuming it is not emergent-Make sure theyve been given a fluid bolus and repeat platelet count (KIM that these pts on Mg are prone to pulmonary edema)
Provide aspiration ppx with H2 blocker and 30 mL of a nonparticulate antacid
Cosnider a line. in severe pre-eclamptics, or in those with uncontrolled BP

Question 9

Intra-op with a patient with pre-ec what can you expect?

Answer 9

YOu can expect BP swings (hyper and hypotensive) KIM that the pre-ecl pateint is more sensitive to pressors. random-you can raise arms to facilitate venous return.

Question 10

Epidural vs Spinal in Pre-eclamptic:

Answer 10

in a stable, non-coagulopathic patient, spinal should be fine, but you can do epidural if you’re worried about the sympathectomy

Question 11

GA in pre-ec:

Answer 11

aspiration prophylaxis: oral nonparticulate antacid, H2 blocker, Metoclopramide
pre-oxygenate
Can consider giving labetalol or ntg to blunt sympathetic response
Sodium thiopental vs succinylcholine?
HAVE SMALLER TUBES AVAILABLE
REMEMBER THAT MG POTENTIATES THE EFFECTS OF NEUROMUSCULAR BLOCKERS

Question 12

Post op in pt with pre-ec;

Answer 12

Be aware of post op development of eclampsia. pt should be monitored for 24-48 hours after delivery due to risk of mg therapy and to be watched for seizures.