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SNRAObPedGer > PREGANCY changes > Flashcards

PREGANCY changes Flashcards

1
Q

Conducting airway

A

improve during pregancny

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2
Q

Dilation of larger airways occurs due to

A

Hormonal influences

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3
Q

Progesterone hormone goals

A

Direct dilation

Indirect by enhancing B2 activity

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4
Q

Pregnancy and Obesity

A

Restrictive

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5
Q

What decrease in Pregnancy in resp (ONLY ONE AFFECTED)

A

FRC Decreases

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6
Q

Airway dilatation compensates for the expected ↑ airway resistance due to
REASON is unknown
•

A

Hypocapnia

• Reduced resting lung volume

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7
Q

Hyperventilating can cause

A

increase airway resistanc

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8
Q

***•Lung volumes and capacities change during

pregnancy most importantly

A

FRC

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9
Q

Diaphragm goes

A

UP not a good thing

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10
Q

•FRC is reduced to 80% of pre-pregnancy values by

A

term

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11
Q

FRC There is a 20% reduction in FRC

• Accounted for by

A
  • 25% reduction in ERV

* 15% RV reduction

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12
Q

No INDUCTION

A

to pregnant ladies

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13
Q

FRC is the gas tank of your lung

A

Storage, HIGHER –> BETTER

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14
Q

decreased FRC

A

quicker desaturation

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15
Q

Doesn’t change at all is

A

Vital capacity

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16
Q

Read table 2-2

A

and changes and percentage

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17
Q

SUPINE

A

worsens PRELOAD AND VENOUS RETURN

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18
Q

Changes in volume affect patients because you have

A

Less time to intubate

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19
Q

Early respiratory cahnges due to hormone initially and also later due to

A

CO2 production

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20
Q

Progesterone

A

INCREASE SeNSItiVity of CENTRAL CHEMORECEPTORS to CO2

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21
Q

Bicarb

A

Increase pH

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22
Q

Ph in mother is

A

SLIGHLY ALKALOTIC

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23
Q

Metabolic alkalosis

A

reduces Co2 and Bicarb to 20

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24
Q

• PaO2 ↑ to 107 mmHg in first trimester due to•

A

↑ CO greater than O2 consumption

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25
Q

• As O2 consumption progresses in 2-3 trimester, the A-V

difference

A

↑ and PaO2 falls

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26
Q

• Supine position decreases PaO2 by

A
  • Reducing FRC
  • Closing small airways
  • ↑ shunt
  • Reducing cardiac output (CO) via aortocaval compression ↑↓
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27
Q

Metabolism & Respiration during Labor

•

A

Pain during labor
• MV ↑ 70-140% by time of delivery
• MV ↑ 120-200% first and second stages

• PaCO2 may fall to 10-15 mm Hg
• O2 consumption ↑ by 40% first stage
• O2 consumption ↑ by 75% second stage
• Due mostly due to 
  - hyperventilation work 50%
• Uterine activity
• Maternal expulsive methods
• Demand outstrips O2 supply- go anaerobic
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28
Q

***• FRC ↑ but below normal up until

A

1-2wks postpartum

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29
Q

• Up to six week (

A
  • ↑ O2 consumption
  • ↑ TV
  • ↑ MV
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30
Q

***CO highest

A

Immediately AFTER you deliver the baby

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31
Q

must compensate for AV fistula

A

Placenta

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32
Q

Increase in blood volum

A

Increase cardiac work

heart musts hypertropy lifting more fluid

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33
Q

Increase in blood volume

A

Increase cardiac work

heart musts hypertropy lifting more fluid

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34
Q

PRESENT IN 94% OF PREGNANT PATIENT

A

TRICUSPID REGURGITATION

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35
Q

• ↑ pulmonary resistance

A

↑ right ventricular pressure
• ↑ risk for pulmonic valve insufficiency
• ↑ risk for TR

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36
Q

• ↑ blood volume

A

↑ cardiac workload
• ↑ risk of developing LVH
• ↑ risk of MR

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37
Q

• ↓ viscosity and AV fistula lowers SVR

A

• Low risk for Aortic valve dysfunctioN

38
Q

• The heart shifts anteriorly and to the left due

to

A

diaphragmatic elevation

39
Q

• Grade I-II systolic murmur is typically

heard;

A

usually TR or MR

40
Q

EKG shows

A

sinus tachycardia with a short PR

41
Q

• Echo

A
  • Elevated pulmonary pressures
  • Pulmonary insufficiency
  • Annular dilations
  • 94% have TR
  • 27% have MR
  • Confirms LVH
  • Aortic valve not affected
42
Q

KNOW TABLE

A

2-4

43
Q 
↑ in CO by \_\_\_\_\_
• Organs with ↑ perfusion
•\_\_\_\_\_
-\_\_\_\_\_\_\_
• \_\_\_\_ GFR by \_\_\_\_\_\_\_\_\_\_
• ↑ to remove \_\_\_\_\_\_\_\_\_\_
• Extremities
• Skin
• ↑ skin temp
• Skeletal muscle
• Other major organs are unaffected
A 
↑ in CO by 2 L/min
• Organs with ↑ perfusion
• Uterus
• Kidneys
• ↑ GFR by 900% at time of delivery
• ↑ to remove ↑ waste products
• Extremities
• Skin
• ↑ skin temp
• Skeletal muscle
• Other major organs are unaffected
44
Q

3 ORGANS THAT REALLY BENEFIT FROM BLOOD FLOW INCREASE

A

UTERUS
KIDNEY
EXTREMITIES

45
Q

PREGANT PATIENT WITH LOW BP

A

VOMITING

46
Q

BP Changes

A 
•BP varies with position, age and parity
•BP higher when supine
•
•Advanced age and nulliparity have higher mean
pressures than younger/parous woman
•Systolic pressure typically unaffected
•Diastolic pressure lowers 20
to low resistance vascular
bed (intervillous space) and hormonally induced
vasodilation
47
Q

BP lower when

A
  • Sitting
  • Standing
  • lateral
48
Q

BP Changes

A 
•BP varies with position, age and parity
•BP higher when supine
•Systolic pressure typically unaffected
•Diastolic pressure lowers 20
to low resistance vascular
bed (intervillous space) and hormonally induced
vasodilation
49
Q

•Advanced age and nulliparity have______ mean

pressures than younger/parous woman

A

higher

50
Q

NULLIPARITY

A

FIRST TIME HAVING BABY

51
Q

WIDENING PULSE PRESSURE

A

PREGANCY

SBP INCREASE, DBP SAYS THE SAME.

52
Q

Supine Position

A
  • Caval compression occurs as early as 13-16 wks
  • ↑ femoral venous pressure
  • At term femoral venous pressures are 2.5x normal due to caval obstruction
  • Collaterals cannot maintain venous return so right heart pressures fall
  • Aorta is partially obstructed
53
Q

• Lateral Decubitus Position

A
  • Partial caval obstruction
  • Collaterals maintain venous return
  • Intraosseous vertebral veins
  • Paravertebral veins
  • Epidural venous plexus
  • Aorta is unaffected (lateral tilt position has 40% aorta compression)
54
Q
  • ↓ preload (10-20%)

* Uterine blood

A
  • SV decreases

* CO decreases

55
Q

LEFT LATERAL TILT AORTA IS

A

NOT AFFECTED

56
Q

RIGHT AFTR SPINAL

A

PUT SOMETHING UNDER RIGHT HIP

57
Q

Aortocaval Compression

•

A 
↓ preload (10-20%)
• SV decreases
• CO decreases
•Uterine blood flow falls by 20%
•Lower extremity blood flow falls by 50%
• ~8% of woman experience bradycardia and substantial
hypotension in the supine position
• “SUPINE HYPOTENSIVE SYNDROME”
• results from the profound drop in venous return from which
the CV system cannot compensate
58
Q

Total blood volume ↑ by
• 1st trimester ___%
• 2nd trimester ___%
• 3rd trimester ____%

A

____%
_____%
_____%

59
Q

• Erythropoietin is ↑ ↑ the RBC production

A

“Dilutional Anemia”

• Hgb falls to ~11.2-11.6 g/dl

60
Q

Hemodilution helps maintain the uteroplacental vascular bed and minimize
• ↑

A

thrombosis/infarction

maternal survival

61
Q

KNOW

A

HORMONLA EFFECT ON PLASMA VOLUM

62
Q

KNOW

A

HORMONAL EFFECT ON PLASMA VOLUME

63
Q

PLASMA CHOLINESTERASE

A

BY 25%

64
Q

PLASMA CHOLINESTERASE

A

BY 25%, needs less succynilcholine

65
Q

Coagustion

A 
• A state of accelerated but compensated intravascular coagulation
• Elevated platelet
• Activation
• Consumption
• Aggregation
• Production also enhanced
----- Except ~7-8% parturients have platelet count <150,000
• Clotting factor concentrations are ↑
• shortened PT/PTT by 20%
• Decreases in antithrombin III
• Pregnancy is a “hypercoagulable state”
• Fibrinolysis enhanced
• See ↑ fibrin degradation products and plasminoge
66
Q

Platelet count

A

LESS than 75 do not do spinal

67
Q

Antithromobin III

A

Decreases, HYPERCOAGULABLE STATE

68
Q

Antithromobin III

A

Decreases leading to HYPERCOAGULABLE STATE

69
Q

EBL NVD

A

500-600

70
Q

EBL C secion

A

about 1L

71
Q

Hematology and coagulation Puerpirium

A

Hgb coung falls

protein concentration falls

72
Q

GI

A

Lower LES

73
Q

GI

A

Assume GERD

Lower LES tone

74
Q

Fasting Gatric volume and pH

A

are normalized by 18 hours

75
Q

Impaired gastric emptying

A

ASSOCIATED WITH OPIOIDS

76
Q

LACTOGEN

A

HORMONAR

77
Q

Thyroid

A

Increase t3 and T4

78
Q

Worse for spinal and epidural

A

LORDOSIS

79
Q

Increase FORGETFUL due to

A

PROGEsterone (

80
Q

Once you’re done with SPINAL, put patinet in LATERAL TILT POSITION given this med IM to prevent Hypotension

A

1 cc/ 50 mg

Draw it up in saline, IM 50 mg

81
Q

Epidural

A

17 inch needle, long

Below

82
Q

Regional

A

STOP if there is contraction

if you keep going, they are tense and they are moving.

83
Q

Epidural

A

BLOOD PATCH , Headaches do not go away

84
Q

BUPIVICAINE IV (CONTRAINDICATED)

A

Cardiac arrest

85
Q

Test dose of epidural

A

LIDOCAINE with a litte epinephrine

86
Q

LEFT LATERAL TILT

A

Before you do anesthesia.

87
Q

MAC is reduced by

A

30%

88
Q

MAC reduced due to

A

Progesterone

CNS serotonic activity

89
Q

Take home message for succ

A

GIve less

90
Q

Pregnant and CSF

A

Less CSF

91
Q

C3, C4, C5

A

phrenic nrve

KEeps them alive

92
Q

C6 be t

A

C with fingers

SNRAObPedGer (25 decks)

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