PREGANCY changes Flashcards
1
Q
Conducting airway
A
improve during pregancny
2
Q
Dilation of larger airways occurs due to
A
Hormonal influences
3
Q
Progesterone hormone goals
A
Direct dilation
Indirect by enhancing B2 activity
4
Q
Pregnancy and Obesity
A
Restrictive
5
Q
What decrease in Pregnancy in resp (ONLY ONE AFFECTED)
A
FRC Decreases
6
Q
Airway dilatation compensates for the expected ↑ airway resistance due to
REASON is unknown
•
A
Hypocapnia
• Reduced resting lung volume
7
Q
Hyperventilating can cause
A
increase airway resistanc
8
Q
***•Lung volumes and capacities change during
pregnancy most importantly
A
FRC
9
Q
Diaphragm goes
A
UP not a good thing
10
Q
•FRC is reduced to 80% of pre-pregnancy values by
A
term
11
Q
FRC There is a 20% reduction in FRC
• Accounted for by
A
- 25% reduction in ERV
* 15% RV reduction
12
Q
No INDUCTION
A
to pregnant ladies
13
Q
FRC is the gas tank of your lung
A
Storage, HIGHER –> BETTER
14
Q
decreased FRC
A
quicker desaturation
15
Q
Doesn’t change at all is
A
Vital capacity
16
Q
Read table 2-2
A
and changes and percentage
17
Q
SUPINE
A
worsens PRELOAD AND VENOUS RETURN
18
Q
Changes in volume affect patients because you have
A
Less time to intubate
19
Q
Early respiratory cahnges due to hormone initially and also later due to
A
CO2 production
20
Q
Progesterone
A
INCREASE SeNSItiVity of CENTRAL CHEMORECEPTORS to CO2
21
Q
Bicarb
A
Increase pH
22
Q
Ph in mother is
A
SLIGHLY ALKALOTIC
23
Q
Metabolic alkalosis
A
reduces Co2 and Bicarb to 20
24
Q
• PaO2 ↑ to 107 mmHg in first trimester due to•
A
↑ CO greater than O2 consumption
25
• As O2 consumption progresses in 2-3 trimester, the A-V
| difference
↑ and PaO2 falls
26
• Supine position decreases PaO2 by
* Reducing FRC
* Closing small airways
* ↑ shunt
* Reducing cardiac output (CO) via aortocaval compression ↑↓
27
Metabolism & Respiration during Labor
| •
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
```
28
***• FRC ↑ but below normal up until
1-2wks postpartum
29
• Up to six week (
* ↑ O2 consumption
* ↑ TV
* ↑ MV
30
***CO highest
Immediately AFTER you deliver the baby
31
must compensate for AV fistula
Placenta
32
Increase in blood volum
Increase cardiac work
| heart musts hypertropy lifting more fluid
33
Increase in blood volume
Increase cardiac work
| heart musts hypertropy lifting more fluid
34
PRESENT IN 94% OF PREGNANT PATIENT
TRICUSPID REGURGITATION
35
• ↑ pulmonary resistance
↑ right ventricular pressure
• ↑ risk for pulmonic valve insufficiency
• ↑ risk for TR
36
• ↑ blood volume
↑ cardiac workload
• ↑ risk of developing LVH
• ↑ risk of MR
37
• ↓ viscosity and AV fistula lowers SVR
• Low risk for Aortic valve dysfunctioN
38
• The heart shifts anteriorly and to the left due
| to
diaphragmatic elevation
39
• Grade I-II systolic murmur is typically
| heard;
usually TR or MR
40
EKG shows
sinus tachycardia with a short PR
41
• Echo
* Elevated pulmonary pressures
* Pulmonary insufficiency
* Annular dilations
* 94% have TR
* 27% have MR
* Confirms LVH
* Aortic valve not affected
42
KNOW TABLE
2-4
43
```
↑ in CO by _____
• Organs with ↑ perfusion
•_____
-_______
• ____ GFR by __________
• ↑ to remove __________
• Extremities
• Skin
• ↑ skin temp
• Skeletal muscle
• Other major organs are unaffected
```
```
↑ 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
3 ORGANS THAT REALLY BENEFIT FROM BLOOD FLOW INCREASE
UTERUS
KIDNEY
EXTREMITIES
45
PREGANT PATIENT WITH LOW BP
VOMITING
46
BP Changes
```
•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
BP lower when
* Sitting
* Standing
* lateral
48
BP Changes
```
•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
•Advanced age and nulliparity have______ mean
| pressures than younger/parous woman
higher
50
NULLIPARITY
FIRST TIME HAVING BABY
51
WIDENING PULSE PRESSURE
PREGANCY
| SBP INCREASE, DBP SAYS THE SAME.
52
Supine Position
* 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
• Lateral Decubitus Position
* 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
* ↓ preload (10-20%)
| * Uterine blood
* SV decreases
| * CO decreases
55
LEFT LATERAL TILT AORTA IS
NOT AFFECTED
56
RIGHT AFTR SPINAL
PUT SOMETHING UNDER RIGHT HIP
57
Aortocaval Compression
| •
```
↓ 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
Total blood volume ↑ by
• 1st trimester ___%
• 2nd trimester ___%
• 3rd trimester ____%
____%
_____%
_____%
59
• Erythropoietin is ↑ ↑ the RBC production
“Dilutional Anemia”
| • Hgb falls to ~11.2-11.6 g/dl
60
Hemodilution helps maintain the uteroplacental vascular bed and minimize
• ↑
thrombosis/infarction
| maternal survival
61
KNOW
HORMONLA EFFECT ON PLASMA VOLUM
62
KNOW
HORMONAL EFFECT ON PLASMA VOLUME
63
PLASMA CHOLINESTERASE
BY 25%
64
PLASMA CHOLINESTERASE
BY 25%, needs less succynilcholine
65
Coagustion
```
• 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
Platelet count
LESS than 75 do not do spinal
67
Antithromobin III
Decreases, HYPERCOAGULABLE STATE
68
Antithromobin III
Decreases leading to HYPERCOAGULABLE STATE
69
EBL NVD
500-600
70
EBL C secion
about 1L
71
Hematology and coagulation Puerpirium
Hgb coung falls
| protein concentration falls
72
GI
Lower LES
73
GI
Assume GERD
| Lower LES tone
74
Fasting Gatric volume and pH
are normalized by 18 hours
75
Impaired gastric emptying
ASSOCIATED WITH OPIOIDS
76
LACTOGEN
HORMONAR
77
Thyroid
Increase t3 and T4
78
Worse for spinal and epidural
LORDOSIS
79
Increase FORGETFUL due to
PROGEsterone (
80
Once you're done with SPINAL, put patinet in LATERAL TILT POSITION given this med IM to prevent Hypotension
1 cc/ 50 mg
| Draw it up in saline, IM 50 mg
81
Epidural
17 inch needle, long
| Below
82
Regional
STOP if there is contraction
| if you keep going, they are tense and they are moving.
83
Epidural
BLOOD PATCH , Headaches do not go away
84
BUPIVICAINE IV (CONTRAINDICATED)
Cardiac arrest
85
Test dose of epidural
LIDOCAINE with a litte epinephrine
86
LEFT LATERAL TILT
Before you do anesthesia.
87
MAC is reduced by
30%
88
MAC reduced due to
Progesterone
| CNS serotonic activity
89
Take home message for succ
GIve less
90
Pregnant and CSF
Less CSF
91
C3, C4, C5
phrenic nrve
| KEeps them alive
92
C6 be t
C with fingers
