Pregnanat going on Chole

Question 1

 Stem: 34 weeks undergoing open chole for necrotising cholecystitis, BP is decreasing, HR is decreasing, reversed telendenberg position, Combined GA, Epidural, the operation is taking longer duration than expected).

Q. Benefits and risks of this patient undergoing this operation:

Answer 1

• Benefits: Reduced risk of mother of sepsis from perforated gallbladder and reduce symptoms
• Risks: more complicated procedures and risk for the fetus and pre-term labor.

Question 2

Q. Who to involve in care?

Answer 2

Neonatologist (in case of pre-term labor), ITU registrar, obstetrician, anaesthesiologist.

Question 3

Q. Where to manage this case post-operative?

Answer 3

Obstetric HDU. / if concern about fatus – > labor ward

Question 4

Q. What are the factors help venous return in a standing person?

Answer 4

. Sympathetic tone
. Skeletal muscle pump
. -ve intrathoracic pressure
x

Question 5

Q. describe the response of ANS which will cause decreased VR?

Answer 5

–Drop in blood pressure will be detected by baroreceptors in aortic arch and carotid sinus.
–Afferent through vagus and glossopharyngeal to VMC
–Autonomic efferent for Symp and parasymp, Sympathetic through sympathetic chain will increase HR and contractility and VC leading to increase VR (Incr. Preload) and Vc of arteriolar system leading to incr. PVR (Incr. afterload)
–Parasympathetic will decr. In its tone leading to incr. HR
What Action the team can take to restore blood pressure?
–Check for hemorrhge.
–Incr. circulating volume by Fluids,
–Incr. Vascular tone by vasopressor agents
–Change position to incr. left lat. Tilt and reduce head up position.

Question 5

Definitions
O Pre-load:
-

Answer 5

Is the end diastolic volume determined by volume of blood return to right atrium via great veins.

Question 6

Q. What are the features in this pt than contribute to reduced preload as a cause of hypotension?

Answer 6

–Venous obstruction due to gravid utures, Reversed telendenberg position.
–obliteration of Sympthetic Vasoconstrictor response caused by anathesia drugs
–Sepsis causing VD and relative hypovolemia may exacerbate the above causes

Question 7

Q. How can devices used TE prophylaxis in VR?

Answer 7

Mechanical compression devices will cause vessel compression increasing the venous return
and artificial pump action preventing stasis of the venous blood.