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RUSVM Anesthesiology > Pregnancy and Cesarean Section > Flashcards

Pregnancy and Cesarean Section Flashcards

1
Q

cardiovascular changes in pregnant animals

A

CO increases 30-50%

  • heart rate
  • stroke volume: increased blood volume, decreased vascular resistance (afterload)
  • blood pressure unchanged
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2
Q

T/F RBC increase > plasma volume increase

A

False

plasma volume increase > RBC increase → decrease PCV

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3
Q

T/F aortocaval compression decreases venous return

A

True

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4
Q

pregnant patients have a decreased _______ reserve

A

cardiac

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5
Q

what is the progesterone effect on the the respiratory center

A

decreased PaCO2 - hyperventilation

≈ 30 mmHg at time of parturition

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6
Q

what is the cause of decreased pulmonary resistance in pregnant animals

A

progesterone → relaxation of bronchial smooth mm.

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7
Q

pregnant animals have a(n) increased/decreased functional residual capicity (FRC)

A

decreased

increased abdominal volume

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8
Q

GI changes in pregnant animals

A

delayed gastric emptying

increased gastric acidity

decreased lower esophageal sphincter tone

increased risk of reguritation/aspiration

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9
Q

causes of delayed gastric emptying

A

pressure from uterus

decreased gastric motility

increased progensterone

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10
Q

renal changes with pregnancy

A

increased GRF (increased CO)

decreased BUN and CREA

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11
Q

pharmacolic changes in the dam

A

decreased MAC
increased sensitivity to local anesthetics

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12
Q

pharmocologic considerations for the fetus

A

most drugs easily cross placenta

fetal drug metabolism is slow - immature hepatic microsomal enzyme system

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13
Q

what is the ideal drug protocol

A

maximize O2 delivery to fetus - maintain CO and oxygenation, avoid uterine contraction/vasoconstriction

minimize drug effects on fetus

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14
Q

sedative use in small animal

A

not recommended

  • acepromazine & benzodiazepines - fetal depression*
  • alpha 2 agonist - decrease CO*
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15
Q

T/F alpha 2 agonists are used routinely in mares despite increased uterine pressure and decreased O2 delivery to the fetus

A

True

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16
Q

which alpha 2 agonist may cause less of an increase in uterine tone compared to xylazine

A

detomidine

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17
Q

which sedative is commonly used with ketamine in large animals

A

benzodiazepines

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18
Q

how should opioids be given

A

administer to mom after pups out

can reverse pups as pull out

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19
Q

how long does fetal elimination of opioids take

A

2-6 days

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20
Q

which induction agent is preferred in small animals

A

propofol

rapid metabolism in neonates, may be used as CRI instead of ISO/SEVO

21
Q

which other induction agents can be used

A

Alfaxalone - safe and effective for C-sections in dogs

Etomidate - induction/recovery may not be as smooth

22
Q

T/F the use of ketamine in small animals is controversial but can be used safely in large animals

A

True

  • small animals - increased mortality in K9 neonates*
  • large animals - limited options for induction in US*
23
Q

MAC in increased/decreased in pregnant patients

A

decreased

24
Q

what are the side effects of inhailed anesthestics in pregnant animals

A

same

hypotension, hypoventilation

25
Q

progesterone increases/decreases does requirements of local anesthetics

A

decreases

26
Q

which local anesthetics are more likely to accumulate

A

Amides

lidocaine, bupivacaine

27
Q

T/F it is safe to use NSAIDs during pregnancy

A

False - not recommened for use during pregnancy

28
Q

which NSAID did not increase risk of abortion in mares with colic

A

Flunixin

29
Q

how can fetal O2 delivery be maintain during anesthesia

A

maintain maternal BP and oxygenation

avoid - uterine contractiona and vascostriction: decrease fetal perfusion

30
Q

underlying problems that need to be corrected in cases of emergency C-section

A

hypovolemia

hypoGLU

hypoCa

31
Q

how long after membrane ruptured should foals be delivered

A

<30 min

almost none survive after > 90 min

32
Q

horse dystocia is a ________

A

true emergency!

33
Q

T/F anesthesia is required for both controlled vaginal delivery (CVD) and C-section

A

True

CVD usually attempted first

34
Q

minimum database in non-emergent c-sections (generally dogs)

A

PCV/TP

Glucose

iCA

lytes

35
Q

technique for small animal non-emergent c-section

A

pre-oxygenate for 5 min

+/- short acting opioid

propofol or alfaxalone induction

rapid control of airway

ISO/SEVO/DES in O2 maintenance

36
Q

which local blocks may be considered in combination with GA in small animal c-section

A

lumbosacral epidural

line block

  • lidocaine or bupivacaine - consider duration of action*
  • for epidural - add morphine for prolonged analgesia*
37
Q

what are some complications with epidurals

A

increased volume of epidural blood vessels and increased epidural fat

DECREASES epidural space and INCREASES cranial spread of drug

38
Q

epidural drugs volume should be decreased by _____ in pregnant patients d/t increased cranial spread (hypotension)

A

epidural drugs volume should be decreased by ≈ 1/3 in pregnant patients d/t increased cranial spread (hypotension)

39
Q

animals should be positioned carefully to avoid ____

A

aortocaval compression

40
Q

small animal neonatal care

A

clear oropharynx (DONT SWING)

clamp and cut umbilicus

towel dry

reverse opioids (1-2 drops naloxone sublingually)

heat support

+/- O2 support

41
Q

small animal analgesia

A

epidural with morphine (up tp 24 hours)

Mu opioid agonist once neonates delivered

acetaminophen for dogs (NO CATS!)

42
Q

what should be monitored closely in large animals GA

A

PaCO2 and PaO2

hypoxemia and hypercapnia likely

43
Q

which types of mechanical ventilation may be required in LA GA

A

PIP

PEEP

44
Q

why might recovery be more difficult in LA GA

A

extra weight

exhaustion from labor

ligament laxity

45
Q

locoregional anesthesia in small ruminants

A

line block

lumbosacral epidural

same considerations as small animals

46
Q

locoregional anesthesia in large ruminants

A

paravertebral block (proximal or distal)

inverted “L” block

47
Q

analgesia in horses

A

butorphanol - can reverse in foal if necessary

NSAIDs - not recommended during pregnancy and lactation

caudal epidural

48
Q

analgesia in ruminants

A

opioids once neonate delivered

L-S epidural with morphine (small)

caudal epidural (cows)

NSAIDs - Rimadyl approved for 1 dose in lactating cows

RUSVM Anesthesiology (39 decks)

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