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RUSVM Anesthesiology > Pregnancy And Cesarean Section > Flashcards

Pregnancy And Cesarean Section Flashcards

1
Q

How does pregnancy affect cardiovascular function?

A

Cardiac output increases 30-50%
-increase HR and SV

Plasma volume increase >RBC increased

BP remains the same

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2
Q

How is respiration affected during pregnancy?

A

Increased O2 consumption

Decreased PaCO2 (hyperventilation)

  • > caused by progesterone
  • > respiratory acidosis is compensated metabolically

Decreased functional residual capacity

Decreased pulmonary resistance

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3
Q

Why is there a decreased functional residual capacity in pregnant animals?

A

Increased abdominal volume

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4
Q

Why is there decreased pulmonary resistance in pregnant animals?

A

Progesterone causes relaxation of bronchial smooth mm

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5
Q

How does pregnancy affect GI function?

A

Delayed gastric emptiness
Increased gastric acidity

Decreased lower esophageal sphincter tone —> increased risk of regurgitation/aspiration

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6
Q

Why is gastric emptying delayed in pregnant animals?

A

Pressure from uterus

Progesterone—>Decrease gastric motility

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7
Q

How does renal function change with pregnancy?

A

Glomerular filtrate rate increases (parallel with CO)

Decreased BUM and creat

No change in electrolytes

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8
Q

Does pregnancy increase or decreased MAC in the dam?

A

Decreased

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9
Q

How does pregnancy affect sensitivity to local anesthetics?

A

Increased sensitivity

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10
Q

T/F: fetal drug metabolism is fast

A

False

Slow —> immature hepatic microsomal enzyme system

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11
Q

How can we maximize O2 delivery to the fetus?

A

Maintain dam CO and oxygenation

Avoid uterine contraction or uterine vasoconstriction

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12
Q

What sedatives are NOT recommended in pregnant small animals??

A

Acepromazine —> long acting, not reversible, fetal depression

Benzodiazepines —> fetal depression

A2 agonstis—> decrease CO

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13
Q

T/F: like in small animals, A2 agonists and Benzodiazepines are not used in pregnant large animals

A

False

A2 are routinely used in pregnant mares

  • > increased uterine pressure and decreased O2 to fetus
  • > detomidine may cause less uterine tone compared to Xylazine

Benzodiazepines are commonly used with ketamine

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14
Q

Can opioids cross the placenta? Do we give to pregnant dams?

A

Yes they cross the placenta

May take 2-6days for fetal elimination

—Reversible, can give naloxone
—administer to mom after neonates are delivered

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15
Q

What induction agents are acceptable in pregnant small animals, what one is not recommended?

A

Propofol, alfaxalone, and etomidate are all acceptable

Propofol is rapidly metabolized in neonate
Etomidate may have less smooth induction and recovery

Ketamine is not recommended —> increase mortality in neonates

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16
Q

T/F: ketamine is used for induction of pregnant mares

A

True

—can be used safely in large animals, unlike small animals

17
Q

What are the side effects of inhalation agent??

A

Unchanged during pregnancy

  • hypotension
  • hypoventilation
18
Q

How would you change your dose of local anesthetics in pregnant animals

A

Do not give max dose, scale back 25%

19
Q

Are esters or amides more likely to accumulate?

A

Amides —> metabolized by hepatic microsomal enzymes

20
Q

T/F: NSAIDS are not recommended for use during pregnancy

A

True

21
Q

What would you include in your premeds to reduce uterine contraction??

A

Anticholinergic —> glycopyrrolate» atropine

Can be used intra-op for bradycardia

22
Q

In an emergency C-section, the patient is likely comprised. What underlying problems should you correct FIRST prior to anesthesia?

A

Hypovolemia
Hypoglycemia
Hypocalcemia

23
Q

T/F: Horse dystocia is a emergency

A

True

Foals normally delivered <30mins from membrane rupture

Almost none survive at > 90mins

24
Q

What are the two approaches in a horse dystocia that anesthesia is required for?

A

Controlled vaginal delivery (attempted first)

C-section

25
Q

T/F: in a non-emergent C-section, dogs are fasted

A

True

26
Q

What is the technique used for small animal C-section?

A

Pre-oxygenate 5mins
+/- short acting opioid
Propofol or alfaxalone induction

Rapid control of airway

ISO/Sevoflurane in O2 maintence

Local anesthesia (?)

  • > lumbosacral epidural (add morphine for prolonged action) and line block
  • > lidocaine or bupivacaine
27
Q

What are potential complications to epidurals?

A

Pregnant
—> increased vol of epidural blood vessels
—> increased epidural fat

=> decreased epidural space and increased cranial spread of drug which can lead to hypotension

28
Q

How should you change your epidural drug volume in pregnant patients

A

Decrease by 1/3

29
Q

How should you position your small animal during C-section surgery?

A

In dorsal recumbency, tilted off of midline to avoid aortocaval compression

30
Q

What do you do for neonatal care after C-section?

A 
Clear oropharynx 
Clamp and cut umbilical 
Towel dry
Reverse opioid (1-2drops naloxone sublingually) 
Heat 
\+/ - O2
31
Q

How can your provide analgesia during C-section and during recovery?

A

Epidural with morphine (up to 24hrs) -> reverse in neonates once delivered

Tramadol or buprenorphine(cat) to go home

Acetaminophen for dog (careful dosing)
-> ABSOLUTELY NOT FOR CAT

32
Q

What is given for large animal general anesthesia during C-section?

A

Xylazine/detomidine for sedation

Ketamine + diazepam/midazolam for induction

Rapid control of airway, supply 100% O2 via demand valve ASAP

ISO/sevoflurane for maintence

Mechanically ventilate (hypoxemia and hypercapnia likely)

33
Q

Why is recovery difficult in lg animals?

A

Extra weight
Exhausted from labor
Ligament laxity

34
Q

What locoregional analgesia techniques can be used in small ruminants?

A

Small ruminants: Line block for lubosacral epidural (morphine)

Lg ruminants: paravertebral block or inverted L block

35
Q

What drugs are used for analgesia in pregnant horse?

A

Butorphanol (can reverse in foal) given as caudal epidural

NSAIDS are not recommended during pregnancy or lactation

RUSVM Anesthesiology (32 decks)

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