Pregnant and Hypotensive

Question 1

A Pregnant lady 34 weeks undergoing open cholecystectomy for a gangrenous gall bladder under epidural anesthesia. Intra-op she developed tachycardia
and BP drop.
Q1. Define preload?

Answer 1

1. Pre-load; Is the end diastolic volume determined by volume of blood return to right atrium via great veins.

Question 2

Q2. Factors governing the preload?

Answer 2

2. HR, vent. Wall compliance, VR ,PVR, cardiac contractility
   .

Question 3

Q3.Why BP dropped in this patient?

Answer 3

3. Epidural anaesthesia that’s causing hypotension, compression of IVC by gravid utureus lowering the VR, pt sepsis that can cause VD.

Question 4

Q4.Do you think this surgcry is ncccssary? Givc factors for and against?

Answer 4

4. Yes, as pt is in sepsis …
   - 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 5

Q6.How the venous return differs in standing Vs supine position?

Answer 5

6. In standing –> VR will decrease as it’s affected by gravity.

Question 5

Q5. What would you do to improve patient’s condition?

Answer 5

5. I will put the pt in lt lat position and push the utureus away from IVC, IV fluids and vasopressors, raise pt legs.

Question 6

Q7.How to prevent DVT?

Answer 6

7. LMWH (anticoagulants), comprssion TEDs Stockings, intermittent pneumatic compression device

Question 7

Q8. What drugs used for epidural anaesthesia?

Answer 7

8. Bupivicain, fantanyl, lidocaine, thiopental.

Question 8

Q9. How does epidural anaesthesia cause hypotension & bradycardia?

Answer 8

9. Hypotension deu to decr. PVR due autonomic disregulation of blocking sympathetic and unopposed parasympathetic action . Low HR – > sympathetic fibers to heart T1-T5 causing VD – > hypotension. Unopposed parasympathetic VAGUS action on heart. (Neurogenic shock)

Question 9

Q10. What’s the management of neurogenic shock in patient with epidural anaesthesia?

Answer 9

11. IV fluids, phenylephidrine, adrenaline and atropine

Question 10

Q11. What’s the effect of epidural anaesthesia in respiration?

Answer 10

12. paralysis of ICM–> limit chest expansion – > shallow breathing – > resp. Failure

Question 11

Q12. Speak about Wells criteria.

Answer 11

13. Wells criteria read it well

Question 12

Q13. Why to test temperature to test sensation?

Answer 12

14. Due to arrangement of the fibres so temp fibres blocked before pain fibres.
    Pain may cause infection and bleeding.
    Tested by ethyl chloride

Question 13

Q. Which fibers will be affected ?

Answer 13

D fibers