pregnant patient

Question 1

gestation blood volume

Answer 1

increases by upto 40%
PCV as low as 30-35

Question 2

cardiac output

Answer 2

increase by upto 30-50%
25% of co is diverted to the uterus and placenta

Question 3

metabolic rate and O2 consumption

Answer 3

O2 demands increased by 25%

Question 4

anaesthetic concerns

Answer 4

hypoventilation, hypoxia
hypotension, haemorrhage
regurgitation aspiration

Question 5

pre anaesthetic exam

Answer 5

bloodwork - PCV, TP, Electrolyte
radiograph and ultrasound- number of neonates

Question 6

pre med

Answer 6

no pre med - best practice
benzodiazepines if anxious
alpha 2 agonist cause bradycardia
antiemetics pre op

Question 7

induction

Answer 7

drug with short duration of acting
propofol

Question 8

maintenance

Answer 8

inhalation agent
reduce potential for prolonged recovery

Question 9

multi modal analgesia

Answer 9

reduce inhalation agent required
local - epidural
splash, line block

Question 10

goals

Answer 10

no deaths
offspring and mother in good health

Question 11

anaesthetic managemnt

Answer 11

minimal restraint
pre clip - reduce anaesthetic time
pre O2 for 5min
monitor BP - ivft 5ml/kg/hr

Question 12

neonate managemnt

Answer 12

once delivered, remove membranes
suction fluid from nose and mouth
swinging is not effective and can cause damage
stimulate the umbilicus and genital reigon

Question 13

recovering neonates

Answer 13

oxygen cage/incubator
dried quickly, cant regulate body temp
warming device

Question 14

recovery

Answer 14

administer opioid once last neonate has beed delivered
continue ivft
monitoring
introduce pups