SEE Obstetrics Anesthesia Review Flashcards
In pregnancy Cardiac output increases mostly because of an increase in _______.By how much does CO increase at term_____? SV by how mucH
an increase in stroke volume and, to a lesser extent, an increase in heart rate. SV 20-50%
CO increase by 40% at term
Blood volume during pregnancy (increase/decrease) , why ?By how much is it (increase/decrease)
Blood volume is markedly increased and prepares the parturient for the blood loss associated with delivery.
25-40%
Plasma volume during pregnancy? by what %?
What about blood cell volume? What %?
What does that cause? Total blood volume change?
Plasma volume is increased by 40-50%
Red Blood cell volume is increased by 20%
PV increase to a greater extent than red blood cell volume, resulting in a DILUTIONAL ANEMIA
Total blood volume increase by 25-40%
Minute ventilation during pregnancy and due to mostly
MV increases 45-50% (Nagelhout) and this is due mostly to an increase in tidal volume.
Oxygen consumption during pregnancy at rest? What about during labor?
Oxygen consumption is markedly increased by 33%; 100% during labor
Carbon dioxide production during pregnancy?
carbon dioxide production is similarly increased.
Pregnancy and Local anesthetics and MAC
Pregnant women have an increased sensitivity to local anesthetics and a decreased minimum alveolar concentration (MAC) for all general anesthetics.
What happens to Platelet count during pregnancy
remains stable or decreases slightly;
Coagulation factors and fibrinogen in pregnancy? What is the significance of the changes?
coagulation factors and fibrinogen are increased, resulting in a hypercoagulable state in pregnancy.
Major cause of Hypotension during pregnancy and how to relieve it?
Aortocaval compression results in profound hypotension and can be relieved by left uterine displacement.
All pregnant women are at increased risk of ______
aspiration
Because of the anatomic and physiologic changes to the gastrointestinal system with pregnancy, parturients should be considered to have a full stomach after what week?
weeks 12 of gestation vs 20 weeks
Pregnancy and labor and airway
associated with major airway changes that can result in a difficult intubation. This highlights the importance of a comprehensive airway evaluation prior to general anesthesia.
During pregnancy The heart rate (HR) is _____By ___% to _____% at term
increased by 20% to 30% at term.
Oxygen consumption increases by about how much in the full-term parturient?
33 percent in the full-term parturient, but minute ventilation increases by 50 percent at term. T
During pregnancy, the increased alveolar ventilation results in an
increase in the PaO2 to about 106 mmHg and a decrease in the PaCO2 to about 30-32 mmHg.
Pregnancy and plasma base
The plasma base (HCO3-) decreases from about 26 to 22 mEq/L, thus, the pH is essentially unchanged.
Provide analgesia by sparing motor blockade:
Ropivacaine
Bupivacaine
Endocrine hormones elevated with pregnancy
Total T3 and T4 (Not free )
Volume of the spinal CSF in pregnancy
Because the volume of epidural fat increases and epidural veins enlarge, the volume of spinal CSF is decreased in pregnancy.
Which anesthetic technique is most likely to reduce uterine blood flow in an obstetric patient?
Paracervical block
By the end of the first trimester, the cardiac output is How much greater than the non pregnant values?.
15-25 percent higher than nonpregnant values.
CO : 24 hours after delivery? When does it return to normal?
Cardiac output is still elevated for 24 hours after delivery and returns to normal slowly over a period of about 10 days
Despite the increased blood volume levels, plasma renin levels are
increased.