Surgery in Pregnancy (General Anesthesia C-section and Non-Obstetrics) Flashcards
What are indications for a c-section under general anesthesia?
Maternal hemorrhage
Fetal distress
Coagulopathy
Patient refusal of regional anesthesia
Contraindications to regional anesthesia
What are benefits of general anesthesia for c-section?
Speed of onset
Secured airway
Greater hemodynamic stability
What are benefits of general anesthesia for c-section?
Speed of onset
Secured airway
Greater hemodynamic stability
What are drawbacks of general anesthesia for c-section?
Risk of difficult mask ventilation
Risk of difficult laryngoscopy
Risk of difficult intubation
Risk of aspiration
Potential MH
Absence of maternal awareness
Neonatal respiratory and CNS depression
What is the most common cause of maternal death during general anesthesia?
Failure to successfully manage the airway
What is a triple agent approach to aspiration prophylaxis?
Sodium citrate- neutralize gastric acid
H2 receptor antagonist (ranitidine) to reduce gastric acid secretion
Gastrokinetic agent (metoclopramide) to hasten gastric emptying
What special considerations should be taken for general anesthesia for cesarean delivery?
Plan for difficult intubation
LUD
Allow surgical team to prep and drape before induction
Preoxygenate for 3-5 minutes or give four vital capacity breaths
HELP position (head elevated laryngoscopy position)
Use of a Datta handle laryngoscope
RSI with 6.0- 7.0 ETT
Extubate fully awake
What induction medications and dosages are appropriate for general anesthesia for a cesarean section?
Propofol 2-2.5 mg/kg
Etomidate 0.3 mg/kg
Ketamine 1 mg/kg
Why is a defasciculating dose not necessary for pregnant patients?
Pregnancy reduces the risk of myalgia
How should general anesthesia be maintained for a c-section?
Low volatile agent (0.8 MAC) + 50% N2O
Why should volatile agents be kept on a lower concentration if possible?
Reduction of uterine contractility
What risks does non-obstetric surgery pose to the fetus?
Growth restriction
Low birth weight
Demise
Preterm labor
When is the “best” time for a surgical procedure in a pregnant patient?
The second trimester
When is the risk of teratogenicity highest during pregnancy?
During organogenesis (day 13-60)
When are parturients considered a full stomach?
18-20 weeks gestation
