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Anaesthesia year 4 > Therapeutics and anaesthesia of the dam and neonates > Flashcards

Therapeutics and anaesthesia of the dam and neonates Flashcards

1
Q

what happens to the diaphragm during pregnancy

A

increased size of uterus
Cranial displacement of the stomach or altered position
Diaphragm pushed cranially

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2
Q

List 3 things that happen to GI system during pregnancy

A

Increased gastrin production –> increased HCl secretion –>decreased stomach pH
Decreased gastric motility
Reduced oesophageal sphincter tone

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3
Q

what is a dog at increased risk of towards the end of gestation

A

regurgitation
aspirational pneumonia

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4
Q

why is oxygen demand increased in pregnant aniamls

A

Pregnant animals have an increased basal metabolic rate and an increased cardiac workload to meet the demands of the growing fetuses.

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5
Q

what happend to lung capacity during pregnancy

A

it decreases

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6
Q

define atelectasis

A

early closure of the small airways

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7
Q

why does atelectasis occur in pregnant patients

A

there is an increased pleural pressure due to the cranial displacement of the diaphragm

there is also a reduced functional residual capacity

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8
Q

why does a V/Q mismatch occur in pregnant patients

A

due to the early collapse of some alveoli, blood will have to be shunted elsewhere

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9
Q

what can be compressed if you place a pregnant animal in dorsal recumbency

A

the inferior vena cava

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10
Q

why does cardiac output increase in pregnant animals

A

to meet the demands of the fetus

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11
Q

what does uterine blood flow depend on

A

maternal cardiac output and uterine perfusion pressure

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12
Q

why does a respiratory alkalosis occur in pregnant patients

A

due to the increased ventilation

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13
Q

do pregnant patients get metabolic alkalosis with their respiratory alkalosis

A

no, renal compensation keeps their blood pH normal

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14
Q

what molecule causes a right shift in haemoglobin affinity in pregnant animals

A

maternal 2,3-DPG

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15
Q

Describe the effects of increased maternal 2,3-DPG

A

reduced affinity of haemoglobin for oxygen, right shift
facilitates movement of oxygen across the placenta

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16
Q

why do we need to consider that pregnant animals have increased progesterone and neuroinhibitors

A

it reduces the amount of drugs we need to use due to the sedative and antinociceptive effects

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17
Q

Define pharmacokinetics

A

movement of drugs through the body
absorption, distribution, metablism and excretion
what the body does to the drug

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18
Q

Define Pharmacodynamics

A

the body’s biological response to drugs
what the drug does to the body

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19
Q

Describe the ASA grades

A
  1. Normal healthy patient
  2. Mild systemic disease
  3. Severe systemic disease
  4. Severe systemic disease that is a constant threat to life
  5. morbbibund patient
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20
Q

what premed should we give before a c section

A

opiods at low doses e.g. methadone

21
Q

why do we use pre-meds off licence in pregnant animals

A

There are currently no drugs licensed for the premedication of pregnant animals, so drug we use are off license and used following the cascade

22
Q

why do we use low dose of pre-med in c-sections

A

Drugs that cross the blood-brain barrier (and therefore sedative and anaesthetic drugs) will also cross the placental barrier. Therefore, these drugs will affect the neonate as well as the dam.

23
Q

why do we avoid alpha-2’s in pregnant patients

A

due to their vasoconstriction and reduced CO effects

24
Q

why is acepromazine avoided in pregnant patients

A

it is long-acting and irreversible

25
Q

why is midazolam/ketamine combination avoided in pregnant patients

A

neurological depression has been seen in puppies following this combo

26
Q

why are benzodiazepines avoided in pregnant patients

A

they cross the placenta and are associated with a reduction in neonates

27
Q

Describe how we can prevent hypoxia in pregnant patients

A

pre-oxygenate for at least 5 mins before induction
supplement O2 during surgery

28
Q

Why are pregnant patients at increased risk of regurgitation and aspiration

A

The cranial stomach position
increase intrabdominal pressure
reduced oesophgeal sphinchter tone
reduced stomach pH

29
Q

Describe how we can reduce the risk of regurgitation and aspiration in pregnant patients

A

give omeprazole or maropitant prior to intubation
prompt induction
raise the head and intubate swiftly
cuff the tube

30
Q

Describe when to extubate pregnant animals

A

only once laryngeal reflexes have returned

31
Q

which induction agent should not be used in pregnant animals

A

Ketamine
because associated with decreased likelihood of puppies breathing

32
Q

why do we tilt the table slightly when performing c sections

A

avoids exacerbating reduced FRC
reduces aortovenous compression
reduces regurgitation risk

33
Q

why are MAC levels lower in pregnant patients

A

potentially due to the increased progesterone levels

34
Q

why do we want to use a balance of different anaesthetics in c sections

A

in order to reduce the level of inhalation agent required

35
Q

if we have hypotension in a pregnant patient, what do we need to do

A

IVFT to increase BP asap

36
Q

what do inhalation agents cause in pregnant aniamls

A

Inhalation anaesthetics cause significant cardiovascular depression in both dam and the neonates

37
Q

what is placental blood flow dependent on

A

maternal blood pressure

38
Q

Why do we need to be careful of hypocapnia in pregnant patients

A

this can cause placental vasoconstriction

39
Q

what does the alveolar recruitment manoeuvre do

A

inflate the lungs in order to open up the alveoli

40
Q

why do we give NSAIDs post c section

A

they provide adequate analgesia and are not excreted in milk

41
Q

List 4 ways that we can assist neonatal ventilation

A

mouth-to-mouth
intubation
IPPV
flow by oxygen

42
Q

List 3 things we should do after puppies are born via c-section

A

prepare a warm box/cage or incubator
Clear away any membranes and fluid from the mouth and nose
Rub vigorously (avoid swinging)

43
Q

if we gave opiods to the dam and we have lethargic puppies, what can we consider

A

naloxone to reverse the opiods

44
Q

why do we no longer recommend swinging puppies after they are born

A

it can cause head/neck trauma and haemorrhage

45
Q

why do we want to avoid giving new born puppies doxapram

A

it increases cerebral oxygen demand

46
Q

What is normal neonatal canine heart rate

A

over 220bpm

47
Q

what is a suitable choice of induction agent for a dog undergoing a C-section

A

either propofol or alfaxalone

48
Q

in a pregnant animal, how might the reduction in FRC (functional residual capacity) affect tissue oxygen delivery

A

reduces oxygen delivery by causing ventilation/perfusion mismatch

Anaesthesia year 4 (5 decks)

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