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56 Cards in this Set

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Define the HELLP syndrome
1. Hemolysis-due to RBC’s being forced thru the fibrin network @ high pressures (DIC not far off)
Bilirubin> 1.2mg/dl
LDH> 600u/l
2. Elevated Liver Enzymes-pre portal lesions/hemorrhage/capsular hemmorrhage SGOT>70u/l
3.Low Plts < 100k
What is the tx when the HELLP criteria is met?
Delivery of the baby-however may still develop postpartum
What are the manifestations of DIC?
Prolonged PT, & aPTT,
DEC Fibrinogen,
INC fibrin degradation products
What is the tx for the CNS involvement of seizures, in Pregnancy?
MgSO4-will cause generalized CNS depression
Load 4-6gm iv over 20 minutes
Infusion: 1-2gm/hr
Breakthru-2-4gm iv
What are the S/E of MgSO4?
Potentiate/prolong MR
Regional- HOTN
Fetal involvement-hypotonia/HR variability /Resp depression
Uterine Atony
What is an ideal anesthetic for PIH pts about to deliver?
Epidural-BP,  placental BF, No respiratory depression
How is BP tx’d with PIH?
Labetalol 1 mg/kg-has both beta and alpha blockade
Hydralzine-5-10mg but has slower onset
Nifedipine-will cause uterine muscle relaxation- has a synergistic effect with MgSo4 = HOTN
NTG-0.25-0.5mcg/kg/min
SNP-safe but may cause VQ mismatching
Why do you not use Esmolol in pregnancy?
Because it will cross the placenta and DEC FHR
The tx for fluid overload, in pregnancy, which is the primary reason for pulm edema consists of?
O2/Diuretics/MSO4
How is Pulm Edema from LV dysfunction tx’d?
Afterload reduction-Hydralzine, Nifedipine, SNP
Why does Creatinine INC in PIH?
Because of the DEC IV volume and subsequent DEC GFR
How is the Renal preservation tx’d?
Judicious fluid challenges
Dopamine
NTG
SNP
The INC uterine arterial resistance and viscosity will result in what uterine problems?
Fibrin deposits-infarcts
Abruptio
DIC
IUGR-lack of flow
Premature delivery
What does the RUQ Epigastric pain evolve from?
Liver involvement-hemorrhage or edema
Requires CT/US and possible immediate delivery
What are the potential complications of placing/removing an epidural in a Preeclamptic pt?
The thrombocytopenia-hematoma/cord compression
HOTN- DEC. UBF/Fetal distress
LA -risk of seizures (already @ risk of seizures), FHR variability DEC, distress/hypoxia
How does a standard General Anesthetic induction proceed FOR DELIVERY?
STP-4mg/kg Sch-1 mg/kg
O2/N2O 50/50 until delivery
After delivery-standard maintenance- INC. N2O use agent-remember MgSO4 will enhance all MR
Major considerations post partum include?
Fluid shifts-pulm edema (diuretics/dopa)
Coagulopathies-platelets reach nadir 1-2 days
Seizures- DEC. risk in 2 days continue MgSO4
HTN-may continue for 6 wks
What two parameters does Cardiotocography monitor?
FHR & Contractions
What is the FHR mostly controlled by?
PNS (Vagus) > SNS the closer to birth
Name the causes of fetal asphyxia?
--Maternal hypoxia
--DEC. UBF
--Cord compression
--Fetal pathology
***Follow the flow
What is the response in the fetus to hypoxia?
1. DEC. Resp movements to decrease consumption
2. Shunt blood to vital organs including adrenals
3.Lactic acid buildup from non-perfused areas = met acidosis
--Continued hypoxia impairs myocardial function = continued vasoconstriction = cell death = fetal death
What indicates good fetal progression on the Cardiotocography?
-- FHR beat-to-beat variability,
-- Normal HR
-- Appropriate timing of decelerations in HR with quick return
What are poor indicators of fetal progression re: Cardiotocography?
-- Tachycardia>150-160 for longer than 10 min or 30BPM INC. from baseline for > 10min
-- Late decelerations may or may not have quick rebound
--Bradycardia- with or w/o quick rebound
What is normal pH of a fetus/newborn?
7.25-high metabolic state
When is one suspicious of stress IN THE FETUS?
<7.25 suspicious <7.2 is significant
What interventions are needed for poor progressing fetuses?
O2 for mom,
Vag exam with scalp stimulation,
∆ positions,
Fluids- evaluate for stat c-s
What is the interval for the recording IN CARDIOTOCOGRAPHY?
Small blocks are 10 secs
Define causes of FETAL Tachycardia?
Hypoxia
Prematurity (nml response) Maternal fever
Chorioamniontitis
Fetal acidosis
Fetal infection
Parasympatholytic-atropine Sympathamomimetic-Terbutaline
DEFINE FETAL Bradycardia-
<110 or  30BPM for > 10 minutes
Causes of FETAL bradycardia?
Asphyxia
Acidemia-cord/Paracervical block/HOTN/Seizures
Post date
Hypothermia
FHR variability is affected by what factors?
Maternal meds-sedatives/opioids/MgSO4
Sleeping
Preterm< 28wks
Fetal anemia
Hypoxia
WHAT CAUSES FHR Accelerations-
Transient INC - due to fetal movement (normal)
SIGNIFICANCE OF Early decelerations-
Benign- mirror contractions-stimulation of head
WAT CAUSES FHR Variable decelerations-
Cord compression- occur at any time in relation to contractions
“V” shaped with shoulders
WHAT CAUSES Late decelerations-
Uteroplacental insufficiency- GET BABY OUT
Occur after contractions
Uteroplacental insufficiency may be caused by?
HOTN/HTN
Pre/Eclamptic
Abruption of placenta
Post maturity
DM
Tx for uteroplacental insufficiency?
LUD
O2
Fluids
DEC Oxytocin if on-causes contractions
What are Sinusoidal wave patterns?
Regular, smooth undulating rhythm with little variability within a normal HR range
Indicates severe fetal anemia (Rh disease)/Hypoxia
Is ominous and has INC rate of M/M
How high does CO peak during pregnancy?
As high as 150% after 28weeks
When in gestation should LUD be implemented on pregnant patients?
12-14 weeks
Define the NY functional classification system?
I-No physical limitations
II-Ordinary activity will precipitate CV problems
III-< ordinary activity precipitates symptoms
IV-CV s/s present at rest
What stage of delivery is a Paracervical block initiated?
Stage I
What stage of delivery is a Pudendal block initiated?
Stage II
What are the 5 evaluations of Cardiac function that should be evaluated in diseased states?
HR Rhythm Preload Afterload Contractility
What arrhythmia is common in Mitral Stenosis?
Afib-due to the Left Atria Hypertrophy
What is a normal Mitral Valve size?
4-6cm- s/s <1cm
What will be noted on the PA waveform indicating MVR?
A large v wave
S/S of MVP?
Anxiety, TIA, Sudden Death, Arrhythmias, Palpitations, SBE
S/S of Aortic Stenosis?
Syncope & Angina-due to decreased coronary-systemic perfusion, DOE, CHF
List the common R to L shunts:
(5 T’s and a P),
TOF,
Tricuspid Atresia, Transposition of the Great Arteries,
Total Anomalous Pulmonary Venous Return,
Truncus Arteriosis,
Pulmonary Atresia
Eisenmenger’s Syndrome,
List the common L to R shunts:
ASD, VSD, PDA
What is Eisenmenger’s Syndrome?
Pulm HTN, (PDA, VSD, ASD shunt sites)
R to L (reversal of end stage)
What things will inc. PVR?
Hypercarbia, Hypoxia, Hypothermia, Acidosis, PIP, ephedrine
What are the anesthetic goals of Eisenmenger’s Syndrome?
Avoiding:
Inc. Pulm HTN (PVR)
Dec. SVR-which already occurs in the disease
Dec in Preload

Desire: Elevated HR-may compromise RV function
Narcs-IT/IV
Anesthetic considerations for VSD and ASD?
Want R to L somewhat
Avoid Pulm HTN that would promote total R to L and
avoid Lto R shunting
What are the 4 components of TOF?
Pulm Stenosis
VSD
RVH
Overriding Aorta