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22 Cards in this Set

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What types of non-ob surgery does pregnant pt's undergo?
trauma, cervical cerclage, appy, biliary, breast, ovarian, cystectomy
List special concerns for surgery in the pregnant patient:
physiological changes, teratogenicity of drugs, urteroplacental blood flow, increased risk for PTL, IUGR, fetal demise
List characteristics of drugs that cross the placenta:
high lipophilicity, low ionization, low maternal protein binding, low molecular weight
How are placental transfer and fetal uptake of a drug measured?
ratio of umbilical vein to maternal venous concentration (UV/MV) = degree of transfer of drug;
ratio of umbilical artery to umbilical vein (UA/UV) = fetal uptake of drug
Is the timing of exposure to a drug important?
Yes, risk is highest during organogensesis (2-8weeks gestation); drugs prior to implantation <1week gestation insignificant; exposure late in pregnancy =functional/behavioral changes
When should non-ob surgery be done on the pregnant patient?
second trimester; cervical cerclage is usually done at 12-16weeks gestation
Name 8 concerns when planning surgery for an OB patient:
1. Decreased MAC
2. Decreased FRC
3. Increased metabolic rate
4. Slowed GI emptying
5. Teratogenicity
6. Maintenance of uteroplacental circulation
7. Increased Risk Preterm Labor
8. Need to monitor FHR
How would you premedicate a pregnant patient for non-ob surgery?
Bicitra, H2 antagonist, metoclopramide, barbiturate, glycopyrrolate
Misc. perioperative concerns:
Keep maternal PaCO2 at 30torr (the PaCO2-EtCO2 gradient is reduced d/t decreased dead space ventilation-perfusion from increased CO); Avoid alpha agonists, high levels of LA, & catecholamines, avoid hypoglycemia
Special considerations appendectomy:
increased incidence pulmonary edema-careful fluid management
Special considerations Neurosurgery:
induced hypotension = decreased UPP; hyperventilation shifts dissociation curve to the left and decreeases O2 released to fetus, high dose mannitol can cause fetal dehydration
Special considerations laparoscopic surgery:
keep intraabdominal pressure <15torr, elevated paCO2 = fetal acidosis; on Varess needle
Special considerations cardiac surgery:
usually for valvular dx, avoid high dose vasopressors = decreased UPP
Special considerations for trauma:
Increased maternal CO may lead to underestimation of hemorrhage; preterm labor, premature rupture of membranes, uterine rupture, placental abruption, spontanous AB
How is cardiac arrest managed in the parturient?
Standard BLS/ACLS guidelines with avoidance of aortocaval compression, emergency c-section at >24-25weeks gestation
Indications for emergent c-section in traumatic event:
stable mother with viable fetus in distress; traumatic uterine rupture; gravid uterus interfering with intraabdominal repair; unsalvageable mother with viable fetus
What are the relative advantages of GA vs. regional in traumatic/non-ob surgery?
GA: inhalation agents are tocolytics
Regional: decreased risk of aspiration, possible increased risk of hypotension
**Priority is to maintain maternal oxygenation & UPP
Is N20 safe in pregnant patients?
N2O shown in animals to vasoconstrict the uterine arteries when not administered with volatile agent (not shown in humans)
Does N2O increase the risk of congenital defects?
In rats shown, not in humans; inactivates Vit. B12, inhibits methionine synthetase & potentially interfers with DNA synthesis; Conservative approach-use 50% N2O during organogenesis, limit use in longer cases
Can benzodiazapines be used in pregnant patients?
Case reports of cleft palates in children, but failed to find in studies
Are there special considerations in patient monitoring of non-ob surgery, pregnant patients?
FHR, uterine activity pre, intra, & post-op; Loss of beat to beat variability is normal after anesthetic medications, but decelerations are NOT expected; atropine can cause decreased beat to beat variability and fetal tachycardia
Which medications are most likely to pass into breast milk?
Highly lipid soluble
Poorly protein bound