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71 Cards in this Set
- Front
- Back
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Most common cause of anesthesia related deaths?
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Unable to secure an airway
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Why does pregnancy cause rapid desaturation?
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Decrease FRC (20%)
Increase O2 demand (60%) |
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What physiologic changes helps improves fetal oxygenation?
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1) Right shift of OxyHem dissociation curve in mother
2) Left shift of OxyHem dissoc curve in peds 3) Increase MV |
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What is the P50:
Pregnancy? Fetal? |
Pregnancy P50 = 30
Fetal P50 = 19 |
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Maternal Cardiac Changes:
CO Plasma Vol SV HR SVR CVP PCWP |
CO = inc 40%
Plasma Vol = 45% SV = 30% HR = 10% SVR = dec CVP = same PCWP = same |
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Maternal Renal changes:
GFR BUN CR |
GFR = inc 50%
BUN = dec 40% CR = dec 40% |
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Hematologic Chages:
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Increase factor VII, VIII, X, XII, & Fibr
dec antithrombin results in hypercoagulable state |
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Shortest half-life factor?
Factor not made by liver? |
VII
VIII |
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MAC in Pregnancy
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reduce by 1/3 by 8th wks
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Placental blood flow supply by?
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Spiral intervillous arteries which are maximally dilated
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When dose Preeclampsia/eclampsia abates?
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within 48hrs after delivery of placenta
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Preeclampsia CNS Changes:
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cerebral edema
cerebral hemorrhage seizure |
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Preeclampsia Cardiovascular Changes:
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Hypovolemia
Hemoconcentration Hypoproteinemia Inc SVR Pulm Edema LVH |
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HELLP?
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Hemolysis
Elevated liver enzymes Low platelets |
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Anesthetic goals for preeclamptics?
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treat HTN
Vol replacement control CNS irritability |
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IVF guided by?
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UOP > 1cc/kg/hr
CVP 4-6 cmH2O |
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How to reverse MgSO4 toxicity?
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CaCl2
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Can one use spinal for preeclampsia pt C-S?
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yes, proven to be safe
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What is the major cause of perinatal moridity and mortality?
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DKA
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How does hyperinsulinemia affect lung maturity?
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delay production of surfactant
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Does BP Change during pregnancy and why?
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No!
because increase CO is counterbalanced by a decrease in SVR |
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What increases cardiovascular changes increase during pregnancy?
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Increase in:
Blood vol - 35% Plasma vol - 45% RBC vol - 20% CO - 40% HR - 15% |
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What cardiovascular changes decrease during pregnancy?
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SVR - 15%
SBP/DBP - Mild decrease or none |
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Anesthetic goals in pregnancy with mitral stenosis?
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Avoid Tachycardia
Avoid Afib Avoid increasing blood vol |
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Anesthetic goals in pregnancy with mitral regurg?
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Avoid inc in SVR
Avoid dec in contractility Avoid bradycardia Maintain sinus rhythm Consider afterload reduction |
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Anesthetic goals in pregnancy with aortic stenosis?
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Avoid inc in SVR
Avoid bradycardia Avoid dec in contractility Maintain MAP |
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What is the most common valvular defect in pregnant pt? 2nd?
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most is mitral stenosis
2nd is mitral insufficiency |
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Congenital Heart disease Left-to-Right shunts?
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VSD
ASD PDA |
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Congenital Heart disease Right-to-Left shunts?
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TOF
Eisenmenger's syndrome |
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Anesthetic goals in L-to-R shunt?
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Avoid inc SVR
Avoid excessive fluid Avoid T-Berg |
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Anesthetic goals in R-to-L shunt?
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Avoid dec SVR
Maintain adequate blood vol Avoid dec contractility because can compromise blood flow to lungs |
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Name tocolytic agents?
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Ritodrine/terbutaline (B2-agonist)
magnesium Indomethacin (prostagladin inhibitor) Nefedipine |
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What is the only approved tocolytics by the FDA?
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Ritodrine
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How does Ritodrine work?
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increase cAMP --> inc intracellular calcium -- inhibibits myosin light-chain kinase
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Side effects of magnesium
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Vasodilation / hypotension
Anxiolytic / sedation Weakness tocolytics |
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How does magnesium cause muscle weakness?
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1) by inhibiting calcium reuptake and binding
2) by inhibiting the release of Ach |
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What is the reversal of magnesium?
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Calcium
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How does Indomethacin affect uterine relaxation?
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inhibiting the cyclooxygenase thereby inhibiting production of prostagladin important in uterine contraction
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Name the Oxytocics?
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Oxytocin
Methergin (Egot Alkaloid) Hemabate (PGF-2apha) |
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Side effects of oxytocin?
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1) Hypotension
2) ECG changes: t-wave flattening/inversion, prolong QT |
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Side effects that is common to Hemabate/methergine
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N/V
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Define 1st stage of labor?
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onset of regular contractions to complete dilation of cervix
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Define 2nd stage of labor?
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complete dilation to delivery
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What kind of pain is associated with 1st stage of labor?
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Visceral caused by dilation of cervix and lower segment of the uterus and as uterine contractions
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What kind of pain is associated with 2nd stage of labor?
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Somatic as stretching and tearing of pelvic ligaments occurs.
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What is the L/S ratio that is indicative of potential respiratory distress in neonates?
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< 2.0
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What is normal fetal blood pH?
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7.25 - 7.45
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What is early decelerations indicative of?
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Uterine contractions
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What is late decelerations indicative of?
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decrease uteroplacental blood flow
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What is variable decelerations indicative of?
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insufficient umbilical blood flow from cord compression
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What %age of parturients undergo c/s?
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20%
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If general for c/s what gas concentrations is recommended?
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50% O2, 50% N2O, low VA < 0.5 MAC
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If after delivery if HR < 100 what is the first step?
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positive pressure ventilation initiated
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If HR < 80 with positive pressure ventilations what is the next step?
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Chest compression at 100 comp/min. Continue until HR>100
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If HR < 60 with chest compression what is the next step?
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cont assist ventilation and chest compression
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IF HR remains < 60 with assist vent & chest compression then what is the next step?
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1) intubation
2) given intrathecal dose of epi 3) umbilical venous catheter placement |
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If HR > 100 but cynotic what should be done?
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give supplemental O2 with FiO2 of
80 -100% |
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How far should an ETT be inserted at the lip?
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Weight + 6
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If blood needs to be given to neonate urgently what type?
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type O (-) crossmatched iwth mother
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Cause of Severe antepartum hemorrhage?
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placenta previa
placenta abruption uterine rupture |
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What is the leading cause of 3rd trimester bleeding?
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placenta previa
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Risk of placenta previa?
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multiparity
repeat c/s |
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What is placenta previa?
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when the placenta covers partially or completely the cervical os opening?
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What is placental abruption?
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separation of normally implanted placenta after 20 wks gestation and before birth
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Risk factors for placental abruption?
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1) multiparity
2) HTN 3) IV drug abuse 4) previous abruption 5) abnormal uterine |
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What can result from intrauterine fetal death?
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DIC within 8 hrs
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Risk factors for uterine rupture?
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1) prior uterine rupture
2) obnormal fetal presentation 3) use of uterotonic agents 4) previous c/s |
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Atypical abd pain
shoulder pain vaginal bleeding uterine tenderness hypovolemia & shock? |
Uterine Rupture
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Postpartum Hemorrhage?
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Uterine atony
genital tract disruption, i.e. vag teer Retained Placenta |
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Risk factor for uterine atony?
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1)multiparity
2) polyhydramios 3) Uterine manipulation 4) retained placenta |
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If postpartum hemorrhage conservation approach fails then what?
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Surgical approach:
1)Bilater hypogastric artery ligation 2) Bilateral ovarian artery ligation 3) Hysterectomy |
