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78 Cards in this Set
- Front
- Back
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what are the major goals of non-obstetric sx during pregnancy
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*maternal safety
*fetal safety *avoidance of preterm labor |
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what is a leading cause of death with sx and pregnancy
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FAILED INTUBATION
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decreased lower esophageal sphinctor tone occurs when in pregnancy
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EARLY
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anatomical distortion of stomach and pyloris develop when in pregancy
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LATER
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beyond when in pregnancy you should consider any pregnant pt a full stomach and at risk for aspiration
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FIRST TRIMESTER
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with non-ob sx in pregnant pts adequate fetal oxygenation is dependent on what factors
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*maternal oxygenation/ventilation
*uteroplacental perfusion |
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what are the fetal concerns with non-ob sx during pregnancy
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*teratogenicity of anesthetic drugs or intra-op events
*adequate fetal oxygenation *avoidance of preterm labor |
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are anesthestic agents or any drugs used routinely used during anesthesia proven human teratogens
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NO
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when during development is the fetus at highest risk of injury from tetratogens
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2-8 wks
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what system in the body is at risk for a greater length of time to tertragons during development
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CNS
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is maternal hypothermia or hyperthermia associated with CNS anomalies
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HYPERthermia
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radiation > than what is a tertragen
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5-10 rads
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chronic hypoxemia associated with high altuditude is associtated with what with preganancy
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lower birth wt
(but is NOT tetratogenic) |
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are bzd tetratogenic
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NO
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prolonged exposure to NO in humans produces what
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neurologic and hematologic symptoms
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what are threats to fetal oxygenation with non-ob sx with pregnancy
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*severe maternal hypoxemia
*maternal hypotension which compromises uteroplacental blood flow *uterine vasoconstriction |
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with non-ob sx in pregnancy what are things that could lead to maternal hypotension which compromises uteroplacental blood flow
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*excessive general anesthetic level
*sympathectomy folllowing regional *aortocaval compression *hemorrhage *hypovolemia |
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with non-ob sx with pregnancy what are things that can cause uterine vasoconstriction
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*increased circulating catecholamines
*alpha-adrenergic agonism *toxic doses of LA |
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with non-ob sx with pregnancy what carries the lowest risk for preterm labor
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SECOND trimester procedures not involving uterine manipulation
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when should elective non-ob sx be perfomed on the pregnant pt
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should be DELAYED into the post-partum period
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what trimester avoids the critical period of organogenesis and minimizes the risk of preterm labor
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SECOND
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regarding non-ob sx in the pregnant pt in urgent or emergent situations what is the primary consideration
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preservation of the mothers life
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regarding fetal monitoring for non-ob sx for pregnant pts transabd doppler montoring of fetal HR is possible when
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~ 18 wks gestation
(may be difficult until ~ 22 wks gestation) |
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with fetal monitoring for non-ob sx in pregnancy fetal heart rate variability is present when
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~ 25-27 wks gestation
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with fetal monitoring for non-ob sx in pregancy at the very least fetal heart rate should be checked when
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*pre-op
*on arrival to the PACU |
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how is dose of local anesthestic affected with non-ob sx in pregnancy
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it is DECREASED
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with non-ob sx in pregnancy fetal HR should be measured after when in gestation
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18-20 wks
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how is MAC affected with non-ob sx and pregnancy
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it is DECREASED
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after the 1st trimester with non-ob sx and pregnancy what kind of airway is needed with general anesthesia
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ET tube
(RSI is preferred) |
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what are the SAFE drugs with non-ob sx and pregnancy
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*thiopental
*opioids *NDMB *succ |
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what are the QUESTIONABLE drugs with non-ob sx and pregnancy
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*propofol
*N2O *bzd |
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why may emergency be more rapid with non-ob sx and the pregnant pt
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*decreased MAC
*decreased FRC *increased alveolar vent |
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what is the most commonly performed operation in the uS
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c-section
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what is the #1 indication for a c-section
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a prior c-section
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what type of uterine incision will a vbac not be done on
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CLASSIC
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prostaglandin gel does what with a vbac
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substantially increases the risk for uterine rupture
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the use of oxytoxin and vbac requires what
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close pt monitoring
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with a VBAC what would be the sign of uterine scar rupture
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fetal heart rate abnormalities
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is there apparent contrainication for use of epidural in a VBAC
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NO--but may want to use dilute local anesthetic concentrations
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majority of maternal deaths related to anesthesia resulted from what
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*failed intubation
*inadequate ventilation/oxygention *aspiration of gastric contents |
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what factors are associated with a higher incidence of maternal death
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*obesity
*HTN disorders of pregnancy *emergency procedures |
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what are maternal complications with a c-section
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*aspiration
*inability to secure the airway *high spinal block *LA toxicity *hypotension |
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with a c-section if the pt develops a high spinal block what should be done
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*support the airway (intubate if needed)
*100% o2 *support circulation *subdural block |
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with general anesthesia and delivery with a c-section what % do you want to keep the N20 under and why
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*50%
*to prevent diffusional hypoxemia in the fetus |
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where are the majority of ectopic pregnancies
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TUBAL
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most of the deaths from ectopic pregnancy are from what
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HEMORRHAGE
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what are the risk factors for ectopic pregancy
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*prior tubal pregnancy
*inflammation (prior PID) *congential anatomic distortion *prev pelvic/abd sx *concurrent IUD use *delayed ovulation *assisted reproductive tech |
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with ectopic pregnancy what are the signs of rupture or impending rupture
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*abd or pelvic pain (90-100%)
*delayed menses (75-95%) *vag bleeding (50-80%) |
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with ectopic pregnancies what type of pregnancies may result in massive hemorrhage and require hysterectomy
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*interstitial
*cervical |
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though many infants survive abd pregnancies what occurs
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*placenta is poorly perfused
*fetal growth restriction and oligohydramnios |
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with abd pregnancies removal of the placenta is problematic and may lead to what
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massive hemorrhage
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in the US most tubals are done with what type of anesthetic
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REGIONAL
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when is epidural anesthesia preferred for a tubal ligation
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when there is an existing catheter in place
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when a pt has an epidural catether that has been in place the best success rate on reactivating catethers is within what time frame
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~ 24 hrs
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when is a spinal preferred for a tubal ligation
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in the absence of an epidural catheter of with failure of epidural catheter reactivation
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volatile agents may do what to uterine tone
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inhibit it
(cause uterine atony) |
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after a tubal ligation insignificant amts of drug are present in breast milk how long post-op
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4 hrs
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in the FIRST stage of labor pain results from what
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cervival dilation and distention on the lower uterine segment with contractions
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in the FIRST stage of labor pain is transmitted how
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by slow conducting A delta and C fibers
(visceral afferents) |
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in the FIRST stage of labor impulses enter where
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the dorsal horn of the spinal cord at T10-T11
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in the SECOND stage of labor pain results from what
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distention of the pelvic floor, vagina and perineum
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in the SECOND stage of labor pain is transmitted how
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by rapidly conducting somatic nerve fibers
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in the SECOND stage of labor impulses enter where
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the dorsal horn of the spinal cord at S2-S4
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what is the most commonly used drug for labor epidurals
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BUPIVACAINE
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bupivacaine provides what kind of block
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excellent SENSORY analgesia with min MOTOR block
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what drug for epidurals is there concerns with cardiotoxicity in high concentrations
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BUPIVACAINE
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what drug for epidurals is thought to be less cardiotoxic than bupivacaine
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ROPIVACAINE
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what drug for epidurals has a longer duration of action that bupivacaine
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ROPIVACAINE
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lidocaine for epidurals is typically used how
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as a test dose and in higher concentrations for sx anesthesia
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what drug for epidurals has a rapid onset
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CHLOROPROCAINE
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what drug for epidurals has a very short half life in maternal and fetal blood
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CHLOROPROCAINE
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what drug for epidural reduces efficacy of subsequently admin bupivacaine and opioids
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CHLOROPROCAINE
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what drug used for epidurals is implicated in back pain following large epidural volumes
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CHLOROPROCAINE
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what are contraindications to labor epidural
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*increased intracranial pressure secondary to mass lesion
*skin or soft tissue infection at site of needle placement *frank coagulopathy *uncorrected maternal hypovolemia |
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if you have no block with an epidural what could be the cause
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*in the wrong place
*forgot to add the drug |
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if you have failure of prev functioning epidural what could be the cause
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*cathether has become dislodged
*catheter migrated *disconnect from infusion pump *have OB examine the pt |
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if you have a spotty block from the beginning what could be the cause
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*improperly positioned catheter
*anatomic barrier to diffusion(epidural adhesion) *drug problem |
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what are indications for emergency imaging of the spine following regional anesthesia
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*severe back pain
*sig delay in normal recovery *deterioration of lower limb fxn *deterioration of bowel or bladder fxn |
