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105 Cards in this Set
- Front
- Back
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what is the 2nd leading cause of pregnancy related death
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HEMORRHAGE
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what are the most common causes of 3rd trimester bleeding
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*placenta previa
*placenta abruption *uterine rupture |
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postpartum hemorrhage occurs in what amt of pregnancies
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~ 10%
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what are the most common causes of postpartum hemorrhage
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*uterine atony
*vaginal tears *retained placenta *placenta accreta *uterine inversion |
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what is placental abruption
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partial or complete seperation of the placenta before delivery of the fetus
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what are the risk factors for placental abruption
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*HTN
*preeclampsia *cocaine use *alcohol use *smoking *prev hx of abruption |
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what is the management of placental abruption
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*delivery
*restoration of blood volume *management of accompanying DIC |
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what are the typical s/s of placental abruption
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*vaginal bleeding +/-
*uterine tenderness *increased uterine activity |
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what are the major complications of placental abruption
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*hemorrhagic shock
*renal failure *fetal distress or dimise *coagulopathy |
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what is the most common cause of DIC in pregnancy
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placental abruption
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what is placenta previa
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placenta implanted in advance of the presenting fetal part
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what are the classifications of placenta previa
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*total
*partial *marginal |
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what is total placenta previa
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placenta competely cervival os
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what is partial placenta previa
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placenta partially covers cervival os
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what is marginal placenta previa
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placenta lies close to but does not cover cervical os
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what are the associated conditions with placenta previa
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*muliparity
*advanced maternal age *prev placenta previa *prev c-section or other uterine sx |
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what is the typical presentation for placenta previa
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painless vaginal bleeding often preterm and typically stops spontaneously following 1st episode
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what are the ACUTE fetal risks with placenta previa
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*uteroplacental insufficiency from placenatal seperation
*preterm delivery |
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what are the CHRONIC fetal risks with placenta previa
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IUGR fom decreased placental blood supply
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what are the anesthetic considerations with placenta previa
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*assessment of fluid volume
*risk of increased intra-op blood loss |
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the type of anesthetic with placenta previa is dependent on what
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pt condition
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uterine rupture is rare when
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in an unscarred uterus
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what factors are associated with uterine rupture
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*prev uterine sx
*uterine manipulation (external version) *trauma *overaggressive use of oxytocin *grand multiparity |
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what are the s/s of uterine rupture
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*vaginal bleeding
*hypotension *cessation of labor *fetal distress *abd pain |
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what is the MOST reliable sign of uterine rupture
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FETAL DISTRESS
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what is an INCONSISTENT sign of uterine rupture
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ABD PAIN
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what is the definitive repair procedure for uterine rupture
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HYSTERECTOMY
(some can have uterine repair) |
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what type of anesthesia is typically preferred with a uterine rupture
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GENERAL--except with a stable pt with a pre-existing epidural
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what is vasa previa
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velamentous insertion of teh cord where the blood vessels traverese the membranes ahead of the presenting part
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with vasa previa what can occur with rupture of membranes
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there is susceptibilty of tearing of vessel
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what is the fetal mortality rate with vasa previa
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50-75%
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how is postpartum hemorrhage defined
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> 500 ml of blood after delivery
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when is primary postpartum hemorrhage
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within 24 hrs of delivery
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which carries a higher M&M primary or secondary postpartum hemorrhage
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PRIMARY
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when is secondary postpartum hemorrhage
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b/t 24 hrs and 6 wks postpartum
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what is the number 1 cause of postpartum hemorrhage
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UTERINE ATONY
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an atonic engorged uterus can hold how much blood
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1000 ml
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what is the management of postpartum hemorrhage
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*oxytoxin
*hemabate *misoprostol *ergonovine & methylergonovine |
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what kind of anesthetic agent would you want to consider with a postpartum hemorrhage
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volatile halogenated agents
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other than uterine atony what are other cause of postpartum hemorrhage
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*lacerations and hemotomas
*retained placenta *placenta arreta |
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what is placenta accreta vera
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adherence to the myometrium without invasion of the uterine muscle
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what is placenta increta
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invasion of the myometrium
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what is placenta percreta
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invasion of the uterine serosa or other pelvic structures
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there is what kind of increase in PULMONARY embolism during pregnancy
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5-6 x increase
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what are the reasons for increased pulmonary embolism during pregnancy
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*increased venous stasis in pelvis & lower ext d/t venal caval compression by uterus
*hypercoagulable state *vascular injury associated w/ delivery leads to increase in coagulation activity |
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what are the dx criteria for pulm thromboembolism in pregnancy
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*dyspnea
*palpitations *anxiety *pleuiritc chest pain *cough *tachycardia *JVD |
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what amt of people in pregnancy will die within the first hour following a PE
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10%
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what is the tx for a pulm thromboembolism during pregnancy
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*adequate oxygenation
*support of maternal circulation and uterine blood flow *immediate anticoagulation or venous interruption |
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venous air embolism is a common occurence when during pregnancy
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during c-section
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there is an increased incidence of venous air embolism with pregnancy when
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*with steep trendelenburg
*with exteriorization of the uterus |
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what are the s/s of a massive air embolism with pregnancy
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*sudden hypoxia
*hypotension *cardiac arrest |
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what are the more common s/s of venous air embolism with pregnancy
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*chest pain
*decreased o2 sat *dyspnea *maybe EKG changes |
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with an amniotic fluid embolus with pregnancy what does not correlate with the severity of the embolus
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volume of particulate matter found in lungs
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with an amniotic fluid embolus in pregnancy what is possibly responsible for damage
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arachidonic acid metabolites (leukotrienes)
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what occurs in the early phase (less than 30 min duration ) with an amniotic fluid embolus in pregnancy
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intense pulm vasospasm with release of vasoactive substances leading to often fatal RIGHT heart failure
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what occurs in the second phase with an amniotic fluid embolus in pregnancy
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*L vent dysfuction in survivors of the early phase
*coagulopathy |
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infusion of what dose of propofol for 100 min will allow the pt to regain consciousness in approx 4 min
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50-70 mcg/kg/min
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what drug used for MAC has a low incidence of N/V
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PROPOFOL
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what drug used for MAC allows the pt to be clear-headed upon awakening
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PROPOFOL
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what dosage of propofol for injection of local or painful stimulus usually will not cause apnea
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30-70 mg boluses
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what kind of delivery of propofol will yield lower accumlative dose and therefore a quicker recovery
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infusion via pump
(vs intermittent boluses) |
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what is the most commonly used bzd for MAC
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MIDAZOLAM
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midazolam has what kind of properties
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*anxiolytic
*amnestic *hypnotic |
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what type of dosage adjustment is needed for mdz in the elderly
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sig reduced dosage
(1/3 to 1/4 normal dose) |
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what occurs with mzd when it is used as a large portion of your MAC
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it has a short elimination half-life (1-4 hrs) yet prolonged psychomotor impairment
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how can midazolam be reversed
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with flumazenil 0.2 mg q 60 sec to a max of 1 mg
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with reversal effects of mzd may occur when
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within 90 min
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opioids for MAC lack what property
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AMNESTIC
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what are the limiting adverse effects of opioid when used for MAC
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*resp depression
*muscle rigidity *emesis *pruritis |
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what can be effective in reversing resp depression from opioids used in MAC
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NARCAN 40 mcg boluses
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opioids + bzd have what kind of relationship for MAC
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sig synergistic
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approx what of ED50 dose is needed if bzd and opioids used together for MAC
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25%
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what is the dose of FENTANYL for MAC
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25-100 mcg boluses
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what opioid is effective with MAC for brief painful stimulation such as retrobulbar blocks
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REMI boluses of 0.5 - 1 mcg/kg over 60 -90 sec
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what opioid infusion is used in MAC with mzd for amnesia
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REMI 0.025 - 0.1 mcg/kg/min
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ketamine is what kind of derivative
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PHENCYCLIDINE
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ketamine has what kind of analgesic effect
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INTENSE
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what dose of ketamine is used in MAC for painful stimuli and is NOT associted with resp or cardiac depression
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0.025 - 0.5 mg/kg
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ketamine with MAC produces what kind of state
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DISSOCIATIVE--eyes remain open with nystagmic gaze
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what drug used for MAC can cause intense halliucations and you need to consider the use of a bzd for amnesia
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KETAMINE
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with ketamine increased oral secretions increase the likelihood of what
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LARYNGOSPASM
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what can be used with ketamine to decrase oral secretions
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glycopyrrolate 0.2 mg IV or 0.4 mg IM
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ketamine used for MAC may increase what pressures
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*intracranial
*intraocular |
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what does doxapram do
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stimulates chemoreceptors in the carotid arteries which then stimulates the resp centers of the brain stem
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with what amt of doxapram should you see an increase in RR and TV
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20-40 mg (1-2 cc)
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what are the s/e of doxapram
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*HTN
*tachycardia *sweating *vomiting *tremors |
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what are s/s of LOW levels of local anesthetic toxicity
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tongue and circumoral tissue numbness
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what are s/s of MEDIUM level local anethetic toxicity
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*restlessness
*difficulty focusing *vertigo *tinnitus |
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what are the s/s of HIGHER levels of local anesthetic toxicity
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*slurred speech
*skeletal muscle twitching *tonic-clonic sz |
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what is the tx of local anesthetic toxicity
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*airway management
*sz suppression *if needed CPR *alert the nearest facility having cardiopulmonary bypass capability *admin 20% lipid emulsion |
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what things delay gastric emptying in pregnancy
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*IM/IV opioids
*intrathecal opioids *bolus epidural opioids (100 mcg fentanyl) |
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what things do NOT delay gastric emptying in pregnancy
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*epidural local anesthetic
*epidural cont infusion opioids |
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during pregnancy labetalol should be used catiously in what population of pts
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*asthma
*CHF |
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what is the tx for benign intracranial HTN with pregnancy
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take out CSF with serial lumbar punctures
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is epidural placement in pregnancy contraindicated d/t presence of a shunt
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NO
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what is the blood volume of a term fetus
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250 ml
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an amniotic fluid bolus is perhaps more of a ______ picuture than an embolic one
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ANAPHYLACTOID
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of the maternal deaths that are related to anesthesia what is the number one cause
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ASPIRATION
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of the maternal deaths that are related to anesthesia what is the number 2 cause
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AIRWAY PROBLEMS
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with a baby that has meconium aspiration what is the preferred technique
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PHARYNGEAL SUCTIONING
(delivery of the head, suctioning of the hypopharynx, then delivery of the thorax) |
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with a baby that has meconium aspiration if the infant is vigorous what is indicated with endotracheal suctioning
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NO endotracheal suctioning is indicated
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with a baby that has meconium aspiration if the infant is NOT vigorous what should be done
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TRACHEAL suctioning should be performed
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with a baby that has meconium aspiration if a previously vigorous infant develops resp compromise what should be done
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TRACHEAL suctioning should be done PRIOR to positive pressure ventilation
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with a baby with meconium aspiration once the heart rate is normal what should be done
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you should empty the stomach with a soft suction catheter
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how do you make narcan 40 mcg
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take the 0.4 mg vial and dilute it in 10 ml = 40 mcg
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