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292 Cards in this Set

  • Front
  • Back
cardiac changes with pregnancy[3]
heart enlarges
ventricular wall thicken
end-diastolic volume increases
by __ weeks, CO increases by __%

venous return (preload) increases because...[2]
increases in plasma volume

autotransfustion from uterus at birth
pregnant women have greater baroreflex mediated changes in HR at __ than at __.

6-8 weeks postpartum
maternal HR is __ at term
a split first heart sound indicates...
early closure of the mitral valve
a 3rd heart sound can usually be heard by __ weeks?
__ murmurs are common.
benign grade 1-2 systolic
__ murmurs are pathologic
maternal blood volume increases to __ at term.
dilutional anemia and decreased blood viscosity is from..
more plasma (50% increase) than RBC's (20% increase)
normal H/H at term?
SVR decreases as much as __% by term secondary to?

decreased resistance of uteroplacental, pulmonary, renal and cutaneous vascular beds.
what causes pooling of the larger blood volume?
the venous capacitance system loses tone.
overall systolic BP changes..
very little
a decrease in diastolic pressure up to __mm.hg may occur resulting in a decreased __?

The pregnant patient is more dependent on ___ for maintenance of blood pressure than the non-pregnant woman.
renin-angiotensin system
baseline plasma levels of __ and __ are increased during pregnancy despite the increase in blood volume.
renin and angiotensin
vascular sensitivity to angiotensin2 is ___ in the 3rd trimester whereas sensitivity to norepinephrine is __.
significantly reduced

what system provides support for MAP in the absence of sympathetic nervous system vasoconstriction?
renin-angiotensin system
the clearance of vasopressin at 36-38 weeks is ____ than before pregnancy.

3-4 times greater

this is secondary to a 50 times increase in vasopresinase
decreased venous return (preload) secondary to aortocaval compression results in a significant reduction in __ and __.
SV and CO
the normal physiologic responses to caval compression are...

despite this, uterine blood flow....
tachycardia and vasoconstriction of the LE's.

aortocaval compression restricts flow distal to ___.

this supplies the LE's and uterus.
the upper body BP response to aortocaval conpression is?
nothing, the BP is unchanged
left uterine displacement can be achieved by __ or __.
OR table tile to 15 degrees left

15cm wedge under right hip and back
LEA defeats compensatory vasoconstriction by...
blocking the sympathetic nerves responsible for vasoconstriction

this results in even greater hypotension to the uterus
upper airway swelling at term is a result of ___
capillary engorgement
swelling of the false cords may cause a?
narrowing of the glottis
Term pregnancy is accompanied by an increase in o2 demand of up to __% at baseline and __% during the second stage of labor.

at term, Ve is increased by __% because of an increase in both __ and __.

Vt(40% increase)

RR(15% increase)
at term, a normal PCO2 is..
the FRC, ER and RV are __ primarily as a result of...

upward pressure on the diaphragm
what changes cause the rapid desaturation with apnea?

increased o2 consumption
parturients can have __ sa02 when sleeping because of?

increased closing volumes
in terms of coagulation, the parturient is said to be ___ which places the parturient at a high risk of __.
hyper coagulable

normal fibrinogen is__ to __.

late pregnancy may be __ to __

__ levels are also elevated.
200-400 normal

400-650 prego

plt levels are elevated unless preeeclamptic
during pregnancy, there is an ___ sensitivity of the nerves to LA's
during pregnancy, GFR and RBF __ as a result, the __ BUN and CR __.

decreade BUN.CR (8/0.5)
__ levels of glycosuria and protienuria are commonly present in the absence of disease.
low levels
increased levels of __ during pregnancy result in greater gastric volume and lower pH.
elevated levels of __ also decrease gastric motility and cause a reduction in lower esophageal sphincter tone. This is the reason for heartburn.
progesterone (a smooth muscle relaxant)
during pregnancy, levels of aspartate aminotransferrase, lactate dehydrogenase and alk. phos ______.
increase to the upper limits of normal
decreased ___ levels may result in increased free fractions of highly protien bound drugs
serum albumin
serum cholinesterase levels ___ by __% or more during the first or second trimester (recovers slightly by term)

but this does/does not change the clinical duration of action of drugs that rely on this pathway for elimination (sux, minavurium)
decreases by 30% or more.

does not change DOA, unless 60% or more decrease in cholinesterase
placental blood flow on the uterine side is supplied by the _____ arteries.[3]
maternal acurate, radial and spiral arteries
the __ arteries expel blod into the intervillous space
the __ sinuses receive blood from the intervillous space and returns it to general circulation
maternal venous sinuses
uterine blood flow increases to a max of ___ and account for __% of CO.

of this, approx. __ supplies nutritive flow to the myometrium and __ to the dicidua
800ml/min 10% of CO

150ml/min to myometrium

100ml/min to dicidua
the dicidua is the...
lining of the uterus
the fetus sends o2 poor blood to the _____.

these vessels perfuse the __ which project into the pool of maternal blood.
2 umbilical arteries

placental villi
the transfer of 02/C02 to the fetus is limited by..
the perfusion of the placenta
evidence of fetal embarrasement occurs if maternal systolic BP drops below ___ in awake, healthy patients during epidural anesthesia.

patients with preeclampsia can develop placental insufficiency at BP's greater than...
100mm hg

unlike patients receiving LEA, patients receiving inhalational anesthesia seem to maintain _____ with drops in BP.
adequate placental blood flow despite drops in BP
placental transfer of free (non-protien bound) drug is dependent on..[4]
the magnitude of the concentration gradient
mol. weight
lipid solubility
drug ionization state
drugs with molecular weights greater than 1000 daltons cross the placenta _____, less than 500 daltons cross___.

ionized molecules are __ and __

the ____cross the placenta
polar and water soluble

don't cross
the chief factor in minimizing the effects of substances (drugs) that have crossed the placenta is....
before reaching the fetus, a drug is diluted in the __ blood, absorbed by the placenta, further diluting in placental blood and circulated to the fetus.
intervillous blood
approx __ of fetal CO returns directly to the placenta because of...

shunt flow through the FO and DA
serum catecholamine levels ___ in response to pain, stress and uterine activity
whole body o2 demand increases an additional __% during painful contractions.
each uterine contraction expels blood from the uterus into the general circulation, this increases __ and __.
preload and SV
CO in the first stage of labor increases ___ to __% during contractions and returns to prego baseline inbetween.
increases in Ve may increase __% in respons to pain and may actually drop to ____.
300% increase

drop to <15
THE FETUS does/does not develop hypoxia or acidosis with maternal hyperventilation except when the mom is stressed.
does not
if contraindicated, give __ and __ to reduce gastric ph and volume
h2 blocker

unlike cimetidine, ranitadine does not...
inhibit the metabolism of amide local anesthetics
after delivery, CO may increase as much as __% above baseline because of..

uterine autotransfusion
relief of aortocaval compression
CO remains elevated for approximately __ days as __ and __ return to normal.
10 days

HR and SV return to normal
the pain of labor and delivery is mediated by _____ sympathetic nerve fibers and __ somatic nerve fibers.
T1-L1 sympathetic

S1-S4 somatic
the nerves at ___ carry pain sensation from cervical dilation and are __ fibers.

C fibers
the nerves at __ carry pain sensation from vaginal and perineal areas.
'Back labor" pain results from referred pain to ____ and ____.
dermatones and sclerotomes
____ are located several inches below the actual vertebral level of involvement, causing the pain to be felt over the ___ region.

The sclerotome pathway (L5-S1) can be interuppted by a _____ or ______ with a LA level up to the __ sensory dermatome.
paracervical block

lumbar sympathetic block

compression and stretching of the pelvic musculature and ligaments produces a pain that is mediated by the ______

this pain can be eliminated with a ___
sacral plexus

pudendal nerve block
in a normal laboring patient, a lumbar epidural block effectively relieves the pain of ___ and __ and under some circumstances also provides effective __ analgesia.

a _
pain of uterine contractions and cervical dilation

sacral (do a pudendal for this)
LEA PROBABLY prolongs ____ stage of labor but if properly conducted, has ___ effect on active labor.
prolongs latent

little effect on active
complete sensory anesthesia (too dense_ eliminates _____
a woman's signal to push
the goal of LEA is to....
provide analgesia for labor that does not remove maternal awareness of uterine contractions and that does not cause a motor block
the most readily available method for assessment of the fetal well being is the --
the FHR also reveals information about fetal response to ____
anesthetic interventions
the FHR is recorded at 3cm/min.

__ is recorded concurrently on a second channel below the FHR tracing.
uterine tone or pressure
given a reasonable maternal o2 saturation, fetal oxygenation is limited primarily by..
uteroplacental blood flow
anything that decreases maternal BP or uterine blood flow also decreases _____.

This results in __ and evtually __.
uteroplacental blood flow

fetal hypoxia

the normal FHR is.
higher with immature
fetal bradycardia down to ___ is generally well tolerated if it lasts less than ____.

less than 2 minutes
feta bradycardia less than ___ is cause for consern and ____ is severe, regarless of duration.

<80 severe
FETAL TACHCARDIA IS __ in a full term fetus. In a few circumstances, it may be the result of hypoxia, but never when normal variability is present.
most common causes of fetal tachycardia include...[5]
fetal arrhythmia
drugs (atropine, terbutaline)
possible ephedrine
fetal bradycardia is ___

caused by...[4]

baseline variability increases with __
gestational age
beat to beat variability can be assessed only with a __ electrode.
long term variability is..

acceleration for short periods followed by a return to baseline

long-term variability is often associated with..

normal when the basline HR varies only by ___ on a frequent and regular basis.
fetal movement

15bpm for 15 sec

variability is considered decreased or absent when the baseline rate changes are less than this
during fetal sleep, short-term variability should ____. but long term variability normally ___ for periods up to 40 minutes.

_____ is the single best non-invasive clinical indicator of fetal well being.
FHR variability
beat to beat and long term variability are seen to occur together and probably represent an ______
intact CNS
changes in beat to beat variability are ___ mediated
hypoxia causes _____ which results in decreased variability.
CNS depression
causes of decreased variability include [7]
fetal sleep
CNS depressant drugs
autonomous agents
defects of the fetal conduction system
administration of opioids to the mother _____ variability for upt to 30 minutes.
maternal Magnesium may _____HR variability
FHR variability is indicative of _____
fetal reserve
the presence of normal variability is a sign that..
the fetus is healthy or well compensated
decreased variability may be a sign that...
the fetus is beginning to decompensate, especially with variable or late decellerations
short and long term variability decrease when scalp pH is ____
7.2 or less
the sinusoidal FHR tracing is a pattern of...

associated with..
consistent, repeating variability superimposed on a background of a normal FHR.

anemia, butorphanol

frequencyof 2-5 cycles/minute
amplitutde of 5-10 bpm
early decelerations occur ___ with uterine contractions.

they begin when ___
they end when___
in concert with

contractions start
contractions end
early decelerations are __ in appearance, ___ in HR change.

caused by...

mild (<20bpm)

may be from pushing too early against a less than dilated cervix or from impending delivery
early decels are physiologic unless seen with..
fetal tachycardia or loss of variability
variable decelerations occur with ______, but not with _____
uterine contractions

every one
variable decelerations may/are....[6]
-start early or late
-end after the contraction ends, sometimes with transient tachycardia
-abrupt in occurance and recovery
-FHR may pl;unge to 60 in only 1-2 sec
-variable in occurence, onset, rate, depth, duration and appearance
-beat to beat variability remains present during decel.
with variable decelerations, beat to beat variability during the deceleration.
remains present
variable decelerations are severe if...
FHR <60 or deceleration is sustained for 60 sec or longer
less severe variable decelerations are still of concern if _____ is absent.
beat to beat variability
if the fetus is comprimised, the recovery phase of the variable deceleration my be ____
if variable decelerations continue to occur, the anesthetic should anticipate...
obstertic intervention
late decelerations...[5]
-begin 10-30 sec after onset of contraction
-smooth in onset/recover
-regular in occurance
-beat to beat may or may not be present
-as the fetus decompensates, the recovery takes longer
a fetus with late deleratins and absent beat to beat variability is likely to have a _______ and/or _______
metabolic acidosis

myocardial depression
late decelerations are severe if FHR is_____

probably caused by..

a problem with the placental-utero interface that is resulting in fetal hypoxia and acidosis
______ late deceleration is a reason for concern.
even small, almost imperceivable late decelerations may represent severe fetal decompensation when they are combined with the absence of ______
FHR variability
if late decelerations are not corrected _____ must occur
emergent C-section
when presented with any FHR abnormality that may indicate hypoxia, the anesthetist must rule out _______ as the cause.
anesthetic intervention

most common-epidural/hypoxia

treat with IVF's, ephedrine
check dermatome level
when making the decision as to whether to use an epidural block for and emergent c-section, consider....[5]
-is the block uniform or patchy?
-hypotension with additional LA admin?
-how fast will the onset be?
-chances the block will fail?
-if no epidural than.GETA
emergent c-section IV placement?
SEVERAL above the wrist.
treatment for Mag OD?
The concentration of atropine in a syringe decreases by __ over 24hrs secondary to__.

disadvantages to IV opioids (solely) for OB anesthesia.[5]
inadequate pain relief
fetal CNS depression
maternal resp depression
decreased lower esophageal sphincter tone
meperidine ___ the placenta ______.
crosses easily

causes less neonatal depression than morphine

<100mg OK

higest neonatal depression if given within 2-3 hrs of delivery

ion-trapping to fetus, normeperidine stays, leads to a higher % of drug in fetus than in mom.
BOTH meperidine and normeperidein can be antagonized by...
____ of butorphanol is eqipiotent to __ of

advantages/disadvantages of butorphanol


less resp depression at higher doses
better sedative than pure opioids

can increase cardiac workload
ketamine produces a ______ mediated effect.

centrally and peripherally

give with versed
slighly increases uterine blood flow
upto 1mg/kg only
crosses placena easily, lipid soluble
onset 1 min, DOA 5-10 min
additional H/P info if doing regional...[9]
-level of dilation/effacement
-FHR, assess variability
-membranes intact?
-gestational age
-bleeding/back problems?
-LEA is not mandatory, other methods available

G-# conceptions
P-# live births
A-# preterm dead births

FPAL-full term, premature, abortus, living
bupivicaine cardio-toxicity is worsened in prego d/t..
increased progesterone levels
ropivicaine is the ___ of _____.

other facts...
S-isomer of bupivicaine

t1/2 5.2 hours (bupiv-10.9)
markedly less toxic
1/3 less motor block
slower onset
goes away quicker
1/3 less dense
must be in ___ labor for LEA
active labor is...

before performing an epidural block...
-check room
-new containers/vials
-baseline BP
-fentanyl 50-100mcg IV (limit 1mcg/kg, esp <2hrs before birth)
epidural levels...

other facts...
early labor-L2-L3 (less volume needed)

5cm in epidural space
goal L4-T10 coverage
stage 2 labor is...
delivery of fetus
when the patient lies down, the distance from the skin to the epidural space ____.

this can pull out the epidural if taped in the sitting position

tape after side-lying with legs straight

side hole/closed end results in more satisfactory blocks
test dose for epidurals?
lido 30mg/epi 15 mcg

or bupiv 10mg
or chlorporcain 60mg

observe for blood/CSF when aspirating!!!
the spread of analgesia when an epidural catheter is placed is primarily determined by..

the extent of anesthesia with a spinal is determined by..
epidural-the volume of LA solution injected

spinal-the dose, baricity and position
normal, healthy late teens.20's need ___ml per dermatome level of spread.
volume for lumbar epidural at L2...
average 16cc for T6-S4
average epidural dose...

6-12 cc of 0.1%-0.2% ropivicaine

or 0.125-0.25% bupivicaine..incrementally (5cc)

infusion: 0.0625-0.2 )10-15ml/hr

along with 1-2 mcg/ml fentanyl
the addition of fentanyl to the LA.....[3]
speeds the onset, increases density, and prolongs durations
the ideal block provides...[3]
analgesia for labor pain

densde analgesia of the perineum for delivery

little motor block
the most common method to prevent maternal hypotension after LEA is...
replacement of fluid volume (not proven)
a small reduction in plasma colloid osmotic pressure results in..
strong inhibition of ADH release
vasopressin release (ADH) in response to loss of intravacular volume requires a ___ stimulus
a fairly strong stimulus
the volume of crystalloid IV preload commonly employed to prevent maternal hypotension may actually inhibit the....
body's efforts to support BP by delaying or reducing the magnitude of vasopressin response
regulation of MAP in healthy pregos undergoing LEA is most strongly influenced by__.
effective prevention of maternal hypotension must include interventions to maintain maternal ___ without increasing uterine arterial resistance.
_____ is probably the most frequent complication in obstetric anesthesia.
intervillous blood flow is dependent on..[1]
maternal MAP
fetal oxygenation is dependent on..[2]
maternal MAP and intervillous blood flow
in healty pregos, the critical duration of hypotension is probably greater than ____.

the critical magnitude of hypotension is ____.
2 minutes

______ is a non-selective, non-catecholamine sympathomimetic drug.
ephedrine dose, duration, S/A's, facts
5-25mg IV to tx BP
5-10 mg IV lasts 5 min

tachycardia can occur with repeated small doses and decreased clinical effects

T1/2 isa 3 hrs (liver) 40% renal unchanes

direct beta, indirect alpha

AFFECT uterine arterial flow the least of all vasopressors

250x less potent than epi

crosses placenta (70:100) ratio
phenylephrine use?
safe, use if ephedrine causes too much tachycardia
aspiration pneumonitis prophylaxis? [3]
10-20mg Reglan (slow IVP)
H2 (pepcid/ranitadine) IV or PO
avg EBL's?

factors effecting blood loss during c-section include...[8]
-surgical time
-surgical technique
-fetal lie
-fetal size
-placental implantation
-materanl coagulation status
-ability of uterus to contract after placenta has been delivered.
risk factors for excessive bleeding with c-section? [6]
-protracted phase of labor
-second state arrest
-hispanic ethnicity
__ and __ make maneuvering of the laryngoscope difficult.
breast enlargement

cephalad movement of the thorax
appropriate induction agents./doses
THIOPENTAL 3-5 mg/kg

ketamine 1mg/kg iv

etomidate 0.3mg/kg IV

ketamine is especialy useful in patients who have ...
reactive airway disease or hypotension
___ is the preferred muscle relaxant for GETA with parturient.
sux is metabolized by...
PCHE activity is normally ____ in healthy pregos at term.
decreased 30%, up to 60% with preeclampsia

LEADS to a prolonged DOA
sux's duration will be prolinged in patient's receiving ____
metaclopramide will proling the DOA od agents being metabolized through./..
ester hydrolysis
once apnea occurs, maternal o2 saturation drops_____ times as fast as in a non-prego.
3 times as fast
essential monitors during intubation are..
____MAC of an inhalational agent can be used safely during C-section

this level decreases uterine contractility by...
2/3 MAC

.75 iso
1.7 sevo
4.8 des


therefore, stop the inhalational agent ASAP after the delivery
if fetal distress is present or maternal sao2 is less than 97%...
100% o2
potential for increased free-radical activity in neonates who's mom's had....

high Fi02

infants born to these mom's had slightly better outcomes
a ___ is the classic technique for muscle relaxation during c-section.

there is a risk of..
sux gtt

prolongs phase 2 block
if tubal ligation is performed at the same time as c-section, what paraylytic can be used?
interval from incision to delivery is best...
<3 minutes, if greater the risk of acidosis increases
anesthetic options dramatically changes when...
the cord is clamped
after the cord is clamped, ____ and ____ work well and do not affect uterine tone.
opioids and N20
oxytocin is a naturally occuring hormone synthisized in the ____ and __ of the ___.
supraoptic and paraventricular regions of the hypothalamus
in the mature uterus, oxytocin causes....
an increase in the frequency and strength of contractions
endogenous oxytocin release occurs with stimulation of the...
cervix, vagina, breast
t1/2 oxytocin?
4-17 minutes
commercially available preps of oxytocin contain a _____ that causes sysolic and esp. diastolic hypotension, flushing, and tachycardia when infused at high doses.
in general, the OB is likely to desire the administration of ______ units of oxytocin over the first hr post-partum
30-40 units
if oxytocin does not work...

these cause a...
ergot alkyloid. (ergonate)

IM 0.2mg

increase in BP, CVP ans PAWP
ergot alkyloids potentiate...

can cause..
ephedrine and esp. alpha agonists

severe hypertension, CVA, RETINAL DETATCHMENT when given together
if ergot alkyloids dont work....
protaglandid F2 250mcg IM or intrauterine

causes strong, painful contractions

n/v, diarheaa
suctioning the stomach with an orogastric tube while the patient's asleep decreases the incidence of ___ after awake extubation
epidural block during c-section...
bupiv-0.5% (30 min onset)
lido 2% (10 min onset)

nahco3 1meq.l speeds onset (5min or less) also makes more dense, speed of onset may make hypotension a problem

no advantage with bupivicaine, only lido

2-chlorprocaine-fast onset, high incidence of backache, ester hydrolysis
disadvantages of throught the needle combined technique.
higher incidence of hypotension

in intravascular, more severe and faster onset
the duration and density of blocks can be increased by the addition of >>>>
using an opioid with LA for epi/spinal decreases noxious.pain during exteriorization of the uterus.

50-100 mcg
Spinal/Subarachnoid doses.
tetracaine 10-15mg o-15 d-90
bupivicaine 10-15mg 90
lido 75-100 5(50-60)

the addition of fentanyl prolongs duration, increases density without the prolongation of motor block and urinary retention seen with epi
when opioids are used with regoinal anesthesia....

-decreased dose
-less motor blockade
-act on substantial gelatinosa in cord

fentanyl 50-100 mcg epidural
10-25 mcg spinal

DOA 3-4dhrs, less cephlad migration than MS

*most women have undetectable serum levels after receiving 100 mcg fentanyl

infusion-up to 2.5mcg/ml
wont affect neonatal scores


sufenta-more potent, shorter DOA
most common S/A Morphine epidural?

none in obese parturients

decreases Ve too much

use Pulse ox post partum!!
S/A's of regional are more common with spinals or epidurals?
IV doses of __ and ___ are effective at reducing or eliminatinf the undesirable S/A's without antagonizing the analgesia and are more effective than antihisatmines against purtits.

there is an increased incidence of puritis with the use of _____.
epi in LA doses
N/V is closely related to ...
a total sympathetic block results in unoppesed vagal stimulation which predisposes the patient to >>>
THE administration of an_______ right before the SA/Epidural prevents nausea by limiting unopposed vagal stimulation
antimuscarinic (atropine.glycopyrolate)
________ have been shown to significantly reduce the incidence of post c-section N/V resulting from regional iopioids.
scopolamine patches
Scopalamine patch onset, DOA, S/A's
onset 2-4 hours
48Hr DOA

dry mouth/dizziness
CSF production?
150 in dura, 500ml/day
__ can mimic PDPH in the initial stages (HA, photophobia)
PDPH severity of sx's are related to __ and __.
volume and rate of CSF leak
increase PDPH incdence with __ vs ___ needles.
beveled (qincke)

pencil (sprotte)
Hallmark appearance of PDPH is its _____ nature.

HA features...


relieved by lying down, returns when standing

occ. neck/shoulder stiffness
severe photophobia
double vision

onset 1-2 days
caffiene 300mg
serotonin receptor antagosnists

definitive tx-blood patch
blood patch tech..
the epidural blodd patch plugs the dural rent with a fibrin clot and the Increased pressure.

same interspace or 1 below
20ml blood draw
inject 15-20
supine for 1 hr
take it easy
signs of LA toxicity...

tiniitis (first)
other changes in hearing, confusion. inability to speak, metallic taste, cirumoral numbness

stop infusion!

barbiturates/benzos to stop sz
control airway, ETT, o2
accidental SA injection leads to...
dyspnea with hypotension

tx sx's
accidental subdural injection (between dura/arachnoid)
more cephlad spread (sudden after 10-25 min)

hypotension is ussually primary problem, tx with ephedrine
EKG changes during c-cestion are/are not ussually myocardial ischemia.
left uterine displacement

c-section in 5 min if no go.
maternal mortality rate?
most common cause of maternal death is...
hemmhorage followed by
______ is a leading cause of perinatal M&M.
premature delivery
____ is implicated in more than 50% of all perinatal deaths.
premature delivery
___% of all live births in US are premature.
premature labor is defined as...
regular uterine contractions that occure between 20-37 weeks that result in dilation and effacement of the cervix.
risk factors for premature labor...[8]
drug use
extremes of maternal age
traditionally ____ was used to stop labor. It depresses myometrial contractility and suppresses the release of oxytocin from the post. pituitary.

S/A's [5]
ethyl alcohol

increased gastric volume
depression of airway reflexes
lactic acidosis
fluid/elec imbalances
Magnesium Sulfate causes....
relaxation of vascular, bronchial and uterine smooth muscle by altering calcium transport and availability.

motor end-plate sensitivity and muscle membrane excitability are also depressed
Nl mag in prego..

tocolytic at....
resp depress at...
apnea at...
arrest at....

4-8 tocolytic

>12 resp depress
>18 apnea
>25 arrest
mag S/A's
skeletal muscle weakness
CNS depression
vascular dilation
decreased BP during epidural
antagonizes vasoconstrictive effects of ephedrine/NEo
cutaneous flushing
depressed DTR's EKG changes
resp depression
All ____ are potentialted by Mag.
Mag is partially antagonized by..
Mag tx's preeclampsia by...[3]
relaxing smooth muscle
decreasing SVR
decreasing BP
progesterone cause histologic changees in...
myometrial cells that limit the spread of contractile impulses
beta agonists cause...
smooth muscle relaxation, including the uterus and increases progesterone production
Maternal S/A's of beta-1 stimulation.
-cerebral vasospasm
-CP, tightness
-glucose intolerance
-myocardial ischemia
-ventricular arrythmias
maternal beta-2 S/A's [4]
-increased secretions
-various metabolic effects
Both __ and __ can antagonize HPV through beta-2 mediated vasodilation.
ritodrine and terbutaline

this can drastically decrease maternal o2 concentrations
BETA stimulation increases BS and insulin levels which can cause...
beta agonists increase risk for ___ in parturients preloaded for regional anesthesia.
risk factors associated with pulmonary edema during beta agonist tocolysis...[5]
fluid overload
prolonged maternal tachycardia
beta agonists effect on neonate/fetus...
tachycardia is common
hypoglycemia in neonates
ritodrine (Yutopar) is a selective beta2 agonist. The average increase in maternal HR is....


increased SBP,decreased DBP
risk for pulmonary edema
no more than 2L fluid over 24hrs
terbutaline (Brethine, Bricanyl) is a synthetic, relatively beta2 specific, non-catecholamine, sympathomimetic amine

less beta specific than ritrodrine

-more chance for arrhythmia
-longer 1/2 life
-risk for pulm edema
when tocolysis fails, preterm deliveries by c-section using epidurals show a higher 1/5 minute APGAR score than with GA.
if rito/terb on board, than no volume load...GETA
No dose of ____ with mag.
non-depolarizing defasciculating dose
No _____ if on a beta-agonist
Labetolol is a selective alpha-1 and non-selective beta agonist that decreases maternal BP while maintaing...
placental blood flow
No ____ with beta agonist.
Halothane, it sensitises the myocardium to catecholamines
____ reduces MAC

light anesthesia is bad, it increases the maternal catecholamine output and decreased uterine blood flow.
the prego has a ____higher risk for PE.
PE is most likely in the __ period.

associated with...[5]

prolonged inactivity
increased age
increased parity
s/s PE...[7]
pleruitic CP
neck vein distension
while in the OR/delivery, the chances of a PE are..
less likely than an air aor amniotic embolus
a venous air embolus can occur during labor, spontaneous vaginal delivery and operative delivery and is associated with...
placenta previa
amniotic fluid embolus is rare and ussually fatal and is associated with
placental abruption
most venous air embolisms are detected when?
between delivery and uterine repair
s/s venous air embolism [5]
millwhell murmur over precordium
decreased ETCO2
increased CVP
s/s amniotic fliud embolism
pulmonary edema
decresede sao2
CV collapse
there is a _____ incidence of thrombolic emboli with regional anesthesia.
if air/amniotic embolus suspected, tx...[3]
flood with NS
return uterus to abd
stimulate contractions
EBL with c-section/hyster
hypotension may not occur until ___% of blood volume has been lost
placenta previa
risk of sudden large blod loss
needs c-section
regional only if SKILLED
placenta abruption
MAJOR BLEEDING like trauma
DIC 50% (embolus)
increased risk with preeclamp 22%
GETA fast
up tp 5L blood concealed in abd1
atonic uterus
no inhalants
NTGIV/sl spray
get fragments out
accounts for 80% of all bleeding
uterine rupture
HEAVY bleeding like trauma

sudden sever pain, tearing in multipart suring heavy labor

fhr tracing!!!!!
the clinical finding most commonly associated with uterine rupture is
abnorma FHR tracing
placental acrreta
placental increta
placenta percreta
placental acrreta-on myometrium
placental increta-in myometrium
placenta percreta-through myometrium

all have large blood loss
DIC associated with..[3]

retention of dead fetus
placental abruption
aminotic embolus

volume, support, eliminate cause before replacing factors

uncontrolled bleeding from consumption of factors
decreased fibronogen
multiples [4]
risk for uterine atony
NO oxytocin til last baby is out, then lots!
aortocaval syndrome
vasospastic dz of pregnancy
abnormal thromboxane (constrictor, aggregator) to prostaglandin (smooth muscle relaxant) ratio.

increased SVR!!!

1-2+ protienuria, edema after 20th week, HTH (2of3=diagnosis)

140/90 or 30/15 above

sever if 3-4+ protienuria
160/110, u/o <20ml/hr CNS(blurred, mentation)
pulm edema
epiugastric pain

BP is key indicator
with preeclampsia the chief cause of maternal mortality is
cerebral hemmorhage caused by HTN

others-pulm edema, hepaticv rupture, DIC, cerebral edema RF
with preeclampsia there is an increased sensitivity to

vasopressin, AT2
with preeclampsia, uteroplacental insufficiency can reslt from...[3]
low intravascular volume
vascular intimal deterioration
increased vascular resistance

placental perf can decrease by up to 70%
preeclampsia tx..
mg (decreases ecclampsia byt 58%, deaths by 45%)

avoid decreases in uterine blood flow
maximize organ perfusion

regional if possible
elevated liver enzymes
low platelet count
pay attention to ____ when starting a regional with preeclampsia
bleeding time is ____ normal
use ephedrine/vasopressors with care in preeclamptic patients because...
the can have exagertted responses
with preeclamtic regional, ____ is DOC
bupivicaine, slower onset
most common cause for GETA with preeclampsis?

deteriorating condition
preeclamptics can have an exageratted response to laryngoscopy.
56mm average WITH antihypertensives


alfentanil 10 mcg/kg 1 min before
up to 1mg/kg

shorter 1\2 life in pregos (1.7hrs)
may improve UPBF
onset 10-20 min
NTG [3]
low placental transfer
make sure the patient has adequate intravascular volume
may increase ICP (esp NTP)
non-depolarizers are markedly potentiated with preeclampsia and therpeutic Mag levels

1/2 ED95