Ob #1 A&p 5/18/06

Front 1

James Young Simpson

Back 1

1) 1st OB anesthetic
2) Ether
3) 1/19/1847
4) Chloroform

Front 2

John Snow

Back 2

1) 1st physician anesthetist
2) Chloroform
3) Queen Victoria

Front 3

Nathan C. Keep

Back 3

1) 1st OB anesthetic in U.S.
2) Ether
3) 4/7/1847

Front 4

Crawford W. Long

Back 4

1) Ether since 1842
2) wife's delivery 1847

Front 5

1900 - 1940's

Back 5

"twilight sleep"
scopolamine-morphine anesthesia

Front 6

Duke inhalers

Back 6

1) Cyprane
2) Penthrane
3) N2O & O2

Front 7

1853

Back 7

hypothermic needle

Front 8

1878

Back 8

cocaine

Front 9

1884

Back 9

Koller eye block

Front 10

1885

Back 10

Corning spinal anes.

Front 11

1905

Back 11

Einhorn - procaine

Front 12

1908

Back 12

Pudendal (anes.?)

Front 13

1926

Back 13

paracervical block

Front 14

1928

Back 14

1) spinal anes. OB
2) Dr. Cleland described pain pathways of uterine contraction

Front 15

1940's

Back 15

caudal blocks followed by epidurals

Front 16

1943

Back 16

Lidocaine

Front 17

mean body weight

Back 17

> 17 % or 12 kg during pregnancy

Front 18

mean body weight: 1 kg

Back 18

1) uterus - 1 kg
2) amniotic fluid - 1 kg

Front 19

mean body weight: 2 kg

Back 19

1) blood volume - 2 kg
2) interstitial fluid - 2 kg

Front 20

mean body weight: 4 kg

Back 20

1) fetus/placenta - 4 kg
2) new fat and protein - 4 kg

Front 21

pulmonary change (anatomic)

Back 21

1) diaphragm elevation
2) < FRC
3) capillary engorgement affects all airways

Front 22

pulmonary change (physiologic)

Back 22

1) > O2 consumption
2) > CO2 production
3) > alveolar ventilation

Front 23

CV change (anatomic)

Back 23

1) biventricular hypertrophy
2) cardiac elevation
3) leftward rotation

Front 24

CV change (physiologic)

Back 24

> CO

Front 25

GI change (anatomic)

Back 25

1) < cardioesophageal sphincter tone
2) horizontal gastric axis

Front 26

GI change (physiologic)

Back 26

1) > volume and acidity of gastric contents
2) > intragastric pressure

Front 27

Urogenital change (anatomic)

Back 27

1) hydronephrosis
2) hydroureter
3) > bladder capacity
4) urine stasis

Front 28

urogenital change (physiologic)

Back 28

1) > renal blood flow
2) > GFR
3) frequent UTIs

Front 29

circulatory change (anatomic)

Back 29

1) aortocaval compression
2) lower body venous stasis

Front 30

circulatory change (physiologic)

Back 30

1) expand blood volume
2) greater thromboembolic risks
3) > procoagulant activity

Front 31

progenterone induces?

Back 31

tracheal and bronchial dilation

Front 32

ventilation

Back 32

1) > min. ventilation 19-50% by term
2) > RR 9%
3) > TV 28%
4) progesterone resp. stimulant
5) CO2 sensitive
6) > O2 consumption 40-60%

Front 33

oxyhemoglobin curve shifts to?

Back 33

right

Front 34

lobor:vent. data

Back 34

1) > RR 22-70
2) > TV 650-2000 ml
3) > MV 9-30 L/M
4) < PaCO2 15-20 mmHg
5) PaO2 100-108 mm Hg

Front 35

time until SAO2 falls to less than 90 %

Back 35

1) ideal wt. - 364 sec.
2) obese - 247 sec.
3) morbid obesity - 163 sec.

Front 36

maternal hyperventilation: fetal effects

Back 36

1) constriction umbilical & uterine arteries
2) fetal acidosis
3) hypocapnia
4) maternal Hb dissociation curve to the left (meta. acidosis)

Front 37

changes in blood volume and circulatory variables are a result of?

Back 37

increased metabolic demand

Front 38

CV >

Back 38

1) > blood volume
2) > plasma volume
3) > RBC volume
4) > CO
5) > stroke volume
6) > HR
7) > femoral (uterine?) venous pressure

Front 39

CV <

Back 39

1) < total peripheral resistance
2) < MAP
3) < SBP
4) < DBP

Front 40

CV: no change

Back 40

1) CVP

Front 41

blood volume

Back 41

1) nonpregnant: 4,000 ml
2) pregnancy: 5,700 ml (+40%)

Front 42

physiologic anemia of pregnancy is caused by?

Back 42

reduced blood viscosity
1) > blood volume 35-50%
2) > plasma volume 45%
3) > RBC volume ONLY 20%

Front 43

clinical implications of physiologic anemia

Back 43

1) Hb should remain > 12 g%
2) > RBC mass = > O2 demands
3) blood loss is physiologically tolerated
4) > nutrient supply to fetal unit (> iron)

Front 44

average blood loss at delivery

Back 44

1) vaginal delivery: 300-500 ml
2) C-section: 500-1000 ml

Front 45

ECG change

Back 45

1) heart to the left
2) axis on ECG to left
3) minor nonspecific ST, T, Q wave changes
4) minor arrhythmias

Front 46

2 components of the aortocaval compression phenomenon?

Back 46

1) inferior vena cava compression
2) aortoiliac obstruction

Front 47

Azygos vein/ paravertebral system

Back 47

1) alternative circulation after 24 weeks gestation
2) by inferior vena cava compression
3) compensatory increase in sympathetic tone and HR

Front 48

aortoiliac obstruction

Back 48

1) arterial side compression
2) no maernal symptoms
3) placental blood flow decreases
4) femoral flow VS brachial flow

Front 49

supine hypotensive syndrome

Back 49

1) avoid supine position
2) syndrome more exaggerated with regional anesthesia
3) lower extremity stasis
4) epidural venous engorgement
5) decreased regional doses

Front 50

blood constituents

Back 50

1) < plasma protein concentration
2) pulmonary edema
3) > leucocyte count
4) hypercoagulable state (all factors > except for 11 & 13 )
5) enhanced fibrinolysis

Front 51

vasodilation may increase the incidence of?

Back 51

accidental epidural vein puncture

Front 52

healthy parturient will tolerate up to ----ml blood loss

Back 52

1,500 ml

Front 53

oxytosin with a free water IV infusion may lead to?

Back 53

fluid overload

Front 54

high Hb level (>14) indicates low-volume state caused by?

Back 54

1) preeclampsia
2) HTN
3) inappropriate diuretics

Front 55

maternal BP of < 90 to 95 mm Hg during regional block should be of concern because?

Back 55

it may be associated with a proportional decrease in uterine blood flow

Front 56

always avoid aortocaval compression because?

Back 56

70-80% of supine parturients with a T4 sympathectomy develop significant hypotension

Front 57

physiologic and anatomic changes in GI system start when?

Back 57

mid-first trimester

Front 58

GI change

Back 58

1) delayed gastric emptying
2) decreased lower esophageal sphincter tone
3) prolonged bowel transit time
4) increased gastric acid secretion
5) increased pepsin secretion

Front 59

treat all pregnant pts as full stomach from?

Back 59

8 weeks gestation to 6 weeks post partum

Front 60

risk factors for aspiration in pregnancy

Back 60

1) compromised LES function
2) higher intragastric pressure
3) anatomic displacement of stomach
4) decreased gastric emptying in labor
5) potential for emergency C/S
6) potential for diff. intubation
7) lower pH from placental GASTRIN

Front 61

agents for aspiration prophylaxis

Back 61

1) Ranitidine (Zantac)
2) Metoclopromide (Reglan)
3) Oral sodium citrate, 0.3M (Bicitra)

Front 62

airway management in the pregnant pts

Back 62

1) RSI with cricoid pressure
2) ETT intubation beyond 8-12 wks and up to 6 wks post partum
3) avoid nasal intubations
4) gastric suctioning prior to emergence
5) awake extubation
6) decrease size of ETT

Front 63

ureters and renal pelvis dilate from?

Back 63

week 12 - mechanical

Front 64

renal system

Back 64

1) ureters and renal pelvis dilation
2) RBF and GFR increase 60%
3) tubular reabsorption of water and electrolytes
4) renal threshold for glucose decreases

Front 65

renal implications

Back 65

1) > UTIs
2) glycosuria is common
3) > aldosterone levels = > total body Na and water
4) normal lab studies may still imply renal problems

Front 66

renal problems are usually encountered with?

Back 66

pre-eclampsia

Front 67

proteinuria occures due to?

Back 67

glomerular damage

Front 68

oliguria may be a consequence of?

Back 68

arteriolar damage and spasm which may lead to acute tubular necrosis

Front 69

hepatic system

Back 69

1) minor > in SGOT and LDH
2) blood flow unchanged
3) < plasma cholinesterase levels
4) > coagulation factors

Front 70

clinical manifestations: liver

Back 70

1) hypercoagulability
2) hepatic protein increase but diluted in increase plasma
3) prolongation of Succs and Miva.

Front 71

neural sensitivity to local anesthetics increase or decrease?

Back 71

increase: due to progestrerone

Front 72

engorgement of epidural veins decreases?

Back 72

epidural and subarachnoid spaces

Front 73

MAC requirement?

Back 73

decreases 25-40 %

Front 74

progesterone production

Back 74

1) corpus luterum (till 8-9 weeks)
2) placental (after 8-9 weeks)

Front 75

epidural and spinal dose requirement?

Back 75

decrease 20-30 %

Front 76

risk for CNS toxicity?

Back 76

increase during pregnancy

Front 77

uterine vasculature

Back 77

1) > uterine wt.
2) > uterine blood flow 700 ml/min
3) uterine vasculature is not auto-regulated

Front 78

uterine blood flow (UBF)

Back 78

UBF = UAP-UVP/uterine vascular resistance

Front 79

factors causing decreased uterine blood flow

Back 79

1) uterine contractions
2) hypertonus
3) Hypotension
4) hypertension
5) vasoconstriction (endogenous)
6) vosoconstriction (exogenous) - most sympathomimetics (alpha-adrenergic) - exception Ephedrine (beta)

Front 80

Ephedrine

Back 80

1) stimulates nitric oxide synthase (NOS) in uterine arterial endothelium
2) thereby counterbalancing its direct vasoconstriction
3) this does not occur in other peripheral vessels, ephedrine increases BP while sparing the uterine circulation

Front 81

placenta

Back 81

1) a complex organ
2) wt: 500g
3) disc shaped of 20 cm
4) 3cm in thickness

Front 82

fuctions of placenta

Back 82

1) produces hormones to sustain pregnancy
2) protects fetus from the maternal immune system
3) allows for active and passive transport of nutrients and metabolites

Front 83

mechanisms of exchange

Back 83

1) diffusion (glucose)
2) active transport (AAs)
3) bulk flow (water)
4) pinocytosis (immune globulins)
5) breaks

Front 84

clinical factors affecting placental drug transfer and drug effects on the fetus

Back 84

1) physiochemical properties of the drug
2) rate at which the drug crosses the placenta and amount of drug reaching the fetus
3) the duration of exposure to the drug
4) distribution characteristics in different fetal tissues
5) stage of fetal deve. at time of exposure
6) the effects of drugs used in combination

Front 85

factors in placental transfer

Back 85

1) lipid solubility
2) degree of ionization
3) molecular wt
4) concentration gradient
5) surface area and thickness of membrane
6) protein binding
7) maternal metabolism

Front 86

fetal compartment

Back 86

1) [ ] of free drug
2) time of injection vs uterine contraction
3) fetal circulation - liver
4) fetal pH
5) protein binding
6) fetal metabolism

Front 87

factors affecting uptake and distribution and metabolism: 1) maternal drug concentration

Back 87

maternal drug concentration
1) site of adm
2) total dose (presence of Epi)
3) maternal protein binding
4) maternal clearance and metabolism
5) maternal blood pH and pKa of drug

Front 88

factors affecting uptake and distribution and metabolism: 2) pacental transfer

Back 88

1) diffusion constant
2) placental factors (area, distance, metabolism)

Front 89

factors affecting uptake and distribution and metabolism: 3) fetal drug concentration

Back 89

1) fetal circulation
2) fetal pH
3) fetal protein binding
4) fetal metabolism (hepatic)
5) fetal drug elimination (renal)
6) tissue binding

Front 90

transfer of drugs

Back 90

1) inhalational agents
2) induction agents
3) opioids
4) muscle relaxants
5) anticholinergic agents
6) anticholinesterase agents
7) antihypertensive agents
8) vasopressors
9) anticoagulants