Anesthesia: Pregnancy – Flashcards
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What are the pregnancy effects on MAC?
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decreases 40%
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Increase or decrease during pregnancy: O2 consumption?
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increases
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Increase or decrease during pregnancy: FRC?
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decreases
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Increase or decrease during pregnancy: minute ventilation?
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increases
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Increase or decrease during pregnancy: tidal volume?
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increases
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Increase or decrease during pregnancy: respiratory rate?
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increases
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Increase or decrease during pregnancy: PaO2?
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increases
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Increase or decrease during pregnancy: PaCO2?
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decreases
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Increase or decrease during pregnancy: bicarb?
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decreases
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Increase or decrease during pregnancy: 2,3 DPG?
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increases
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Increase or decrease during pregnancy: blood volume?
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increases
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Increase or decrease during pregnancy: plasma volume?
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increases
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Increase or decrease during pregnancy: cardiac output?
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increases
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Increase or decrease during pregnancy: Heart Rate?
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increases
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Increase or decrease during pregnancy: SAP?
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decreases
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Increase or decrease during pregnancy: DAP?
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decreases
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Increase or decrease during pregnancy: hemoglobin?
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decreases
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Increase or decrease during pregnancy: platelets?
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decreases
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Increase or decrease during pregnancy: clotting factors?
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increases
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Increase or decrease during pregnancy: GFR?
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increases
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Increase or decrease during pregnancy: epidural blood volume?
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increased
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What do you do to the anesthesia/pregnancy epidural dose?
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decrease by 1/3
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What is the cause of rapid O2 desaturation during apnea (2)?
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increased O2 consumption + decreased FRC
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What does hyperventilation do to the Hb/O2 curve?
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shifts to the left
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What does 2,3 DPG do to the Hb/O2 curve?
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offsets hyperventilation, right shift
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What does closing volume > FRC result in (2)?
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atelectasis and hypoxemia
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What causes an increase in inhalant uptake rate in pregnancy anesthesia (2)?
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decreased FRC + increase minute ventilation
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When is CO reduced in pregnancy anesthesia?
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dorsal recumbency
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How do you fix decreased CO due to dorsal recumbency?
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give bolus of ephedrine
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What does vena cava compression cause in pregnancy anesthesia?
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vomiting
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When is the aorta compressed in pregnancy anesthesia?
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dorsal recumbencey
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What is the aortocaval compression in pregnancy anesthesia due to (2)?
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vc and aortic compression
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How does aortocaval compression lead to fetal asphyxia (pathogenesis, 5 steps)?
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vc, systemic hypertension, increase in uterine venous pressure, uterine arterial hypoperfusion, ACC + anesthetics
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Which 2 drugs have issues due to a decrease in plasma cholinesterases?
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succinylcholine, remifentanil
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What are the GIT effects of pregnancy?
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delayed gastric emptying, increased HCL/enzymes, decreased LES
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What is the anesthetic protocol of pregnancy anesthesia (3)?
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metoclopramide, famotidine, +/- anticholinergics
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Why do you give metoclopramide in pregnancy anesthesia?
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decreased regurg
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Why do you give famotidine in pregnancy anesthesia?
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decreases acidity
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What is the + of anticholinergics in pregnancy anesthesia?
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increases LES tone
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What drug do anticholinergics interfere with in pregnancy anesthesia?
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metoclopramide
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What is uterine blood flow directly related to?
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systemic perfusion
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What is uterine blood flow indirectly related to?
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vascular resistance
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What does anesthesia do to uterine blood flow?
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decreases
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Why do uterine contractions + uterine hypertonia lead to decreased uterine blood flow?
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increased vascular resistance
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What are 3 causes of placental hypotension?
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hypovolemia, anesthetic induced CV depression, SNS blockade from epidural
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How is the placenta permeable to anesthetic drugs?
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simple diffusion
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What are the diffusion determinants (4)?
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molecular weight, low protein binding, high lipid solubility, poor ionization
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Why do muscle relaxants not cross placental barrier so well (2)?
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highly ionized, low lipid solubility
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What % of UVB passes through the fetal liver first?
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85%
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What is fetal circulation?
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UVB enters VC and mixes with drug-free blood from lower extremities and pelvic viscera
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Why is glycopyrrolate used in pregnancy anesthesia (2)?
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does not cross BBB/placenta, increases gastric pH
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Should you typically use tranquilizers/sedatives in pregnancy anesthesia?
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no
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What does ace lead to in pregnancy anesthesia?
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maternal and fetal depression
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What do benzodiazepines in the mom cause in the neonate (2)? Are they reversible?
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neonatal lethargy, apnea, reversible
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In which species do you use a-2 agonists in pregnancy anesthesia?
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horses only (because you have to use something)
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What do opioids cause in pregnancy anesthesia (2)?
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neonatal respiratory and neurobehavioral depression
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When is the fetal elimination of opioids?
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2-6 days
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Are opioids reversible in neonates?
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yes
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How do you reverse opioids in neonates?
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naloxone
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What do you watch for when you reverse opioids in neonates?
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renarcotization
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What induction agent rapidly crosses the placenta, and is rapidly cleared from neonatal circulation, but is not used in pregnancy anesthesia?
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thiopental
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Why is etomidate not used in pregnancy anesthesia?
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hemolysis or seizures in neonate
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What is the metabolism of propofol?
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hepatic and extra-hepatic metabolism
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Why is Ketamine usually used only in large animal pregnancy anesthesia?
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mortality due to apena in puppies
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What are the 4 NMB used in pregnancy anesthesia?
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ATRACURIUM, succinylcholine, mivacurium, guaifenesin
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Why is GGE used as a skeletal muscle relaxant in LA pregnancy anesthesia?
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minimal transplacental transfer
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What can an epidural cause in pregnancy anesthesia?
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SNS blockade
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delete
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yes
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What do deep levels of inhalants cause in pregnancy anesthesia (2)?
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hypotension, fetal acidosis
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What are the + of GA for c-sections (4)?
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induction, reliability, control, immobile patients
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What are the - of GA for c-sections (3)?
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neonatal depression, increased SNS tone, aspiration
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What is the leadsing cause of death in c-section women?
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aspiration post-induction before intubation
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How many minutes after chorioallantoic membrane rupture do few fetuses survive?
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40 mins
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How many minutes after chorioallantoic membrane rupture do no fetuses survive?
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90 mins
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What is the premed used more commonly in mare sedation for c-sections?
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xylazine
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Why is detomidine used in mare sedation for c-sections?
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less increase in uterine tone
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What are the 2 induction drugs for mare c-sections?
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GGE, bolus of ketamine (low dose)
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What does hypocapnia lead to in pregnancy?
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decreased uterine BF
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What is the protocol for newborn care if the mom underwent anesthesia?
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ventilation, doxapram (treats breathing issues), dextrose
