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How would your PE parameters be different in a pregnant patient?
- increased metabolic demand of the fetus(es) leads to...
- increased blood flow to the uterus, which is compensated for by increased blood volume and increased SV and CO
- increased HR
- decreased BP (result of increased progesterone)
- increased chamber size of the heart
- increased cardiac mass, atrial stretching--> predisposed to arrhythmias
- increased minute ventilation and RR
Uteroplacental perfusion is ___________ proportional to uterine vascular resistance; __(5)__ increase uterine vascular resistance.
- pain, fear, excitement, shock, and hyperventilation
Parameters that increase with pregnancy. (7)
- blood volume
- GFR/ RBF
- O2 consumption
- minute ventilation
- gastric emptying time (prolonged)
Parameters that decrease with pregnancy. (6)
- plasma protein
- FRC (functional reserve capacity)
- gastric pH
What is the ASA physical status of a C-section anesthesia patient?
I or II (I if elective C-section)
What anesthetic concerns do we have for pregnant patients? (9)
- drug metabolism/ transfer
What are GI changes in pregnancy? (4)
- decreased LES tone (effect of progesterone)
- increased intragastric pressure d/t enlarged uterus
- increased gastric acid production (increased gastrin production by fetus and placenta)
- prolonged gastric emptying
Anesthetic considerations for C-sections. (5)
- minimize the time from drug administration to delivery of fetus
- minimize anesthesia and surgery time
- prevent maternal hypoxemia or hypotension
- minimize post-operative maternal depression (get them out of the hospital ASAP)
- nether induce nor prevent uterine contractions
What are factors influencing drug transfer across the placenta? (2)
- diffusion properties of drugs: lipid soluble, small molecules, large doses, and decreased protein binding all increase transfer
- maternal and fetal drug concs: avoid bolus doses of drugs, continuous infusion
What pre-med drugs are most often used in pregnancy?
- Large animals: alpha-2 [xylazine b/c it is the shortest acting]
- NO PRE-MED IN SMALL ANIMALS
Why might alpha-2's not be a great option for pregnancy pre-med? (3)
- decreased HR, respiratory depression, sedation
- [a pro is that they are reversible'
Why might ace not be a great option for pregnancy pre-med? (2)
hypotension, not reversible
Why might benzos not be a great option for pregnancy pre-med?
- very little sedation in healthy adults, profound sedation in neonates
- [pros are that they are reversible and have minimal CVS/ resp effects]
Why might opioids not be a great option for pregnancy pre-med? (2)
- CV depression, resp depression
- [pro is that they are reversible]
What are the preferred drugs to induce a pregnant patient?
- ketamine/midazolam (small animal)
- ketamine/ guiafenesin (large animal)
MAC _________ during pregnancy.
Describe how pain is altered during pregnancy.
- progesterone increases during pregnancy
- pregnanolone and pregnanedione 9progesterone metabolites) possess potent anesthetic, muscle relaxant, and analgesic properties
- less pain than a non-preg animal
What is the protocol for small animal C-section at Ohio State?
- no pre-med
- place IV catheter
- pre-oxygenate patient
- line block
- induce with propofol
- isoflurane or sevo
- once puppies are out, opioid IV
With pregnancy there is a increased blood volume and increased shunting of abdominal blood to epidural tissues; this leads to _____________ and increased ____________.
The clinical implications of this are...
- distension of lumbar epidural venous plexus; epidural fat stores
- decreased potential volume of epidural space--> reduce dose of epidural drugs
What is the protocol for equine C-section at ohio state?
- place IV cath
- minimal alpha-2 pre-med (none if possible)
- pre-oxygenate if possible
- induce with guiafenesin and ketamine
- isoflurane or sevoflurane
What is the Apgar Score?
- utilized t determine neonatal well-being and resuscitation; score of 10 is perfect
- A= appearance
- P= pulse rate
- G= grimace (reflex irritability)
- A= activity
- R= respiratory effort
What are potential complications in anesthetized pregnant patients? How is each treated/ managed? (2)
- hypotension- fluids, ephedrine/ dopamine/ dobutamine
- bradycardia- atropine
What are perioperative risk factors for puppies delivered by C-section? (5)
- brachycephalic dam
- emergency sx- dystocia
- vaginal delivery of some of the litter prior to sx
- presence of deformed pups in the litter
- anesthetic drug choices (xylazine)
Describe pain management post-c-section.
- probably opioids
- NSAIDs have not been studied in pregnant/ lactating animals
What are signs of pyometra?
- septicemia/ endotoxemia
- PU/PD (dogs)
- abdominal pain
- blood work- neutrophilia, left shift, nonregen anemia, hyperproteinemia, azotemia, increase ALT/ ALP
How are pyometra patients treated pre-op?
- depends on how sick the patient is
- correct dehydration
- optimize BP