Anesthesia3- Obstetrics

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  1. 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
  2. Uteroplacental perfusion is ___________ proportional to uterine vascular resistance; __(5)__ increase uterine vascular resistance.
    • inversely
    • pain, fear, excitement, shock, and hyperventilation
  3. Parameters that increase with pregnancy. (7)
    • HR
    • CO
    • blood volume
    • GFR/ RBF
    • O2 consumption
    • minute ventilation
    • gastric emptying time (prolonged)
  4. Parameters that decrease with pregnancy. (6)
    • PCV
    • hemoglobin
    • plasma protein
    • COP
    • FRC (functional reserve capacity)
    • gastric pH
  5. What is the ASA physical status of a C-section anesthesia patient?
    I or II (I if elective C-section)
  6. What anesthetic concerns do we have for pregnant patients? (9)
    • anemia
    • hypoglycemia
    • hypocalcemia
    • arrhythmias
    • hypotension
    • hypoxemia
    • pain
    • regurg/vomiting
    • drug metabolism/ transfer
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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'
  12. Why might ace not be a great option for pregnancy pre-med? (2)
    hypotension, not reversible
  13. 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]
  14. Why might opioids not be a great option for pregnancy pre-med? (2)
    • CV depression, resp depression
    • [pro is that they are reversible]
  15. What are the preferred drugs to induce a pregnant patient?
    • ketamine/midazolam (small animal)
    • ketamine/ guiafenesin (large animal)
  16. MAC _________ during pregnancy.
    decreases
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. What are potential complications in anesthetized pregnant patients? How is each treated/ managed? (2)
    • hypotension- fluids, ephedrine/ dopamine/ dobutamine
    • bradycardia- atropine
  23. 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)
  24. Describe pain management post-c-section.
    • probably opioids
    • NSAIDs have not been studied in pregnant/ lactating animals
  25. What are signs of pyometra?
    • septicemia/ endotoxemia
    • lethargy
    • anorexia
    • vomiting
    • PU/PD (dogs)
    • abdominal pain
    • temperature
    • blood work- neutrophilia, left shift, nonregen anemia, hyperproteinemia, azotemia, increase ALT/ ALP
  26. How are pyometra patients treated pre-op?
    • depends on how sick the patient is
    • correct dehydration
    • optimize BP

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Author:
Mawad
ID:
325953
Filename:
Anesthesia3- Obstetrics
Updated:
2016-11-22 16:49:08
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vetmed anesthesia3
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vetmed anesthesia3
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