Non-OB sx for the OB pt ppt Flashcards Preview

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Flashcards in Non-OB sx for the OB pt ppt Deck (42)
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1

perioperative risk include what

fetal loss
fetal asphyxia
premature labor
premature ROM
difficult airway
thromboembolism
teratogens

2

_____ - _____% of pregnant women undrgo non-OB sx

0.5-2%

3

trauma complicates ___-___% of surgeries

6-7

4

the nonOB gets how many anesthetics a year?

80,000

5

Cerclage is usually done b/t what age of gestation

12-26 wks

6

contraindications to cerclage

active labor
ROM
dilation >4 cm
intrauterine infection
fetal abnormalities
abrupto placenta

7

risk with ceclage

PROM
chorioaminonitis
cervical laceration

8

*****************
what is important to remember about Cardiac and valve sx

CPB is safe
**** Circ arr not rec *** (don't stop all circulation)

9

a rise any any lab will be alarming but he said one lab inparticular is ALWAYS alarming in prego's what is it

creatinine

10

what does progesterone do?

reduce pressure at LES
increase gastric acidity
decreased GB motility
decrease SVR
resp alkolosis
decreased MAC

11

are IV anesthetics Bad for uterine blood flow?

no, there is a small reduction in uterine flow that is dose dependent! only drops if you drop moms pressure

12

what do VAAs do to uterine blood flow

decrease BP=> lower UBF
Mild changes < 1 MAC
UTERINE RELAXATION

13

do local anesthetics cause a problem in the uterus?

no, unless you have very high levels

14

drugs crossing the placenta depend on what?

MW- large drugs don;t cross
Charge- non-ionized cross more than ionized
Protein binding- non protein bound cross easier
lipophilic- higher lipophilicity is advantageous

15

state 5 drugs that we use that DON'T cross placenta?

Sux's
non-depol
Glycopyrrolate
Insulin
Heparin

16

State 9 drugs that DO cross the placenta that we use?

VAA's
Opiates
Benzo's
Propofol
Thiopental
LA
Atropine
BB
Ephedrin
Phenylephrine

17

what is ion trapping?

fetal blood is slightly more acidic than mothers
a distressed fetus becomes more acidic
weakly basic drugs (LA and Opiates) can cross the placenta
then in acidodic enviroment become ionized and can have trouble crossing back into mothers circulation
this can cause a build up of drug in the fetus

18

when is the best time for surgeries?

2nd trimester

19

elective sx usually is done when?

> 6 wks post partum

20

are VAA's teratogens? and why or why not?

yes (potentially)
b/c unethical to test in prego

21

LA, VAAs, induction agents, opioids, and MR are all safe for the fetus when?

in clicical circumstances

22

Name14 teratogenic drugs?

ACEi's
ETOH
COCAINE
COUMADIN
androgens
antithyroid
chemo
Diethystibesterol
Lead
Lithium
Mercury
Phenytoin
Streptomycin
Thalidomide
Trimethadione
Valproic acid

23

which teratogenic drug was given to girls to prevent excess hight

diesthylstilbestrol

24

what was big about Thalidomide and it's teratoginicity

it was OTC in germany and used for morning sickness
gave kids phocomelia (flippers)

25

Pregnancy cat A

no risk identified in well controlled studies

26

Pregnancy Cat B

no adequate and well controlled studies in PREGNANT WOMEN, however animal studies have revealed no fetus harm

27

Pregnancy Cat C

no adequate and well controlled studies in PREGNANT WOMEN, however an adverse effect has been shown in animals
or
Adequate and well controlled studies in PREGNANT WOMENhave failed to show a risk to the fetus; but an adverse effect has been shown in an animal

28

Pregnancy Cat D

a risk to the fetus has been demonstrated in adequate, well controlled or observational studies in pregnant women; however the benefits of therapy may outweigh the potential risk

29

Pregnancy cat X

positive evidence of fetal abnormalities has been demonstrated in adequate well controlled studies or observational studies in pregnant woman or animals, the drug is contraindicated in women who are or may became pregnant

30

what are the effects of N2O in prego

affects B12 synthesis
increases adrenergic tone
may vosoconstrict uteine vessels (animals)