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
Q

perioperative risk include what

A
fetal loss
fetal asphyxia
premature labor
premature ROM
difficult airway
thromboembolism
teratogens
2
Q

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

A

0.5-2%

3
Q

trauma complicates ___-___% of surgeries

A

6-7

4
Q

the nonOB gets how many anesthetics a year?

A

80,000

5
Q

Cerclage is usually done b/t what age of gestation

A

12-26 wks

6
Q

contraindications to cerclage

A
active labor
ROM
dilation >4 cm
intrauterine infection
fetal abnormalities
abrupto placenta
7
Q

risk with ceclage

A

PROM
chorioaminonitis
cervical laceration

8
Q

what is important to remember about Cardiac and valve sx

A

CPB is safe

** Circ arr not rec *** (don’t stop all circulation)

9
Q

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

A

creatinine

10
Q

what does progesterone do?

A
reduce pressure at LES
increase gastric acidity
decreased GB motility
decrease SVR
resp alkolosis
decreased MAC
11
Q

are IV anesthetics Bad for uterine blood flow?

A

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

12
Q

what do VAAs do to uterine blood flow

A

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

13
Q

do local anesthetics cause a problem in the uterus?

A

no, unless you have very high levels

14
Q

drugs crossing the placenta depend on what?

A

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
Q

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

A
Sux's
non-depol
Glycopyrrolate
Insulin
Heparin
16
Q

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

A
VAA's
Opiates
Benzo's
Propofol
Thiopental
LA
Atropine
BB
Ephedrin
Phenylephrine
17
Q

what is ion trapping?

A

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
Q

when is the best time for surgeries?

A

2nd trimester

19
Q

elective sx usually is done when?

A

> 6 wks post partum

20
Q

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

A

yes (potentially)

b/c unethical to test in prego

21
Q

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

A

in clicical circumstances

22
Q

Name14 teratogenic drugs?

A
ACEi's
ETOH
COCAINE
COUMADIN
androgens
antithyroid
chemo
Diethystibesterol
Lead
Lithium
Mercury
Phenytoin
Streptomycin
Thalidomide
Trimethadione
Valproic acid
23
Q

which teratogenic drug was given to girls to prevent excess hight

A

diesthylstilbestrol

24
Q

what was big about Thalidomide and it’s teratoginicity

A

it was OTC in germany and used for morning sickness

gave kids phocomelia (flippers)

25
Q

Pregnancy cat A

A

no risk identified in well controlled studies

26
Q

Pregnancy Cat B

A

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

27
Q

Pregnancy Cat C

A

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
Q

Pregnancy Cat D

A

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
Q

Pregnancy cat X

A

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
Q

what are the effects of N2O in prego

A

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

31
Q

you want to deliver the fetus with in how long following mothers cardiac arrest?

A

5 min

32
Q

is direct fetal death common?

A

no usually results from maternal shock

placental abruption

33
Q

anesthethic management for prego
main goal

A
maintain uterine perfusion
\+
adequate maternal oxygenation
=
preservation of fetal O2
34
Q

when should non elective surgeries be performed?

A

2nd trimester

35
Q

Intraop fetal monitoring

it is possiable at what weeks?

A

18 weeks gestation

36
Q

Intraop fetal monitoring

it is only advised when? and what weeks is that?

A

if the fetus is considered viable

22-24 weeks

37
Q

Intraop fetal monitoring

if the fetus is not viable what do you wanna do pre and post op

A

check fetal tones

38
Q

Intraop fetal monitoring

who must monitor the fetus

A

trained personal OB RN

39
Q

who’s decision is it to monitor fetus intraop

A

OB not anesthesia

40
Q

complications of tocylitics?

A

pulm edema
arrythmias
hypokalemia

41
Q

Virchow’s triad

A

hypercoaguability
stasis
endothelial injury

42
Q

what is required and why during fetal surgery

A

high dose inhalation agents

to anesthetizing mother, fetus, and to provide uterine relaxation