Pregnancy and C Section

Question 1

How much does Cardiac output increase during pregnancy?

Answer 1

30-50%

Question 2

What happens during pregnancy for the cardiovascular system?

Answer 2

Plasma volume increases
RBC increase
Decreased PCV
Decreased Cardiac reserve 
Aortacaval compression

Question 3

Aortacaval compression

Answer 3

when a pregnant animal is put on their back the weight of the fetus and uterus presses on the great vessels causing decreased venous return

Question 4

What happens to the Respiratory system of a pregnant animal?

Answer 4

Increased O2 consumption 
Decreased PaCO2 (hyperventiation)
Decreased functional residual capacity 
Increased abdominal volume 
Decreased pulmonary resistance

Question 5

How does progesterone affect the pulmonary resistance?

Answer 5

relaxation of bronchial smooth muscles

Question 6

What happens to the GI system during pregnancy?

Answer 6

Delayed gastric emptying
Decreased gastric motility
Increased progesterone
Increased gastric acidity
Decreased lower esophageal sphincter tone
Increased risk of regurgitation/aspiration

Question 7

What happens to the Renal system during pregnancy?

Answer 7

Glomerular filtration rate increases in parallel with cardiac output
Decreased BUN and creat
No change in electrolytes

Question 8

What changes pharmacologically with pregnant animals?

Answer 8

Decreased MAC

Increased sensitivity to local anesthetics

Question 9

What is the ideal drug protocol for pregnant animals?

Answer 9

Maximize O2 delivery to fetus
Maintain CO and oxygenation
Avoid uterine contraction or uterine vasoconstriction
Minimize drug effects on fetus

Question 10

What drug causes fetal depression?

Answer 10

Benzodiazepines

Question 11

What drugs cause decreased cardiac output in a pregnant animal?

Answer 11

Alpha-2 agonists

Question 12

What drug is long acting, not reversible, and fetal depression in pregnant animals?

Answer 12

Acepromazine

Question 13

What do alpha 2 agonists cause in large animals?

Answer 13

Increased uterine pressure

Decreased O2 delivery to fetus

Question 14

What is the difference between detomidine and xylazine in pregnant animals?

Answer 14

Detomidine may cause less increase in uterine tone compared to xylazine

Question 15

What does xylazine cause in ruminants?

Answer 15

abortion

Question 16

What drug is used in induction of small pregnant animals?

Answer 16

Propofol

Question 17

What induction agent can be used safely in large animal but is controversial in small animal pregnancy?

Answer 17

Ketamine

Question 18

What does pregnancy do to dose requirement of Local anesthetics?

Answer 18

Decreases dose requirement

Question 19

What do you do for anesthesia during pregnancy?

Answer 19

Maintain fetal O2 delivery by maintaining maternal BP and oxygenation

Question 20

What do you want to avoid with anesthesia during pregnancy?

Answer 20

Uterine contraction

Uterine vasoconstriction

Question 21

When is Anesthesia required?

Answer 21

Controlled vaginal delivery

C-section

Question 22

Small Animal Pregnant Anesthesia Technique

Answer 22

Pre-oxygenate 5 mins
\+/- short acting opioid
Propofol or alfaxalone induction 
Rapid control of airway 
Iso/Sevo/Des in O2 maintenance
Consider Local anesthesia in conjunction with GA
Careful positioning

Question 23

What are the complications associated with Epidurals in pregnant animals?

Answer 23

INcreased volume of epidural blood vessels
Increased epidural fat
Increase the cranial spread of drug

Question 24

What should you do for epidural drug volume in a pregnant animal?

Answer 24

1/3 volume decrease

Question 25

Small Animal neonatal care

Answer 25

Clear oropharynx
Clamp and cut umbilicus 
Towel dry 
Reverse opioid sublingually 
Heat support 
\+/- O2 support

Question 26

What does Large animal GA require?

Answer 26

High peak inspiratory pressures or positive end-expiratory pressure