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Anesthesia Exam 3 > Anesthesia for Pregnant and Neonate > Flashcards

Anesthesia for Pregnant and Neonate Flashcards

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1
Q

special considerations for pregnant patient

A
  • maternal safety: volume, blood pressure, etc
  • delivery = need to think about effect on neonate: may have to deal with drugs that were given to mother
  • unrelated procedures (ie not delivering)- just make sure O2 delivery to uterus and fetus is rigth
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2
Q

pregnancy is a state of increased/decreased metabolic needs

A

increased = lots of physiological changes happen

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3
Q

what CV changes happen with pregnancy?

A
  • increased Blood volume: more tissue to support!
  • most of the increase in blood volume is plasma!! can create a relative anemia bc the RBC are diluted
  • might see PCV of 30-35% and that is normal
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4
Q

most of the increase in blood volume with pregnancy is ________

A

plasma
can create a relative anemia bc the RBC are diluted
- might see PCV of 30-35% and that is normal

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5
Q

why might a pregnant patient have a PCV of 30-35%?

A
  • increased Blood volume: more tissue to support!
  • most of the increase in blood volume is plasma!! can create a relative anemia bc the RBC are diluted
  • might see PCV of 30-35% and that is normal
  • related to the # of fetuses. more puppies = lower PCV
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6
Q

what happens to CO with pregnancy?

A

40% increase: working harder to perfuse more
- increased STROKE VOLUME primarily. HR increases a lil
- there is a DECREASE in systemic vascular resistance, so BP remains the same

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7
Q

in pregnancy, CO increases by 40%. is this increase due to increased stroke volume or increased heart rate?

A

both increase, but primarily is due to increased stroke volume

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8
Q

does systemic vascular resistance increase or decrease with pregnancy?

A

it DECREASES. thus there are no changes in MAP because CO is increasing
BP = CO x SVR

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9
Q

BP = __________ x ___________

A

CO x SVR

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10
Q

T/F: blood pressure increases drastically in pregnancy

A

false: CO is increasing and systemic vascular resistance is decreasing, therefore there is no change
BP = CO x SVR

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11
Q

in pregnant patient, cardiac compensatory reflexes may be

A

delayed. struggle a little bit more, and need to be aggressive in treating CV cahnges

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12
Q

uteroplacental perfusion is ________ dependent

A

pressure dependent
hypotension = decreased fetal perfusion
ALWAYS MONITOR BP

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13
Q

what should you always monitor in a pregnant patient?

A

blood pressure!!

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14
Q

a 4 year old golden presents for dystocia with 12 puppies. bloodwork shows PCV of 47 and a TP of 7. what is your assessment?

A

abnormal: likely suspicious. they are within normal ranges
- place catheter, give fluids before induction bc likely to become hypotension after induction
- likely is dehydrated if pt has been having dystocia for a while
need to be proactive and correct

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15
Q

what respiratory changes happen with a pregnant patient?

A
  • pregnant uterus displaces diagphrag: lungs cannot expand as much
  • total lung capacity decreases
  • FUNCTIONAL RESIDUAL CAPACITY DECREASES: what is left in lungs after a normal breath
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16
Q

do TLC and FRC increase or decrase with pregnant

A

decrease

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17
Q

what is FRC

A

functional residual capacity
what is left in lungs after a normal breath

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18
Q

oxygen consumption increases by 20% in pregnancy. thus what happens to ventilation, TV, RR?

A

alveolar ventilation incraess 50%
TV: increases 40%
RR increases 10%

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19
Q

why does ventilation, TV and RR increase in pregnant patients?

A

progesterone! make body more susceptible to CO2, so trying to maintain a lower CO2 so resp rate and ventilation increases

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20
Q

pregnant patients have decreased FRC, meaning they are more likely to become ______ faster

A

hypoxemia. why a pregnant patient should be pre oxygenated 3-5 mins before hand = there is less volume. want to fill with 100% O2
- rapid desaturation can occur (apnea)

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21
Q

pregnant patients should always be _______ before induction

A

pre-oxygenated bc their FRC is less

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22
Q

CNS changges in preg patient

A
  • anesthetic requirement decreases
  • bc progesterone affects GABA modulatory effects and hormonal influence on pain, but still keep on pain meds
  • this increases sensitivity of anesthetics, so need to titrate to effect!!
  • increased overdose risk
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23
Q

during propofol induction to induce anesthesia in preg dog, the SpO2 drops to 96%. why did this happen?

A
  • more sensitive to drug
  • propofol causes apnea takes 90 seconds from vein to brain. often is given too fast
  • decreased FRC: patient became hypoxemic very quickly
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24
Q

how can apnea and hypoxemia be prevented when inducing anesthesia in a pregnant drug?

A
  • pre oxygenate
  • go slowly- titrate drug slowly
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25
GI changes in pregnant patients
- GI motility DECREASES - delayed gastric emptying - decreased esophageal sphincter tone = easier to regurgitate/reflux even tho fasted, might have full stomach!!
26
why are pregnant patients at a higher risk of regurgitation/aspiration?
decreased esophageal sphincter tone = easier to regurgitate/reflux even tho fasted, might have full stomach!! need rapid induction/protection of airway
27
fetal physiology with drugs
- if drugs cross BBB, they cross the placenta - fetal hepatic enzymes are not fully developed: drugs take longer to clear, feti might be more depressed - increased duration of drugs (liver metabolism)
28
T/F: fetal hemoglobin has a higher affinity for oxygen
true; see a left shift. fetal blood supply can saturate more even with low PaO2
29
fetal blood supply
- fetal Hgb has higher affinity - can saturate more with a lower PaO2 = good thing - fetal hemoglobin is more efficient at being able to bind to O2 even at a low saturation environment - blood coming to placenta is coming in at a lower PaO2, so fetal Hgb being efficient at saturating themselves is a very good adaptation!!
30
fetal circulation
- blood goes to the liver first - metabolism not great, but there is first pass. also combines with blood coming from vena cava, so there is some dilution effect =minimizes exposure of brain and heart to levels of drug -
31
where does blood first go in the fetus
liver
32
what drug protective mechanisms do feti have when dealing with drugs?
blood goes to the liver first - metabolism not great, but there is first pass. also combines with blood coming from vena cava, so there is some dilution effect =minimizes exposure of brain and heart to levels of drug
33
correcting deficits in circulating volume is especially important in what cases
dystocias: especially Ca2+ can have issues, glucose, hypovolemic, etc. need to correct electrolytes
34
why is it important to preoxygenate pregnant patients?
prevent rapid desaturation and hypoxemia rapid induction and secure airway too!
35
T/F: pregnant animals need less drug doses
true: want to minimize. care not to overdose!! decreased anesthetic requirement
36
inhaled anesthetics in pregnant patients
rapid IA induction/changes in depth because of decreased FRC = less dilution, so changes with inhaled anesthetics happen quickly
37
how to minimize pregnant anesthesia time
animal clipped and surgeon ready to go but want to wait 15 mins after induction = allows mom to metabolize induction (ex propofol) so that puppies are coming off mostly from inhalant by the time the surgeon cuts
38
what ratio for neonates from c section
1:1 = need 1 person for every puppy
39
how to maintain mom's blood pressure during pregnancy
- abdominal pressure getting removed very fast! become hypotensive - decrease anesthetic depth - fluids - inotropes - blood pressure often drops!
40
blood pressure often _______ when puppies come out
drops
41
premedication with pregnant patients?
controversial: many benefits, but only downside is that whatever is given to mother gets given to neonates. so it depends if stressed + preg = will premed. endogenous catecholamines aren't good for uterus either - will you give ace? no! cannot reverse, and lasts a long time - will you give alpha 2s? no, decreases CO a lot
42
ace and alpha 2s to pregnant patient?
no! - will you give ace? no! cannot reverse, and lasts a long time - will you give alpha 2s? no, decreases CO a lot
43
if you are going to premed a pregnant animal, what do you do
opioid, small dose, shorter acting, gentle, lil bit and make sure you have naloxone available to reverse in puppies if needed pros and cons to both
44
local/regional anesthesia in pregnant patients?
yes! really good, esp if you did not premedicate. lowers inhalant, lowers induction drugs. local blocks make a big difference- do line block in prep room or epidural: short acting local anesthetic, bupivicaine, local
45
biggest time of stimulation in C section
opening belly: creates a lot of stimulation esp if they have not been premedicated. do line block in prep room
46
anticholinergics in preg animals?
- opioids/no premeds if you can - anticholinergics?? glycopyrrolate does not cross the BBB and would not go to uterus. atropine crosses and will increase HR of fetuses ^ concern of when puppies are in distress ex dystocia. big parameter that tells you if puppies are in distress is dropped HR = lack oxygen. bradycardia is energy saving mode = need to conserve O2. if you give atropine and it crosses the placenta and increases HR, they need more O2 - if not in distress and are bradycardic because mom got opioid, then would give mom atropine because they are not in distress
47
T/F: large animals even when pregnant need premedicated
true: alpha 2 animals is only choice in equine
48
premedication in rumiannts?
often don't need to bc most are done standing, so more reliable on regional anesthetic techniques if using benzodiazepines, need to have flumazenil to reverse the neonate
48
what are the preferred alpha 2 agonists with large animals for premed? why?
xylazine or dexmedetomidine are preferred compared to others bc they are short acting so by the time the baby horse is coming out, most of the alpha 2 is gone and can reverse with atipamezole
49
50
if you use benzodiazepines in preg ruminants, what do you need to have on hand for fetus
flumazenil to reverse neonate
51
T/F: you can IV or mask down a pregnant patient for induction
false- only IV induction
52
why only IV induction in pregnant patients
- rapid induction, rapid intubation - propofol and alfaxolone are preferred bc they are quickly redistributed and meetabolized; don't have to worry about neonates - opioids can be added in compromised or sick patients if you are worried about how they will tolerate the propofol. but now have to deal with opioid with neonates
53
horse preg induction
ketamine + propofol can use a benzo instead of propofol but then need to have flumazenil
54
what is the induction protocol in pregnant SA?
- IV only induction - propofol or alfaxolone preferred - can use opioid in sick or compromised patients but then need to be able to manage that in the neonates
55
mask induction in pregnant patients?
no! used to be thing but is stressful, longer, and more risk of regurgitation/aspiration - more impact of CV and resp depression when using inhaled anesthetics
56
how are pregnant patients maintained on anesthesia?
- inhalants: iso, sevo or desflurane - use low dose to minimize neonate depression - use local/regional anesthesia to decrease stimulation - use IPPV
57
post operative pain in preg patient
- incision block: can reblock surgical line. CSU does prolonged slow release bupivicaine - lidocaine/morphine epidural. morphine carries on for 18 hours - can do epidural post op, but just use morphine. don't use local anestheitcs: want mom to walk! - systemic opioids after puppies are out - NSAIDS: carprofen for first 24 hours
58
what is an appropriate anesthetic protocol for C section in a frenchie?
methadone (low dose) , propofol, isoflurane
59
60
how can you give antagonizing drugs to neonates if needed?
sublingual or even better using the umbilical vein. volumes are very small; need to flush behind it
61
acupuncuture in neonates
can help stimulate respiration, at GV26
62
doxapram in neonate patient?
very controversial. it is a resp stimulant, but it doesn't work in the hypoxic brain, so is unlikely to work in a patient that has never taken a breath. best as alternative if you have done everything else
63
what do you have to worry about if you have to anesthetize a neonate?
- immature hepatic enzyme system: decrased drug metabolism - reduced glycogen stores = suscpetible to hypoglycemia - greater surface area: body weight = iincreased heat loss - immature SNS: decreased ability to increase contractility, CO dependent on HR, lower BP - increased thoracic compliance bc of weak muscles
64
what are anesthetic concerns with a neonate?
- decreased ability to metabolize drugs - hypoglycemia - hypothermia - bradycardia - hypotension - hypoventilation/atelectasis
65
66
do neonates have higher or lower BP than adults?
lower BP than adults bc decreased SVR have increased thoracic compliance; weak muscles which increases susceptibility to atelectasis
67
T/F: fasting neonates should be done 12 hours before the anesthetic procedure
false- do not want to fast neonates! become more hypoglycemic
68
fasting neonates
- don't do it; become more hypoglycemic - short acting, reversible drugs - maintain glucose >70mg/dL: add 2.5-5% dextrose to fluids
69
neonate glucose should be maintained at
>70 mg/dL
70
what should you do if a neonate becomes bradycardic?
anticholinergic if needed
71
as long as a neonate's BP is above _______ then you do not need to treat
>55mmHg (lower than adult)
72
you see a neonate patient whose MAP is 55mmHg. their HR, CRT, and mm are all normal. what should you do
this is normal and you should continue monitoring as neonate BP should be maintained at >55mmHg
73
you are monitoring a neonate and their MAP drops below 55mmHg. what do you administer?
ephedrine: inotrope and causes vasoconstriction probably also start IPPV because their chest likes to collapse

Anesthesia Exam 3 (7 decks)

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