Ex 3 - AC for pregnant patients, C-sections; neonatal or pediatric patients Flashcards Preview

737 - Principles of Anesthesia > Ex 3 - AC for pregnant patients, C-sections; neonatal or pediatric patients > Flashcards

Flashcards in Ex 3 - AC for pregnant patients, C-sections; neonatal or pediatric patients Deck (16)
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1
Q

When do we use anesthetics in pregnant patients?

A

For delivery (C sections or manual)

For emergency procedures

2
Q

CV changes w/anesthesia

A
  1. Increased Blood Volume
    - plasma > RBC
    - “anemia” (PCV 30-35%)
    - related to # of fetuses
  2. Increased CO (40%)
  3. Compensatory CV reflexes delayed
  4. Uteroplacental perfusion is PRESSURE DEPENDENT!
    - hypotension = dec fetus perfusion

**Always monitor BP

3
Q

Respiratory changes

A
  1. Pregnant uterus displaces the diaphragm
    - dec TLC and FRC
  2. O2 consumption increased 20%
  3. Inc P4 –> sensitivity to PaCO2
  4. Inc risk of hypoxemia
    * **Preoxygenate patients!
4
Q

CNS changes

A
  1. Anesthetic requirement decreased by 25-40%

2. Increased sensitivity to anesthetics –> risk of Overdosing!

5
Q

GI changes

A
  1. Delayed gastric emptying
  2. Decreased esophageal sphincter tone
    * risk of regurgitation and aspiration
    * *need to induce rapidly and protect the airway asap
6
Q

Fetal physiology

A
  1. Some drugs can cross BBB into the placenta
  2. Fetal blood supply has low PaO2
    - fetal Hb has higher affinity for O2
7
Q

Pregnant patient - Anesthesia Recommendations

A
  1. Correct any deficits in circulating volume
    - correct electrolytes (Ca++)
  2. Prooxygenate
  3. Rapid induction/secure airway
    - risk of regurgitation/aspiration
  4. Minimize dose
  5. Minimize time
  6. Have help to resuscitate neonates (1:1)
  7. Maintain mom’s BP
8
Q

Premedication

A
  1. Small animals
    * opioids and anticholinergics
  2. LA
    * a2-agonists
  3. Ruminants/camelids
    * Benzodiazepines or no premed
9
Q

Induction agents

A

Usually IV better than IA

  1. SA
    * propofol (and alfaxalone)
    * Etomidate (or fentanyl) in special cases
  2. LA
    * Ketamine +/- propofol (benzo)
10
Q

How much time do you give for drug redistribution

A

~15 mins

11
Q

Is IA good for induction?

A

NO!

Its stressful, prolonged, risk of regurgitation & aspiration, severe CV and respiratory depression

12
Q

Inhalant Anesthesia

A

Iso, sevo, or desflurane

low dose, IPPV, avoid nitrous oxide

13
Q

Post-op pain

A

Line (incision) block

Morphine epidural

Systemic opioids

NSAIDS

14
Q

Neonatal Resuscitation - I

A
  • Remove placental membranes
  • Clear oropharynx of secretions
  • bulb syringe or gentle suction
  • don’t swing neonate (obvi)
  • Antagonize drugs
  • sublingual or into umbilical vein
15
Q

Neonatal Resuscitation - II

A
  • Rub chest vigorously
  • O2 and heat
  • intubate if not breathing
  • acupuncture at GV 26
    Doxapram?
  • increases O2 consumption but not in hypoxemia
16
Q

Neonate - concerns

A
  1. dec ability to metabolize drugs
  2. Hypoglycemia
  3. Hypothermia
  4. Bradycardia
  5. Hypotension
  6. Hypoventilation/atelectasis