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Anesthesia & Analgesia > Lecture 30: Ax for Cesarean Sections, Neonates, & Geriatrics (Exam 4) > Flashcards

Lecture 30: Ax for Cesarean Sections, Neonates, & Geriatrics (Exam 4) Flashcards

1
Q

What increases during Pregnancy

A
  • CO (b/c Increased HR & SV)
  • Blood & plasma vol
  • Minute ventilation (b/c of increased RR)
  • Oxygen consumption by 20%
  • Intragastric pressure
  • Renal plasma flow & GFR
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2
Q

What decreases in pregnancy

A
  • HB & PCV
  • Plasma protein
  • PaCO2
  • Tidal volume
  • Function residual/total lung capacity
  • Total pulmonary resistance & peripheral vascular resistance
  • GI motility/gastric emptying/ pH
  • BUN & Creatinine
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3
Q

What are potential complications w/ venous return in the dam

A

Venous return may be decreased when placed dorsally due to compression of vena cava by gravid uterus resulting in decreased cardiac output & hypotension (not a concern unless less than 25 kg)

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4
Q

Describe relative anemia as a potential complication

A
  • Maternal blood vol increases ~20%
  • PCV w/in the norm range may mean the dam is actually dehydrated
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5
Q

What is a potential complications in small breed dogs, large litters, or w/ uterine inertia

A

Hypocalcemia

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6
Q

What are some other complications

A
  • Increased myocardial work & reduced cardiac reserve
  • Increases in alveolar ventilation & reduced FRC results in reduced MAC req
  • Prone to hypoxemia
  • Elevated renal values can indicate dehydration or underlying kidney dx
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7
Q

What is necessary during ax to maintain kidney perfusion

A
  • Pre op fluid resuscitation
  • Tailored fluid plan +/- use of vasopressors
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8
Q

Describe an emergency C-section

A
  • Px has been in active labor for > 1 H w/ no fetus delivered
  • May be in a compromised metabolic state
  • Viability of puppies is a concern (b/c of increased mortality for the dam & fetuses)
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9
Q

What is the most common cause of dystocia

A

If the fetuses are to big or to large of a litter

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10
Q

What fetal heart rate is considered healthy

A

150 - 200 bpm

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11
Q

What fetal HR is seen if there is fetal stress

A

100 - 150 bpm

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12
Q

What is the goal amount of time it should take to get the fetuses out

A

Have them out w/ 5 - 10 mins of induction

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13
Q

What may increase the risk of esophageal reflux

A
  • Increased gastric acid
  • Decreased lower esophageal tone b/c of increased abdominal pressure
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14
Q

What drugs can be given to help w/ reflux

A
  • Cerenia
  • Metoclopramide
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15
Q

Why is pre oxygenation be done pre op

A

Prone to hypoxemia in late-preg due to decreased functional reserve capacity

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16
Q

What should be considered when discussing premeds for C section

A
  • Can us noncompliant px
  • Avoid drugs that cause vomiting
  • Most cross the placenta (short acting that can be antagonized preferred)
  • Drugs highly protein bound don’t readily cross the placenta
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17
Q

Describe opioid as a pre med

A
  • Sedation & analgesia
  • Dose dep respiratory depression & bradycardia in the dam & fetuses
  • Can reverse w/ naloxone
18
Q

Describe anticholinergics as a pre med

A
  • Atropine: controversial b/c crosses placenta & increases O2 consumption by the fetuses
  • Glycopyrrolate doesn’t cross the placenta
19
Q

Describe benzodiazepines as a pre med

A
  • Mild sedation & skeletal muscle relaxation
  • Prefer midazolam b/c water soluble & therefore shorter duration than diazepam
  • Can cause respiratory depression
  • Fetal livers do no metabolize so there is prolonged sedation
  • Antagonize w/ flumazenil after delivery
20
Q

Describe a2 agonist as a pre med

A

This & phenothiazines (ace) are not recommended for c sections

21
Q

T/F: If you want viable babies give a pre med

A

False; don’t give a pre med if you want viable babies

22
Q

What reduces the risk of aspiration during induction

A
  • Swiftly securing the airway via intubation
  • Cuff inflation during induction
  • Have suction ava
  • Keep px in sternal w/ head above the stomach
23
Q

Is “Masking down” recommended

24
Q

Describe the use of propofol as an injectable induction agent

A
  • Metabolized in the liver & crosses the placenta
  • Causes hypotension due to vasodilation
  • Respiratory depression may necessitate IPPV
  • Provides no analgesia
  • Not cumulative
25
Describe the use of Alfaxalone as an injectable induction agent
Given IV for a C section in dogs had similar puppy survival rates to propofol & was assoc w/ better neonatal vitality during first 60 mins of birth
26
Describe using injectable ketamine + diazepam for a C section
* Ketamine causes less CV depression in dams but has significant depressant effects in neonates * Decreased likelihood of puppies breathing spontaneously @ birth w/ use of ketamine
27
Describe using injectable etomidate for a C section
* Used for dams w/ pre existing cardia dx * Rapid induction & short duration w/ min CV & respiratory depressant effect
28
Describe using inhalant ax for maintenance
* All cross the placenta b/c of lipid solubility & low molecular wgt * Cause CV & respiratory depression * Keep as low as possible to avoid neonatal respiratory depression
29
When is mechanical ventilation used?
When there is pressure won the diaphragm from uterus
30
Why should hyperventilation be avoided
B/c maternal hypocapnia is assoc w/ decreased uterine & umbilical BF & increased maternal affinity for hemoglobin (can cause fetal hypoxemia)
31
What LAs can be considered for a Csection
* Line block w/ lidocaine * Bupivacaine before sx & epidural * TAP Block
32
Why can LAs be used in c-section
To improve relaxation of ovarian pedicles & facilitate exteriorization of the uterus
33
Describe the use of epidural ax in c-sections
* Decrease vol by 25% (b/c of decreased epidural space) * Epidural lidocaine provides good regional ax & muscle relaxation * Use lidocaine & not bupivacaine b/c of shorter onset & duration * Can use morphine to add analgesia
34
What is a major complication during c section ax
* Hypotension * Treat if MAP is below 60 mmHg or systolic is below 80 mmHg
35
What can be give if experiencing hypotension during c-section
* Positive inotropes like ephedrine, dobutamine, or dopamine * To improve maternal BP
36
What management should be done once the babies are out
* Deliver as quickly as poss * Rub vigorously to stimulate breathing & movement * Supplement w/ O2 using a face mask or in the oxygen chamber * Analeptics can be used to stimulate respiration but should be given w/ supplemental O2 * Give naloxone if dam was given opioids before the removal of fetus
37
What can be done if the babies are bradycardic (HR of < 180)
* Supplement O2 * Consider atropine
38
Define neonate
Up to 4 to 6 Wks
39
Define pediatric
6 to 12 W
40
What are some considerations of ax for neonatal/pediatric pxs
* CO is HR dep (avoid bradycardia) * Airway obstruction, hypoventilation, & hypoxemia can occur * Tissue oxygen demand is 2 to 3 times greater * Hepatic renal systems are not fully fxnal until 8 Wks (avoid drugs w/ extensive metabolism or reduce the dose) * Hypoglycemia can occur from fasting & min glycogen stores (add dextrose to IV) * High fluid rates are not tolerated * Highly protein bound drugs will have a greater effect (b/c more free drug circulation) * Poor thermoregulatory ability (have a warming device ready)
41
What are some premed considerations of ax for neonatal/pediatric pxs
* Avoid acepromazine & a2 in pediatric px * Midazolam has short duration & better uptake * Opioids may cause respiratory depression & bradycardia (provide IPPV w/ anticholinergic) * Glycopyrrolate lasts longer & less likely to produce sinus tachycardia
42
What are some considerations of ax for geriatric pxs
* Lower drug dosages & use of short acting drugs that can be antagonized * Plan for oxygen supplementation & IPPV * Careful titration of IV fluids before, during, & after ax * Hypothermia & prolonged recovery are common * Hypotension should be swiftly treated w/ a positive inotrope

Anesthesia & Analgesia (29 decks)

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