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OB Test 2 > Non_OB Surgeries > Flashcards

Non_OB Surgeries Flashcards

(59 cards)

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1
Q

How many pregnant women undergo surgery while pregnant?

A

0.3-2.2% or 93,000 - 110,000 women

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2
Q

How many surgeries during pregnancy occur during the first trimester?

A

42%

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3
Q

When is surgery during pregnancy the most concerning for the fetus? Why?

A

During the first trimester, because this is the period of organogenesis
-avoid if possible

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4
Q

What is associated with general anesthetic exposure during the first trimester?

A

Hydrocephalus and eye defects

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5
Q

What are the most common procedures performed during the first trimester?

A

Torsion

Neoplasm or cysts of the ovary

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6
Q

What side effect do benzodiazepines have if used during the first trimester?

A

2x increase in cleft palate

9% increase in miscarriage

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7
Q

How many surgeries are done during the second trimester?

A

35%

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8
Q

What are the most commonly performed surgical procedures performed during the second trimester?

A

Appendectomies

Cholecystectomies

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9
Q

Why is it safer to have surgery during the second trimester than the first?

A

Risk for preterm deliver is lowest during the second trimester

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10
Q

How many surgical procedures are performed in the third trimester?

A

23%

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11
Q

What are the most common procedures performed during the third trimester?

A

Appendectomy

Cholecystectomy

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12
Q

When is fetal well being first monitored during surgery?

A

From the age of viability, 24 weeks gestation

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13
Q

If performing anesthesia for procedures before the first trimester, what drugs should you avoid and why?

A

Versed
IV lidocaine: fetal cardiac and CNS toxicity
Morphine: polyploidy, abnormal chromosome numbers
N2O

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14
Q

When is pregnancy testing occur (age wise)?

A

Ages 10-60 y

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15
Q

What percentage of women showing up for elective sterilization procedures have positive pregnancy test?

A

3%

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16
Q

When can a pregnancy test be excluded?

A

Hx Hysterectomy

Young w/o menstral cycle (?)

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17
Q

Are pregnancy tests needed if someone has had their tubes tied?

A

Yes, can have reconnection of the Fallopian tubes

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18
Q

What are the maternal complications with surgery during pregnancy? Rate?

A 
6%
Infection
Respiratory problems
VTE
Re-operation
Death
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19
Q

What are the overall risks of surgery during the first trimester?

A

Increased risk of miscarriage and fetal defects

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20
Q

What are the overall risks of surgery performed in the second and third trimester?

A

Triggering of labor and lower birth weight infants

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21
Q

Why is O2 reserve decreased in pregnant women?

A

FRC is reduced 20%

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22
Q

What positions make the risk of small airway closure higher in pregnant women?

A

Supine

Trendelenburg

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23
Q

What about a laparoscopic procedure also increases the risk of small airway closure?

A

Pneumoperitoneum

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24
Q

By how much is MAC reduced during pregnancy?

25
Why is MAC decreased during pregnancy?
Decreased FRC and increased minute ventilation
26
What effect does pregnancy have on peripheral neural blockade?
Increases sensitivity to peripheral neural blockade
27
What happens to plasma cholinesterase during pregnancy?
It decreases 25% in the first trimester and stay there till 1 week postpartum
28
Does the increased sensitivity to LAs and decreased plasma cholinesterase prolong blockade during pregnancy?
It is uncommon due to the large volume of distribution
29
Can toradol be used in the pregnant patient? Why or why not?
NO. Toradol can cause closure of the ductus arteriosis
30
How much do NSAIDs increase the risk of closure of the ductus arteriosis?
15x
31
What occurs if the ductus arteriosis closes prematurely?
Progressive right heart dysfunction Tricuspid regurgitation CHF Intrauterine fetal death
32
What concern does laparoscopic surgery present in the pregnant patient?
Uterine or fetal trauma Fetal acidosis from absorbed CO2 Decreased maternal CO and uteroplacental perfusion d/t intra-abdominal pressure
33
What affect does the pneumoperitoneum have on the airway pressures and compliance?
Pneumoperitoneum results in higher peak airway pressures and decreased compliance
34
What happens with advancing gestation and the risks associated with laparoscopic surgery?
Changes are progressively greater
35
Why are cholecystectomies the most common procedure seen in pregnancy?
Pregnant women are at an increased risk for gall bladder disease
36
What procedures are worst for infant mortality?
Appendiceal abscess | Cervical incompetence
37
By how much is the risk of premature deliver and LBW increased by appendiceal abscess and cervical incompetence?
9%
38
Neural tube defects are worse in surgery done at how many weeks?
4-5
39
Why are appendiceal abscesses more likely to have generalized peritonitis during pregnancy?
Increased steroid levels during pregnancy | -inhibits normal inflammatory response of walling off the appendiceal abscess by the omentum
40
Why is appendiceal abscess misdiagnosed?
Abdominal pain may be mistaken for round ligament pain or uterine contraction pain
41
Why are pregnant women at an increased risk for appendiceal abscess?
The appendix rotates counterclockwise as term approaches and the tip lies over the right kidney
42
Why is white count possibly not diagnostic to help with Dx of appendiceal abscess?
WBC in pregnancy can be elevated to 15,000 | -so marked elevation would be needed to be helpful
43
What is the rate of misdiagnosis with appendiceal abscess?
36%
44
When can ECTs be performed during pregnancy?
All 3 trimesters
45
When is FHR and uterine contraction activity monitored with ECT?
Pre and post procedure | -if viable
46
What are the guidelines for ECT during pregnancy?
Obtain preop OB consult Monitor FHR and uterine contractions pre and post Ensure hydration and denitrogenation Left uterine displacement after 18-20 weeks Aspiration prophylaxis Observe for vaginal bleeding post
47
What could be considered for ECT in pregnant women with symptoms of GERD?
ETT | -some providers say this should be done after 20 weeks gestation for ECTs
48
What drugs are typically used for ECTs?
Brevitol | Succinylcholine
49
Derangements of maternal physiology with surgery may result in what negative effects?
Hypoxia Hypercapnia Stress Abnormal temperature
50
What conditions enhance teratogenicity?
Hypoxia Hypercapnia Stress Abnormal temperature
51
Are anesthetic agents teratogens?
They are listed as unlikely
52
Hyperthermia is teratogenic, what is it associated with?
``` Increases: Miscarriage Neural tube defects Cataracts Teeth abnormalities Heart defects Craniofacial and skeletal defects ```
53
What is Category A for drug safety in pregnancy?
No risk and find no evidence of harm
54
What is Category B for drug safety in pregnancy?
Animal studies show no risks, but there are no controlled studies on pregnant women
55
What is Category C for drug safety in pregnancy?
Animal studies have shown risk, but no human studies
56
What is Category D for drug safety in pregnancy?
Positive evidence of human for fetal risk | -in life threatening situation might use
57
What should be avoided during anesthesia during pregnancy?
``` Long exposure Repeated exposures Pain Stress Hypotension Hypoxia Sepsis Hyperventilation ```
58
Maternal PaCO2 correlates directly with fetal PaCO2, severe acidosis can lead to what?
Fetal myocardial depression and hypotension
59
What occurs with maternal hyperventilation?
Low PaCO2 and high pH adversely affects fetal oxygenation by causing uterine artery vasoconstriction

OB Test 2 (4 decks)

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