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NUNA 693 Obs/Regional > OB: Non-Obstetric Sx During Pregnancy > Flashcards

OB: Non-Obstetric Sx During Pregnancy Flashcards

(70 cards)

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1
Q

Up to 1 in ___ parturients will require surgery during their pregnancy
_____/year in the US

A

50
80,000

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2
Q

Most are urgent or emergent surgeries

A

Trauma
Ovarian cysts
Appendicectomy
Cholecystectomy
Breast
Cervical incompetence
Craniotomy
CPB
Liver transplantation

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3
Q

Anesthetic Management

Maternal Physiology (4)

A

Respiratory
Cardiovascular
Gastrointestinal
CNS

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4
Q

Anesthetic Management

Maintenance of ____ _____

A

Fetal Oxygenation

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5
Q

Anesthetic Management

Prevention of _____ Labor

A

Preterm

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6
Q

Teratogenicity - what not to give

The usual suspects (2)

A

Nitrous Oxide
Benzodiazepines

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7
Q

Teratogenicity - what not to give

New issues

A

Neurotoxicity?
Apoptic neurodegeneration?

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8
Q

Anesthetic Management less than 24 wks gestation

A

Postpone if possible
Post op assessment by OB
Counsel preoperatively
Nonparticulate antacid
Maintain normal O2, CO2, BP, & Glucose
Regional when appropriate
Document FHT before & after

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9
Q

Anesthetic Management greater than 24 weeks

A

Postpone if possible
Counsel preoperatively
OB consult, prophylactic tocolytics?
Aspiration prophylaxis
Uterine displacement
Maintain normal O2, CO2, BP, & Glucose
Document FHT before & after, or continuous if feasible
Regional when possible

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10
Q

Tocolysis - PO/PR _____ few anesthesia implications

A

Indomethacin

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11
Q

Tocolysis - PO _____ contribute to hypotension

A

Nifidepine

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12
Q

Tocolysis - IV Mag Sulfate potentiates ______ and attenuates ______ responsiveness

A

nondepolarizers
vascular

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13
Q

Preoperative Pregnancy Testing

Minimum: date of ____

A

LMP

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14
Q

Preoperative Pregnancy Testing

_____ testing is controversial

A

mandatory

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15
Q

Intraoperative Management

No preference as to type of anesthesia maintenance, assuming maintenance of _______

A

normotension

One small study suggested general better than regional of ovarian mass, but not replicated in larger studies

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16
Q

Intraoperative Management

_____ monitoring

A

standard

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17
Q

Intraoperative Management

____ pre and post at minimum, intraoperatively either continuous or intermittent if it won’t interfere with surgery

A

FHT

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18
Q

Intraoperative Management

Loss of beat-to-beat is _____ (General or MAC), but not fetal ______

A

expected
bradycardia

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19
Q

Intraoperative Management

Decelerations: increase maternal _____, increase maternal ___, increase uterine _____, adjust surgical ______, begin tocolysis

A

oxygenation
BP
displacement
retraction

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20
Q

Intraoperative Management

Monitoring ____ ____ to improve fetal outcomes

A

hasn’t shown

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21
Q

General Anesthesia implications (7)

A

Full preoxygenation/denitrogenation
RSI
Avoid hypoxia
Difficult airway??
First trimester – high dose ketamine (>2mg/kg) can cause uterine hypertonus
MAC is decreased 20-40% in pregnancy
Muscle relaxants should be given slowly to prevent acute increases in acetylcholine

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22
Q

Regional Anesthesia implications (4)

A

Minimize drug exposure
No change in FHT variability
Adequate volume and ephedrine or phenylephrine to prevent hypotension
Decrease neuraxial dose by 1/3

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23
Q

Postoperative Care

Continue monitoring ____ & _____ activity

A

FHT & uterine

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24
Q

Postoperative Care

Treat preterm labor ____ & ____

A

early and aggressively

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25
Postoperative Care L&D unit or L&D RN in ____ area
recovery
26
Postoperative Care Pain meds will _____ beat-to-beat variability
decrease
27
Postoperative Care High risk for embolus, should ____ as early as possible
ambulate
28
Postoperative Care Maintain oxygenation and ____ ____
uterine displacement
29
Postoperative Care _____ consult if greater than 23 weeks
Neonatology
30
Trauma Leading cause of ____ ____
maternal death
31
Trauma Fetal loss due to (3)
hemodynamic instability, abruption or maternal death
32
Trauma Continuous fetal monitoring ____ weeks
>23
33
Trauma Do not avoid diagnostic tests, but ____ ____ if possible
shield fetus
34
Trauma ___ & ____ do not use ionizing radiation, Head CT is of ___ risk to fetus
U/S & MRI no
35
Trauma Cesarean delivery indication (4)
Stable mom, fetus in distress Uterine rupture Gravid uterus interfering with maternal abdominal repairs Viable fetus, nonviable mom
36
ECT _____ disease is a significant cause of maternal morbidity and mortality
Psychiatric
37
ECT Withholding treatment for any disease is ____ ____
rarely justified
38
Cardioversion Direct current cardioversion is ____ in all stages of pregnancy
safe
39
Cardioversion Careful ___ monitoring is required ___ ____ displacement
FHT Left uterine
40
Cardioversion Aspiration risk: sedation vs. GETA precuations (2)
Non-particulate antacid Consider H2 antagonist
41
Maternal Cardiac Arrest ____ Uterine displacement, Hands __-____ ____ on sternum for compressions
Left 1-2 cm higher
42
Maternal Cardiac Arrest Perimortem cesarean delivery within __ _____
5 minutes
43
Maternal Cardiac Arrest Similar causes for arrest as non-pregnant, with addition of (4)
AFE Eclampsia Placental abruption Hemorrhage
44
Laparoscopic - Fetal outcomes are ____ with laparotomy or laparoscopy
similar
45
Laparoscopic - CO2 insufflation does cause fetal ___ ____
respiratory acidosis
46
Laparoscopic - Keep intraabdominal pressures as ___ as possible and as ___ as possible
low short
47
Laparoscopic - Fetal shielding during ____ (cholangiograms)
x-ray
48
Laparoscopic - Maintain ___ ____ displacement
left uterine
49
Laparoscopic - ____ _____ to prevent DVT
Compression stockings
50
Cardiopulmonary Bypass - Maternal decompensation can occur 28-30 weeks with increase of blood volume and cardiac output with _____ _____ ______ or ____
stenotic valvular lesions or PHTN
51
Cardiopulmonary Bypass - Immediate _____ is another time of concern
postpartum
52
Cardiopulmonary Bypass - If possible, delay to ____ trimester
second
53
Cardiopulmonary Bypass - In patients close to term combined ____ and ____ replacement has been successful
cesarean and valve
54
Cardiopulmonary Bypass - Beyond ___ weeks, monitor fetus & maintain uterine displacement
24
55
Cardiopulmonary Bypass - Higher pump flows may be ______ per animal studies
beneficial
56
Cardiopulmonary Bypass - Fetal ____ is common when going on pump, but returns to normal without beat-to-beat
bradycardia
57
Cardiopulmonary Bypass - Hypo____? Normo____?
Hypothermia? Normothermia?
58
Fetal Interventions Rapidly _____ Ethical issue: maternal safety vs. risks to the mother & fetus vs. benefits to the fetus
evolving
59
Fetal Interventions Performed at few highly ____ centers
specialized
60
Fetal Interventions _____, ultrasound guided trocars into amniotic cavity
Fetoscope
61
Fetal Interventions Work around placenta _____
implantation
62
Fetal Interventions Can be with ____ or ____ with sedation depending on case and surgical technique
local or neuraxial
63
EXIT Procedures __-__ MAC for uterine relaxation
2-3
64
EXIT Procedures Partial ____, then ___ _____ for fetal analgesia & immobilization
delivery IM injection
65
EXIT Procedures Step one is secure ___ ____
fetal airway
66
EXIT Procedures After procedure, ___ decreased to increase uterine tone, then ____ _____ baby delivered. Now uterine tone = good
MAC cord clamped
67
Open Mid-Gestation Fetal Surgery Myelomeningocele Intrathoracic ____ with _____ (severe fetal edema) Similar to EXIT, but fetus is returned to uterus prior to ____ ____ Aggressive _____
lesions with hydrops uterine closure tocolysis
68
___ ____ increase risk of uterine rupture
Fetal surgeries
69
____ ____ is necessary for this (uterine rupture) and all future deliveries prior to onset of labor
Cesarean delivery
70

NUNA 693 Obs/Regional (13 decks)

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