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AP: Summer Exam 3 > Obstetric Anesthesia: Hertz cont. > Flashcards

Obstetric Anesthesia: Hertz cont. Flashcards

(55 cards)

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1
Q

How is chronic HTN defined?

What drug is safe for mom to treat it?

A

BP > 140/90 before 20 weeks gestation

Labetolol (mixed alpha, beta blocker)

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2
Q

What is the triad of symptoms of preeclampsia?

A

HTN >140/90 or > 20% of baseline

Proteinuria > 300mg /24 hrs AND/OR
Edema (hand, face)

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3
Q

What are the risk factors of preeclampsia? (5)

A

Primarily primigravidas
Primipaternity
Previous Hx
Obesity
Multiple gestations

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4
Q

What is the etiology of preeclampsia? (4)

A
  • Not definitely known
  • Abnormal fetal trophoblastic cell migration through placenta resulting in increased BP
  • Changes in placental/abnormal vascular endothelium
  • Platelet adhesion occurs resulting in release of seratonin, thromboxane
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5
Q

What vasoconstrictors are more prevalent in preeclampsia? (4)

A
  • Thromboxane (AT1, AT2 platelet aggregation)
  • Endothelin (causes pulmonary HTN)
  • Angiotensin II
  • Serotonin
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6
Q

How is severe preeclampsia defined?

A

One of the following:

  • BP > 160/110
  • Proteinuria > 5 Grams/24 hrs
  • Symptoms such as headache, blurred vision, oliguria, pulmonary edema, myocardial dysfunction, RUQ pain (liver congestion), platelets < 100k, HELLP
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7
Q

Severe preeclampsia contributes to ___ - ___% of maternal deaths and ____% perinatal deaths.

A

20-40

20

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8
Q

What turns preeclampsia into severe eclampsia?

A

HELLP

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9
Q

What is contraindicated in HELLP syndrome?

A

REGIONAL

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10
Q

Can seizures occur with preeclampsia?

A

Yes

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11
Q

What is the treatment of preeclampsia?(5)

A
  • Bedrest
  • Sedation
  • Labetalol, Hydralazine
  • Magnesium sulfate
  • Delivery
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12
Q

What are antihypertensives safe for mom? (5)

A
  • Labetolol 5-10 mg IV
  • Hydralazine 5mg IV
  • Methyldopa 250-500 mg PO (alpha 2 agonist)
  • Magnesium sulfate
  • Nitroprusside (arterioles, venules)
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13
Q

What are attributes of magnesium sulfate? (3)

A

Treats hyperreflexia and prevents seizures

Direct vasodilating action on smooth muscle of arterioles and uterus

Potentiates sedation

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14
Q

Excessive magnesium sulfate can cause what? (6)

A
  • prolonged PR interval, widened QRS (5-10 mEq)
  • muscle weakness (10 mEq)
  • loss of DTRs
  • respiratory depression
  • SA, AV block (15 mEq)
  • cardiac arrest (25 mEq)
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15
Q

SNP in doses > _____mcg/kg/min or prolonged period can increase risk of what?

A

10 mcg/kg/min

cyanide toxicity

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16
Q

What drugs do you NOT use in pregnant women?

A

ESMOLOL –adverse fetal effects

Calcium channel blockers–tocolytic action and potentiate circulatory depression induced by magnesium

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17
Q

What is the anesthetic management of severe preeclampsia?

A

Pts are critically ill and need to be stabilized prior to any type of anesthesia.

Need a-line

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18
Q

What are antihypertensives needed in OR?

A

Labetalol
Hydrazaline
NTG
Nitroprusside

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19
Q

What are signs of magnesium toxicity? (3)

A

Oversedation
Loss of reflexes
DROPPING SATURATIONS

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20
Q

How do we manage a preeclamptic patient? (3)

A

Monitor UO

Hypovolemia treated with no more than 500ml LR

Check platelets and coags prior to regional anesthesia

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21
Q

Avoid regional if platelets < _____, but lowest is _____.

A

100k

70k

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22
Q

What is ideal anethesia for preeclamptic pt?

A

Epidural or spinal

Vaginal

C/s

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23
Q

What is controversial regarding regional in the preeclamptic pt?

Study These Flashcards
A

EPI contained in test dose

24
Q

What drugs/doses are appropriate for hypotension in pregnant patients, specifically preeclamptic pts that become hypotensive during epidural placement?

Study These Flashcards
A

Ephedrine 5mg

Phenylephrine 50 mcg

Note: Pregnant women are more sensitive to meds.

25
What are anesthetic considerations for general anesthesia in preeclamptic pts? (4)
* Difficult airways so be prepared! * Limit IV fluid to avoid pulmonary edema * Doses of non-depolarizing relaxants are reduced in patients on magnesium since it potentiates NMB. * A-line for severe preeclampsia
26
What is usually better tolerated, regurgitant or stenotic lesions in the pregnant woman?
regurgitant
27
What is the 2nd most common valve defect in pregnant pts?
mitral regurge
28
What should you avoid in mitral regurge? (3)
Increases in SVR Decreases inHR and contractility Maintain sinus rhythm
29
What should you avoid in aortic regurge? (2)
Increases in SVR Decreases in HR and contractility Note: consider afterload reduction
30
What should be avoided in mitral stenosis? (3)
Avoid tachycardia Atrial fibrillation--perfusion depends on atrial kick Increases in blood volume because may precipitate pulmonary edema Note: Maintain SVR
31
What should you avoid in aortic stenosis? (3)
Decreases in SVR Avoid bradycardia Avoid hypovolemia
32
What is the dose of mg sulfate?
Loading dose: 4 GRAMS then 1-3 gram/hr Plasma level: 1.5 -2 mEq/L Therapeutic level: 4-6 mEq/L
33
What are congenital heart diseases? (3)
left to right shunt right to left shunt cardiomyopathy
34
What are left to right shunts? (3)
ASD--atrial septal defect VSD--ventricular septal defect PDA--patent ductus arteriosus
35
What should you avoid in left to right shunt? (3)
Avoid excess fluids Avoid trendelenberg position Avoid increases in SVR
36
What is tetrology of fallot?
RV hypertrophy Pulmonary valve stenosis Ventricular septal defect Overriding aorta
37
What should you avoid in right to left shunt (ie. tetralogy of fallot for example)? (3)
Decrease in SVR b/c enhances shunt leading to cyanosis. Use phenylephrine Decrease in blood volume because preload is necessary to eject blood past the outflow obstruction Avoid myocardial depressants to avoid decrease to pulmonary circulation
38
Cardiomyopathy can present at any point of pregnancy. True or false?
True
39
What are risk factors for cardiomyopathy? (5)
* multiple gestation * preeclampsia * obesity * advanced age * breastfeeding
40
What are anesthetic considerations for cardiomyopathy? (4)
Invasive monitoring Intubation, ventilation inotropic support IABP
41
What are risk factors for gestational diabetes? (4)
* Advanced age * Obesity * Family hx of diabetes * **Hx of stillbirth, neonate death, etc.**
42
What effects does gestational diabetes have on mom? (4)
HTN Polyhydramnios C-section more likely Preterm labor more likely
43
What are the effects of gestational diabetes on baby? (5)
Macrosomia (large baby) Structural malformations Intrauterine death Respiratory distress syndrome Neonatal HYPOglycemia
44
What are structual malformations that can occur in baby with diabetic mom? (6)
* CNS: anencephaly (brainless), spina bifida, encephalocele * Transposition of great vessels, situs inversus, single ventricle * Caudal regression--dolphin like features * Renal agenesis * Anal/rectal atresia--hole not present * Lack of pulmonary development
45
Critical organogenesis before \_\_\_\_th week.
7th
46
What are anesthetic considerations for gestational diabetic pts? (3)
Autonomic dysfunction leads to increased risk of hypotension Gastroparesis--give reglan Strict sugar control
47
How may asthma change during pregnancy?
May improve, worsen, or stay the same
48
How will ABG change for pregnant women?
pH increases CO2 decreases pO2 decreases
49
What are anesthetic concerns for pregant asthmatic? (3)
* Prevent hypocarbia * Prevent hypercarbia --\> vasoconstriction--\>decreased UBF--\> fetal distress * Avoid high thoracic block
50
What type of anesthesia is preferred for asthmatic?
Regional, spinal or epidural
51
What meds do you avoid in asthmatics? (3)
**Hemabate**--prostaglandin F2alpha increases smooth muscle tone--\>constricts a/w **Methergine ** **Labetolol**--use hydrazaline, snp
52
What is BMI for obesity?
30 kg/m2
53
What are obese pts at increased risk of? (4)
* HTN * Aspiration * Diabetes * Increased risk of DVTs
54
What is a risk factor for c/s for obese pt? (4)
Increased risk of fetal distress Increased risk for abnormal labor (arrest of descent) Increased risk of shoulder distocia Increased risk of maternal death
55
Do people recover from cardiomyopathy? What do you do if it occurs antepartum?
50% do not fully recover and some require transplant Promptly deliver the baby

AP: Summer Exam 3 (7 decks)

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