Pregnant Anaesthesia Flashcards Preview

Jason's MD3 Women's > Pregnant Anaesthesia > Flashcards

Flashcards in Pregnant Anaesthesia Deck (25):
1

Aorta-caval compression?

When T3 lying on back, get hypotension
Response: sympathetic response

2

Blood volume in Preg?

Increases, plasma more 50%
RBC more 30%
Physiological dilution
Clotting factors increase 800%

3

Biggest cause of materal death?

Suicide, post partum depression, puerperal psychosis

4

Why reflux in preg?

Diaphragm is pushed up and when breathing, doesn't pinch off the sphincter as well -- reflux

5

Why pregnant women get oedema?

Concentration of protein, albumin, globulin decrease
Decrease plasma oncontic pressure
Oedema

6

CNS in preg?

More sensitive to narcotics
Local a aesthetics
General gases
Increased endorphins

7

Post delivery circulation mother?

Increase after load, increase venous return after low shunt placenta is gone, likely to have heart failure in the first 5 minutes of birth

8

Longer term probs of post delivery

DVT if told to lie in bed

9

Challenges of pregnant anaesthesia

Weight gain
Fluid retention
Laryngeal oedema
Breast enlargement (laryngoscopes)

10

Clinical implications of pregnant anaesthesia?

-Body is at end of reserve point:
More risk of:
-hypoxia
-failed intubation
-aspiration
-risk of embolism

11

Visceral, dull pain in preganancy from where in first stage in preg

T10-L1-2
Poorly localized

12

Second stage of labour from where?

S2-4, well localized
Distension of outlet, vagina, vulva

13

Non pharma pain relief

Antenatal classes
Hypnosis: only 1/4 of ppl
Acupuncture: 25% ppl
TENS

14

Pharma analgesia for preg?

Nitrous Oxide
OpioIds - Pethidine(no longer) Morphine 1/10dose of Pethidine,
Fentanyl, Remifentanil (ultrashort)

15

Probs with IM morphine?

N/V
Respiratory depression
Dysphoria

Useful for early labour

16

Fentanyl if can't do epidural then?

PCA

17

Remifentanil probs? PCA?

Narrow safety margin, between relief and Resp depression

18

Epidural indications:

Cardiac disease
Preeclampsia
Reduce delivery trauma
So it reduced pain

19

Contraindication epidural

Patient refusal
Hypovolaemia
Coagulopathy
Sepsis: localized/Generalised
Active neurological disease
Dental distress

20

Advantage of epidural

Pain relief
No sedation
Improves placental flow
Allows instrumental delivery

21

Epidural complications immediate.

Hypotension
Sympatholysis:

22

Delayed epidural complications?

Post dural head ache
Blood patch

23

Epidural cause long term back ache?

NOPE. lOcalized only

24

Epidural drugs given?

Bupivacaine
Ropivacaine (more common) and Fentanyl synergistic

25

Caesarean How to anesthetize?

Regional
Spinal
Or epidural top-up

GA if needed immediately