Flashcards in Pregnant Anaesthesia Deck (25):
When T3 lying on back, get hypotension
Response: sympathetic response
Blood volume in Preg?
Increases, plasma more 50%
RBC more 30%
Clotting factors increase 800%
Biggest cause of materal death?
Suicide, post partum depression, puerperal psychosis
Why reflux in preg?
Diaphragm is pushed up and when breathing, doesn't pinch off the sphincter as well -- reflux
Why pregnant women get oedema?
Concentration of protein, albumin, globulin decrease
Decrease plasma oncontic pressure
CNS in preg?
More sensitive to narcotics
Local a aesthetics
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
Longer term probs of post delivery
DVT if told to lie in bed
Challenges of pregnant anaesthesia
Breast enlargement (laryngoscopes)
Clinical implications of pregnant anaesthesia?
-Body is at end of reserve point:
More risk of:
-risk of embolism
Visceral, dull pain in preganancy from where in first stage in preg
Second stage of labour from where?
S2-4, well localized
Distension of outlet, vagina, vulva
Non pharma pain relief
Hypnosis: only 1/4 of ppl
Acupuncture: 25% ppl
Pharma analgesia for preg?
OpioIds - Pethidine(no longer) Morphine 1/10dose of Pethidine,
Fentanyl, Remifentanil (ultrashort)
Probs with IM morphine?
Useful for early labour
Fentanyl if can't do epidural then?
Remifentanil probs? PCA?
Narrow safety margin, between relief and Resp depression
Reduce delivery trauma
So it reduced pain
Active neurological disease
Advantage of epidural
Improves placental flow
Allows instrumental delivery
Epidural complications immediate.
Delayed epidural complications?
Post dural head ache
Epidural cause long term back ache?
NOPE. lOcalized only
Epidural drugs given?
Ropivacaine (more common) and Fentanyl synergistic