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104 Cards in this Set
- Front
- Back
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Trendelenburg does what to the body |
Head down compression of lungs and everything compresses cause decrease SV and possible hypotension venous return should increase ICP may increase |
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Prone |
compression of inferior vena cava and aorta lung bases forced cephalad can hinder venous return need abdominal rolls |
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Lateral decubitus |
Ventilation mixmatch need axially roll under thorax just caudal to axilla |
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sitting |
venous drainage from neck/head and upper body no change pulmonary venous return decreases and CO decrease AIR EMBOLISM |
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lithotomy |
cephalad diaphragm will compress lung venous return increase from legs up nerve injury- watch sciatic, common peroneal, and femoral, saphenous, obturator. Most common is common peroneal |
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most common postoperative peripheral neuropathy |
ulnar nerve Claw hand |
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2nd most common postoperative peripheral neuropathy |
brachial plexus arm abducted greater than 90 degree compression between clavicle and first rib |
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Median nerve injury |
unable to oppose first finger and thumb |
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radial nerve injury |
wrist drop can't extend weakness in abduction of thumb decrease sensation over dorsal surfaces of the lateral three and one half fingers |
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most frequently injured nerve in the lower extremity |
common peroneal nerve nerve pressed between head of the fibula and metal brace - lithotomy position foot drop or inability to evert the foot/ dorisflex |
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What nerve besides the common peroneal can be injured by lithotomy boots |
saphenous nerve compression against the medial tibial condyle when the foot is suspended lateral to a vertical brace |
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what happens when you have a sciatic nerve injury |
weakness of all skeletal muscles below the knee and diminished sensation over lateral half of the leg and almost all of the foot FOOTDROP |
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What happens if you injurer the anterior tibial nerve |
foot drop |
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what nerves are injured during face mask ventilation |
buccal branch of the facial nerve VII supraorbital branch of the trigeminal nerve (V) may be damaged during face mask ventilation |
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OB anesthesia things to know |
Csection started within 30 minutes twice the risk of death compared to any other surgery- Csection most deaths occur after all patients are full stomachs |
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Maternal respiratory changes |
FRC decrease 20% TLC, VC, and IC do not change Respiratory alkalosis PaCO2 30- but compensatory excretion bicarb keeps ph normal. (think about vasoconstriction to fetus) PaO2 higher in pregnant TV increase 40 % 70% increase in alveolar ventilation |
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What happens to the OB airway |
airway edema due to engorgement most evident in 3rd trimester. ETT tubes smaller |
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What increases respiratory wise with pregnancy |
Oxygen consumption, TV, Dead space, RR, minute ventilation, alveolar ventilation, Diaphragm excursion, PaO2, PH |
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what decreases respiratory wise with pregnancy |
RV, FRC, Chest wall excursion, chest wall compliance, airway resistance, total pulmonary resistance, PaCO2, Bicarb |
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What happens to MAC with pregnancy |
decrease up to 40%` |
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Why do you get dilutional anemia pregnancy
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increase in blood volume 35% increase in plasma volume 45 % Increase in red blood cell volume dilutional anemia (correct with iron and folic acid) |
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CV changes increase pregnancy |
Cardiac output increase 40% SV 30% HR 15% |
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CV decrease pregnancy |
MAP -15mmhg SBP 0-15mmhg DBP -10-20 mmhg |
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CV whens it greatest in pregnant patient |
immediately after delivery for up to a couple of weeks. |
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whats cardiac output to the uterus |
700-800 ml/min... need to keep SBP above 100 for uterus perfusion |
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Maternal supine hypotensive syndrome |
lay them left lateral. gets rid of compression of inferior vena cava which decrease venous return and results in decrease SV and hypotension. you'll see tachy and hypotension - and you treat with laying on side. |
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how much blood loss can a OB patient handle |
1500ml. |
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Coagulation at time lab test changes |
PT, PTT shortened TEG Hypercoagulable Platelet no change or decrease Plasminogen increase bleeding time no change |
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coagulation factors unchanged or decrease |
Unchanged - II and V Decrease - XI and XII |
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GI changes in pregnancy |
prolonged gastric emptying time and decrease lower esophageal sphincter pressure bc of progesterone |
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Renal changes in pregnancy |
normal decreases in BUN and CR are due to increases in renal blood flow and glomerulus filtration rate. renal plasma flow and GFR increase 50-60% by 4th month and decrease to normal in 3rd trimester |
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Drug passage across the placenta - |
low molecular weight less than 500 lipid solubility non-ionizing drugs |
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Drugs that don't cross the placenta |
He Is Going Nowhere Soon Heparin, insulin, glyco, NonDepolarizer, Succ |
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How many umbilical arteries and veins |
Arteries -2 Vein -1 |
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how many tissue layers are found in the placental membrane? what are the layers? |
Three layers fetal trophoplasts, fetal connective tissue, and the endothelium. |
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1st stage of labor pain relief |
T10- L1 pain is from uterine contractions, dilating cervix and lower uterine segment.. cervix and perineum play major role in pain primarily from uterine contractions above 25 mm hg |
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2nd stage of labor pain relief |
T10-S4 perineal pain as fetus descents down birthing canal. distending of lower vagina, vulva, and perineum. pain travels via the pudenql nerve (s2-s4) |
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drugs for pregnancy that don't cause resp depression but with be effective for pain |
butorphanol and nalbuphine. |
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What drug can you give phenergan with |
demerol |
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whats drugs are not recommend in pregnant patients for pain |
NSAIDS - suppression of uterine contractions - promotes closure of fetal ductus arteriosus Benzos- prolonged neonatal depression |
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PDPH treatment |
bedrest, hydration, oral analgesic, epidural saline injection (50-100ml), caffeine epidural blood patch, don't give prophylactic |
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Umbilical cord prolapse |
may lead to fetal hypoxia nonreassuring fetal heart pattern fetal scalp ph<7.20, meconium-stained amniotic fluid, and oligohydramnios. |
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Placenta Previa (what types) |
Marginal - placenta lies close to, but does not cover cervical os Partial - placenta partially covers over the cervical os (c-section) total - placenta covers over cervical os (c-section) |
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Placenta Previa s/s and treatment |
first episode of bleeding typically preterm and with bleeding there are no contractions. Painless vaginal bleeding. Bedrest and observation is treatment especially if fetus is less than 37 weeks gestation and bleeding is mild or moderate ultrasound for confirmation. avoid vaginal exam |
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Placenta Previa what hx is associated with it?
Anterior or posterior lying position increases risk for csection? Management is based off what |
Associated with previous c-section and uterine myomectomy anterior lying placenta pre via increase risk of bleeding and csection management is based of vaginal bleeding and maturity of fetus |
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Placental abruption |
separation of the placenta from the deciduas basal is before delivery. - etiology unknown marginal, partial , or complete. painful bleeding (may be concealed up to 2500) HTN common cause |
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Whats tx of placental abruption what vessels are bleeding? |
delivery of fetus, No epidural with bleeding issues, aggressive fluid resuscitation exposed decidual vessels accounts for lot of bleeding |
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Placenta accreta vs increta vs precreta |
accreta = adherence to the myometrium without invasion of or passage through uterine muscle Increta = invades and is confined to the myometrium percreta = invades and may penetrate the myometrium, the uterine serosa, and other pelvic structures |
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Risk for placenta accreta? Management of acceta? |
previous c-section increase risk. most cases require c section or post partum hysterectomy (most common indication) Lots of blood and need to give VOLUME |
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Amniotic fluid embolism |
mortality 86%, 50% within the first hour. amniotic fluid gets into the maternal circulation due to breaks in the uteroplacental membranes. Tx CV resuscitation, stabilization, and support. Afterwards DIC |
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Uterine Rupture |
TOLAC vs VBAC may occur due to dehiscence of scar from previous c-section, intrauterine manipulation, or spontaneous rupture due to labor. continuous abdominal pain and hypotension may identify rupture. Tx volume and immediate laparotomy |
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Blood coagulation and Lab tests with DIC vs pregnancy |
Fibrinogen pregnant 400-650 vs DIC <150 Platelet Pregnant 150-300 vs DIC <50 Thrombin time Pregnant 15-20 sec vs >100 sec PT pregnant 10-12sec vs >100 sec PTT 35-50 sec vs >100 sec |
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Pre-clampsia |
HTN, proteinuria, generalized edema occurring after the 20th week of gestation usually abating within 48 hours of delivery |
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Eclampsia |
Occurrence of convulsions superimposed on pre-eclampsia |
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Magnesium Sulfate and Levels |
1-2 normal plasma level 4-8 - therapeutic range 5-10 - EKG P-Q interval prolonged, QRS widens 10 loss of deep tendon reflex 15-SA and AV node block 15 Resp Paralysis 25 Cardiac arrest |
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Magnesium sulfate what does it do |
attenuates smooth muscle contraction by competing with calcium at the cell membrane level and preventing an increase in free intracellular calcium SE - hypotension, may increase NDMR |
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MG effects on preeclampsia or eclampsia |
Anticonvulsant, Vasodilation, increased uterine blood flow, increased renal blood flow, antihypertensive, increased prostacyclin, decrease renin, decrease ACE, attenuates vascular response of pressers, reduced platelet aggregation, bronchodilation, Tocolysis - improves uterine blood flow |
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Detrimental effects of MG |
prolonged labor and PP-hemorrhage decreased FHR variability myoneural blocking effects muscle weakness lower APGAR scores |
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Effective measures to prevent pulmonary aspiration |
regional fasting gastric prophylaxis RSI and cricoid pressure |
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VEAL CHOP stand for |
Variable - Cord (type 3) Early - Head (type 1) Accelerations - Okay Late - Placenta (type 2) |
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1st stage of labor pain vs 2nd stage of labor pain |
1st - T10 L11 2nd stage S2-S4 |
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What is the normal PaCO2 and PaO2 in the normal fetus |
48 PaCO2 30 PaO2 leaving the placenta |
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What determines uterine blood flow |
is directly related to perfusion pressure ( uterine mean arterial pressure - uterine venous pressure). inversely related to uterine vascular resistance. |
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Normal Fetal HR? whats brady? whats tachy |
normal 120-160 Brady less than 120 tachy greater than 160 |
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which hemodynamic parameter decrease the most with pregnancy ? what increases the most? |
SVR decreases 20% Cardiac output 50%(starts 5th week of gestation) |
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When is cardiac output the greatest during pregnancy? How long does it last and what percent does it go up? |
Immediately after delivery, goes up 80-100% for 24 hours. |
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what happens to plasma cholinesterase with pregnancy |
decreases by 30%, takes 2-6 weeks to return to normal |
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FRC decreases how much during pregnancy |
20% biggest decrease out of all respiratory parameters |
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Whats HELLP |
hemolysis, elevated liver, and low platelets occurs before 36 weeks gestation and requires immediately delivery |
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Triad with pre-eclampsia |
HTN 160/110 Proteinuria 5g per day, and Edema generalized |
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Preeclamptic patient what do you tx them with (HTN agents) |
Give Labetalol and Hydralazine Don't give esmolol |
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Mg toxicity is treated with |
Ca Gluconate |
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Ritodrine side effects and what does it do |
ritodrine is beta 2 agonist - slows contractions causes hypokalemia, tachycardia, hyperglycemia, and pulmonary edema |
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Ion trapping is facilitated by what acid base disturbance in fetus and mom |
Maternal alkalosis and fetal acidosis |
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Rank Amide local anesthetics from greatest to least according to ability to cross the placenta |
Maternal Elevated Locals are Risky to Baby Mepi>Eitd>Lido>Ropi>Bupi Ester dont cross |
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How much less of LA do you need with pregnant patient |
30% less |
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Which drug do you not give to a HTN pregnant patient |
Methylergonovine = GIVE IM 0.2mg |
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What is the most common cause of maternal death during obstetric general anesthesia |
hemorrhage |
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APGAR score is determined by Fetal ph when is it considered acidotic |
Heart Rate, RR, Reflex irritability, Muscle tone, and Color Fetal ph below 7.2 is considered acidotic, above 7.25 is normal |
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Whats considered a neonate? Infant? Child? |
Neonate 1-30 days Infant 1-12 months Child 1-12 years |
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Cardiac output in a infant is dependent on what |
Heart Rate |
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Chest wall and Lung compliance in a child |
Chest wall Compliance is greater and lung compliance is less |
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Changes in a infant |
Higher ratio of body surface area to body weight higher total body water content(large volume for water soluble drugs) Large Head and tongue, Nasal breathers Long epiglottis and stiff |
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Differences between adult and pediatric airway |
Adult C5-C6 cords, C3-C4 child Narrowest portion of airway in adults Glottis and Cricoid in child Omega shaped epiglottis (C) vs V-Shaped (A) Right main stem bronchus less vertical in kids |
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Airway significance of peds |
narrow nares - resistance 12 times an adult large tongue high glottis slanting vocal cords narrow cricoid ring(younger than 5) |
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ET sizing |
16+ age /4 neonates <3kg =3.0-3.5 Infants to 1 year = 3.5-4.0 Children 1-2 = 4.0-4.5 |
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Calculating ET length at the mouth |
Height cm/ 10 + 5 weight (kg) / 5 + 12 |
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Estimating Blood volumes premature to adult |
Premature 90 Infant 80 Toddler 75 child 2-12 = 72 Adult male 70 Adult female 65 |
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Calculate fluid maintenance for a 27 kg child |
4 ml/kg for first 10 kg 2ml/kg for 10-20 kg 1 ml/kg for every Kg>20 67 ml/hr |
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Fetal Circulation flow |
RA to Foramen to LA to LV to Aorta RA to RV to PA to Ductus Arteriosus The Ductus Venosus shunts the blood from the from placenta to the liver and heart |
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Body fluids comparison between infant and adults |
Infant and adult both 40% intracellular
Extracellular 35-40% in infant and 20% in adult Blood 8-10% infant and 7% in adult |
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Total body water preterm to infant |
preterm 90% term 80% 6-12 months 60% |
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Why are infants of diabetic mothers prone to hypoglycemia |
infant produce insulin in response to maternal blood sugar to control its own sugar, but when the cord is clamped the baby will have extra insulin b/c it doesn't have to control the additional glucose from the mother |
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Local anesthetic for infants |
Bupivacaine most common. |
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Greatest risk of experiencing post anesthetic complications |
less than 60 weeks post conceptional |
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Prematurity defined as what |
birth before 37 weeks |
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Congenital Diaphragmatic Hernia |
70-90% on left side associated with pulmonary hypoplasia caused by utero compression gut herniates into the thorax *profound arterial hypoxia (RtoL shunt), Barrel shaped chest (scaphoid abdomen), and severe retractions* Hallmark signs |
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Treatment for congenital diaphragmatic hernia
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maintain pre-ductal saturation above 85% and keeping peak inspiratory pressure below 25 and allow PaCO2 to rise to 45-55 decompress stomach and O2 supplementation R side pneumothorax big concern paralysis with narcotics |
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Trachesoesophageal fistula |
Most common form ends in a blind pouch and a lower esophagus that connects to the trachea. Type C s/s - gastric distention w/ resp, aspiration, and dehydration. Diagnosis made by not being able to pass catheter into stomach - |
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TE FISTULA VACTERL Syndrome |
associated congenital anomalies V- Vertebral defect A Anal Atresia C- Cardiac Anomalies T - TE Fistula E Esophageal Atresia R Renal Dysplasia L Limb anomalies |
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TE Fistula Anesthetic considerations |
copious secretions no + pressure ventilation awake intubation no MR principal cause of death - pulmonary complications |
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Pyloric Stenosis |
Idiopathic hypertrophy of the circular smooth muscle of the pylorus - results in compression and narrowing of the pyloric channel Non bilious projectile vomiting at 2-5 weeks of age... See olive-like mass that can be palpated in epigastrium |
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Metabolic presentation with Pyloric Stenosis |
Hypokalemic, Hypochloremic, and primary metabolic alkalosis - w/ 2nd resp acidosis |
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Treatment of Pyloric Stenosis |
Medical before Surgical Tx Hypokalemia and Resp Acidosis first NO LR Feedings begin 4-6 hours after surgery Avoid pulmonary aspiration (OG tube) monitor for hypocalcemia and hypoglycemia for 2-3 hours after surgical correction |
