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A & P of OB 2
Princinples II NERV, GI, RENAL
| Question | Answer |
|---|---|
| WHAT ARE THE PHYSIOLOGICAL CHANGES WITH NERVOUS SYSTEM. | DREASED ANESTHESTIC REQUIREENTS -MAC LOWER VA -PROGGESTERON PRODUCED SEDATION -INCREASED INHALATIONAL AGENT R/T PULMONARY CHANGES. |
| ANESTHETIC CONSIDERATIONS: | -CNS DEPRESSION-> INCREASED RISK FOR ASPIRATION R/T IMPAIRED UPPER AIRWAY REFLEXES. |
| WHAT HAPPEN TO THE EPIDURAL AREA AND THE VEINS | EPIDURAL VEINS ARE ENGORGED. THE EPIDURAL SPACE IS DECREASED AND THE THE VOLUME OF THE CSF IS ALSO DECREASED. |
| WHAT HAPPEN TO ANESTHETIC AGENT. LA | THERE IS AN EXAGGERATED SPREAD OF LOCAL ANESTHETICS. DECREASE THE DOSE REQUIRED BY 30% TO 50% |
| DO YOU DECREASE THE DOSE OF LA WITH A PREGNANT WOMAN? | YES. |
| BY HOW MUCH OF A DECREASE OF LA | 30-50% |
| WHAT ARE THE PHYSIOLOGICAL CHANGES WITH RENAL SYSTEM | -3RD MONTH OF PREGNANCY THERE IS 50-60% INCREASE OF RENAL BLOOD FLOW. AND GFR. 50% DECREASE IN (UPPER NORMAL LIMITS).- BUN ( APPROX 8MG/DL). -CREATININE CONCENTRATIONS (O.5MG/DL) |
| WHAT ARE THE PHYSIOLOGICAL CHANGES WITH HEPATIC SYSTEM. | - 10TH WEEK OF PREGNANCY TO 6 WKS POSTPARTUM- . THERE IS INCREASE LDH, ( ALT/SCOT) . 25% DECREASE IN PLASMA CHOLINESTERASE ACTIVITY .HYERCOAGUABLE STATE. (DVT RISK) -PLASMA CONCENTRATIONS OF COAGULATION FACTOR (I, VII, VIII, IX, X, XII). |
| IS THERE ALSO INCREASED IN FIBRINOGEN AND PLATELETS? | YES. BOTH ARE INCREASED. |
| ANESTHETIC CONSIDERATION FOR HEPATIC SYSTEM | SUCCINYLCHOLINE AND MIVACURIUM. |
| WHAT HAPPEN WITH BLOCKADE | THERE MIGHT BE POSSIBLE PROLONGATION OF NEUROMUSCULAR BLOCKING EFFECTS. ALWAYS USE A PERIPHERAL NERVE STIMULATOR |
| WHAT ARE PHYSIOLOGICAL CHANGES WITH GI SYSTEM | UPWARD AND BACKWARD DISPLACEMENT OF PYLORUS - RETARDS GASTRIC EMPTYING. DECREASED IN GASTRIC MOTILITY R/T PORGESTERONE.-INCREASED GASTRIC FLUID VOLUME. GASTRIN (PLACENTA)STIMULATES GASTRIC HYGROGEN ION SECRETION -> LOWER PH OF GASTRIC FLUID. |
| WHAT HAPPEN TO THE PHYSIOLOGIC SPHINCTER MECHANISM | IT BECOMES INCOMPETENT. |
| WHAT IS MENDELSON'S SYNDROME | ASPIRATION PNEOMONITIS |
| WHAT IS THE PH AND GASTRIC VOLUME | PH < 2.5 AND GASTRIC VOLUME OF > 25 ML |
| WHAT ARE THE ANESTHETIC CONSIDERATIONS FOR GI; | -COMMONLY EXPERIENCE ESOPHAGITIS, GERD -GASTRIC FLUID VOLUME AND GASTRIC FLUID PH -FULL STOMACH |
| PRETREAT WITH PREGNANT WOMEN WITH | REGLAN 10MG IV; ZANTAC 50 MG IV; AND BICITRA 30 ML PO |
| SUMMARY OF GA CONSIDERATIONS | REGIONAL ANESTHESIA-AVOID HYPOTENSION GENERAL ANESTHESIA- -PREOXYGENATION, PREMEDICATE -RSI WITH CRICOID PRESSURE -SMALLER ETT (SIZE 6.0-7.0) -CAREFUL WITH LARYNGOSCOPY (GENTLE DL). |
Created by:
eonaodow
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