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A & P of OB 2

Princinples II NERV, GI, RENAL

QuestionAnswer
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