Princinples II NERV, GI, RENAL
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| WHAT ARE THE PHYSIOLOGICAL CHANGES WITH NERVOUS SYSTEM. | DREASED ANESTHESTIC REQUIREENTS
-MAC LOWER VA
-PROGGESTERON PRODUCED SEDATION
-INCREASED INHALATIONAL AGENT R/T PULMONARY CHANGES.
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| ANESTHETIC CONSIDERATIONS: | -CNS DEPRESSION-> INCREASED RISK FOR ASPIRATION R/T IMPAIRED UPPER AIRWAY REFLEXES.
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| 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.
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| WHAT HAPPEN TO ANESTHETIC AGENT. LA | THERE IS AN EXAGGERATED SPREAD OF LOCAL ANESTHETICS. DECREASE THE DOSE REQUIRED BY 30% TO 50%
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| DO YOU DECREASE THE DOSE OF LA WITH A PREGNANT WOMAN? | YES.
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| BY HOW MUCH OF A DECREASE OF LA | 30-50%
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| 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)
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| 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).
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| IS THERE ALSO INCREASED IN FIBRINOGEN AND PLATELETS? | YES. BOTH ARE INCREASED.
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| ANESTHETIC CONSIDERATION FOR HEPATIC SYSTEM | SUCCINYLCHOLINE AND MIVACURIUM.
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| WHAT HAPPEN WITH BLOCKADE | THERE MIGHT BE POSSIBLE PROLONGATION OF NEUROMUSCULAR BLOCKING EFFECTS. ALWAYS USE A PERIPHERAL NERVE STIMULATOR
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| 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.
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| WHAT HAPPEN TO THE PHYSIOLOGIC SPHINCTER MECHANISM | IT BECOMES INCOMPETENT.
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| WHAT IS MENDELSON'S SYNDROME | ASPIRATION PNEOMONITIS
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| WHAT IS THE PH AND GASTRIC VOLUME | PH < 2.5 AND GASTRIC VOLUME OF > 25 ML
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| WHAT ARE THE ANESTHETIC CONSIDERATIONS FOR GI; | -COMMONLY EXPERIENCE ESOPHAGITIS, GERD
-GASTRIC FLUID VOLUME AND GASTRIC FLUID PH
-FULL STOMACH
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| PRETREAT WITH PREGNANT WOMEN WITH | REGLAN 10MG IV; ZANTAC 50 MG IV; AND BICITRA 30 ML PO
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| 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).
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