Physiologic Changes
This phenomenon causes an increased risk of aspiration during pregnancy.
What is decreased lower esophageal sphincter pressure?
This anesthetic drug has been proven to be clearly dangerous to the human fetus.
What is none?
This is the best trimester to perform urgent-nonelective surgery.
What is the second trimester?
There is no difference in fetal outcome with laparoscopy versus laparotomy. True or false?
What is true?
What percentage of pregnant women require nonobstetric surgery?
What is 0.48 to 0.7%?
(17-25k cases in US and EU annually)
The pressure of the gravid uterus on the inferior vena cava is called this and becomes a concern after the 18-20 weeks of gestation.
What is aortocaval compression?
Small case-controlled studies identified this class of anesthetics as causing congenital anomalies such as cleft palate and cardiac diseases. But larger, better controlled studies have refuted this.
What are benzodiazapenes?
During this critical period in human gestation an all-or-nothing phenomenon exists; the fetus is lost or preserved intact.
What is the first 2 weeks (15 days)
Loss of fetal heart rate variability under maternal general anesthesia is always an indicator of fetal distress. True or false?
What is false?
This is when regional anesthesia is preferable to general anesthesia in a pregnant patient.
What is almost always?
Pregnant patients have an increased risk of aspiration and are therefore functionally considered "full stomachs" from this week in pregnancy to this time postpartum.
What is from the 16th week of pregnancy to 48hrs postpartum?
Randomized controlled trials of anesthetic drugs in pregnancy are nonexistent because of this reason.
Which is it is unethical?
Fetal heart rate monitoring should be performed from this week in pregnancy onwards.
What is- there is no concensus?! ACOG recommends each patient to be taken on an individual basis, however, convention is to include some form of fetal monitoring for a viable fetus.
Passive dependence of the uteroplacental circulation on maternal blood pressure is the reason to avoid this.
What is maternal hypovolemia (or hypotension!)?
Meta-analysis of studies involving more than 12,000 pregnant women who had nonobstetric surgery indicate this this is the rate of maternal mortality.
What is 4-25 deaths/10,000?
0.04-0.25%
Hemodynamics change significantly to prepare the parturient for labor and delivery. These are the changes in the blood volume, cardiac output and hematocrit.
What is 50% increase in cardiac output and blood volume, and a 20% decrease in Hct?
Though it is unclear that there is clinical significance, the convention is to avoid nitrous oxide in pregnancy because of this.
What is methionine synthetase inhibition?
Aspiration prophylaxis is recommended from this trimester.
What is the second trimester?
This can cause uteroplacental vasoconstriction, decreased perfusion, fetal acidosis and fetal death.
What is prolonged maternal hypoxia?
The same meta-analysis concluded that surgery and anesthesia had this effect on risk of birth defects.
What is no increased risk of birth defects?
Hypoxemia with induction is common during pregnancy because of these three risk factors.
What are increased oxygen consumption, decreased FRC, and maternal obesity?
This drug has been associated with increased spontaneous abortions in dental workers when it is not scavenged.
What is nitrous oxide?
This effect of anesthetic gases on rodent neurons has caused some alarm, but it is unclear that this finding can be extrapolated to humans.
What is apoptosis?
Meta-analysis has demonstrated that this particular surgical condition has been associated with fetal loss.
What is acute appendicitis with peritonitis?
This describes two acceptable ways to reverse muscle relaxants in pregnancy.
What are glycopyrrolate/neostigmine and atropine/neostigmine. Suggamadex is yet unproven in the pregnant population and should be used with caution. Stay tuned...