TAILIEUCHUNG - OPERATIVE OBSTETRICSANESTHESIA

Anesthesia management is markedly influenced by pregnancy. Pregnancy-induced physiologic alterations may be compounded by labor, pregnancy-associated conditions (., pregnancy-induced hypertension), or intercurrent disease states of the mother or fetus (., heart disease, pulmonary hypertension, diabetes, or isoimmunization). The pregnancy alterations most influencing anesthesia are those of the cardiovascular, pulmonary, and gastrointestinal systems. At term, cardiac output is increased by 30%–40% above nonpregnant levels in the absence of aortocaval compression. Increased cardiac output speeds the onset of inhalation anesthetics. Uterine involution leads to an autotransfusion of 500 mL. . | ANESTHESIA Anesthesia management is markedly influenced by pregnancy. Pregnancy-induced physiologic alterations may be compounded by labor pregnancy-associated conditions . pregnancy-induced hypertension or intercurrent disease states of the mother or fetus . heart disease pulmonary hypertension diabetes or isoimmunization . The pregnancy alterations most influencing anesthesia are those of the cardiovascular pulmonary and gastrointestinal systems. At term cardiac output is increased by 30 -40 above nonpregnant levels in the absence of aortocaval compression. Increased cardiac output speeds the onset of inhalation anesthetics. Uterine involution leads to an autotransfusion of 500 mL. Thus there is potential for fluid overload with volume loading. Parturients have a diminished functional residual capacity despite increased total lung capacity increased oxygen consumption and diminished oxygen saturation. Little apnea may produce significant hypoxia. Therefore supplemental O2 is recommended with either regional or general anesthesia. There is a decrease in physiologic dead space and a decreased gradient between arterial and end-tidal CO2 tensions. Thus with general anesthesia the end-tidal CO2 levels should be maintained several torr higher than in the nonpregnant patient. Term parturients have increased intragastric volumes decreased gastric pH accentuated intragastric pressure and delay in gastric emptying. Thus there is enhanced risk of gastric aspiration. Aspiration of gastric contents may cause maternal death. Modified from . Pernoll and J. Mandel Cesarean section. In . McDonald ed. Bonica s Text of Obstetrical Anesthesia. 1994. 483 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms ofUse. 484 BENSON PERNOLL S HANDBOOK OF OBSTETRICS AND GYNECOLOGY PREOPERATIVE PREPARATION LABORATORY DETERMINATIONS For the normal patient undergoing anesthesia determination of Hct or Hgb is necessary but a differential count contributes little to .

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