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Anesthesia for Non-Obstetric Surgery Most common reasons for surgery: – Appendicitis – Cholecystitis – Trauma – Ovarian torsion.

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Presentation on theme: "Anesthesia for Non-Obstetric Surgery Most common reasons for surgery: – Appendicitis – Cholecystitis – Trauma – Ovarian torsion."— Presentation transcript:

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2 Anesthesia for Non-Obstetric Surgery Most common reasons for surgery: – Appendicitis – Cholecystitis – Trauma – Ovarian torsion

3 Anesthesia for Non-Obstetric Surgery Maternal safety is related to: – Physiological adaptations associated with pregnancy Fetal safety is related to: – Teratogenicity – Avoidance of fetal asphyxia – Avoidance of preterm labor

4 Anesthesia in the 1 st Trimester Altered cardiac, haemodynamic, respiratory, metabolic and pharmacological parameters Increase minute ventilation, O2 consumption and dec. reserve More difficult laryngoscopy and intubation Marked reduction of plasma cholinesterase Higher aspiration risk

5 Pharmacologic considerations 20-30% reduction in MAC Increased sensitivity to local anesthetics More extensive spread of local anesthetics given intrathecally 25% reduction of plasma cholinesterase levels Most drugs can easily cross placental barrier No proven teratogen among anesthetics

6 Examples Vecuronium at 0.2mg/kg – faster onset and longer duration Rocuronium at 0.6 mg/kg – unchanged onset but longer duration Atracurium – faster onset and shorter duration

7 Preoperative management Anxiolytics Aspiration pneumonitis prophylaxis – H2 – receptor antagonist – Dopamine antagonist

8 Anesthesia Technique Regional/Local Anesthesia Reduced exposure of fetus to potential teratogens Decreased maternal respiratory complications (failed intubation, aspiration, etc) General Anesthesia Ensures patient comfort Nitrous oxide without concomitant administration of a halogenated anesthetic is reported to reduce uterine blood flow

9 Anesthesia Technique Regional or local anesthesia should be employed whenever possible – Spinal is preferred over epidural due to: decreased drug exposure to fetus not associated with unintentional intravascular injections or potentially large intrathecal doses of local anesthetic

10 Intraoperative management 15 0 left lateral tilt (esp 2 nd trimester onwards) Slow change in positioning If GA, utilize rapid sequence induction: – Initiate only after abdomen has been prepped – 5 minutes meticulous denitrogenation – Apply cricoid pressure – Use drugs with well-known history of safety – No positive pressure ventilation

11 Monitor Maternal oxygenation Maternal BP Maternal PaCO2 ABG in some cases Uterine blood flow Fetal heart tone (18 wk onward)

12 Dosages Induction agents: – Thiopental 4mg/kg – Propofol 2mg/kg – Ketamine 1mg/kg – Etomidate 0.3mg/kg – Succinylcholine 1-1.5mg/kg Inhalants: – 50% N2O/50% O2 and 0.5 to 1.0 MAC desflurane, sevoflurane or isoflurane

13 Spinal – reduce by 25% segmental dose requirement (not seen in 1 st trimester)


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