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IN THE NAME OF GOD. Ahvaz Jundishapur University of Medical Science Nesioonpour Sholeh,MD 2012 DEC.

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Presentation on theme: "IN THE NAME OF GOD. Ahvaz Jundishapur University of Medical Science Nesioonpour Sholeh,MD 2012 DEC."— Presentation transcript:

1 IN THE NAME OF GOD

2 Ahvaz Jundishapur University of Medical Science Nesioonpour Sholeh,MD 2012 DEC

3 PHYSIOLOGIG CHANGES OF PREGNANCY

4 *HORMONAL ALTERATION *MECHANICHAL EFFECT OF GRAVID UTERUS *METABOLIC & OXYGEN REQUIREMENT *METABOLIC DEMANDS OF FETOPLACENTAL UNIT *HEMODYNAMIC ALTERATION WITH PLACENTAL CIRCULATION

5 CARDIOVASCULAR SYSTEM

6  HEART RATE 20-30%  STROKE VOLUME 20-50%  CARDIAC OUTPUT 30-50%

7 CVP UNCHANGED  SVR BP UNCHANGED  PVR  PAP

8 Tachyarrhythmias are more common in pregnancy

9 SUPINE HYPOTENTION SYNDROME

10 SEVERE HYPOTENTION IN SUPINE POSITION Inf vena cava obstruction

11

12 15-20 degree left uterine displacement with small pillow or wedge

13 shortness of breaths palpitation dizziness edema poor exercise tolerance

14 further investigation chest pain syncope severe arrhythmia systolic murmur > 3 diastolic murmur further investigation

15 Chest radiography Apparent Cardiomegaly Enlarged Left Atrium Increased Vascular Marking Postpartum pleural Effusion

16 Electrocardiogram Electrocardiogram right axis deviation right bundle branch block Q wave in lead III

17 Echocardiography Echocardiography Tricuspid Regurgitation Pulmonary Regurgitation Mitral Regurgitation Pericardial Effusion

18

19 HEMATOLOGIC SYSTEM

20  Total body water 8/5 Lit Sodium retention

21 Physiologic anemia HB : 11/6 gr/dl  blood volume 45%  red cell volume 30% oxygen transport not impaired

22 Hypercoagulability  Fibrinogen  VII factor  VIII,IX,X,XII Platelets unchanged

23  Protective adaptation to lessen hemorrhage risk at delivery - thromboembolism, a maternal mortality cause DVT 5 – 6 times higher than general female at chilbearing age

24 Platelets Neuraxial Block Platelets ? ? ?

25 Gradual return to prepregnancy blood volume 6-9 weeks postpartum

26 RESPIRATORY SYSTEM

27  WORKING OF BREATHING

28 The most impressive change  FRC 20% at term

29 Minute Ventilation  45% Tidal Volume  50% Unchanged RR

30 Desaturation Faster than Nonpregnant  O2 consumption  Basal metabolic rate  FRC Desaturation Faster than Nonpregnant

31 Fully preoxygenated nonpregnant desaturation 100%  90% 9min healthy pregnant  3-4 min morbid obese pregnant  98 S

32 Administration of 100% oxygen 3-5 minutes before induction of anesthesia

33 Emergency : 4 maximal capacity breathing with 100% o2

34 difficult intubation Capillary engorgement of mucosa edema of Oropharynx Larynx & Trachea  difficult intubation

35 17 times higher mortality rate among parturient women undergo general anesthesia than regional

36 Upper airway manipulation suctioning, airway laryngoscopy edema, bleeding, trauma

37 Endotracheal tube 6 - 7

38

39 GASTROINTESTINAL SYSTEM

40 GI function in pregnancy & labor is contraversy

41  Risk of aspiration with GA  Risk of aspiration with GA Progestrone relax smooth musle  impairs esophaseal & intestinal motility during pregnancy Opioids delay gastric emptying

42  Bile secretion progestrone change of bile composition  stasis  gall stone formation cholecystectomy 2th surgery in pregnancy

43 RENAL SYSTEM

44 Major changes in pregnancy

45  Urea  creatinine  uric acid clearance

46  CO   RPF  GFR  PLASMA CREATININE & UREA

47 lower Normal renal indices in pregnancy are lower than in nonpregnancy glycosuria is a common finding

48 CENTRAL NERVOUS SYSTEM

49 REGIONAL & GENERAL INCREASED SENSITIVITY TO REGIONAL & GENERAL ANESTHETICS

50 MULTIFACTORIAL EXPLANATION

51  CSF UNCHANGED ICP

52  Progestrone  Endorphine   Pain Treshold

53 THANKS FOR YOUR ATTENTION


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