Flashcards in Week 2 Anesthesia for Fetal Surgery (everything) Deck (69)
pulmonary valvuloplasty is for
1. evolving hypoplastic right heart syndrome with pulmonary atresia or stenosis without a ventricular septal defect and
2. fetal pericardiocentesis
Complications of congenital cardiac interventions include
-preterm delivery, and
What are some good things about the intrauterine environment as it relates to surgery?
supports rapid wound healing, provides adequate nutritional and respiratory needs, and limits robust immune responses to interventions.
Is serious maternal morbidity from intrauterine fetal surgery is relatively common or uncommon?
but the welfare of the mom must always be emphasized.
If the mom was to absorb significant amounts of crystalloids during uterine irrigation what may occur?
pulmonary edema could occur
True or False
Fetal surgeries do affect future fertility?(bold in ppt)
Fetal surgeries do not affect future fertility.
Is the fetal risk of intrauterine surgery relatively high still? (bold in ppt)
Yes, it remains relatively high!
What types of issues can occur to a fetus if intrauterine surgery occured?
central nervous system injuries, membrane separation, Premature Rupture of Membranes (PROM), placental abruption, preterm labor and delivery, blood loss, chorioamnionitis, post-operative amniotic fluid leaks with oligohydramnios, fetal demise
How many patients are involved in fetal surgery (bold in ppt)
Fetal surgery involves 2 patients and the anesthesia provider must balance the needs of both.
Who's safety is paramount during fetal surgery? (bold in ppt)
Maternal safety is paramount.
(I assume she is more important than fetus according to this bullet point, could easy be a chose between mom or baby question) BUT know that the fetus is not an innocent bystander (stated in another bullet point)
What needs to be completely relaxed during open fetal surgical procedure?
Complete uterine relaxation is necessary.
Fundamental considerations for the anesthetic management of fetal surgery are similar to those for ???
non obstetric surgery during pregnancy.
What kind of roles does the Anesthesia Provider play during fetal surgery?
Anesthesia Providers should participate in preoperative maternal assessment
Anesthesia Providers must understand the physiologic impact of pregnancy on anesthetic management
Anesthesia Providers should serve as a member of the multidisciplinary team.
What should you review imaging studies for when considering fetal surgery? (what are you looking for?)
placental location, anatomic information.
Is the fetus an innocent bystander if a surgery is performed during pregnancy?
No (according to ppt)
What forms of anesthesia and analgesia can be provided to the Momma?
local infiltration, IV sedation, neuraxial anesthesia, general anesthesia or a combination of these techniques.
How is Fetal analgesia and anesthesia achieved?
Fetal analgesia and anesthesia can be achieved via placental transfer of anesthetic agents given to the mother.
What two administration methods of medications to the mom will transfer medication to the fetus?
IV (peripheral fetal vein or umbilical vein) or IM administration of agents or by a combination of these techniques.
can you assess pain in a human fetus?
The subjective phenomenon of pain has not been , and perhaps cannot be, assessed in human fetuses.
Know how pain is complex, that it is not just having a direct stimulus that causes pain. (the next slide is just information to know in general, no hard memorization.
Pain is multidimensional, subjective, psychological construct that can exist in the absence of physical stimuli (phantom limb pain) and it includes emotional and affective components that require higher-level cortical processing.
Although pain is commonly associated with noxious physical stimuli, it is more than a nociception (response to noxious or potentially harmful stimuli) or a simple reflex activity associated with withdrawal response.
Do volatile anesthetic agents cross the placenta into the fetus?
With maternal administration of general anesthesia volatile anesthetic agents readily cross the placenta to the fetus.
What two factors determine the fetal level of halogenated anesthesia?
(it states halogenated in the slide but I might assume these two factors are true for all volatile gasses?)
depends of both the inspired maternal concentration as well as the duration of administration.
What has to be maintained so that the fetus does not have fetal hypoxia, hypercarbia, or acidosis even after 2 hours exposure to deep maternal inhalation anesthesia?
maternal arterial blood pressure must be maintained! (bold in ppt)
Evidence for neuronal apoptosis in the developing brains of rats was shown after exposure to a wide range of anesthetic agents, what does this mean for human fetuses and neonates?
It is not known if anesthetic agents similarly affect human fetuses or neonates.
(these studies can not be performed so....)
Even though issues with a babies brain can not be definitively proven with the use of anesthesia medications, what has the FDA stated in regards to this? (general information, not bold or anything in ppt)
Nonetheless in December of 2016 the FDA issued a communication warning “repeated or lengthy exposure to general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's’ brains.
Tell me some way to monitor the fetus? (looking for three answers)
Fetal Heat Rate Monitoring
Ultrasonography ( including echocardiography and Doppler assessment of umbilical cord blood flow)
Blood gas and acid base analysis
What is the most common (and sometimes simple) way to monitor a fetus during labor and delivery? (easy answer)
Fetal heart rate monitoring! Electronic or with a stethoscope.
Fetal heart rate can be monitored intermittently with a simple Delee or Pinard stethoscope. Can also use Doppler ultrasonography or fetal electrocardiography (ECG) electrode can be used to monitor the FHR intermittently or continuously.
what is the process physiologically for a decrease in fetal hear rate?
Parasympathetic outflow by means of the vagus nerve decreases the FHR.
What physiologically increases FHR and CO?
Sympathetic activity increases FHR and cardiac output.