Physiologic Changes of Pregnancy

1
Physiologic Changes of Pregnancy

• Anesthesia for Non-obstetrical surgery in the
  pregnant patient

2
Case

• An 18 year-old, G1P0, at 16 weeks gestation,
  presented for removal of a giant ovarian cyst (US
  showed 15 x 25 x 30 cm simple, cystic mass
  stemming from the right ovary).
• Issues??

3
Physiologic Changes

• Neurologic-
• Cardiovascular-
• Pulmonary-
• Renal-
• Hepato/GI-
• Endocrine-
• Hematologic/Fluid Balance-
• Metabolic-
• Musculoskeletal-

4
Case

• She claimed to have had a pot-belly for years
  which was never evaluated until an ultrasound was
  performed recently my Maternal-Fetal Medicine
  after referral for a history of ASD repair at age
  16

5
Case

• ROS
• Accelerated increase in abdominal girth over
  the past 5 months.
• Early satiety.
• Excellent exercise tolerance.
• No palpitations, SOB, syncope.
• No respiratory problems.

6
Case

• PE
• 18 yo pregnant female
• 56, 130
• Class I Airway
• Lungs clear
• Heart regular, rate 80s, no murmur
• Fundal height 6 cm above the umbilicus

7
Case

• Pre-op Echo
• Hyperdynamic systolic function and high
  volume consistent with pregnancy
• No evidence of residual ASD

8
Pre-op Preparation

• Coordination with OB team-
• Type of Surgery-
• Risk of pre-term labor-

9
Premedication
10
Induction

• Positioning-
• Drugs Choices-
• Technique-
• Hemodynamic goals-
• Vasopressors??
• Monitors-

11
Maintenance

• Technique-
• Drugs-
• NDMBs-
• Tocolysis-
• Hemodynamic Goals-

12
Cyst
Uterus
13
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