Pregnancy Anaesthesia considerations

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  • Pregnancy
    • Risks
      • First trimester - embryo toxicity
      • Second trimester - placental separation
      • Third trimester - major physiological changes
    • CV changes
      • CO and blood volume increase
      • both plasma volume & red cell mass increase
      • albumin levels decrease
      • cardiac reserve decreases nb animals with pre existing cardiac disease
      • SVR decreases
      • Hypotension
    • Respiratory changes
      • Minute voulme & O2 consumption increases
      • FRC decreased
    • GI changes
      • Gravid uterus places pressure on stomach
      • oesophagus kinked by altered position
      • increase serum progesterone
      • more prone to regurgitation
    • Renal effects
      • RBF & GFR increase
      • urea and creatinine concentrations decrease
    • Anaesthesia
      • Premed
        • dam often exhausted
          • premed passed to offspring
            • pethidine IM
      • Maintenance
        • low resistance breathing system
          • may need to IPPV
            • use of N2O is controversial
              • NMBs will not cross the placenta
      • Positioning
        • gravid uterus will put pressure on the aorta and vena cava which will reduce venous return and CO
          • vena cava is the easiest to compress and lies to the right of midline, so tilt animal to the left

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