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Physiologic Changes of Pregnancy

Physiologic Changes of Pregnancy. Anesthesia for Non-obstetrical surgery in the pregnant patient. 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??.

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Physiologic Changes of Pregnancy

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  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 * 5’6”, 130# * Class I Airway * Lungs clear * Heart regular, rate 80’s, 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- NDMB’s- * Tocolysis- * Hemodynamic Goals-

  12. Cyst Uterus

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