This document summarizes key aspects of perinatal pharmacology. It discusses the perinatal period and fetal circulation. It describes the three processes of transplacental drug transfer: distribution to the placenta, placental sequestration and metabolism, and transfer to the fetal and maternal circulations. The mechanisms of simple diffusion, facilitated diffusion, active transport, and pinocytosis are explained. Factors affecting transplacental drug transfer like lipid solubility, molecular weight, and protein binding are also summarized. The document concludes by reviewing the pharmacodynamics and pharmacokinetics of various drug classes as they relate to the perinatal period.
Pharmacological agents in obs and placental transfer of drugs krishna dhakal
This presentation discusses pharmacological agents used in obstetrics and their placental transfer. It begins by reviewing the basic mechanisms of placental drug transfer and factors that affect maternal to fetal drug transfer. It then reviews various anesthetic agents and other drugs used in obstetrics, including their placental transfer properties and anesthetic implications. The presentation concludes by reviewing oxytocics that stimulate uterine contraction.
Anaesthetic management of ruptured ectopic pregnancy by Arowojolu BoluwajiArowojolu Samuel
anaesthetic management of a patient with ruptured ectopic pregnancy. helping anaesthetist to know what to do in emergency anaesthesia. this is an emergency case. salpingectomy. arowojolu boluwaji
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
1) Preoperative hypertension is common and increases the risk of perioperative complications, however well-controlled hypertension may not need surgery postponement.
2) Isolated systolic hypertension over 180 mmHg and high pulse pressure over 80 mmHg are associated with increased risk and reasonable to postpone surgery.
3) Left ventricular hypertrophy and diastolic dysfunction from long-standing hypertension increase perioperative risk and require careful fluid management during surgery.
This document provides information on the anaesthetic management of surgery for Tetralogy of Fallot (TOF). It describes the key anatomical features of TOF and its variants. It outlines the natural history of untreated TOF, including risks of cyanotic spells, heart failure and early death. The document discusses the goals of palliative and corrective surgeries, including the modified Blalock-Taussig shunt. It provides guidance on preoperative evaluation, intraoperative management and goals of anaesthesia to optimize hemodynamics and oxygenation during surgery.
The document discusses obstetric emergencies including massive obstetric hemorrhage, antepartum hemorrhage from placenta previa or abruption, uterine rupture, and postpartum hemorrhage. It provides definitions, risk factors, diagnostic criteria, management guidelines, and anesthetic considerations for each of these conditions. Prevention and treatment involve careful monitoring, IV access, blood products, oxytocic medications, and timely delivery when indicated to stabilize both mother and fetus.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
Cerebral physiology and effects of anaesthetic agentsRicha Kumar
The document discusses cerebral physiology and the effects of anesthetic agents. It covers topics such as:
- Anatomy of the cerebral circulation including the circle of Willis.
- Regulation of cerebral blood flow including chemical, myogenic, and neurogenic factors.
- Effects of increased intracranial pressure on cerebral perfusion.
- How different anesthetic agents like barbiturates, propofol, etomidate, narcotics, benzodiazepines, ketamine, and volatile anesthetics affect cerebral blood flow and cerebral metabolic rate.
Pharmacological agents in obs and placental transfer of drugs krishna dhakal
This presentation discusses pharmacological agents used in obstetrics and their placental transfer. It begins by reviewing the basic mechanisms of placental drug transfer and factors that affect maternal to fetal drug transfer. It then reviews various anesthetic agents and other drugs used in obstetrics, including their placental transfer properties and anesthetic implications. The presentation concludes by reviewing oxytocics that stimulate uterine contraction.
Anaesthetic management of ruptured ectopic pregnancy by Arowojolu BoluwajiArowojolu Samuel
anaesthetic management of a patient with ruptured ectopic pregnancy. helping anaesthetist to know what to do in emergency anaesthesia. this is an emergency case. salpingectomy. arowojolu boluwaji
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
1) Preoperative hypertension is common and increases the risk of perioperative complications, however well-controlled hypertension may not need surgery postponement.
2) Isolated systolic hypertension over 180 mmHg and high pulse pressure over 80 mmHg are associated with increased risk and reasonable to postpone surgery.
3) Left ventricular hypertrophy and diastolic dysfunction from long-standing hypertension increase perioperative risk and require careful fluid management during surgery.
This document provides information on the anaesthetic management of surgery for Tetralogy of Fallot (TOF). It describes the key anatomical features of TOF and its variants. It outlines the natural history of untreated TOF, including risks of cyanotic spells, heart failure and early death. The document discusses the goals of palliative and corrective surgeries, including the modified Blalock-Taussig shunt. It provides guidance on preoperative evaluation, intraoperative management and goals of anaesthesia to optimize hemodynamics and oxygenation during surgery.
The document discusses obstetric emergencies including massive obstetric hemorrhage, antepartum hemorrhage from placenta previa or abruption, uterine rupture, and postpartum hemorrhage. It provides definitions, risk factors, diagnostic criteria, management guidelines, and anesthetic considerations for each of these conditions. Prevention and treatment involve careful monitoring, IV access, blood products, oxytocic medications, and timely delivery when indicated to stabilize both mother and fetus.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
Cerebral physiology and effects of anaesthetic agentsRicha Kumar
The document discusses cerebral physiology and the effects of anesthetic agents. It covers topics such as:
- Anatomy of the cerebral circulation including the circle of Willis.
- Regulation of cerebral blood flow including chemical, myogenic, and neurogenic factors.
- Effects of increased intracranial pressure on cerebral perfusion.
- How different anesthetic agents like barbiturates, propofol, etomidate, narcotics, benzodiazepines, ketamine, and volatile anesthetics affect cerebral blood flow and cerebral metabolic rate.
Anaesthesia to patiens with liver disease or a liver transplantscanFOAM
A presentation by Anna Januszkiewicz at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Delayed recovery from anesthesia can have multiple contributing factors and causes. It is important to consider potential drug interactions, metabolic abnormalities, and organic causes that may cause prolonged unconsciousness and have serious health implications. Signs and symptoms of metabolic issues may not present normally in an anesthetized patient. The Glasgow Coma Scale provides an objective measure of conscious state regardless of cause.
anaesthetic management of Meningomyelocele and its Surgical excision ZIKRULLAH MALLICK
This document discusses the anaesthetic management of patients with meningomyelocele. Key points include:
- Meningomyelocele is a complex birth defect involving protrusion of the meninges and spinal cord through the vertebrae.
- Patients often have other associated anomalies and hydrocephalus.
- Anaesthetic challenges include airway management, physiological immaturity of organ systems, fluid management due to third spacing and blood loss.
- Careful pre-operative evaluation, positioning to protect the meningocele, and meticulous intraoperative fluid management are important to optimize outcomes.
Context-Sensitive Half-Time in Anaesthetic Practicemonicaajmerajain
The document discusses context-sensitive half-time (CSHT), which is the time required for drug concentrations to decrease by 50% after discontinuing an infusion. CSHT is useful for understanding the duration of drug effects after an infusion stops. It reflects how much drug accumulates in tissues during infusion and then redistributes into the blood. CSHT depends on factors like accumulation, distribution, and excretion rates, which vary between drugs. In anesthetic practice, it is important to understand if a drug has a short, predictable CSHT like remifentanil, or a more prolonged, variable CSHT like fentanyl. While half-life measures elimination rates, CSHT incorporates distribution and depends on infusion duration,
1. Mitral stenosis is most commonly caused by rheumatic fever and results in thickening and calcification of the mitral valve, reducing the valve orifice area and obstructing blood flow from the left atrium to ventricle.
2. The pathophysiology involves elevated left atrial pressure, pulmonary hypertension, and reduced cardiac output. Symptoms range from easy fatigability to pulmonary edema.
3. Physical exam findings include an opening snap, rumbling diastolic murmur, and signs of right heart failure in severe cases. Severity is graded based on orifice area, pulmonary artery pressure, and NYHA functional
Anesthesia For Congenital Diaphragmatic Herniakrishna dhakal
This document discusses congenital diaphragmatic hernia (CDH), a birth defect where organs protrude into the chest cavity due to a hole in the diaphragm. It covers the embryology, pathophysiology, diagnosis, and management of CDH. Surgical repair is the only treatment, but stabilization of the patient's respiratory and general status is needed first. Extracorporeal membrane oxygenation (ECMO) has improved survival for CDH. Long-term follow up is also important due to potential complications. A regional anesthesia method without opioids allowed early operating room extubation for CDH repair in one study.
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Anaesthetic management of obstetric emergenciesVidhi Gajjar
This document discusses the anesthetic management of obstetric emergencies such as major obstetric hemorrhage and fetal compromise. It covers the challenges in managing obstetric hemorrhage including difficulty in estimating blood loss and early diagnosis of shock due to masking of signs by normal pregnancy physiology. The management approach "ORDER" is outlined which includes organization, resuscitation, defective coagulation, evaluation of response, and remedying the cause of bleeding. General anesthesia techniques for cesarean sections in hemorrhage emphasize rapid sequence induction, cricoid pressure, and hemodynamic support through fluid resuscitation and blood product transfusion to maintain coagulation.
This document discusses pregnancy and surgery, specifically addressing whether they can safely mix. It notes that around 0.75-2% of pregnancies involve surgery. The most common surgeries are appendectomy, cholecystectomy, adnexal disease procedures, and trauma procedures. It reviews important physiologic changes in pregnancy and rates of complications from surgery. It discusses fetal hazards, principles of teratology, and implications for anesthetizing pregnant patients. It provides FDA categories and reviews effects of specific anesthetic agents. The document emphasizes using minimal effective doses of historically safe drugs and avoiding maternal hypotension, hypoxia, and hypercarbia.
This document discusses anesthesia considerations for children with congenital heart disease (CHD). It begins by classifying common CHD types as left-to-right shunts which increase pulmonary blood flow or right-to-left shunts which decrease it. The goal of anesthesia management is then to manipulate systemic and pulmonary vascular resistances to optimize blood flow based on the individual defect. Thorough preoperative evaluation and understanding of the child's specific anatomy and hemodynamics are essential to tailoring the anesthetic plan.
This document discusses low-flow and minimal-flow anesthesia techniques. It begins by defining low-flow as a fresh gas flow of 1 L/min and minimal-flow as 0.5 L/min. Rebreathing systems allow reuse of exhaled gases after removal of carbon dioxide. Using these techniques can reduce costs by 55-75% and minimize environmental pollution from volatile anesthetic gases. Proper monitoring and maintenance of breathing gas conditions is important for patient safety when using low fresh gas flows.
Chronic kidney disease is defined as kidney damage or decreased kidney function (GFR <60mL/min/1.73m^2) for more than 3 months. It is staged based on GFR from stage 1 to 5. Major causes include diabetes and hypertension. Patients experience cardiovascular, respiratory, immune, electrolyte, gastrointestinal, endocrine, hematological, neurological and acid-base abnormalities due to decreased kidney function. Anesthesia management focuses on optimizing fluid, acid-base, electrolyte and hemodynamic status as well as modifying dosages based on creatinine clearance. Regional techniques may be used but prolonged bleeding time is a contraindication.
COPD patients pose challenges for anesthesiologists due to increased risk of intraoperative and postoperative complications. The document discusses COPD definitions, pathophysiology, preoperative evaluation including pulmonary function tests, effects of smoking and benefits of smoking cessation. It also covers preoperative preparation including bronchodilation and options for anesthetic technique including benefits of neuraxial anesthesia for COPD patients.
The document discusses the posterior fossa, including its boundaries, contents, blood supply, clinical presentation of lesions, and considerations for anesthesia. The posterior fossa is bounded anteriorly by the clivus and petrous bone, posteriorly by the occipital bone, and laterally by the temporal bone. It contains the cerebellar hemispheres, brainstem, and cranial nerves III-XII. Lesions can cause a variety of signs and symptoms depending on location, including ataxia, nystagmus, limb weakness, and cranial nerve deficits. Anesthesia for posterior fossa surgery requires careful monitoring and positioning to maintain stability while allowing surgical access.
Cardiac output can be measured through various invasive and non-invasive methods. The pulmonary artery catheter using thermodilution is still considered the gold standard but is invasive. Minimally invasive methods include lithium dilution, pulse contour analysis devices, esophageal Doppler, and transesophageal echocardiography. Non-invasive methods include partial gas rebreathing, thoracic bioimpedance, and Doppler ultrasound. The ideal monitor is accurate, continuous, non-invasive and provides reliable measurements during different physiological states.
Anesthesia for children with Congenital Heart Diseasecairo1957
This document provides an overview of congenital heart disease (CHD) in children, including:
- The incidence of CHD is 7-10 per 1000 live births, with some forms being more common in premature infants. The most common types are ventricular septal defects and atrial septal defects.
- CHD can be classified based on the direction of blood shunting (left-to-right or right-to-left), presence of mixing lesions, or obstructive lesions. Examples of different types of CHD are provided with diagrams.
- Management of CHD depends on whether the heart defect is uncorrected, partially corrected, or completely corrected. A multidisciplinary approach is needed and
Pulmonary hypertension is defined as a mean pulmonary artery pressure greater than 25 mmHg. It is classified based on whether the elevation in pressure is pre-capillary or post-capillary. The pathogenesis involves various changes in the pulmonary vasculature that lead to increased pulmonary vascular resistance. Diagnosis involves symptoms, physical exam findings, imaging like echocardiogram, and right heart catheterization. Treatment aims to improve hemodynamics and symptoms through pulmonary vasodilators and diuretics. Anesthetic management of pulmonary hypertension patients requires optimizing preload, afterload, and contractility while avoiding triggers of pulmonary hypertension. Close monitoring is important both intraoperatively and postoperatively.
Physiological considerations and patient positioning during anesthesia for th...Abeer Nakera
This document discusses ventilation/perfusion relationships and the lateral decubitus position. It explains the advantages of the lateral position for surgical access but also the disadvantages like ventilation/perfusion mismatch and pressure injuries. Anesthesia, positive pressure ventilation, and open pneumothorax can also cause mismatches. Complications of the lateral position include peripheral nerve injuries, vascular issues, and retinal damage, but can be prevented with proper positioning support and padding.
Anaesthetic management of tracheoesophageal fistula and congenital diaphragmaticIqraa Khanum
The document discusses the anesthetic management of tracheoesophageal fistula (TEF) and congenital diaphragmatic hernia (CDH) in neonates. It covers the embryology, clinical presentation, diagnosis, and preoperative, intraoperative and postoperative anesthetic considerations for repair of each condition. TEF results from imperfect division of the foregut during development, while CDH occurs due to failure of the diaphragm to fully form, allowing abdominal organs to herniate into the chest cavity. Proper management requires careful attention to the neonate's respiratory status and minimizing risks of aspiration or overdistention.
This document discusses the perioperative management of hypertension in surgical patients. It notes that hypertension is a common complication of cardiac surgery and that patients often experience elevated blood pressure during induction of anesthesia. Uncontrolled hypertension can increase risks during procedures like carotid endarterectomies. The document provides guidelines for evaluating patients preoperatively, maintaining antihypertensive treatment before and during surgery, monitoring blood pressure intraoperatively, and having protocols for rapidly addressing hypertension when it occurs. A variety of intravenous antihypertensive drugs and their dosages are listed for treating different hypertensive emergencies during surgery.
This document discusses fetal circulation and placental transfer of drugs and anesthetic agents. It begins by describing the fetal circulation and transitional circulation at birth. It then discusses placental anatomy and the various mechanisms by which substances can transfer across the placenta, including diffusion, active transport, bulk flow, and pinocytosis. Several factors that can influence placental transfer are also outlined, including properties of the drug, fetal conditions, maternal conditions, and placental factors. Specific details are provided about the placental transfer and effects of various inhaled anesthetics, intravenous drugs, opioids, benzodiazepines, and local anesthetics.
Pharmacokinetic variability occurs due to differences in drug absorption, distribution, metabolism, and excretion between individuals. Several factors influence this variability including age, body weight, pregnancy, and disease states. Drug metabolism and excretion are often lower in newborns compared to adults due to immature organ systems and lower enzyme levels. Plasma protein binding is also lower in newborns which increases drug distribution. Renal function is reduced in newborns leading to slower drug clearance. These developmental differences can increase the risk of adverse drug reactions in newborns if dosages are not appropriately adjusted.
Anaesthesia to patiens with liver disease or a liver transplantscanFOAM
A presentation by Anna Januszkiewicz at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Delayed recovery from anesthesia can have multiple contributing factors and causes. It is important to consider potential drug interactions, metabolic abnormalities, and organic causes that may cause prolonged unconsciousness and have serious health implications. Signs and symptoms of metabolic issues may not present normally in an anesthetized patient. The Glasgow Coma Scale provides an objective measure of conscious state regardless of cause.
anaesthetic management of Meningomyelocele and its Surgical excision ZIKRULLAH MALLICK
This document discusses the anaesthetic management of patients with meningomyelocele. Key points include:
- Meningomyelocele is a complex birth defect involving protrusion of the meninges and spinal cord through the vertebrae.
- Patients often have other associated anomalies and hydrocephalus.
- Anaesthetic challenges include airway management, physiological immaturity of organ systems, fluid management due to third spacing and blood loss.
- Careful pre-operative evaluation, positioning to protect the meningocele, and meticulous intraoperative fluid management are important to optimize outcomes.
Context-Sensitive Half-Time in Anaesthetic Practicemonicaajmerajain
The document discusses context-sensitive half-time (CSHT), which is the time required for drug concentrations to decrease by 50% after discontinuing an infusion. CSHT is useful for understanding the duration of drug effects after an infusion stops. It reflects how much drug accumulates in tissues during infusion and then redistributes into the blood. CSHT depends on factors like accumulation, distribution, and excretion rates, which vary between drugs. In anesthetic practice, it is important to understand if a drug has a short, predictable CSHT like remifentanil, or a more prolonged, variable CSHT like fentanyl. While half-life measures elimination rates, CSHT incorporates distribution and depends on infusion duration,
1. Mitral stenosis is most commonly caused by rheumatic fever and results in thickening and calcification of the mitral valve, reducing the valve orifice area and obstructing blood flow from the left atrium to ventricle.
2. The pathophysiology involves elevated left atrial pressure, pulmonary hypertension, and reduced cardiac output. Symptoms range from easy fatigability to pulmonary edema.
3. Physical exam findings include an opening snap, rumbling diastolic murmur, and signs of right heart failure in severe cases. Severity is graded based on orifice area, pulmonary artery pressure, and NYHA functional
Anesthesia For Congenital Diaphragmatic Herniakrishna dhakal
This document discusses congenital diaphragmatic hernia (CDH), a birth defect where organs protrude into the chest cavity due to a hole in the diaphragm. It covers the embryology, pathophysiology, diagnosis, and management of CDH. Surgical repair is the only treatment, but stabilization of the patient's respiratory and general status is needed first. Extracorporeal membrane oxygenation (ECMO) has improved survival for CDH. Long-term follow up is also important due to potential complications. A regional anesthesia method without opioids allowed early operating room extubation for CDH repair in one study.
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Anaesthetic management of obstetric emergenciesVidhi Gajjar
This document discusses the anesthetic management of obstetric emergencies such as major obstetric hemorrhage and fetal compromise. It covers the challenges in managing obstetric hemorrhage including difficulty in estimating blood loss and early diagnosis of shock due to masking of signs by normal pregnancy physiology. The management approach "ORDER" is outlined which includes organization, resuscitation, defective coagulation, evaluation of response, and remedying the cause of bleeding. General anesthesia techniques for cesarean sections in hemorrhage emphasize rapid sequence induction, cricoid pressure, and hemodynamic support through fluid resuscitation and blood product transfusion to maintain coagulation.
This document discusses pregnancy and surgery, specifically addressing whether they can safely mix. It notes that around 0.75-2% of pregnancies involve surgery. The most common surgeries are appendectomy, cholecystectomy, adnexal disease procedures, and trauma procedures. It reviews important physiologic changes in pregnancy and rates of complications from surgery. It discusses fetal hazards, principles of teratology, and implications for anesthetizing pregnant patients. It provides FDA categories and reviews effects of specific anesthetic agents. The document emphasizes using minimal effective doses of historically safe drugs and avoiding maternal hypotension, hypoxia, and hypercarbia.
This document discusses anesthesia considerations for children with congenital heart disease (CHD). It begins by classifying common CHD types as left-to-right shunts which increase pulmonary blood flow or right-to-left shunts which decrease it. The goal of anesthesia management is then to manipulate systemic and pulmonary vascular resistances to optimize blood flow based on the individual defect. Thorough preoperative evaluation and understanding of the child's specific anatomy and hemodynamics are essential to tailoring the anesthetic plan.
This document discusses low-flow and minimal-flow anesthesia techniques. It begins by defining low-flow as a fresh gas flow of 1 L/min and minimal-flow as 0.5 L/min. Rebreathing systems allow reuse of exhaled gases after removal of carbon dioxide. Using these techniques can reduce costs by 55-75% and minimize environmental pollution from volatile anesthetic gases. Proper monitoring and maintenance of breathing gas conditions is important for patient safety when using low fresh gas flows.
Chronic kidney disease is defined as kidney damage or decreased kidney function (GFR <60mL/min/1.73m^2) for more than 3 months. It is staged based on GFR from stage 1 to 5. Major causes include diabetes and hypertension. Patients experience cardiovascular, respiratory, immune, electrolyte, gastrointestinal, endocrine, hematological, neurological and acid-base abnormalities due to decreased kidney function. Anesthesia management focuses on optimizing fluid, acid-base, electrolyte and hemodynamic status as well as modifying dosages based on creatinine clearance. Regional techniques may be used but prolonged bleeding time is a contraindication.
COPD patients pose challenges for anesthesiologists due to increased risk of intraoperative and postoperative complications. The document discusses COPD definitions, pathophysiology, preoperative evaluation including pulmonary function tests, effects of smoking and benefits of smoking cessation. It also covers preoperative preparation including bronchodilation and options for anesthetic technique including benefits of neuraxial anesthesia for COPD patients.
The document discusses the posterior fossa, including its boundaries, contents, blood supply, clinical presentation of lesions, and considerations for anesthesia. The posterior fossa is bounded anteriorly by the clivus and petrous bone, posteriorly by the occipital bone, and laterally by the temporal bone. It contains the cerebellar hemispheres, brainstem, and cranial nerves III-XII. Lesions can cause a variety of signs and symptoms depending on location, including ataxia, nystagmus, limb weakness, and cranial nerve deficits. Anesthesia for posterior fossa surgery requires careful monitoring and positioning to maintain stability while allowing surgical access.
Cardiac output can be measured through various invasive and non-invasive methods. The pulmonary artery catheter using thermodilution is still considered the gold standard but is invasive. Minimally invasive methods include lithium dilution, pulse contour analysis devices, esophageal Doppler, and transesophageal echocardiography. Non-invasive methods include partial gas rebreathing, thoracic bioimpedance, and Doppler ultrasound. The ideal monitor is accurate, continuous, non-invasive and provides reliable measurements during different physiological states.
Anesthesia for children with Congenital Heart Diseasecairo1957
This document provides an overview of congenital heart disease (CHD) in children, including:
- The incidence of CHD is 7-10 per 1000 live births, with some forms being more common in premature infants. The most common types are ventricular septal defects and atrial septal defects.
- CHD can be classified based on the direction of blood shunting (left-to-right or right-to-left), presence of mixing lesions, or obstructive lesions. Examples of different types of CHD are provided with diagrams.
- Management of CHD depends on whether the heart defect is uncorrected, partially corrected, or completely corrected. A multidisciplinary approach is needed and
Pulmonary hypertension is defined as a mean pulmonary artery pressure greater than 25 mmHg. It is classified based on whether the elevation in pressure is pre-capillary or post-capillary. The pathogenesis involves various changes in the pulmonary vasculature that lead to increased pulmonary vascular resistance. Diagnosis involves symptoms, physical exam findings, imaging like echocardiogram, and right heart catheterization. Treatment aims to improve hemodynamics and symptoms through pulmonary vasodilators and diuretics. Anesthetic management of pulmonary hypertension patients requires optimizing preload, afterload, and contractility while avoiding triggers of pulmonary hypertension. Close monitoring is important both intraoperatively and postoperatively.
Physiological considerations and patient positioning during anesthesia for th...Abeer Nakera
This document discusses ventilation/perfusion relationships and the lateral decubitus position. It explains the advantages of the lateral position for surgical access but also the disadvantages like ventilation/perfusion mismatch and pressure injuries. Anesthesia, positive pressure ventilation, and open pneumothorax can also cause mismatches. Complications of the lateral position include peripheral nerve injuries, vascular issues, and retinal damage, but can be prevented with proper positioning support and padding.
Anaesthetic management of tracheoesophageal fistula and congenital diaphragmaticIqraa Khanum
The document discusses the anesthetic management of tracheoesophageal fistula (TEF) and congenital diaphragmatic hernia (CDH) in neonates. It covers the embryology, clinical presentation, diagnosis, and preoperative, intraoperative and postoperative anesthetic considerations for repair of each condition. TEF results from imperfect division of the foregut during development, while CDH occurs due to failure of the diaphragm to fully form, allowing abdominal organs to herniate into the chest cavity. Proper management requires careful attention to the neonate's respiratory status and minimizing risks of aspiration or overdistention.
This document discusses the perioperative management of hypertension in surgical patients. It notes that hypertension is a common complication of cardiac surgery and that patients often experience elevated blood pressure during induction of anesthesia. Uncontrolled hypertension can increase risks during procedures like carotid endarterectomies. The document provides guidelines for evaluating patients preoperatively, maintaining antihypertensive treatment before and during surgery, monitoring blood pressure intraoperatively, and having protocols for rapidly addressing hypertension when it occurs. A variety of intravenous antihypertensive drugs and their dosages are listed for treating different hypertensive emergencies during surgery.
This document discusses fetal circulation and placental transfer of drugs and anesthetic agents. It begins by describing the fetal circulation and transitional circulation at birth. It then discusses placental anatomy and the various mechanisms by which substances can transfer across the placenta, including diffusion, active transport, bulk flow, and pinocytosis. Several factors that can influence placental transfer are also outlined, including properties of the drug, fetal conditions, maternal conditions, and placental factors. Specific details are provided about the placental transfer and effects of various inhaled anesthetics, intravenous drugs, opioids, benzodiazepines, and local anesthetics.
Pharmacokinetic variability occurs due to differences in drug absorption, distribution, metabolism, and excretion between individuals. Several factors influence this variability including age, body weight, pregnancy, and disease states. Drug metabolism and excretion are often lower in newborns compared to adults due to immature organ systems and lower enzyme levels. Plasma protein binding is also lower in newborns which increases drug distribution. Renal function is reduced in newborns leading to slower drug clearance. These developmental differences can increase the risk of adverse drug reactions in newborns if dosages are not appropriately adjusted.
1. During pregnancy, there are significant hemodynamic changes including increased blood volume, cardiac output, and regional blood flow to the uterus and placenta. The hematocrit decreases due to disproportionate rises in plasma volume.
2. Respiratory changes include increased tidal volume, minute volume, and oxygen consumption due to effects of progesterone. Low carbon dioxide levels and risk of difficult intubation are seen.
3. Other changes involve increased renal blood flow and glomerular filtration rate, hypercoagulability, and increased permeability of the placenta to lipid soluble drugs like general anesthetics. These changes are important considerations for anesthesia management in pregnancy and the peripartum period.
PHARMACOKINETICS AND PHARMACODYNAMICS OF
ANAESTHETIC DRUGS IN PAEDIATRICS (based on the article that came up in INDIAN JOURNAL OF ANAESTHESIA, OCTOBER 2004)
Pharmacology for pediatric anaesthesia [autosaved]DeepakGupta825
This document discusses pharmacology considerations for pediatric anesthesia. It covers several key topics:
1) Developmental pharmacology - Drugs affect infants and children differently due to factors like body composition, organ maturity, and blood-brain barrier development. This impacts drug dosing, distribution, and elimination.
2) Inhalational agents - Sevoflurane and isoflurane are commonly used and have advantages like rapid induction/recovery, but sevoflurane can cause renal damage with prolonged use.
3) Intravenous agents - Propofol, ketamine, midazolam, fentanyl and other opioids are discussed. Propofol requires higher doses in children and should not be used for prolonged sedation in those under 12
During pregnancy, most drugs can cross the placenta and expose the fetus to their effects, with factors like molecular weight, lipid solubility, and placental transporters influencing transfer. Physiologic changes in pregnancy can impact drug absorption, distribution, and metabolism in the mother. Certain drugs are known to cause adverse effects in the fetus like congenital malformations, growth issues, or neonatal withdrawal symptoms.
Drugs used in special age groups like children, elderly and preganancyRoopali Somani
This document discusses drug therapy considerations in special patient populations including pediatrics, pregnancy, and the elderly. It covers changes in pharmacokinetics and pharmacodynamics that occur due to age-related differences in absorption, distribution, metabolism, and excretion of drugs. Key points include reduced drug clearance in neonates and elderly due to immature or declining organ function, increased drug effects in pediatrics due to higher body water content, and altered metabolism during pregnancy due to physiological changes. The document emphasizes the need to adjust drug dosing based on the specific age group or condition to maximize efficacy and minimize adverse reactions.
This interesting and useful ppt highlights different pharmacokinetic concepts with illustrations for easy understanding - an overview for revision for medical and paramedical students
Biological membranes as a barriers to drugs(pH trapping)Freya Cardozo
Transport of drugs across the membrane, Passive Diffusion, carrier mediated, Facilitated, Endocytosis, Ion transport and pH trapping.
Blood brain barrier and(BBB) stratergies to overcome BBB
CPB during pregnancy and Anesthesia considration by ArsalanArsalan Khan
This document discusses cardiopulmonary bypass (CPB) during pregnancy. CPB is a technique used during open heart surgery to temporarily take over the function of the heart and lungs. Certain physiological changes occur during CPB that can impact the fetus, such as hypothermia, hemodilution, and non-pulsatile blood flow. Optimization of the CPB machine settings, fetal monitoring, and timing of surgery can help improve neonatal outcomes, though maternal outcomes are similar to non-pregnant women. Diseases such as valve problems or congenital heart defects may require cardiac surgery during pregnancy.
The document discusses several key factors that affect pharmacokinetics and pharmacodynamics of drugs in pregnancy and infants. During pregnancy, physiological changes like increased blood volume, cardiac output and liver/kidney function impact drug absorption, distribution, metabolism and excretion. The placenta regulates fetal exposure to maternal drugs based on their physicochemical properties. Drugs administered during critical periods of fetal development can cause teratogenic effects or toxicity. In infants, immature organ systems lead to differences in absorption, distribution, metabolism and excretion compared to adults that influence drug effects.
The placental blood barrier protects the fetus from potentially harmful substances in the mother's bloodstream. Most substances over 500 Daltons cannot cross the barrier, though some like antibodies can pass through via endocytosis or pinocytosis. During pregnancy, the placental barrier can allow maternal infections or drugs to impact the fetus. The factors that influence placental transfer from mother to fetus include substance properties like molecular weight and lipid solubility, as well as maternal and placental properties. Nutrients are transferred via simple diffusion, facilitated diffusion using transporter proteins, or active transport against gradients. The placenta also functions as an endocrine gland and provides immunological protection for the fetus.
Clinical pharmacokinetic studies are performed to examine the absorption, distribution, metabolism, and excretion of a drug under investigation in healthy volunteers and/or patients
This document discusses maternal medication use and breastfeeding. It notes that over 75% of infants in the US are breastfed initially, but that rate drops to around 50% by 6 months due to various social factors and medication use. The average number of medications taken by breastfeeding mothers is 4. Key concepts around how medications enter breast milk are discussed, such as molecular weight, plasma levels, and protein binding. Calculating the relative infant dose is presented as a useful tool to determine safety. Common psychiatric medications like SSRIs, benzodiazepines, and atypical antipsychotics are highlighted as generally compatible with breastfeeding when used at standard doses due to low relative infant doses. Antiepileptics and mood stabil
This document discusses pharmacokinetics, specifically absorption, distribution, metabolism, and excretion of drugs. It covers the following key points:
- Drug absorption occurs through various routes like the gastrointestinal tract, lungs, skin and is influenced by factors like pH, blood flow and lipid solubility.
- Distribution of drugs depends on capillary permeability, blood flow, protein binding and is described using the volume of distribution.
- Metabolism occurs mainly in the liver through cytochrome P450 enzymes and conjugation reactions, and can inactivate drugs, produce active metabolites, or activate prodrugs.
- Absorption, distribution and metabolism determine the bioavailability of drugs and their delivery to sites of action.
1) Pregnancy causes significant alterations in a woman's anatomy, physiology, and pharmacokinetics that impact drug disposition. These include changes in absorption, distribution, metabolism and excretion of drugs.
2) Drugs can cross the placenta and expose the developing fetus, with the extent of transfer dependent on the drug's properties and placental physiology. The fetus undergoes its own metabolism and clearance of drugs.
3) Understanding how pregnancy impacts a drug's pharmacokinetics is important for developing evidence-based dosing guidelines to ensure safe medication use during pregnancy. Physiologically based pharmacokinetic models can incorporate anatomical and physiological changes to predict a drug's disposition.
Physiological Changes in Pregnancy and Its Anaesthetic Implications.Mohtasib Madaoo
This document summarizes the physiological changes in pregnancy and their implications for anesthesia. It discusses how pregnancy causes increased blood volume, cardiac output, oxygen consumption and acidity levels. These changes can cause issues like supine hypotension syndrome when the mother lies on her back. The document also covers respiratory, coagulation, gastrointestinal and central nervous system changes in pregnancy and how they impact drug dosages and anesthesia techniques. Special considerations are discussed for intubation, regional anesthesia and placental drug transport.
This document summarizes key concepts in cardiovascular physiology including:
1. Determinants of cardiac output which are stroke volume and heart rate. Stroke volume is determined by preload, afterload, and contractility as described by Frank-Starling law of the heart.
2. Control of arterial blood pressure involves immediate control by baroreceptors and chemoreceptors, intermediate control by the renin-angiotensin-aldosterone system and atrial natriuretic peptide, and long-term control through sodium and water retention in the kidneys.
3. Coronary physiology includes characteristics of coronary blood flow such as intermittent flow, autoregulation to maintain flow, and metabolic and
Here is a detailed presentation on anatomy of heart
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HERE IS A SEMINAR BASED ON ALL THE NEWER MODES OF MECHANICAL VENTILATION .
MY SINCERE APOLOGIES , BECAUSE I HAD TO TAKE INFORMATION FROM OTHERS SLIDES TOO , SINCE THERE IS VERY LESS INFORMATION AVAILABLE ABOUT THIS TOPIC
This document provides an overview of acid-base disorders. It discusses the history of acid-base balance, definitions, buffers, and the different types of acid-base disorders including respiratory acidosis, metabolic acidosis, respiratory alkalosis, and metabolic alkalosis. It also covers analyzing arterial blood gases, interpreting values, compensatory responses, and treatment approaches for acid-base imbalances. Case examples are presented to demonstrate interpreting acid-base disorders from blood tests.
Preop evaluation of cardiac patient postd=ed for non cardiac surgery Rajesh Munigial
This document discusses pre-operative evaluation and preparation of cardiac patients for non-cardiac surgeries. It outlines that patients with coronary artery disease undergoing non-cardiac surgery are at increased risk of complications. A thorough pre-operative evaluation including history, physical exam, diagnostic tests, and knowledge of the planned surgery is important to assess risk factors and develop a management plan. Tests like ECG, stress testing, echocardiogram and in some cases angiography help evaluate cardiac status. Medical optimization including management of angina, heart failure, diabetes, etc. can help reduce perioperative risk. Timing of surgery depends on the clinical status and risk of delay. Intraoperative management focuses on preventing ischemia.
This document discusses guidelines for planning and designing intensive care units (ICUs) in hospitals of different sizes and capabilities. It provides recommendations for the number of beds, equipment, staffing, location, and design of ICU rooms. Key recommendations include having 6-12 beds for general hospitals and 10-16 beds for tertiary hospitals, adequate monitoring equipment in each room, appropriate staffing ratios, and designing rooms to be at least 100 square feet per bed with flexibility to accommodate equipment and procedures. Proper planning of the nursing station, storage, and other support areas is also emphasized.
Anesthesia for eye surgery presents unique challenges. The anesthesiologist must have detailed knowledge of ocular anatomy, physiology, and pharmacology to prepare an appropriate anesthesia plan. They must regulate intraocular pressure, prevent oculocardiac reflex, and ensure smooth intubation and extubation. Regional techniques may be preferable to general anesthesia in some cases to avoid risks of increases in intraocular pressure.
This document discusses fetal surgeries and their anesthetic implications. It covers prerequisites for fetal surgery, risks, maternal and fetal factors to consider, transplacental drug transfer, types of fetal surgeries including EXIT, midgestation open and minimally invasive procedures. It discusses anesthesia management goals, techniques for each surgery type and fetal monitoring. Preventing preterm labor post-surgery through tocolysis and avoiding uterine contractions is also summarized.
This document discusses lung volumes, capacities, compliance, and various pulmonary function tests. It defines key terms like tidal volume, inspiratory reserve volume, vital capacity, total lung capacity, functional residual capacity, residual volume, compliance, closing volume, and closing capacity. It describes methods to measure lung volumes like spirometry, body plethysmography, nitrogen washout technique, and helium dilution. Factors affecting pulmonary function in conditions like obesity, age, anesthesia, and position are also summarized.
Anticoagulants, antiplatelet drugs and anesthesiaRajesh Munigial
It is a presentation on anticoagulants and antiplatelets in anesthesia , starting from basis of coagulation , its tests and dugs and anesthetic implications
Based on latest ASRA (AMERICAN SOCIETY OF REGIONAL ANESTHESIA GUIDELINES)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
4. Access of drugs to the fetus
Pharmacodynamic aspects of drug action in fetus
Aspects of drug therapy during
pregnancy
5. Distribution of drug from maternal circulation to placenta
Placental sequestration by intracellular binding to placental
component by placental metabolism
Transfer of placental to fetal and maternal circulation
Transplacental transfer of drugs
comprises 3 process
7. Most drugs cross the placenta by simple diffusion
It occurs down the concentration gradient which is
influenced by
Rate of drug administration
Volume of drug administration
Rate of drug clearance
The Ph of the fetal plasma also influences the rate of
drug transfer across the placenta
Ex: paracetamol, midazolam
Simple diffusion
8. Lipid solubility
Molecular size
Protein binding
Placental and fetal metabolism
Drug factors affecting transfer
9. Lipid soluble drugs readily cross the placenta whereas
ionized drugs do not
Eg: thiopentone can readily cross the placenta and cause
sedation & apnea in newborn
Volume of distribution for water soluble drugs is increased
Lipid solubilty
10. Placenta excludes drugs of high molecular weight
Mw : 250-500 are readily permeable
Mw: 500-1000 , greater difficulty in crossing the placenta
Mw: >1000 excluded or diffuse very poorly
Molecular weight
11. Plasma protein binding of a drug will inhibit placental
transfer .
Highly lipid soluble may anyway transfer despite avid
protein binding
Plasma protein affinity may be different in fetal
circulation vs maternal
Thus free fetal plasma concentration may be higher
than free maternal plasma concentration of the drug at
equilibrium.
Protein binding
12. Protein binding plays a very important role in determining the
amount of free drug that is available to cross the placenta
,because it is the free fraction that crosses placenta.
Fetal albumin concentrations progressively increase during
fetal development to the point being higher than maternal
values b term gestation.
13. Only the non ionized fraction of a partly ionised drug crosses
the placental membrane.
The degree to which a drug is ionised depends on its pka and
the ph of maternal blood
Most drugs used in the anaesthesia practice are poorly ionised
and readily get transferred across the placenta , except
neuromuscular blocking agents which are highly ionised.
DEGREE OF IONISATION
14. It is a form of passive transport that is
dependent on transmembrane proteins.
These proteins assist transport of polar
molecules and charged ions that are unable to
passively cross the biological membrane.
Ex; glucocorticoids and cephalosporins
Facilitated diffusion
15. It has characteristics similar to facilitated
diffusion in that it is carrier mediated.
It requires cellular energy and the transport of
substances occurs across an electrochemical
or concentration gradient.
Ex: dopamine , norepinephrine
Active transport
16. Pinocytosis and phagocytosis involves solutes being
invaginated into the cell membrane and then
transferred across the membrane to the opposite side
.
These process are too slow to have any significant
impact on foetal drug concentration.
Pinocytosis
17. Q/t = KA(Cm − Cf) D
q/t : quantity transferred in unit time
K : drug diffusion constant
A: placental area for transfer
D : diffusion distance across membrane
Cm and Cf are the maternal and fetal concentration
of drugs
Ficks law of diffusion :
18. Uterine blood flow varies from 100ml/min in non
pregnant state to 700ml/min in pregnant state .
Vasculature is dilated
Uterine ands placental blood flow is mainly depended
on maternal cardiac output.
Uteroplacental physiology
19. GAS EXCHANGE :
Placenta is wholly responsible for the transfer of oxygen
and carbon dioxide ,to and from the developing fetus
Functions of placenta
20. Oxygen is a small molecule which readily crosses the
placenta by passive diffusion .
Oxygen transfer to foetus is enhanced by BOHR effect. At
the materno fetal interface , maternal blood takes up more
co2 and becomes acidotic . This causes a rightward shift of
the maternal ODC curve which favours oxygen release to
fetus .
At the same time , fetal blood releases co2 and becomes
more alkalotic , it leads to leftward shift of fetal odc curve
favouring fetal take up of o2.
This is called DOUBLE BOHR EFFECT.
OXYGEN
21.
22. Co2 transfer from foetus to mother is facilitated by HALDANE
effect(the increased capacity of deoxygenated blood to carry
co2 compared to oxygenated blood).
As maternal blood releases oxygen(producing deoxyhb)it is
able o carry more co2as bicarbonate and carbaminHB.
At the same time as fetal blood takes up oxygen to form
oxyHB , it has reduced affinity for CO2 and therefore releases
co2 to mother .
The combination of these two events is called as DOUBLE
HALDANE EFFECT.
Carbon dioxide
23. O2 and 2,3 DPG compete with HBF for binding, the reduced
affinity of HBF for 2,3 DPG causes the HBF to bind to o2
tighter .
P50 is 27mmhg for adults whereas it is only 20mmhg for
fetus. This causes a left shift in odc curve
OXYGEN HEMOGLOBIN DISSOCIATION CURVE
24. ABOSORPTION AND UPTAKE :
Oral absorption and bioavailability not affected
Intestinal motility decreased and delayed gastric emptying
Cardiac output is increased to 30-50%during pregnancy and
increase blood flow to skin and mucous membrane enhances
absorption from these sites.
Reduced FRC and increased MV lead to increased uptake of
inhalational anaesthetic agents.
MATERNAL PHARMACOKINETICS
25. Increased cardiac output during pregnancy causes
increased distribution of drugs to tissues.
Drugs acting peripherally will be delivered to their site
quickly.
A delay in arterial and brain anaesthetic
concentrations will result from increased peripheral
perfusion.
DISTRIBUTION
26. Plasma albumin concentration is reduced to about 70% of normal ,
whereas apha 1 glycopotein is largely unchanged.
The total (free+bound) concentration of drug will decrease , and it
may necessary to reset the therapeutic range lower to
compensate.
27. Some cytochrome p450 isoenzymes (CYP3A4,CYP2D6 AND
CYP2C9) and UGT isoenzymes are increased activity and
increases metabolism of dug like phenytoin midazolam and
morphine.
CYP1A2 an CYP2C19 have decreased activity ,caffeine and
theophylline metabolism reduced
Metabolism
28. RBF is increased by 60-80% and GFR is increase by
50%, renal excretion of unchanged drugs is
increased.
Increased minute ventilation enhances elimination
of inhalational anesthetic agents.
Elimination
29. The F/M ratio provides a quantitative measurement that
helps delineate the degree o fetal exposure of drugs
administered to mother.
But this ratio does not provide information on rate of
drug transfer or amount of drug that has already been
transferred
Placental transfer and metabolism
30. Fetal ph is lower than materal ph , so weak bases become
more ionised in the fetus , thus limiting their transfer back
across placenta .
Normally difference in ph is only 0.1 and this ION TRAPPING is
irrelevant , but fetal acidosis can significantly increase the
fetal concentration of drugs like local anesthetics.
31.
32. They metabolize , but at a reduced rate .
RBF is minimal till near near term and excreted
products would just pass into amniotic fluid to be
swallowed
Elimination is mainly depended on placental transfer
Large MV promotes neonatal elimination of
inhalational agents
Fetal and neonatal elimination
33. Depend on enzyme maturity and hepatic blood flow
Phase 1 reactions (oxidation , reduction , hydrolysis ) :
mature to adult value by 6months of age
Phase 2 reaction : sulfation is mature at birth
Glucoronidation , acetylation and glycination mature by
1 year of age
Hepatic metabolism of drug
35. Requirement of iv anesthetic agents is reduced by 8-18%.
THIOPENTONE :
Rapid transfer due to its high lipid solubility
For hypnosis reduced by 17%
For anesthesia reduced by 18%
For induction reduced by 35%
T half increases by 26hrs compared to 11 hrs in non pregnant
state.
Induction dose : 4mg/kg
F/M : 0.87-0.96
Highly bound to albumin
It is extensively uptake by fetal liver with decreased plasma
levels reaching fetal brain
IV ANESTHESTIC AGENTS
36. F/M 0.6-0.7
Produces severe hypotension
Awareness is more with propofol
Increasing uterine blood flow results in increased maternal
venous concentrations .
Decreased extraction of propofol from the maternal
circulation is due to shortened contact time with placental
tissue.
Propofol @2.5mg/kg does not affect neonatal APGAR
SCORES
But at high doses like 9mg/kg causes neonatal depression
PROPOFOL
37. KETAMINE :
F/M 1.26
Lipid soluble
1mg/kg – no neonatal depression
At high doses lower apgar scores and neonatal muscular
hypertonicity
ETOMIDATE
F/M : 0.04-0.5
Its affets on fetus are similar to thiopentone (similaities in apgar
scores is observed)
Quick acting and rapid hydrolysis, hence short duration of action
Very minimal effects on maternal hemodyanmics (0.3mg/kg)
38. DIAZEPAM :
F/M 0.9 -1
T half :10-14hrs
A dosage of o.3mg/kg is acceptable
If >30mg in maternal circulation in conditions like in
ecclampsia , metabolic passage in fetus occurs and can
cause floppy infant syndrome (apnea , hypotonia ,
hypothermia )
MIDAZOLAM :
F/M o.6 is preferred
Use of midazolam has not ben associated with new born
sedation
BENZODIAZEPINES
39. Volatile agents are highly lipid soluble and can cross placenta freely
Blood gas coefficient is low in neonates .
Cross placenta and can depress frequency , amplitude , duration of uterine
contraction
Complete inhibition at MAC2
Mac requirement reduces by 25-40%
Inhalational induction is faster because increased minute ventilation and
reduced FRC .
Reduced uterine tone and hypotension are potential side effects
INHALATIONAL AGENTS
40. Halothane
with induction to delivery time averaging 10.8 minutes , an F/M
ratio of 0.71 is reported after exposure to 0.5% halothane .
There is correlation of duration of exposure to halothane and
measured F/M ratio.
It is quickly eliminated since the blood gas partition coefficient is
less in newborns
As soon as respiration is stabilized it is eliminated
It is the best uterine relaxant
Isoflurane
0.8% rapidly crosses the placenta resulting in F/M ratio of 0.71 ,
being less soluble it eliminates faster.
41. F/M o.18 at 19min of exposure and decreases at 36min of
exposure
Diffusion hypoxia can occur during rapid elimination of
nitrous from fetus and can be prevented by administering
supplemental o2 to fetus exposed to n2o immediately
before delivery.
Prolonged exposure may inhibit DNA synthesis so avoid in
first trimester
NITROUS OXIDE
42. They do not readily cross placenta
SUCCINYLCHOLINE
has not been detected in umbilical cord
1-1.5mg/kg iv has rapid onset
>10mg/kg required for detection
Reduced cholinesterase levels are seen in pregnancy ,
possibly prolonged action may be seen
Muscle relaxants
43. F/M 0.06 to 0.11 for vecuronium , it was seen that degree of
placnetal transfer decreases as the time interval from
maternal injection to delivery of newborn increases.
O.o7 for atracurium, no adverse affects are seen with
maternally administered atracurium.
0.16 for rocuroonium
NON DEPOLARISING MUSCLE
RELAXANTS
44. Increased lipid solubility causes increased trans placental
transfer
Increased maternal sensitivity , fetal withdrawal , IUGR with
tonic use
PETHIDINE :
F/M 0.6 immediately
1 after 2 hours
Neonatal CNS and respiratory depression
Within 90 seconds found in umbilical cord
Maternal level falls more rapidly than fetal levels
OPIODS
45. Highly protein bound compared to morphine
Predisposed to trapping in fetus in presence of fetal
compromise
Baby should be delivered within 1 hour of pethidine
administration
T half : 13-23 hrs
Nor pethidine : t half 62hrs
46. F/M 0.6 following 10-15mg IM maternally
It is seen that morphine exposed fetuses had absent or
decreased fetal breathing movements and non reactive non
stress tests
Intrathecal administration : F/M 0.9
The impact of 1000mcg intrathecal related in very low
umbilical levels of morphine
MORPHINE :
47. Fentanyl :
Maternal epidural : F/M 0.37-0.57
In 1 min it appears in fetal blood
It is a basic drug , more ionised in fetus than in the mother ,
hence predisposed to ion trapping leading to fetal hypoxia.
REMIFENTANYL
It crosses the placenta but is rapidly metabolized by the fetus
and its use for labor analgesia has not been associated with
adverse neonatal effects.
ALFENTANYL :
Following an iv dose of 30mc/kg , F/M ratio of 0.31 is seen and it
decreases to 0.28 in patient receiving epidural analgesia with
loading dose of 30mcg/kg and infusuion of 30mcg/kg/hr
48.
49. LIGNOCAINE :
The f/m ratio for lidocaine has been reported to be 0.9 in a
perfused human cotyledon after 2 hour
There can be accumulation of lidocine in fetus and can
cause acidosis
Despite accumulation it wont alter fetal heart rate , blood
pressure , arterial ph , blood gas responses to asphyxia
There is a very little back transfer of lidocaine from fetal
circulation back to maternal circulation.
LOCAL ANAESTHETICS
50. The f/m ratio is reported to be 0.56 after 2 hours
Mode of placental transfer of bupivacaine is primarily by
passive diffusion.
Fetal bupivacaine rises with increasing maternal doses
The f/m ratio is highly influenced by transplacental AAG
gradient given that bupivacaine is highly protein bound.
Increased risk of toxicity is seen
Low intrathecal doses to be used
BUPIVACAINE
51. Neostigmine
It is a quaternary ammonium compound but is a small molecule
which is able to cross the placenta more rapidly than glycop
In few cases profound fetal bradycardia has been reported
Atropine can be used to prevent fetal bradycardia caused by
neostigmine
Edrohonium:
It is ionised quaternary compound with minimal placental
transfer , but it causes preterm labour
ANTICHOLINESTERASE AGENTS
52. Atropine : it rapidly causes placenta , F/M ratio of 1.0.
Has no effects on fetal arterial pressure , heart rate or
beat to beat variability
Glycopyrollate : F/M 0.13 , doesn’t cross the placenta.
ANTICHOLINERGIC AGENTS
53. Ephedrine and phenylephrine are commonly used o treat
hypotension
Ephedrine increases maternal arterial pressure by increasing
cardiac output via beta 1 receptors , with smaller contribution
via alpha 1 vasoconstriction
F/M ratio 0.71
It has minimal effects on uteroplacental blood flow
It increases fetal heart rate and beat to beat variabiity
It decreases umbilical artery ph , probably through stimulating
increase in fetal metabolic rate
Vasoactive drugs
54. Phenylephrine increases maternal arterial pressure by
vasoconstriction through its direct effect on alpha 1
receptors
F/M ratio is 0.17
It prevents maternal hypotension without causing fetal
acidosis, when combined with rapid crystalloid infusion
immediately after spinal anesthesia
55. Warfarin : it readily crosses placenta and causes
chondrodysplasia .
Heparin :
Large molecular weight 20000-40000 , doesn’t cross the
placenta .
Tinzaparin : it is a LMWH , can cause aplasia cutis
Enoxaparin : no placental transfer
ANTICOAGULANTS :
56. INSULIN : doesn’t cross placenta
But glucose can cross and produce foetal hypeinsulinemia and
neonatal hypoglycemia
GLYBURIDE : F/M < 0.3
High protein binding , rapid clearance.
ANTI HYPERGLYCEMIC AGENTS
57. ONDANSETRON : F/M 0.41 , no major neonatal
malformations .
METOCLOPROMIDE : if used in first trimester can cause
malformations , spontaneous abortion or decreased birth
weight. Chronic use causes tardive dyskinesia
DEXAMETHASONE ; 3 to 4 fold increase in cleft lip and palate
If used in first trimester.
ANTIEMETICS :
58. Alpha methyl dopa (F/M 1.17)has the least effects on
uteroplacental hemodynamics , hence ideal option for
treatment of hypertension in parturient population.
Beta blockers can cross placenta and increase levels of
insulin and decrease in glucagon causing hypoglycemia in
newborn .
Labetolol : mixed alpha/beta antagonist , F/M ratio of 0.38.
produces mild neonatal bradycardia , clinically insignificant.
Antihypertensives
59. Dexmedetomidine : F/M 0.88 , no adverse effects are
seen .
Nitroglycerin : F/M ratio 0.18 , decrease in foetal pao2
when compared to control group have been seen .
60. Albutrol is the preferred short acting b2 agonist
Salmetrol is preferred long acting b2 agonist
Budesonide is the recommended inhaled corticosteroid
5lipoxygenase inhibitors and leukotriene antagonists have
no adverse events and can be used
RESPIRATORY DRUGS
61. CATEGORY A DRUGS :
They hold no risk
No anesthetics come under this category
CATEGORY B DRUGS :
no evidence of risk in humans
Induction agents : propfol , methohexital
Inhalational agents : sevoflurane , desflurane ,enflurane
Opiods : pethidine
NMB : rocuromnium , cis atracurium
LOCAL ANESTHETICS : ropivacaine , lignocaine
U.S FDA drug classification system
63. CATEGORY D DRUGS :
Evidence of risk is present
Diazepam and midazolam
CATEGORY X DRUGS :
No anesthetic drugs
Alcohol , warfarin , cocaine , phenytoin , thalidomide
64. Stoeltings pharacology and physiology in anesthtesia
practice , 5th edition
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