1)Capillary engorgement of

mucosal layer
2) Inc tissue friability
3)Risk-obstruction and bleeding
(inteumentation).
4) Take care during
suction,Intubation, Ryles tube
AIRWAY

Difficult Airway Cart

Concern and considerations

Smaller ET tube 6-6.5 mm ID

After 20 wks
1)Enlarged uterus 1) Non particulate oral Antacid
2)Stomach & pylorus- cephalad (3O ml sodium citrate)
displacement and increased 2)I/V- H2 receptor blocker ( Inc ph
intragastric pressure in 1 hour.
3) Reposition of intra- abdominal 3) I/V Metclopramide- Inc gastric
oesophagus emptying.
ASPIRATION 4) Inc Estrogen and progesterone
Treat as a full stomach

leads to dec tone of

Rapid sequence intubation-
Gastroesophageal sphincter
- cricoid pressure 10 N before 40
5)Gastric Ph is lower- placental
N after loss of consciousness
gastrin
6)Delayed gastric emptying

1) Inc sensitivity to LA & > Dec Epidural space

1) keep low dose of inhalational
inhalation Due to > Inc Fat
CNS 2) MAC dec by 28 %
agent
> Distended epidural vein
2) Neuroaxial dose dec by 40 %
3) Inc CBF due to Aorto cavalcomp

Supine hypotension occurs after 20

wks of POG due to AORTOCAVAL
compression,
Term - Cardiac output - 45-50% }
NIBP falls by 15 mm of Hg and HR
- Stroke volume - 25-30 % }- All increased
increases , more than 20 bpm it is
- HR- 15-25 % }
associated with the iPhone is this
- SVR - 20-25 % Decreased
nausea vomiting changes in the
meditation.

CVS
Labour - 10-25 % Inc in 1st stage
- 40 % Inc in 2nd stage

Post labour- 80% inc from prelabour value

Return- Prelabour values- after 48 hrs
Return- prepregnancy value - 12-24 wks

1) HR dependent dec in PR & QT

interval
2) AXIS -RT in 1st and LT in 3rd
ECG Trimester
3)ST dep 1 mm in preview leads
4) small Q wave an T wave Inv in

PHYSIOLOGICAL
lead 3.

DR ANKUSH MALHOTRA
CHANGES OF 1)Heart displaced LT and anterior
2) RT side chamber Inc 20 % MD ANAESTHESIA
2D ECHO
PREGNANCY
3) LT side chamber Inc by 10-12 %
4) E/F Inc - Lt vent eccentric Contact- +91 9041817291
hypertrophy
+91 7986414239
Reason-
Mainly by inc TV
MV inc by 50% 1) progesterone
Minimal by RR
2) Inc CO2 production

ABG-
1)PH -7.42-7.44,
ANAESTHESIA
2)PCO2 - 30
Due inc renal excretion of bicarbonate ions.
3)PO2 inc 100 mm Hg initially
BLUEPRINT
due to hyperventilation & dec. PCO2
4)Then dec later trimester due Airway closure Ref- MILLERS
and associated intrapulmonary shunting
RESP
1)RT Shift of ODC
2)P50 inc from 27 to. 30 mm Hg
3)Oxygen consumption increased
by 20% @ term, 40% @1st stage,
75% @ 2nd stage

LUNG VOL -
1)FRC dec by 20 % - causes early 1) Dec FRC (Dec Oxygen reserves)
airway closing ( ATELECTASIS) 2) Inc O2 consumption
2) TLC dec 0-5 % 3) Aortocaval compression - Dec Preoxygenation with 100% O2,
APNEA - Rapid desaturation
2) VC, FEV1, FEV1/FVC, closing venous return - dec CO - Inc for 3 minutes- Mandatory
capacity - no change oxygen extraction- decreased
3) Rapid inhalation induction & PO2 in venous blood
emergence

@Term Decreased
1) RBF 1)BUN Return to normal 3 month
RENAL 2) GFR 2) S. creatinine postpartum
Both Inc by 50-60 % By 5O% of prepregnancy value

1) Hepatic blood ow- no change

1) Inc blood level of highly
2) plasma protein ( Albumin)
protein bound drugs
GIT reduced ( hemodilution)
2) No signi cant change in
3) Plasmacholinestrase activity
duration of succinylcholine .
dec by 25-30%

Intravascular volume
Anaemia of increases 1000 -1500 ml
HAEMATOLOGY pregnancy Plasma volume inc 50%
RBCs vol inc 25 %

Factor- 1,7,8,10,12 Increased

Factor- 9, 11, anti thrombin 3 -
COAGULATION dec
Hyperciagulable state
PROFILE Protein S and C - Decreased
platelet - Normal or dec by 10%
PT & PTT- decreased by 20 %
fi
fl