Gastrointestinal System Changes During Pregnancy
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Questions and Answers

What is the effect of progesterone on the lower esophageal sphincter?

  • It has no effect on the lower esophageal sphincter.
  • It increases the competence of the lower esophageal sphincter.
  • It increases the tone of the lower esophageal sphincter.
  • It reduces the competence of the lower esophageal sphincter. (correct)

    • What is the recommended medication to stimulate gastric emptying and increase lower esophageal sphincter tone?

  • Sodium citrate
  • Metoclopramide (correct)
  • Ranitidine
  • Omeprazole

    • What is the purpose of positioning patients at a 45° angle before induction?

  • To reduce the fall in FRC (correct)
  • To decrease saliva production in the airway
  • To increase oxygen content in the FRC
  • To increase the fall in FRC

    • What is the purpose of applying cricoid pressure during anesthesia?

    <p>To prevent passive reflux</p> Signup and view all the answers

    What is the benefit of using antimuscarinic drugs before induction?

    <p>To reduce the quantity of saliva in the airway</p> Signup and view all the answers

    Why are pregnant patients considered to have 'full stomachs', regardless of fasting?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of using PEEP during mechanical ventilation?

    <p>To maintain alveolar patency and prevent hypoxia</p> Signup and view all the answers

    What is the purpose of administering a non-particulate antacid, such as sodium citrate?

    <p>To reduce gastric acidity and volume</p> Signup and view all the answers

    What is the benefit of recruitment maneuvers during intra-operative care?

    <p>To open collapsed portions of the lung</p> Signup and view all the answers

    When should positive pressure ventilation be initiated during anesthesia?

    <p>If the patient's pulse oximetry reading starts to decline or a difficult airway is encountered</p> Signup and view all the answers

    What is the effect of placental gastrin on gastric acid secretion?

    <p>It increases gastric acid secretion</p> Signup and view all the answers

    What is the benefit of continuing oxygen therapy post-operatively?

    <p>To increase oxygenation in patients at risk of hypoxia</p> Signup and view all the answers

    What is the benefit of using CPAP masks post-operatively in obese patients?

    <p>To reduce airway collapse and atelectasis</p> Signup and view all the answers

    What is the recommended patient positioning to prevent passive reflux?

    <p>A slight reverse Trendelenburg position</p> Signup and view all the answers

    What is the benefit of providing good postoperative analgesia?

    <p>To increase deep breathing and coughing</p> Signup and view all the answers

    What is the benefit of extubating ICU patients onto bi-level noninvasive ventilation?

    <p>To reduce the rate of re-intubation</p> Signup and view all the answers

    What is the effect of ketamine on bronchial smooth muscle tone?

    <p>Reduction in tone</p> Signup and view all the answers

    Which of the following is NOT a method to decrease the effect of anesthesia on the respiratory system?

    <p>Withholding oxygen in the postoperative period</p> Signup and view all the answers

    What is a negative effect of isoflurane on the respiratory system?

    <p>Increased secretions</p> Signup and view all the answers

    Which anesthetic drug does NOT cause a dose-dependent reduction in minute ventilation?

    <p>Etomidate</p> Signup and view all the answers

    How does anesthesia affect gas exchange?

    <p>Change in tidal volume</p> Signup and view all the answers

    What is the definition of an inhalational anesthetic?

    <p>A chemical compound possessing general anesthetic properties that can be delivered via inhalation</p> Signup and view all the answers

    What is NOT a method of administering an inhalational anesthetic?

    <p>Oral tablet</p> Signup and view all the answers

    What is the benefit of using positive end-expiratory pressure (PEEP) in anesthesia?

    <p>Maintains alveolar patency and prevents hypoxia</p> Signup and view all the answers

    What is the minimum alveolar concentration of an inhaled anesthetic that prevents movement in 50% of patients in response to a standardized stimulus?

    <p>The MAC of the anesthetic</p> Signup and view all the answers

    Which of the following factors does not affect the MAC of an anesthetic?

    <p>Sex</p> Signup and view all the answers

    What is the characteristic of an ideal inhalational anesthetic?

    <p>Non-flammable and non-explosive at room temperature</p> Signup and view all the answers

    What is the MAC of Sevoflurane?

    <p>2.0%</p> Signup and view all the answers

    Which of the following decreases the MAC of an anesthetic?

    <p>Hypocapnia</p> Signup and view all the answers

    What is the MAC of Nitrous oxide?

    <p>105%</p> Signup and view all the answers

    Which of the following is a characteristic of sevoflurane on the respiratory system?

    <p>Respiratory depressant with increased rate and decreased tidal volume</p> Signup and view all the answers

    What is the effect of sevoflurane on the cardiovascular system?

    <p>Vasodilatation and hypotension may occur</p> Signup and view all the answers

    What is the effect of sevoflurane on uterine relaxation?

    <p>Dose-dependent uterine relaxation, less than isoflurane and sevoflurane</p> Signup and view all the answers

    Which of the following does not affect MAC?

    <p>Hyponatraemia</p> Signup and view all the answers

    What is the MAC of sevoflurane?

    <p>2</p> Signup and view all the answers

    Which of the following anesthetics requires the use of an electrically powered vaporizer?

    <p>Desflurane</p> Signup and view all the answers

    What is a characteristic of an ideal inhalational anesthetic?

    <p>Flammable at room temperature</p> Signup and view all the answers

    Which of the following is a side effect of sevoflurane on the skeletal muscle?

    <p>Skeletal muscle relaxation</p> Signup and view all the answers

    Study Notes

    Gastrointestinal System Changes in Pregnancy

    • Mechanical and hormonal alterations lead to changes in the gastrointestinal system during pregnancy.
    • The enlarging uterus puts pressure on the stomach, causing an incompetent lower esophageal sphincter.
    • Progesterone reduces the competence of the lower esophageal sphincter.
    • Placental gastrin increases gastric acid secretion.
    • These changes cause reflux of gastric acid into the esophagus and delayed gastric emptying.
    • Pregnant patients are at risk for aspiration during anesthesia.

    Anesthetic Considerations for Gastrointestinal Changes in Pregnancy

    • Pregnant patients should be considered to have "full stomachs" regardless of fasting.
    • Administer medications to reduce gastric acidity and volume before anesthesia.
    • Use a non-particulate antacid, such as sodium citrate, and Metoclopramide (Plasil) 10mg IV to stimulate gastric emptying and increase lower esophageal sphincter tone.
    • Position the patient with a roll under the right hip and a slight reverse Trendelenburg position to prevent passive reflux.
    • Apply cricoid pressure until the patient is intubated.
    • Avoid routine administration of positive pressure ventilation before intubation.

    Pre-operative and Intra-operative Management

    • Position patients at a 45° angle before induction to reduce the fall in FRC.
    • Pre-oxygenate to maximize oxygen content in the FRC.
    • Administer antimuscarinic drugs, such as atropine or glycopyrrolate, before induction to reduce saliva in the airway.
    • Use mechanical ventilation, especially for obese patients, to reduce airway collapse and atelectasis.
    • Apply positive end-expiratory pressure (PEEP) to maintain alveolar patency and prevent hypoxia.
    • Use recruitment maneuvers to open collapsed portions of the lung.

    Post-operative Management

    • Continue oxygen into the postoperative period for patients at risk of hypoxia.
    • Use a head-up tilt to increase FRC and prevent atelectasis.
    • Extubate obese patients onto a CPAP mask to prevent airway collapse and atelectasis.
    • Ensure good postoperative analgesia and encourage patients to take deep breaths and cough.

    Inhalational Anesthetics

    • Definition: Inhalational anesthetics are chemical compounds that can be delivered via inhalation and possess general anesthetic properties.
    • Administration: Inhalational anesthetics are administered through a face mask, laryngeal mask airway, or tracheal tube connected to an anesthetic vaporizer and delivery system.
    • Main use: Inhalational anesthetics are used to maintain anesthesia, and some can be used for induction.

    Minimum Alveolar Concentration (MAC)

    • Definition: MAC is the alveolar concentration of an inhaled anesthetic that prevents movement in 50% of patients in response to a standardized stimulus.
    • Examples: Halothane MAC 0.75%, Isoflurane MAC 1.2%, Desflurane MAC 6.0%, Sevoflurane MAC 2.0%

    Factors Affecting MAC

    • Factors increasing MAC:
      • Hyperthermia
      • Hypernatraemia
      • Sympatho-adrenal stimulation
      • Chronic alcohol abuse
      • Chronic opioid abuse
      • Increases in ambient pressure
      • Hypercapnia
      • Decreasing age
      • Thyrotoxicosis
    • Factors decreasing MAC:
      • Nitrous oxide
      • Hypothyroid/myxedema
      • Hypocapnia
      • Hypothermia
      • Hyponatraemia
      • Increasing age
      • Hypoxaemia
      • Hypotension
      • Anemia
      • Pregnancy
      • CNS depressant drugs
      • Other drugs: lithium, lidocaine, magnesium, acute alcohol abuse

    Ideal Inhalational Anesthetic Characteristics

    • Non-flammable, non-explosive at room temperature
    • Stable in light
    • Does not cause airway irritation
    • Has minimal respiratory and cardiovascular effects
    • Does not cause uterine relaxation or skeletal muscle relaxation
    • Does not potentiate non-depolarizing neuromuscular blockade

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    Description

    This quiz covers the mechanical and hormonal changes that occur in the gastrointestinal system during pregnancy, including effects on the stomach and esophageal sphincter.

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