Physiologic Physiologic Changes of Changes of PregnancyPregnancyAnesthesia for Non-Anesthesia for Non-

obstetrical surgery in the obstetrical surgery in the pregnant patientpregnant patient

CaseCaseAn 18 year-old, G1P0, at 16 weeks An 18 year-old, G1P0, at 16 weeks gestation, presented for removal of a gestation, presented for removal of a giant ovarian cyst (US showed 15 x giant ovarian cyst (US showed 15 x 25 x 30 cm simple, cystic mass 25 x 30 cm simple, cystic mass stemming from the right ovary).stemming from the right ovary).

Issues??Issues??

Physiologic ChangesPhysiologic ChangesNeurologic-Neurologic-Cardiovascular-Cardiovascular-Pulmonary-Pulmonary-Renal-Renal-Hepato/GI-Hepato/GI-Endocrine-Endocrine-Hematologic/Fluid Balance-Hematologic/Fluid Balance-Metabolic-Metabolic-Musculoskeletal-Musculoskeletal-

CaseCaseShe claimed to have had a “pot-She claimed to have had a “pot-belly” for years which was never belly” for years which was never evaluated until an ultrasound was evaluated until an ultrasound was performed recently my Maternal-performed recently my Maternal-Fetal Medicine after referral for a Fetal Medicine after referral for a history of ASD repair at age 16history of ASD repair at age 16

CaseCaseROS:ROS:* Accelerated increase in abdominal * Accelerated increase in abdominal girth over girth over the past 5 months.the past 5 months.* Early satiety.* Early satiety.* Excellent exercise tolerance.* Excellent exercise tolerance.* No palpitations, SOB, syncope.* No palpitations, SOB, syncope.* No respiratory problems.* No respiratory problems.

CaseCasePE:PE:* 18 yo pregnant female* 18 yo pregnant female* 5’6”, 130#* 5’6”, 130#* Class I Airway* Class I Airway* Lungs clear* Lungs clear* Heart regular, rate 80’s, no murmur* Heart regular, rate 80’s, no murmur* Fundal height 6 cm above the * Fundal height 6 cm above the umbilicusumbilicus

CaseCasePre-op Echo:Pre-op Echo:* “Hyperdynamic systolic function * “Hyperdynamic systolic function and high and high volume consistent with volume consistent with pregnancy”pregnancy”** No evidence of residual ASDNo evidence of residual ASD

Pre-op PreparationPre-op Preparation* Coordination with OB team-* Coordination with OB team-* Type of Surgery-* Type of Surgery-

Risk of pre-term labor-Risk of pre-term labor-

PremedicationPremedication

InductionInduction* Positioning-* Positioning-* Drugs Choices-* Drugs Choices-* Technique-* Technique-* Hemodynamic goals-* Hemodynamic goals-

Vasopressors??Vasopressors??* Monitors-* Monitors-

MaintenanceMaintenance* Technique-* Technique-* Drugs-* Drugs-

NDMB’s-NDMB’s-* Tocolysis-* Tocolysis-* Hemodynamic Goals-* Hemodynamic Goals-

UterusCyst