Gilstrap III. Hegewald, Matthew J. Zwillich, C. Levinson, Gershon, Sol M. Shnider, and John L. Huch, Renate. Med 14 3. Indian J Physiol Pharmacol ; Heidemann B. Changes in maternal physiology during pregnancy. Update in Anaesthesia ; Lung function and breathing regulation parameters during pregnancy. Arch Gynecol Obstet ; Expiratory Flow Rate in normal pregnancy. Obstet Gynecol ; This article has been cited by. Related articles Inspiratory capacity inspiratory reserve volume pregnancy respiratory rate tidal volume.
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Clin Obstet Gynecol ; 57 : — Critical care in the pregnant patient. Articles from Breathe are provided here courtesy of European Respiratory Society. Support Center Support Center. External link. Please review our privacy policy. Recommended use of corticosteroids to prevent critical illness.
Oral corticosteroids associated with a two-fold increase in pre-eclampsia and with a minimal incidence 0. Cardiogenic basis secondary to haemodynamic factors occurring during pregnancy:.
Risk of hypoxic and hypercapnic respiratory failure because the ability to increase ventilation is limited. Severely reduced vital capacity but pregnancy can be well tolerated. Minimal complication: preterm delivery with newborn needing high-dependency support.
Supplemental oxygen and noninvasive ventilation may be required. The most common obstetric disorder, with multisystem ramifications. Potential pregnancy-related complications: prematurity, low weight at birth and postpartum graft loss. The relative scale of the problem must be brought into perspective. Greater concern should be made of managing the maternal airway and less worry about neonatal respiratory depression. The pound parturient at 28 weeks' gestation presenting for emergency cesarean delivery due to a prolapsed cord is better served by a sedated fiberoptic intubation than a failed rapid sequence induction.
It is easier to intubate an g neonate than to struggle with the airway of the mother. The neonate will be intubated and ventilated anyway because of fetal lung immaturity. An order-of-magnitude mentality can easily mislead. Although the neonatal airway is much smaller than the adult, intubation equipment is appropriately scaled to the task.
Larger laryngoscope blades are used in adults. However, this does not guarantee success because of the challenge of aligning less plastic airway anatomy with the usual field of the intubator. Gaining Experience There is increasing concern that as the number of cesarean deliveries to patients receiving general anesthesia decreases, there will be insufficient cases for training.
Unlike the situation in other institutions, the fiberoptic cannot be shared with respiratory care or the general operating room. When facing a nonurgent situation, such as a retained placenta or termination, it is appropriate for a tyro to try his or her skills with fiberoptics.
How can we ensure that attending physicians covering obstetric patients are qualified in the use of fiberoptics?
Experience performing three awake fiberoptic intubations per month is considered the minimum to maintain proficiency. Age of the physician seems less of a handicap in using the fiberoptic laryngoscope than lack of hand-eye coordination. When using a straight or curved laryngoscope blade, presbyoptics are at a disadvantage because it is impossible to focus on an anterior larynx through their lower set of bifocal lenses.
By enhancing the visual acuity of the optically challenged physician, the fiberoptic soon becomes an indispensable part of their armamentarium. The video game generation quickly grasps the use of the fiberoptic because the controls on the handle are similar to the controls of a joystick. Simulators are being developed to take advantage of the generation's youthful proclivity in navigating through virtual environments from Mario World to the Virtual Larynx.
However, regional anesthesia may fail in situations in which it is needed the most, or the opposite may happen: too high a level is reached in a parturient with a difficult airway. They protest that the hypermetric use of the fiberoptic exposes patients to the very dangers we are trying to avoid: 1 delays in delivery, 2 lower neonatal Apgar and umbilical cord gases, 3 maternal aspiration and asphyxiation, and 4 psychological trauma.
Surviving Prolonged Periods of Apnea The physiologic changes of pregnancy include increased oxygen consumption and cardiac output but a decrease in alveolar volume. During apnea, these factors shift the maternal hemoglobin de saturation curve to the left. The curve is shifted to the right by increased maternal blood volume. Overall, there is a faster rate of hemoglobin de saturation in the gravid patient compared with the nongravid patient 58 Fig.
A rapid sequence induction without preoxygenation should be proscribed. The whole scenario of failed intubation and impossible ventilation can be avoided by securing the airway before induction. Maternal, and thereby fetal, oxygenation then can be maintained up to the time of delivery. In preparation for fiberoptic intubation, a nasal cannula should be placed on the mother before sedation and topicalization.
Even in the presence of high maternal PaO 2 , the fetal p v O 2 cannot exceed maternal mixed venous PO 2. J Clin Invest , Anesthesiology , Chicago, Year Book Medical Publishers, Br J Anaesth , The Respiratory System, pp — Vol 3. Baltimore, Waverly Press, Shapiro BA: Editorial: When is an increase in the work of breathing clinically significant? Crit Care Med , Am J Obstet Gynecol , Reg Anaesth 6: 28, J Appl Physiol , Serial observations in normal women.
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