ACCRAC Podcast

In this 162nd episode I welcome Dr. Henao back to the show to discuss hypertensive disorders of pregnancy and how to manage them.

CLARIFICATIONS:

1. During our discussion of treatment of eclamptic seizures Dr. Henao said benzos were first line treatment. This is assuming the patient is already getting magnesium. For test questions, the answer for first line treatment should be Mg. In reality, patients will likely get both at the same time.
2. Serum Mg concentrations can be reported as mmol/L, meq/L or mg/dL. The important ranges to know for testing (though in reality different people may get symptoms at different times) are a therapeutic range of 2-3.5 mmol/L or 4-7 mEq/L or 5-9 mg/dL; A loss of patellar reflexes at >3.5, >7, >9; Respiratory paralysis at >5, >10, >12 and cardiac arrest at >12.5, >25, >30. EKG changes including prolonged PR and widened QRS happen in much the same range as loss of patellar reflexes, maybe a bit before but there is a lot of overlap.

References:

1. Hofmeyr R, Matjila M, Dyer R. Preeclampsia in 2017: Obstetric and Anaesthesia Management. Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):125-138.
2. Dhariwal NK, Lynde GC. Update in the Management of Patients with Preeclampsia. Anesthesiol Clin. 2017 Mar;35(1):95-106.
3. Aya AG, Mangin R, Vialles N, Ferrer JM, Robert C, Ripart J, de La Coussaye JE. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg. 2003 Sep;97(3):867-72.
4. Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017 Feb;216(2):110-120.
5. David Chestnut Cynthia Wong Lawrence Tsen Warwick D Ngan Kee Yaakov BeilinJill Mhyre Brian T. Bateman Naveen Nathan. Chestnut’s Obstetric Anesthesia: Principles and Practice. 5th edition. Chapter 36: Hypertensive Disorders. Pg 825-859

Killers of the Flower Moon (Dr. Henao’s random recommendation): https://www.amazon.com/Killers-Flower-Moon-Osage-Murders/dp/0385534248

In this 160th episode I welcome Dr. Dave Berman back to the show to discuss anesthesia for non-OB surgery during pregnancy.

References:

1. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016;124(2):270–300.

2. Nonobstetric Surgery During Pregnancy – ACOG [Internet]. [cited 2019 Jul 18];Available from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Nonobstetric-Surgery-During-Pregnancy?IsMobileSet=false

3. Tolcher MC, Fisher WE, Clark SL. Nonobstetric Surgery During Pregnancy. ObstetGynecol 2018;132(2):395–403.

4. UpToDate [Internet]. [cited 2019 Jul 18];Available from: https://www.uptodate.com/contents/management-of-the-pregnant-patientundergoing-nonobstetric-surgery

5. Upadya M, Saneesh PJ. Anaesthesia for non-obstetric surgery during pregnancy. Indian J Anaesth 2016;60(4):234–41.

6. Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery duringpregnancy. Br J Anaesth 2011;107 Suppl 1:i72–8.

7. Nejdlova M, Johnson T. Anaesthesia for non-obstetric procedures during pregnancy. Contin Educ Anaesth Crit Care Pain 2012;12(4):203–6.

8. Mazze RI, Källén B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 1989;161(5):1178–85.

9. Committee on Obstetric Practice and the American Society of Anesthesiologists. Committee Opinion No. 696: Nonobstetric Surgery During Pregnancy. Obstet Gynecol 2017;129(4):777–8.

10. Wilcox AJ, Weinberg CR, O’Connor JF, et al. Incidence of early loss of pregnancy. N Engl J Med 1988;319(4):189–94.

11. Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet 2016;387(10015):239–50.

12. Sun LS, Li G, Miller TLK, et al. Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. JAMA 2016;315(21):2312–20.

13. Center for Drug Evaluation, Research. FDA Drug Safety Communication [Internet]. U.S. Food and Drug Administration. 2019 [cited 2019 Jul 21];Available from: http://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communicationfda-review-results-new-warnings-about-using-general-anesthetics-and

14. Huang S-Y, Lo P-H, Liu W-M, et al. Outcomes After Nonobstetric Surgery in Pregnant Patients: A Nationwide Study. Mayo Clin Proc 2016;91(9):1166–72.