surgical management of dystocia

Foetal considerations for anaesthesia

Drugs cross placenta (timing, licensing)

CV + resp dep

Hypothermia

Resuscitation

Monitoring

Maternal considerations for anaesthesia

Preg inc oxygen demands (Pre oxygenate prior to induction)

Preg inc CO

VC obstruction (delay rolling into dor recumbenbcy)

Hypothermia

Anaesthesia plan - pre med features

Avoided as longer to metabolise

Use Reversible if needed

Anaesthesia plan - Pre oxygenation features

Tight fitting mask

Anaesthesia plan - IVFT features

Isotonic crystalloids

5ml/kg/hr

Anaesthesia plan - Pre op prep features

Clip conscious + stood

Anaesthesia plan - Induction agent features

Rapid onset

Rapid metabolisation

Titrated to effect

Anaesthesia plan - Induction agents to use + which is best

Propofol

Alfaxalone - best

Anaesthesia plan - LA purpose

Minimise inh requirements if no pre med

Anaesthesia plan - LA ROA + when to use

Sc - during prep + before incision

Linea alba - during abd entry

Ovarian + cervical pedicle - OHE

Anaesthesia plan - Maintence agents

Isoflurane, sevoflurane

Anaesthesia plan - Position during surgery

Dor recumbency + thorax elevated

Anaesthesia plan - When to provide systemic analgesia

After delivery

Anaesthesia plan - Analgesia options drugs (care as lactating) + which is best

NSAIDs

Buprenorphine, methadone

Paracetamol - best

Surgical technique - incision

Umbilicus → pubic brim

Surgical technique - What cut through to enter abd

Linea alba

Surgical technique - How to protect abd from uterus

Pack with damp laparotomy swabs

Surgical technique - Uterine closure

2 layer monofilament absorbable

Simple continuous then inverting

Surgical technique - What to give if no uterine involution after pup removal

Oxytocin

Surgical technique - Steps

1- midline approach

2- enter abd

3- exteriorise uterus + pack abd

4- uterine incision

5- remove pups + clamp umbilicus

6- check for pups

7- uterine closure

8- flush

9- abd closure

Surgical technique - Where to clamp umbilicus + why

Far from pup for IV access

Neonatal care - warming

Box + warm towels + heat pad (not direct)

Neonatal care - Resus equipment

IV catheter, clamps, drugs, resp stimulant, masks, et tubes

Neonatal care - Resus drugs

Atropine, adrenaline, opioid/ alpha 2 reversal agents (naloxone/ atipamezole)

Neonatal care - Resp stimulant + issue

Doxapram - worsen hypoxia

Recovery - what to avoid in cleaning teats

Hibiscrub

Recovery - What to check pups for when stable

Palates, bums