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OBSTETRICS > 1F - Obstetric Anesthesia > Flashcards

1F - Obstetric Anesthesia Flashcards

1
Q

What are hematologically increased in a pregnant woman?

A

plasma volume, blood cell volume, procoagulant factors

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2
Q

Hgb and hematocrit during pregnancy is decreased or increased?

A

Decreased

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3
Q

What ASA class is a pregnant patient?

A

Class 2 with mild systemic disease

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4
Q

Serum cholinesterase activity in pregnant women is decreased by?

A

20%

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5
Q

Total protein in preg woman is?

A

Increased

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6
Q

plasma protein in preg woman is?

A

De

to below 6g/dL

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7
Q

Free drugs in preg woman are?

A

In

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8
Q

What are de in cardio in preg woman?

A

SVR, arterial bp

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9
Q

what are in in cardio in preg woman?

A

HR, CO, SV

*inc in SVR greater than inc in CO

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10
Q

Supine hypotension syndrome is caused by the occlusion of what greater vessel?

A

Superior vena cava

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11
Q

What maneuver can help alleviate supine hypotension syndrome?

A

Left uterine displacement using a wedge under the hip and left lateral decubitus position

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12
Q

The diaphragm during pregnancy is displaced where?

A

Cephalad

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13
Q

what partial pressure is decreased in the blood during pregnancy?

A

CO2 pressure

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14
Q

Due to inc metabolic rate and dec FRC, what is the preg woman presidposed to?

A

Hpoxemia

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15
Q

Overall GI transit time during preg is?

A

Increased

*gastric emptying time is not prolonged

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16
Q

What GI function is distorted and incompetent during pregnancy?

A

LES

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17
Q

Before any surgical procedure, due to the changes in GI tract during pregnancy, what drugs are given?

A

H2 blockers and metoclopramide

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18
Q

The preg patient requires more or less inhaled anesth?

A

Less

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19
Q

What categories in ficks principle permits placental transfer of drugs?

A

Non ionized, lipid soluble and small molecular size (<500Da)

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20
Q

What vasoconstrictor is used to prevent transfer of drugs to the fetus?

A

Epinephrine (vasoconstrictor)

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21
Q

What drug if induction to to delivery exceeds 5-10 minutes, causes newborn depression?

A

Nitrous oxide (NO)

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22
Q

Metabolic clearance of the fetus when compared to an adult is inc, dec, or same?

A

Same

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23
Q

renal clearance of fetus when comparesd to an adult is inc, dec, or same?

A

inc

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24
Q

The spinal cord segments involved in labor pains at the first stage of labor are?

A

T10 to L1

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25
Q

Spinal cord segments involved in the second stage labor pains?

A

S2 to S4

26
Q

Most commonly administered for labor analgesia?

A

Opioids

27
Q

what is the go to drug for analgesia?

A

Meperidine

IV effects in 5-10 mins
IM peaks in 40-50 mins

28
Q

what type on obstetric analgesia has lower incidence of nausea and vomiting and dysphoria?

A

Antagonist-agonist - nalbuphine, butorphanol

safer then meperidine - ceiling effect on ventilatory depression

29
Q

Synthetic opioids upon repeated doses can cause what fetal complication?

A

neonatal depression

*fentanyl

30
Q

Which potent analgesic causes amnesia?

A

Ketamine

31
Q

What stage of labor does regional anesth prolong?

A

None

32
Q

What epidural anesth are called walking epidural by sparing of motor skills?

A

Ropivacaine and Bupivacaine

33
Q

What form of regional anseth is used for imminent deliveries or multiparous deliveries?

A

Spinal anesth

fentanyl + bupicavaine

34
Q

Repeated spinal anesth can cause what problem to the patient?

A

postdural puncture headache

35
Q

the painting wall sites of defence requires giving medications in what order of spaces?

A

Spinal then epidural

36
Q

If patients have aortic stenosis what form of analgesic should be given?>

A

Opioid only

37
Q

What is the ideal analgesic technique for labor?

A

Combined spinal and epidural anesth

*opioid only or opioid + bupivacaine

38
Q

If central neuraxial anesthetic technique is contraindicated, what is the alternative?

A

Paravertebral lumbar sympathetic block

39
Q

What nerve block is used for forceps delivery and episiotomy?

A

Pudendal nerve block

40
Q

What is the most often used is the most often used inhalational anesthesia?

A

Nitrous oxide

41
Q

What is the most common complication of neuraxial anesth?

A

Hypotension

42
Q

Interval of monitoring in patients receiving neuraxial anesth?

A

Every 2-3 mins for first 20 mins

43
Q

Drug and method used for neuraxial anesth?

A

Morphine either epidural or intracthecal

44
Q

What dermatome is blocked for surgery of the preg woman?

A

T4

45
Q

What form of anesth is most commonly used in CS delivery?

A

Spinal anesth

46
Q

In addition to bupivacaine used in spinal anesth for CS delivery, what is added to increase rapidity of the blockade, and reduce symptoms such as nausea and vomiting and shivering?

A

Opioids

47
Q

What is the main disadvantage of lumbar epidural anesth?

A

Slow onset

48
Q

Bupivacaine is associated with greater risk of what complication?

A

LAST (local anesth systemic toxicity)

49
Q

What combination drug for lumbar epidural anesth poses less risk of LAST compared to bupivacaine?

A

Ropivacaine + fentanyl

50
Q

What is used when there is absolute or relative contraindications for neuraxial anesth?

A

general anesth

51
Q

What evaluation is important before undergoing general anesth?

A

preoperative airway evaluation

52
Q

What is the leading cause of maternal death related to anesth?

A

inability to intubate or ventilate

53
Q

What preventive measure to hypoxia is done before induction of general anesth?

A

denitrogenization for 3-5 minutes or 4 deep breaths of 100% oxygen

54
Q

what muscle relaxant is used to facilitate intubation?

A

Succinylcholine

55
Q

Which form of anesth is more related to anesth related maternal deaths, general or neuraxial?

A

General anesth

56
Q

Treatment for hypotension syndrome caused by anesth?

A

Vasopressin, epinephrine, Left uterine displacement, co load etc

57
Q

Treatment for convulsions occurring in LAST?

A

benzodiazepines

58
Q

Treatment for ventricular arrhythmias in LAST?

A

Amiodarone

59
Q

If unresponsive to lipid emulsion, what is the treatment?

A

Cardiopulmonary bypass

60
Q

withdrawal of what hormone causes post puncture headache?

A

estrogen

61
Q

Most commonly abused substance?

A

Tobacco

OBSTETRICS (36 decks)

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