Advanced | Obstetric Anesthesia Part II Flashcards
A parturient receives ketamine 2 mg/kg and succinylcholine 1.5 mg/kg for induction prior to elective cesarean delivery. Which of the following is most likely to be present in the newborn infant?
(A) Normal muscle tone
(B) Bradycardia
(C) Opisthotonos
(D) Respiratory depression
(E) Seizures
(A) Normal muscle tone
- Succinylcholine does not cross the placenta.
- Ketamine rapidly crosses the placenta but does not have a clinical implication to the placental transfer.
Chestnut Obstetric Anesthesia | 6th Edit
The concentration of bupivacaine is higher in maternal blood than in fetal blood because:
(A) bupivacaine is metabolized in the placenta
(B) maternal blood has a higher pH
(C) maternal blood has greater plasma protein binding
(D) maternal hemoglobin has a higher affinity for bupivacaine
(E) placental transfer of bupivacaine is limited
(C) maternal blood has greater plasma protein binding
Which of the following changes in pulmonary function best explains the more rapid rate of rise of alveolar concentration of volatile anesthetics in pregnant women than in nonpregnant women?
(A) Decreased functional residual capacity
(B) Decreased dead space ventilation
(C) Increased cardiac output
(D) Increased oxygen consumption
(E) Increased pulmonary venous admixture
(A) Decreased functional residual capacity
The functional residual capacity (FRC) begins to decrease by the FIFTH month
of pregnancy with uterine enlargement and diaphragm
elevation, and is decreased by 400 to 700 mL to 80% of the
prepregnancy value at term.
The overall reduction is
caused by a 25% reduction in expiratory reserve volume (200 to 300 mL) and a 15% reduction in residual volume (200 to 400 mL).
Assumption of the supine position causes the FRC to decrease further to 70% of the prepregnancy value.
The supine FRC can be increased by 10% (approximately 188 mL) by placing the patient in a 30-degree head-up position.
A 26-year-old woman has headache, nausea, and photophobia 36 hours after cesarean delivery for chorioamnionitis using subarachnoid block. Temperature is 38.8°C and leukocyte count is 14,200/mm3. Which of the following is the most appropriate next step in management?
(A) Oral ibuprofen
(B) Intravenous caffeine sodium benzoate
(C) Intravenous hydration
(D) Epidural blood patch
(E) Diagnostic lumbar puncture
(E) Diagnostic lumbar puncture
The supine hypotensive syndrome of pregnancy:
(A) begins at 32 weeks’ gestation
(B) causes fetal distress by aortocaval compression
(C) is corrected by Trendelenburg’s position
(D) is less likely following subarachnoid block than epidural block
(E) occurs in 90% of supine women at 38 to 40 weeks’ gestation
(B) causes fetal distress by aortocaval compression
Which of the following statements concerning the management of diabetes mellitus during pregnancy is true?
(A) Insulin requirements remain essentially unchanged during pregnancy
(B) Maternal blood glucose concentration of 200 mg/dL is optimal
(C) Maternal hyperglycemia may cause neonatal acidosis
(D) Neonatal hyperglycemia is common
(E) Infants delivered under general anesthesia have lower Apgar scores than those delivered under spinal anesthesia
(C) Maternal hyperglycemia may cause neonatal acidosis
Recognized side effects of magnesium sulfate used for the treatment of preeclampsia that would be of anesthetic concern include each of the following EXCEPT:
(A) maternal pulmonary edema
(B) neonatal hypotonia
(C) increased maternal sensitivity to succinylcholine
(D) increased maternal sensitivity to vecuronium
(E) maternal hypokalemia
(E) maternal hypokalemia
TRUE/FALSE
One of the emphasis of Pre-eclampsia treatment is to NORMALIZE blood pressure.
FALSE
ACOG Guideline
As per ACOG guideline, which of the following is NOT clinically considered to be a 2nd line anti-hypertensive agent in the management of Pre-eclampsia?
A. Labetalol
B. Magnesium Sulfate
C. Hydralazine
D. Nifedipine
B. Magnesium Sulfate
- Mg Sulfate is NOT an anti-hypertensive agent
The pathophysiologic profile of a pre-eclamptic is consistent with the following EXCEPT:
A. Decreased colloid osmotic pressure
B. Decreased LVEDP(left ventricular end-diastolic pressure)
C. Increased endothelial permeability
D. Increased LVEDP
B. Decreased LVEDP(left ventricular end-diastolic pressure)
You have a well-working T10 labor epidural in a woman with a questionable difficult airway and have just been informed that an urgent cesarean section is needed for a non-reassuring FHR tracing. Which of the following local anesthetics would give you the SLOWEST onset of surgical anesthesia?
A. 3% chloroprocaine with freshly added epinephrine (1:200,000)
B. 2% lidocaine with freshly added epinephrine (1:200,000)
C. 2% lidocaine and epinephrine with added bicarbonate
D. 0.5% levobupivacaine with fentanyl
D. 0.5% levobupivacaine with fentanyl
This is the recommended maximum IV dose of NTG when and if used for the purpose of labor analgesia:
A. 100 ug
B. 250 ug
C. 150 ug
D. 75 ug
B. 250 ug
- In current practice, intravenous nitroglycerin (50 to 250 μg) has largely replaced the need for general anesthesia for uterine relaxation.
Which of the following is NOT ACCURATE pertaining to the placental transfer of drugs during pregnancy?
A. The fetal oxyhemoglobin dissociation curve is left-shifted
B. . The maternal oxyhemoglobin dissociation curve is right-shifted
C. Transfer of oxygen between the mother and fetus is dependent on the acid-base status of the fetus
D. Charged and lipophilic drug will likely cross faster
D. Charged and lipophilic drug will likely cross faster
- Uncharged and Lipophilic cross faster
Which local anesthetic has the SHORTEST plasma half-life after being injected into the epidural space?
A. Bupivacaine
B. Chloroprocaine
C. Lidocaine
D. Ropivacaine
B. Chloroprocaine
American Society of Regional Anesthesia (ASRA) guidelines for the treatment of local anesthetic systemic toxicity (LAST) for cardiac arrhythmias include the use of Intralipid and the AVOIDANCE of all of the following drugs EXCEPT
A. Vasopressin
B. β-Blockers
C. Calcium channel blockers
D. Low-dose epinephrine (< 1 μg/kg)
D. Low-dose epinephrine (< 1 μg/kg)
