AEMC OB FAQs

Question 1

How soon after an epidural test dose will you see intravascular vs intrathecal symptoms?

Answer 1

intravascular: 45-60sec
intrathecal: 3-5minutes

Question 2

What makes the onset of 3% Chloroprocaine so rapid?

Answer 2

The higher concetnration

• delivering more moleculues will result in a faster onset

Question 3

If you have a type and screen do you need a type and cross?

Answer 3

No, only if the type and screen shows antibodies

Question 4

Discuss ion trapping

Answer 4

local anesthetics are weak bases and will easily diffuse across lipid bilayers in the placenta and enter the fetus

-the fetal ciculation is slightly more aciditic than moms (7.2); so once the local anesthetic is in fetal circulation it will ionize and be unable to cross back over the placenta

-the accumulation of local anesthetic in fetal circulation will distress the baby and cause further acidosis, worsening the cycle.

Question 5

How does pH impact fetal survical and neurologic outcomes?

Answer 5

pH < 7.2 is associated with acidosis and poor outcomes

Question 6

What is the most important thing to do immediately post-spinal insertion?

Answer 6

LUD

Question 7

Do not use methergine for what 2 conditions

why

Answer 7

HTN and cardiac disease

can cause severe vasoconstriction (direct alpha agonist), arrhythmias and coronary spasm

Question 8

How much of an increase in intravascular volume in mom (L) and why?

Answer 8

1L … to offset blood loss with delivery

Question 9

Why does mom have increased gastric emptying time?

Answer 9

bc progesterone causes decreased motility

Question 10

What causes mom to have increased gastric acid and pressure?

Answer 10

due to gastrin secretion from the placenta

Question 11

why do moms always have reflux?

Answer 11

bc the weight of the uterous changes the angle of the GE junction in combination with decreased LES tone

Question 12

3 Liver changes in mom

Answer 12

1. hypercoagulable but compensated DIC
2. fibrinogen increases (200-400)
3. 25% decrease in PCHE from week 10- 6 weeks PP

Question 13

Shortest and fastest local anesthetic

Answer 13

Chloroprocaine (metablized by esterases)

Question 14

Local anesthetic with the lowest fetal concentration

Answer 14

chloroprocaine (metablized by esterases before it can cross placenta to baby)

Question 15

Longest acting local anesthetic

Answer 15

tetracaine

Question 16

main local anesthetic to produce methemoglobin

Answer 16

priolocaine

Question 17

How is the CSF return affected by pregnancy?

Answer 17

It’s not

Question 18

T/F- mom has increased fluid requirements to prevent hypotension

Answer 18

true

Question 19

How does pregnancy affect the elimination half-life of propofol?

Answer 19

It’s unaltered

Question 20

How does prenancy affect the duration of sux?

Answer 20

it doesnt (or slightly decreased)

Question 21

T/F- pregnancy reduces the sensitivy to sux (need less)

Answer 21

true

(i thought you would need more due to increased volume of distrubution?)- im going to go with - dose needed is unchanged bc u have a decreased sensitivity + increase in total body fluid/water)

Question 22

How are vec and roc affected by pregnancy?

Answer 22

increased sensitivity (need less)
&
shorter half life

Question 23

Terbutaline (brethine)
MOA

S/E (6)

Answer 23

Beta-2 agonist
- ↑cAMP in uterous > activates protein kinases and turns off myosin light chain kinases > relaxation

tachycardia, temors, pulmonary edema, palpitations, hypokalemia, restlessness

Question 24

Ritodrine MOA

3 patients you would not use this in

Answer 24

Beta-2 agonist
- ↑cAMP in uterous > activates protein kinases and turns off myosin light chain kinases > relaxation

PIH, pulmonary HTN (wouldnt it be good for that?), hyperthyroidism)