Analgesia SMFM questions Flashcards
level of spinal for c-section
T4
level of epidural for vaginal delivery
T10
Spinal nerves for uterine pain
10-12
Spinal nerves for perineal pain
S2-4
Spinal nerves affected with numbess of hands
C6-8
Spinal nerves for the diaphram
C3-5
Vassopressors for hypotension after spinal
ephedrine 5-10 mg (alpha and beta agonist)- fetal tachycardia
Phenylephrine 50-100 mcg ( higher umbical pH and less nausea/vomiting)
What are the two opioid agonist/antagonists
nubain ( nalbuphine), and Stadol (butorphanol)
are any of the anesthetic agents teratogenic?
No
level of spinal cord lesion where autonomic dysreflexia is suspected
T6 - 80% wil have autonomic dysreflexia
Cuases of autonomic dysreflexia
bowel/bladder distension, pelvic exams, painful stimuli
Symptoms of autonomic dysreflexia
hypertension, hyperthermia, respiratory distress, bradycardia, tachycardia, seizures, death
invasive hemodynamic monitoring in pregnancy
MAP 90 Cardiac output 6 SVR 1200 PCWP 7.5 CVP 3.5 LVSWI 48 COP 18
pseudocholinesterase deficieny
accentuated by pregnancy (decreased 25%)
- prolongation of succinylcholine
magnesium effect on anesthesia
binds to prejunctional motor nerve endings
block entry of calcium
decreasing the release of acetylcholine
decreasing sensitization of the motor end plate
prolongation of nondepolarizing muscle relaxants (no suc)
neuraxial anesthesia with brain mass
mass without any mass effect, or evidence of hydrocephalus, or increased intracranial pressure, or CSF flow obstruction can have neuraxial anesthesia. Everyone else needs a neurosurgery consult
anesthesia with Arnold chiari malformation type 1
No new onset symptoms lower risk
some will not place an epidural
Anesthesia for pulmonary hypertension
minimize pulmonary vascular resistance - avoid over-sedation/prostaglandin - given oxygen Maintain blood volume Avoid myocardial depression - avoid beta blockers - Tele Maintain Afterload - intra arterial blood pressure - careful neuraxial - phenylepherine for vasopressors - titrate oxytoxin carefully
anesthesia for aortic root dilation
continue beta blocker
careful neuraxial
avoid methergine/prostaglandins
anesthesia for aortic stenosis
maintain afterload! - art line monitoring - careful neuraxial - phenylephrine if needed Avoid tachycardia Tele Maintain normovolemia
anesthesia for mitral stenosis
avoid atrial fib (consider cardioversion)
Fetal Hyperthroidisum
Growth restriction
fetal tachycardia
fetal goiter
craniocynostosis
Thyroid storm
fever
tachycardia
cardiac dysregulation
CNS dysfunction
- PTU/dex (block conversion)
- iodine (block release)
Anesthesia for cardiomyopathy
ephedrine (consider milrinone, dobutamine)
avoid bradycardia
effect of NO on pulmonary pressure
can increase pulmonary pressure