Anesthesia before and during pregnancy Flashcards
Site for epidural C/s vs labor
T10-L1
S2-S4
Motor block with epidural?
Not really, they should be able to feel them and move them
Order of tissue
SILPA
supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural-> dural POP-> subdural -> arachnoid-> subarachnoid
Posterior longitudinal ligament
Anterior longitudinal ligament
Where does spinal cord end?
L1
AKA conus medularis
What is the conus medularis
end of spinal cord L1 in adults S1 in neonates
Risk factors for PDPH
Younger age
Female
Pregnant
-
Cutting tip needle
Larger needle
Using air for LOW
Needle perpendicular
LOW risk for PDPH
Men
Older
Non pregnant
-
Non cutting tip
Smaller needles
Fluid for LOR
Needle parallel
Continuous spinal after wet type
What has no effect on risk of PDPH
Early ambulation
Continuous spinal catheter
PDPH treatment
Bed rest- lay down
NSAIDS
Caffeiine
Blood patch (definitive treatment and diagnosis) 10-20 cc blood
Presentation of total spinal
Hypoxemia
Dyspnea
HOTN
Legs heavy
Contraindicatinos to neuraxial
Refusal
Coag PLT <100,000
Increased ICP
Sepsis
Infection at site
Hypovolemia (relative)
Fixed valve lesions
AS and severe MS
When are pregnants considered full stomach?
18 weeks
Best time for surgery
2nd trimester (ideally delayed 2-6 weeks after delivery)
High risk for teratogenicity
first trimester
3 weeks old per redbook
Highest risk for pre term delivery
3rd trimester
