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OB > Anesthesia c section > Flashcards

Anesthesia c section Flashcards

1
Q

Disadvantages of GA

A
  1. aspiration
  2. airway management
  3. fetal sedation and narcotizing
  4. awareness under light GA
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2
Q 
possible class 1 emergencies
or indications for GA
A

class 1 emergencies: massive hemorrhage, non reassuring FHR/fetal distress, abruption, eclampsia

indications: refusal of regional, contraindications of regional, coagulopathy

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3
Q

induction drug doses for GA

A

prop 2.5mg/kg; can be infused 6mg/kg/hr
etomidate 0.3 mg/kg
ketamine 1-1.5 mg/kg; fetal depression at 2mg/kg (decreased UBF)
sux 1 to 1.5mg/kg

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4
Q

physiological causes of neonatal depression

A

maternal hypoventilation/hyperventilation
reduced UP perfusion from aortocaval compression
neonatal acidosis increases when time between uterine incision and delivery exceeds 3 min

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5
Q

pharmacologic causes of neonatal depression

A

induction agents
NMBA
low O2 concentration
NO2 and other IAs

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6
Q

Duration of CS

A

15-120 min

Avg 40min

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7
Q

When is GA indicated for CS

A

Class I emergency without epidural, and spinal

Or either regional method takes too long

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8
Q

When is local anesthesia indicated for CS

A
  • for life threatening fetal compromise
  • anesthesia providers are not present
  • mom consents
  • supplementation of patchy epidural
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9
Q

What sensory level is necessary for adequate regional anesthesia for CS

A

T4

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10
Q

Which anticoagulant is not contraindicated while patient has an indwelling neuraxial catheter

A

Heparin

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11
Q

Minimal time between last dose and spinal injection/catheter placement

A

Warfarin 12-24 hours
Heparin aPTT<40; 6 after last dose for 5000u TID or higher
Heparin 5000 units BID no contraindication

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12
Q

Minimal time between spinal injection/catheter removal and next dose of anticoagulant

A

Warfarin 2 hours
Heparin 1 hour
Lovenox 24 hours; 6-8 hours

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13
Q

Spinal anesthesia contraindications

A

Specific cardiac lesions, technical problems, short stature, obese, neurological d.o

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14
Q

What is the preop prophylaxis for aspiration when doing a CS

A

Sodium citrate 30ml

Gastrokinetic such as reglan 10mg

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15
Q

What positions can you perform a spinal on

A

Lateral preferred but sitting more common

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16
Q

Preferred sites for spinal/epidural for CS

A

L2L3 L4L5

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17
Q

Solution for spinal for CS

A

Hyperbaric bupi 0.75% (7.5-15mg) with 6.25 to 25 mcg of fentanyl and or 0.1-0.3 morphine mg)

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18
Q

BUPI dose for spinal CS and DOA

A

7.5-15mg

60-120min

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19
Q

Fentanyl dose for Spinal CS and DOA

A

10-25 mcg

DOA 180-240min

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20
Q

Morphine dose and DOA for spinal CS

A

0.1-0.2 mg

720-1440

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21
Q

Epi dose for spinal CS

A

0.1-0.2 MG

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22
Q

True or false epidural anesthesia for CS is a less dense block, greater chance of failure, and has an increased complexity of the technique

A

True

23
Q

How much cc of LA for each level anesthetic blockage

A

1cc

24
Q

How many cc’s do you give with an epidural and how long between doses

A

5cc and 2 min between doses

25
Q

What can you add to an epidural

A

Epi and sodium bicarb

Fentanyl/morphine

26
Q

Which LA can be used in an epidural for fastest onset, no fetal transfer, acidotic fetus

A

2 chloro

27
Q

Which LA is most frequently used for CS epidural if not urgent/emergent

A

Bupi

28
Q

What do you add to epidural LA in case of emergency

A

2% lidocaine with epi and sodium bicarb
10-20 ml of lido
2ml of pedi bicarb (1ml of sodium bicarb with 9ml of 2% lidocaine)

29
Q

Which cocktail for epidural CS has the fastest onset and longest duration

A

50/50 lido/bupi with sodium bicarb

30
Q

Dose and DOA for Lidocaine 2% with epi 5mg/ml dose for Epidural CS

A

300-500 mg

DOA 75-100min

31
Q

Dose and DOA for 3% 2-chloro

Epidural CS setting

A

450-750mg

40-50 min

32
Q

Bupi 0.5% dose and DOA for epidural CS setting

A

75-125 ming 120-180 min

33
Q

Ropi 0.5% dose and DOA for epidural CS

A

75-125mg 120-180 min

34
Q

Fentanyl dose and doa for epidural CS

A

50-100 mcg 120-240 min

35
Q

Morphine epidural cs dose and doa

A

3-4mg

720-1440min

36
Q

How do you perform a sequential block

A

Inject 10ml of saline through epidural to help rostral spread of spinal
Squeezes dural sac

Smaller initial spinal dose - less hypotension

37
Q

Why is spinal after failed epidural controversial

A

Risk of high or total spinal

38
Q

How much of the OB spinal dose is recommended after a failed epidural

A

75%

39
Q

Causes of total spinal

A

Epidural injection into subarachnoid (too much volume)
Epidural dose into subdural (subdural space low volume space)
Spinal after failed epidural

40
Q

S/S and management for total spinal

A

Presents 10+25min after
Rapid progression of motor and sensory block
Sx: dyspnea, difficulty phonating, significant hypotension, LOC

Tx: IVF LUD, vasopressors, elevation of legs, intubate, r/o eclampsia, fluid embolism, anaphylactic shock

41
Q

Acid Prophylaxis tx against aspiration for GA CS

A

Sodium citrate
H2 antagonist (-tidine)
Prokinetic - reglan

42
Q

Is patient prepped and draped before induction of GA for CS

A

YES

43
Q

Patient position considerations for RSI

A

15 degree at least of LUD
Cricoid 44 newtons
BURP
Head and neck elevated

44
Q

How much MAC with GA CS

A

0.5-0.8 MAC with nitrous

Higher than 0.5 MAC run the risk of uterine relaxation and decreases sensitivity to oxytocin

45
Q

What happens if you can’t intubate for cs

A

Ventilate through cricoid
Awaken, fiberoptic intubation
LMA fast track

46
Q

Which induction drug has less histamine release and myocardial depression compared to thiopental

A

Etomidate

47
Q

T or F

Decreased cholinesterase does not prolong sux

A

True

48
Q

T or F defasiculation dose and repeat dose not necessary with sux

A

T

49
Q

What is ideal maternal PaCO2 with MV for GA CS

A

27-31

50
Q

Why is hypoventilation with mom bad

A

Eliminating UV/M gradient, limiting CO2 transfer - fetal respiratory acidosis

51
Q

What is NDMR prolonged by

A

MAG

52
Q

Central acting post CS analgesia

A

Ofermiv 1g IV q6h

Oral 650mg q6h

53
Q

Which is the gold standard for neuraxial opioids

A

Morphine

54
Q

Additional adjuncts for post CS analgesia (part of ERAS)

A

Ketamine 10mg or .15mg/kg after neuraxial anesthesia
TAP block
.25%-.375% bupi and ropi
Gabapentin 600mg 1hr prior to sx

OB (10 decks)

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