Anesthesia for C-section Flashcards

1
Q

What does the choice of anesthetic depend on?

A
  • Indications for surgery
  • degree of urgency
  • maternal status
  • condition of fetus
  • desires of pt
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2
Q

What are the advantages of using GA for C/S?

A
  • Rapid, reliable induction
  • control of airway
  • superior control of hemodynamics
  • excellent surgical conditions
  • possible in presence of coagulopathy, hemorrhage, sepsis
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3
Q

What are the disadvantages of using GA for c/s?

A
  • Potential for difficult or failed intubation
  • unconscious patient
  • aspiration
  • fetal effects
  • neonatal depression
  • maternal awareness
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4
Q

What is the process of induction when using GA for c/s?

What agents should you use?

A
  • Pt does all pre-op prep before induction, while pt awake
  • Preoxygenate!
  • RSI w/ cricoid pressure
  • Meds:
    • ketamine (if pt hypotensive) 1mg/kg
    • etomidate 0.3 mg/kg
    • propofol 2-2.5 mg/kg
    • succ 1-1.5 mg/kg
      • preferred muscle relaxant
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5
Q

When does the surgeon make the incision for a c/s?

How should you ventilate?

what is the critical interval?

A
  • Surgeon makes incision immediately after placement of ETT is confirmed
  • Ventilate with half and half O2/N2O and small amt of VA (<1 MAC) or propofol
  • Critical interval of 3 minutes between uterine incision and delivery of fetus
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6
Q

What will you give the c/s patient right after delivery of baby?

How will you extubate?

A
  • you will discontinue or reduce the VA, maybe increasing N2O to 70%
  • give opioids or benzos
  • possible NDMR
  • deliver the placenta
  • then can add oxytocin to help uterus contract
  • Reverse NDMR
  • Extubate awake!
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7
Q

What is the difficult airway/fetal distress flowchart?

A
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8
Q

What are the advantages of spinal anesthesia for c/s?

disadvantages?

A
  • Advantages
    • rapid onset
    • dense and reliable anesthesia
    • minimizes risk for aspiration/failed intub
    • little risk of LA toxicity
    • minimal drug transfer to fetus
    • awake patient
    • decreased blood loss
  • disadvantages
    • hypotension
    • limited duration of action
    • N/V
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9
Q

How can you prevent hypotension when placing a spinal for c/s?

A
  • LUD
  • crystalloid coloading
  • ephedrine (5-10 mgIV)
  • phenylephrine (50-100 mcg IV)
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10
Q

What are the symptoms of a total spinal?

treatment?

A
  • symptoms
    • hypotension
    • dyspnea
    • inability to speak
    • loss of consciousness
  • Treatment
    • intubation
    • oxygen
    • ventilation
    • support maternal hemodynamics
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11
Q

What should you know about non-obstetric surgery in an OB pt?

A
  • prior to viability (<24 weeks)
    • document FHR prior to and after procedure via doppler or US
  • After viability (> 24 weeks)
    • admitted to L&D 2 hrs prior to surgery
    • external FHR monitoring for 30-60 minutes
    • intraoperative FHR monitoring by L&D nurse, may want delivery equipment in room
    • return to L&D post op for FHR monitoring after short stay in pacu
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12
Q

What are post-anestesia concerns for pregnant patients?

A
  • miscarriage
  • teratogenic drugs
  • breastfeeding
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