Anesthesia for C-section Flashcards
What does the choice of anesthetic depend on?
- Indications for surgery
- degree of urgency
- maternal status
- condition of fetus
- desires of pt
What are the advantages of using GA for C/S?
- Rapid, reliable induction
- control of airway
- superior control of hemodynamics
- excellent surgical conditions
- possible in presence of coagulopathy, hemorrhage, sepsis
What are the disadvantages of using GA for c/s?
- Potential for difficult or failed intubation
- unconscious patient
- aspiration
- fetal effects
- neonatal depression
- maternal awareness
What is the process of induction when using GA for c/s?
What agents should you use?
- 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
When does the surgeon make the incision for a c/s?
How should you ventilate?
what is the critical interval?
- 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
What will you give the c/s patient right after delivery of baby?
How will you extubate?
- 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!
What is the difficult airway/fetal distress flowchart?
What are the advantages of spinal anesthesia for c/s?
disadvantages?
- 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
How can you prevent hypotension when placing a spinal for c/s?
- LUD
- crystalloid coloading
- ephedrine (5-10 mgIV)
- phenylephrine (50-100 mcg IV)
What are the symptoms of a total spinal?
treatment?
- symptoms
- hypotension
- dyspnea
- inability to speak
- loss of consciousness
- Treatment
- intubation
- oxygen
- ventilation
- support maternal hemodynamics
What should you know about non-obstetric surgery in an OB pt?
- 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
What are post-anestesia concerns for pregnant patients?
- miscarriage
- teratogenic drugs
- breastfeeding