Anesthesia for Vaginal Delivery and C Section

Question 1

First stage of labor:

pain fibers are from:

Answer 1

Uterine contractions to complete dilation of the cervix

Pain from T10-12 and then Later T10-L1

Question 2

Second stage of labor:

Pain fibers

Answer 2

Full cervical dilation to the delivery of the fetus

Impulses carried via pudendal nerves from S2-S4

Question 3

Third stage of labor:

Answer 3

Delivery of placenta

Question 4

Pain relief of well conducted obstetrical analgesia can help improve what?

Answer 4

Can help improve uterine blood flow

Question 5

Meperidine and baby:

Answer 5

Placenta transfers active metabolite normeperidine which has a long elimination half life in neonates

Question 6

Absolute contraindications for regional anesthetic in labor:

Answer 6

Patient refusal 
bacteremia/sepsis 
increased ICP 
Infection at insertion site 
shock or severe hypovolemia 
coagulopathy or therapeutic anticoagulation

Question 7

Why no lidocaine in spinal?

Answer 7

TNS: pain in buttocks and legs that develop a few hours after receiving local anesthesia

Question 8

What leaves first in spinal anesthetics?

What is the last organ to recover from spinal anestheisa?

Answer 8

autonomic first
sensory second
motor last

Bladder is last organ to recover, making urinary retention very common

Question 9

Epidural blocks pain for which stage of labor?
Always be prepared to tx what?
Intravascular injection causes which sxs?

Answer 9

T10-L1 and S2-S4
Always be prepared to tx high spinal!
Intravascular injection: tachycardia, tinnitus, metallic taste in mouth, and perioral numbness

Question 10

DOSING OF LOcal anesthetics in preggo with stuff:

Answer 10

Dose is 1-1.5 mL per segment blocked

Question 11

Why does bupivicaine have low placntal passage?

Answer 11

Secondary to being highly protein bound

Question 12

2-chloroprocaine has significant antagonsim with:

Answer 12

significant antagonism with subsequently injected epidural opioids or bupivicaine

Question 13

Paracervical block is associated with:

Answer 13

High incidence of fetal asphyxia and poor neonatal outcomes WHICH IS WHY I WILL NEVER DO IT

Question 14

Why regional?

Answer 14

Well, here at regional, we have:
Less increase in BP
Less need for opioid analgesics
improvement in placental and renal blood flow

Question 15

What is the benefit of adding fentanyl to spinal? Duramorph?

Answer 15

Benefit: can decrease intra op nausea and decdrease visceral pain associated with exteriorization of uterus and visceral traction
Morphine helps with long term post-op pain control

Question 16

Do patient’s hegith, weight, or BMI correlate with height of block?

Answer 16

No

Question 17

Why would you give bicarb with a regional block:

Answer 17

Shortens onset time (NOT EFFECTIVE FOR BUPIVICAINE)

Question 18

WHY WOULD You give epi during a regional block?

Answer 18

because it decreases vascular absorption of local anesthetic (not effective for bupivicaine)

Question 19

KIM when taking care of preggo pts:

Answer 19

The mother’s life is always YOUR FIRST PRIORITY

Question 20

Maintenance fo anesthesia can be provided with what in preggo pts?

Answer 20

50% nitrous oxide and 50% oxygen plus 0.5 MAC of volatile anesthetic. This can be increased to 2 MAC temporarily just prior to delivery to aid in uterine relaxation
After delivery, increase the percentage of nitrous oxide to 70 and decrease volatile anesthetic