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S5 - Regional/OB - Test 1 > Article - Obesity & OB Anesthesia > Flashcards

Article - Obesity & OB Anesthesia Flashcards

1
Q

Does being obese increase the risk of requiring C section?

A

yup

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2
Q

Do obese preggos generally have a longer or shorter first stage of labor

A

longer

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3
Q

what is often seen in regards to babies weight when the mother is obese

A

higher fetal weights

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4
Q

Is there a higher rate of neuraxial failure in the obese population

A

yup

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5
Q

how does being obese affect the time of neuraxial procedures

A

longer

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6
Q

What % of maternal deaths were in overweight or obese mothers?

A

76%

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7
Q

are obese women more likely to die during labor

A

yes

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8
Q

Which class of obesity is it recommended for their to be a formal anesthesia consultation during the third trimester

A

Class 3 obesity. BMI > 40

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9
Q

What is included in the anesthesia consultation with obese mothers

A
  • comprehensive physical exam
  • extensive medical history
  • screening for comorbidities
  • screen for OSA
  • pulm, CV, and airway assessment
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10
Q

Why is it advised that obese women need to request neuraxial anesthesia early in labor?

A

because placement is often challenging

  • Requesting early is important to ensure sufficient time for placement/confirmation
  • also reduces the risk of needing GA for emergency C section
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11
Q

Is the rate of OSA in obese pregnant women higher compared to healthy women

A

obvi

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12
Q

What adverse pregnancy outcomes are seen in women with OSA

A

hypertensive disorders

Gestational diabetes

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13
Q

What are the risk factors for OSA in pregnant women

A
  • advanced maternal age
  • obesity
  • chronic HTN
  • snoring

*usual OSA screening tools not shown to be accurate for the pregnant population

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14
Q

What is one of the safest methods for delivering labor analgesia in the obese population

A

epidural

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15
Q

When assessing analgesia epidural what would indicate being less likely to convert use to surgical anesthesia if necessary?

A
  • fails to achieve a sensory level of T10

- requires frequent top offs

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16
Q

What should be done if the epidural is not providing adequate labor analgesia?

A

replace immediately to minimize risk of failure should a C section be required

17
Q

What is the concern with administering IV analgesia to obese OSA parturients

A

they have increased sensitivity to respiratory depressant effects

18
Q

What confirms placement for CSE

A

obtaining CSF through the spinal needle

19
Q

an alternative technique to CSE in obese parturients

A

dual puncture epidural

20
Q

What benefits were found to using the dual puncture epidural (DPE) instead of CSE in obese parturients?

A
  • decrease the likelihood of asymmetric block

- less pruritus, hypotension, tachysytole, and category II fetal heart tracing

21
Q

What limits the use of continuous spinal labor analgesia

A

risk of post-dural puncture headache

22
Q

How do you Preoxygenate obese parturients?

A

3 mins of tidal volume breathing OR 8 deep breaths in 1min with 100%

23
Q

what additional technique should be used during intubation to prolong the time to desaturation

A

administer 5L/min via nasal cannula

24
Q

What position is preferred to sniffing position for intubation of obese parturients

A

ramp em up bby

25
Q

Should dosing of induction drugs for obese parturients be based on total or ideal body weight?

A

ideal body weight

26
Q

can you extubate an obese parturient deep

A

no no no must be fully awake

27
Q

what device can be used to help with moving obese parturients onto the OR table and decrease the risk of injury

A

air-inflated mat

28
Q

If cephalad retraction is used to gain a better view for C section what must be carefully monitored

A

hemodynamics and respiratory status.

* Fetal death linked to hypotension after cephalad retraction.

29
Q

What postpartum complications are obese parturients at risk for

A
  • wound complications
  • UTI
  • peripheral nerve injury
  • VTE
  • respiratory complications
  • sepsis
  • MI
  • death
30
Q

What method is seen as superior for post cesarean analgesia

A

neuraxial morphine

31
Q

If neuraxial morphine is contraindicated d/t allergy or intolerance what is the next option often utilized for post cesarean analgesia?

A

PCA

32
Q

Which block has been shown to reduce pain scores and analgesic consumption in patients who did not receive neuraxial morphine?

A

transversus abdominis plane (TAP) block

*not additionally beneficial if pt received neuraxial morphine

33
Q

Why are local blocks an inferior technique for labor/postpartum analgesia

A

covers only incisional pain not visceral pain

34
Q

Is there a universal VTE prophylaxis guideline for obese parturients

A

no, varies widely amongst institutions

S5 - Regional/OB - Test 1 (13 decks)

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