Chapter 37: The Obstetric Airway

Question 1

Overall obstetric mortality is:

Answer 1

1:10,000 live births

Question 2

Anesthesia-related obstetric mortality occurs:

Answer 2

1: 1 million cases

Question 3

Name six pregnancy + airway risk factors:

Answer 3

Failure to intubate
Aspiration
Hypoxemia
Urgency for two patients
Failure to prepare completely

Question 4

Pregnant women have decreases gastric emptying primarily due to

Answer 4

Progesterone levels
Stress of Labor
(Narcotics)

Question 5

Pregnant women have an increased gastric acidity due to:

Answer 5

gastrin

Question 6

Does NPO status effect GI risk in pregnant patients?

Answer 6

No.

Question 7

Pregnant women are more prone to aspiration because of decreased gastroesophageal sphincter tone due to:

Answer 7

Reflux
Anticholinergic use
Narcotics
Insertion + removal of NG tube (reduces integrity of GE junction)

Question 8

Frequency of hiatial hernias in pregnant patients?

Answer 8

27%

Question 9

Aspiration in pregnant patients; contributing factions include:

Answer 9

Increase in gastric pressure

Failure to intubate

Question 10

What is the gastric pressure of a woman who is pregnant w/ a singleton?

Answer 10

+17 cmH2O

Question 11

What is the gastric pressure of a woman who is pregnant with twins?

Answer 11

+40 cmH2O

Question 12

What is the gastric pressure of a patient in lithotomy?

Answer 12

+24 cmH2O

Question 13

Contributing factors to failure to intubate in pregnant patients:

Answer 13

Upper airway edema
Adiposity of head, neck and trunk
Breast enlargement

Question 14

In what trimester does upper airway edema generally occur?

Answer 14

Third trimester

Question 15

How much more likely is failure to intubate in the pregnant patient than the non-pregnant patient?

Answer 15

10 x more likely

Question 16

Why are pregnant women more prone to hypoxia?

Answer 16

Their FRC decreases by 20%, but their VO2 increases by 20% a term–in labor, it increases by 60%.

Question 17

What is Cimetidine?

Answer 17

A medication used to treat ulcers

Question 18

Appropriate dose of Cimetidine to prep pregnant woman for surgery?

Answer 18

300 mg IV 60 min prior

Question 19

Appropriate dose of metoclopramide to prep pregnant woman for surgery?

Answer 19

10 mg IV 30 min prior

Question 20

In emergent situation, what is an appropriate medication for a pregnant women to prep for surgery?

Answer 20

Sodium citrate 30 ml PO immediately prior to surgery

Question 21

Two stomach-attenuating medications to give pregnant women prior to elective surgery?

Answer 21

Cimetidine

Metoclopramide

Question 22

What stomach-attenuating medication is appropriate to give pregnant woman prior to emergent surgery?

Answer 22

Sodium citrate

Question 23

Which maneuver is important in managing airway of pregnant woman?

Answer 23

Sellick manuever