Class 1 Complications Flashcards
What is the most common cause of Intrinsic obstetric paralysis?
-Cephalopelvic disproportion (huge head / little pelvis) that leads to lumbosacral trunk compression (nerve compression)
What two things contribute to prego backache?
- ↑ lumbar lordosis (counterbalance)
- ↑ laxity of pelvic joints
3 complications of neuraxial blocks.
- Nerve injury
- PDPH
- High, total spinal
How are nerves damaged during neuraxial block?
- Hematoma
- Abcess
- Chemical nerve injury
- Needle trauma
- Positioning injury
Hematomas occur w/ what type of patients and when?
- Hemostatic abnormality or coagulopathy
- Upon insertion or removal of catheter
Preggos w/ PIH platelets should be over _______ and not dropping while ____ _____ should be normal before block is placed
- 100k
- PT, PTT
When can a block safely be given with a patient on theraputic heparin? prophylatic heparin?
- Theraputic - 24 hours after last dose
- Prophylatic - 12 hours after last dose
If a patient is given heparin with a catheter in place, when can it safely be removed?
-12 hours after last dose
When can you safely give heparin w/ a catheter in place? and what should be avoided if you do give heparin?
- 2-4 hours after placement
- Concurrent NSAIDS
Signs of epidural hematoma?
- Bilat leg weakness
- Loss of bowel / bladder
- Back pain
When must a hematoma be surgically decompressed for full neurological recovery?
-within 6 hours
25% of lumbar epidural catheters colonize w/ bacteria after _______ days w/o signs of _______ _______.
- 1-5 days
- Local infection
After a infection is present, how long before symptoms occurs, and what are they
- 4-10 days
- Pain and loss of function
What is the treatment for abscess and when should it be done before permanent damage occurs?
- ABX and Laminectomy
- 6-12 hours
Signs of epidural abcess
- Back pain
- Exquisite local tenderness
- Fever
- Malaise
- ↑ WBC
Progression of abcess can lead to what?
- Neuro deficit
- Osteomyelitis
Why is the epidural space resistant to toxicity?
- Very vascular
- Intact membrane between subarachnoid space
What is Transient neurological symptoms (TNS)? What causes it? and in what position?
-Pain and dysesthesia in butt, legs or calves after a block, resolves in 72 hours.
What causes (TNS) and in what position?
- Lidocaine spinals
- Lithotomy position
Where is the conus? and where does the chord end?
- Conus T12-L3
- Chord ends @ L1/L2
If you hit the spinal chord with a needle what should you do? and not do?
- Immediately withdraw
- Do not inject
What nerve injury is common with lithotomy stirrups? What injury is common?
- common peroneal nerve
- Foot drop
What nerve injuries are common with the lithotomy position? What problems arise
- Femoral (difficult climbing stairs)
- Obturator (↓ sensation upper thigh, weak hip abduction)
What is the onset and duration of a PDPH?
- 12-48 hours after dura puncture
- Duration days to weeks
What determines severity of PDPH?
- Size of hole
- Type of needle
What is normal CSF volume? How much is made per day?
- 150 mls
- 450 CSF made per day
What causes PDPH?
- Loss of as little as 20 mls of CSF
- Cerebral vasodilation
- Sagging intracranial contents
PDPH risk factors?
- Young age
- Needle size and type
- Previous PDPH
What is the hallmark of PDPH?
-Continuous head pain when sitting and standing. and relieved when by lying down.
When does a pneumcephalus headache occur?
- When LOR air injects intrathecal
- Instant headache / short duration
What is the most common periop headache?
-Caffeine headache
Name the headache? Fever, nuchal rigidity, systemic illness
Meningitis
Name the headache? Rare, Throbbing, Not relieved by bed rest, seizure.
Cortical vein thrombosis
Name the headache? Rupture of arterio venous malformation, focal neurological signs
Subarachnoid hemorrage
Name the headache? Related to Arnold-chiari. Looks sicker, changes in LOC
Subdural hematoma
Risk of not treating PDPH
- Chronic Headache
- Permanent impairment
- Convulsion
- Brainstem death
Non-invasive PDPH treatment
- Bedrest
- Hydration
- ABD binders
- Analgesia
- Cerebral vasoconstrictors
- ACTH
When do you stop giving the blood patch?
- When headache is gone
- Pressure in ears
Why is prophylactic blood patch controversial?
-Total spinal anesthesia
What symptoms can occur w/ total spinal?
- Hypotension
- Dyspnea
- Aphonia
What can cause a total spinal
- migrated epidural catheter
- Dural puncture
- Spinal after failed epidural (all medicine kicks in)
What position is LUD?
Left uterine displacment
How do you manage total spinal?
- LUD and trendelenberg
- Naloxone
- Epinepherine may be needed
- Maternal sedation 1-3 hours
What accounts for 1/3 of all anesthetic lawsuits in OB?
-Aspiration
What 3 things would you suspect aspiration?
- Hypoxia
- Pulmonary edema
- Bronchospasm
Aspiration prevention in pregos.
- Cricoid pressure
- NPO 6 hours for planned C/S
- Sodium Citrate (raise gastric PH)
- H2 blockers
- Reglan
