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Personal OB > Class 2 Analgesia & Pharmacology > Flashcards

Class 2 Analgesia & Pharmacology Flashcards

1
Q

Describe the 1st stage pain pathway, and what dermatomes they are associated with.

A
  • Lower uterine from contractions

- T10 - L1

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2
Q

Describe the 2nd stage pain pathway and it’s associated dermatomes.

A
  • Perineal structure via pudenal nerve

- S2-S4 (not covered by epidural)

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3
Q

Opioids that cross the placenta can do what 2 things to the fetus?

A
  • Loss of beat to beat variability

- Decreased movement

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4
Q

Name the 4 PCA advantages

A
  • Satisfaction scores
  • Less neonatal depression
  • Less nausea
  • Less maternal respiratory depression
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5
Q

Why is morphine not used?

A

-increased risk of respiratory depression r/t Immature BBB in baby

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6
Q

Demerol (meperidine) concerns

A
  • Nausea and vomiting
  • Baby respiratory depression unlikely if given < 1hr prior to delivery
  • contraindicated with seizure / or renal failure (metabolite)
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7
Q

Fentanyl concerns

A
  • Rapid placenta transfer

- resp depression longer than analgesia benefits

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8
Q

Nubain concerns

A
  • Ceiling effect on respiratory depression
  • Dysphoria
  • treats opioid induced puritis
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9
Q

Stadol concerns

A
  • Sedation
  • Ceiling effect on resp depression
  • better analgesic profile than fentanyl
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10
Q

Volatile agent concerns

A
  • Rarely used
  • pulmonary aspiration risk
  • decreased uterine tone
  • Supplement to nerve block
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11
Q

When is a pudenal block used, and on what patients?

A
  • 2nd stage of labor

- pts with contraindication of neuraxial block

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12
Q

Risk of Pudenal block

A
  • Fetal injury
  • Infection
  • Hematoma
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13
Q

when is a paracervical block used? What pain does it help with?

A
  • When epidural cannot be achieved

- 1st stage labor

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14
Q

What are the complications of paracervical block?

A
  • Uterine artery injection,
  • fetal LA toxicity,
  • nerve injury,
  • hematoma
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15
Q

Ester local anesthetics.

A
  • PABA
  • Metabolized by plasma cholinesterase
  • PABA metabolite is an allergen
  • No previous “I”
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16
Q

Amide local anesthetic tidbits

A
  • Metabolized by liver
  • No PABA, allergic reactions rare
  • 2 “i”s
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17
Q

Local anesthetics site of action?

A

-Neuronal cell membrane sodium channel

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18
Q

What determines the speed of Local anesthetic onset?

A

-pKa

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19
Q

To have a faster onset you would want pKa closer or farther away from physiological pH?

A

Closer

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20
Q

How can you artificially raise pH, to be closer to pKa?

A

-Add bicarb

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21
Q

Once across the membrane what form of drug is responsible for receptor binding and blockade?

A

-Polar form

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22
Q

What dictates the onset, quality and duration of a Local Anesthetic?

A

-Total dose

23
Q

increasing dose =

A

faster onset and longer duration

24
Q

How do vasoconstrictors effect LA?

A
  • prevent absorption

- More available for blockade

25
Q

How does temperature effect LA?

A

-Warm LA reduces onset time

26
Q

How does pregnancy effect LA?

A
  • Smaller amounts are required

- Faster onset

27
Q

Small and poorly myelinated nerves, like type ____ fibers are ______ ______ susceptible to blockade.

A
  • C

- More rapidly

28
Q

Large, myelinated nerves like type ____ fibers require ______ concentrations of LA for blockade.

A
  • A

- Higher

29
Q

Local Anesthetic used for labor epidural.

A
  • Bupivicaine
  • Ropivacaine
  • Lidocaine
30
Q

Local Anesthetic used for operative epidural.

A
  • Lidocaine

- 2-chloroprocaine

31
Q

Local anesthetics used for OB spinal anesthesia?

A
  • Tetracaine

- Bupivacaine

32
Q

Lidocaine concerns

A
  • Not for continuous infusion
  • Test epidural catheter function
  • Motor block
  • activate epidural for C-section
  • Short duration
33
Q

2-chloroprocaine concerns

A
  • only ester used in epidural space
  • Rapid onset / short duration
  • Large motor block
  • low risk of toxicity
34
Q

2-chloroprocaine will interfere with the analgesic effects of what med?

A

-Epidural fentanyl

35
Q

Bupivacaine concerns (used at Hamot)

A
  • Long duration

- Less motor block (can still feel contractions and push)

36
Q

What happens if a large does of bupivicaine is given IV?

A
  • CV collapse

- Refractory V-tach/V-fib

37
Q

Benefits of levobupivicaine?

A

-less cardiotoxic

38
Q

Ropivicaine benefit and problem.

A
  • Less cardio toxic

- 25% less potent

39
Q

What is the best lumbar level to cover in OB? Where should catheter be placed to achieve that level?

A
  • T10 - S4

- L3 - L4

40
Q

For 95% of OB, the spinal chord ends at? The other 5%?

A
  • L1

- L2/3

41
Q

What imaginary line passes between the iliac crests?

A

-Truffiers (about L3/4)

42
Q

Contraindications to neuraxial block?

A
  • Patient refusal
  • Infection
  • Intracranial mass
  • Coagulopathy
  • Aortic stenosis
  • Spinal pathology
  • Hemodynamic instability
43
Q

On average the epidural space is how deep?

A

4.75 cm

44
Q

How much of the tip should be in the epidural space?

A

-5 cm

45
Q

What are the differences between spinal and epidurals?

A
  • Spinal is one tissue layer deeper
  • Drugs given via spinal are 10x more potent
  • Spinals require smaller needle
46
Q

When is a subarachnoid block used?

A
  • C-sections

- Not enough time for epidural

47
Q

Benefit and problem with combined spinal / epidural

A
  • instant relief

- Cant test epidural catheter

48
Q

Local anesthetic Central nervous system toxicity problems?

A
  • Tinnitus
  • Metallic taste
  • Light headedness
  • Circumoral numbness
  • Convulsions
  • LOC
  • Respiratory arrest
49
Q

Increase in what 2 things lower the seizure threshold?

A
  • PaCO2

- Acidosis

50
Q

How doe LA toxicity effect the CV system?

A
  • Sodium channel inhibition
  • Decrease depolarization of purkinjes fiber and ventricle muscle
  • Decrease action potential
  • Decrease refractory period
  • Increased toxicity to bupivicaine and cocaine
51
Q

LA toxicity is treated by what?

A

-20% intralipid

52
Q

Subdural block is located where?

A

-Between dura and arachnoid matter

53
Q

A subdural block may involve what?

A
  • Cervical roots
  • Cranial nerves
  • Trigeminal block
  • Horners syndrome

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