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Personal OB > Class 3 Surgery > Flashcards

Class 3 Surgery Flashcards

1
Q

Indications for C-section

A
  • Failure to progress
  • Fetal distress
  • Fetal malpresentation
  • Previous C/S or failed VBAC
  • fetal/maternal condition making vag delivery unsafe
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2
Q

What is the most common analgesia technique for C/S and why?

A
  • Regional
  • Safer than GA
  • Epidural already in place
  • Less neonatal depression
  • Mother is awake
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3
Q

Reasons for GA for C/S

A
  • Fetal distress with no time for block
  • Non functioning epidural
  • Any block contraindications
  • Regional inadequate
  • Patient refusal
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4
Q

Disadvantages of GA for C/S

A
  • Not as safe as regional
  • Difficult airways
  • Failed intubation
  • Failed ventilation
  • Awareness
  • Aspiration pneumonia
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5
Q

What is the optimal time between uterine incision and delivery?

A

-3 minutes

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6
Q

Infants exposed to GA have ______ Apgar at one minute but __________ at 5 mins.

A
  • Lower

- No difference

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7
Q

Aspirations prophylaxis in C/S.

A
  • Antacid (sodium bicitrate) = Raise pH
  • Ranitidine (zantac) = H2 blocker
  • Metoclopramide (Reglan) = Decrease gastric volume
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8
Q

A combination of what two things results in faster desaturation among C/S? Which makes what critically important and how should it be done?

A
  • Increased O2 consumption and decrease FRC
  • Preoxygenation
  • 100% O2 w/ tight mask for at least 3 minutes
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9
Q

Propofol dose and tidbit?

A
  • 2.0-2.8 mg/kg

- Readily crosses placenta

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10
Q

Ketamine dose and tidbits?

A
  • 1.0-1.5
  • Useful for hemorrhage (BP support)
  • Decrease bronchospasm
  • Sfx = HTN and Dysphoria
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11
Q

Versed problems

A

-Neonatal depression

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12
Q

Etomidate problem

A

-Neonate adrenal supression

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13
Q

What type of induction is mandatory in most C/S?

A

-Rapid sequence

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14
Q

Why are muscle relaxants safe in OB?

A

-Hydrophilic nature limits placenta transfer

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15
Q

2 options for GA maintenance?

A
  • 50% nitrous + 2/3 MAC of volatile agent

- 1.2 MAC + Fentanyl until delivery, then 0.5 MAC + N2O +Versed

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16
Q

In most prospective studies the incidence of neonatal depression is _______ between general and regional anesthesia.

A

-Similar

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17
Q

Epidural advantages in C/S

A
  • Tailored doses
  • Can prolong block for long case
  • Post op analgesia
  • Gradual block w/ less hemodynamic change
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18
Q

Disadvantages in epidurals for C/S

A
  • Patient contrainndications
  • Not as good as spinal
  • May not produce enough surgical block w/ ten fold increase in total spinal risk
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19
Q

How does an epidural work?

A
  • LA infuses into epidural nerve roots
  • Sodium channels are blocked
  • Sensory and motor function is reduced
20
Q

A midthoracic block height results in what?

A
  • Lower extremity sympathectomy and splanchnic beds
  • Decreases venous return and BP
  • Arterial dilation
21
Q

What happens if block reaches to T1?

A

-Decrease in HR and contractility

22
Q

What happens with a sensory block above T2?

A

-Sense of dyspnea

23
Q

With an epidural, how are expiratory pressure and flows reduced?

A

-In proportion with decreased abd muscle strength

24
Q

What will speed onset of lidocaine of 2-chloprocaine?

A

-Bicarb

25
Q

What is the ideal block height for epidural?

A

-T4-T8

26
Q

How to treat breakthrough pain?

A
  • 5cc epidural local
  • Fentanyl IV or epidural
  • N2O
  • Ketamine
  • Surgeon to infiltrate w/ local
  • Convert to GA if not working
27
Q

Why is spinal better than epidural?

A
  • More dense block w/ single injection
  • Defined end point (CSF=correct place)
  • No IV injection concerns
  • Faster and more simple than placing catheter
28
Q

Disadvantages of spinal vs. epidural

A
  • Finite duration
  • PDPH
  • Total spinal
  • Maternal hypotension
29
Q

Why do laboring women have less hypotension than non-laboring women?

A
  • Laboring women have been in the hospital and have received fluids
  • Aortocaval depression is reduced by head into pelvis
30
Q

Reason why phenylepherine is now the drug of choice for hypotension in OB.

A
  • phenylepherine uterine vasoconstriction have not been proven
  • Ephedrine increases fetal acidosis
31
Q

Tetracaine considerations

A
  • Long time to work
  • Long duration
  • unreliable
32
Q

Lidocaine considerations

A
  • Short acting

- Neurological symptoms

33
Q

Bupivicaine considerations

A
  • Best choice
  • quick onset
  • Intermediate duration
34
Q

Duramorph considerations

A
  • Long acting analgesia
  • Delayed respiratory depression
  • Nausea
  • Pruritis
35
Q

Once in the OR and block is in what position should the patient be placed?

A

-Lateral tilt

36
Q

After delivery, what should be given?

A
  • 20 units of pitocin in 1L bag

- Consider duramorph

37
Q

Most common non obstetric surgeries in preggos?

A
  • Appendix

- Gallbladder

38
Q

Preggo altered response to anesthesia.

A
  • Decrease MAC
  • Increase sensitivity to Neuraxial agents
  • Decrease plasma cholinesterase
  • Decreased protein binding
39
Q

What anesthesia meds are deemed safe for fetus?

A
  • Thiopental
  • Morphine
  • Meperdine
  • Fentanyl
  • Muscle relaxants
40
Q

Anesthetic management for preggos

A
  • Avoid: hypoxemia, hypotension, acidosis
  • Maintain PaCO2 in normal range
  • Minimize aortacaval compression effects
41
Q

What should be monitored at 20 weeks?

A
  • Fetal HR

- Uterine activity

42
Q

If organized uterine activity is detected, what can be used?

A
  • Beta agonist like ritodrine

- Magnesium

43
Q

What drugs need t be avoided with preggos?

A
  • Benzos (congential anomalies)

- Nitrous (Interfere with B12)

44
Q

When should elective surgery be scheduled after delivery?

A

-6 weeks after

45
Q

When are physiological effects of pregnancy well established?

A

20 weeks

46
Q

Volatile agents may suppress what?

A

Preterm labor

Personal OB (7 decks)

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