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Obstetrics > Complications In Obstetric Anesthesia > Flashcards

Complications In Obstetric Anesthesia Flashcards

1
Q

Most common cause of postpartum maternal palsy (intrinsic obstetric paralysis

A

Cephalopelvic disproportion which results in lumbosacral trunk compression as it crosses the pelvic brim by the baby’s head

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2
Q

intrinsic obstetric paralysis I swore common in its who had anesthesia: true or false

A

False. They were more frequent in pts who had no anesthetic and were the same for epidrual and GA

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3
Q

What causes 75% of preggos to have a backache (new onset for 60%)

A
  • increased lumbar lordosis to counterbalance the growing uterus
  • increased laxity of cacrococcygeal, sacroiliac, and pubic joints
  • soft tissue trauma (common but self limited)
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4
Q

complications of neuraxial blocks

A
  1. Nerve injury
  2. PDPH
  3. High or total spinal anesthesia
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5
Q

5 types of nerve injury caused by neuraxial blocks

A
  1. epidural hematoma
  2. epidural abscess
  3. chemical nerve injury
  4. needle trauma
  5. positioning injury
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6
Q

2 causes of epidural hematoma and a way to prevent it

A
  1. block placement
  2. Cath removal

only insert or remove epidural when coag fx is normal

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7
Q

describe a pt who would be safe for neuraxial blockade

A
  1. no hx of bleeding problems
  2. no s/s PIH (preg induced HTN)
  3. not on anticoags
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8
Q

Paramaters for safe neuraxial blockade in pt with PIH

A
  1. plt ct >100K
  2. normal PT, PTT (required)
  3. Plt ct insta rapidly falling (could be HELLP syndrome; recheck if last check was >6-8 hrs ago)
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9
Q

Lovenox

  1. avoid neuraxial block for _____ if therapeutic anticoagulated
  2. avoid neuraxial block for _____ if prophylactic anti coagulated
  3. Remove catheter at least _____ hrs after last dose4.
  4. do not administer LMWH until ______ hr after block is placed or Cath is removed
  5. avoid concurrent ___ or ___
A
  1. 24 h
  2. 12 h
  3. 12 h
  4. 2-4 h
  5. NSAIDS or anticoagulants
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10
Q

S/S epidural hematoma

A
  • bilat leg weakness
  • incontenence
  • absent rectal sphincter tone
  • back pain
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11
Q

what actions should be taken if epidural hematoma is suspected?

A
  • STAT CT or MRI

- surgical decompression w/in 6 hrs for full neurological recovery to occur

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12
Q

Bottles of 10% iodine can become colonized w bacteria after ______

A

a single use

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13
Q

___% of lumbar epidural catheters are colonized, mostly by ____ bacteria after _____ days w/o signs of local infection

A

25%

Gram +

1-5 days

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14
Q

how long does it take for signs of epidural infection to appear? what are the most common signs?

A

4-10 days

pain and loss of fx

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15
Q

tx for epidural abscess; how long do you have to tx it before permanent damage?

A

ABX and laminectomy

6-12 hrs

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16
Q

How does epidural abscess usually present?

A
  • Severe back pain (worse w flexion; sometimes radiation)
  • exquisite local tenderness
  • fever, malaise, meningitis-like HA w neck stiffness
  • lab changes (inc. WBC and ESR, positive BC)
  • progression over hrs to days to neuro deficit or osteomyelitis
17
Q

What makes the epidural space very resistant to toxicity?

A
  • it is very vascular

- the membrane b/t it and the subarachnoid space must be intact

18
Q

What are the s/s of transient neurological symptoms (TNS)?

A

pain and dysphasia in butt, legs, or calves that can follow SAB (subarachnoid block); resolves w/in 72 hrs

19
Q

Most common cause of TNS (transient neurological symptoms)

A
  • Lidocaine spinals (high concentration in high doses)

- lithotomy position

20
Q

Where is the conus of the spinal cord?

A

T12-L3

21
Q

T/F: Hitting the cord w a small needle causes significant pain and paresthesias but if needle immediately w/d, usually no permanent sequalae.

A

True, but if you inject into the cord, that is a different story.

22
Q

T/F: regional blocks are best done on sleeping pts

A

FALSE

23
Q

2 common compression injuries in pregnancy and their causes

A
  1. common peroneal nerve - lithotomy stirrups

2. femoral or obturator nerves - lithotomy position

24
Q

T/F: Nerve compression injuries may range from transient ischemic injury to axonal crush. recovery could be in 2-6 days if mild or 2-3 yrs to permanent if severe.

A

True

25
Q

If your pregnant has post partum foot drop, what injuries would you suspect?

A

either common peroneal from stirrups or brow compression of lumbosacral trunk (it is probably the CPN)

26
Q

How to differentiate b/t femoral and obturator neuropathy

A
  • femoral - difficulty climbing stairs

- obturator - decreased sensation over upper inner thing and weak hip adduction (weird patches of numbness)

27
Q

Common presentation and onset of PDPH

A
  • throbbing, postural, variable distribution HA

- onset: 12-48 h after dura puncture

28
Q

T/F: PDPH is typically self limited w a spinal needle, less likely with an epidural, is usually self-limited, but can become chronic.

A

True

29
Q

principal determinants of a PDPH

A

size of dural hole

type of needle used

30
Q

what types of needles would you use if you want to increase likelihood of PDPH in your pt?

A

larger gauge and cutting edge needles

31
Q

Normal CSF volume is _____

How much CSF is made/day?

A

150 cc

450 cc/day

32
Q

Acute loss of _____ cc of CSF will produce HA symptoms caused by ______ when pt assumes an upright posture.

A

20 cc

sagging of intracranial contents and stretching of the pain sensitive tissues

33
Q

PDPH risk factors

A
  1. young age
  2. big needle
  3. cutting-edge Quincke spinal needle
  4. cephalic or caudal orientation of Quincke needle
  5. hx of PDPH or migraines
34
Q

Risk factors for dural puncture w epidural needle

A
  1. Me - I have no experience
  2. Air LOR technique (saline is less risk)
  3. fatigue or haste (night shift)

Obstetrics (10 decks)

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