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Obstetrics > Complications in Obstetric Anesthesia > Flashcards

Complications in Obstetric Anesthesia Flashcards

1
Q

What is the most common cause of pospartum maternal palsy?

A

Cephalopelvic disproportion which results in lumbosacral trunk compression.

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2
Q

Are postpartum maternal palsies more common with or without anesthesia of any kind?

A

More frequent without anesthetic.

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3
Q

What are the 7 complications that can occur with neuraxial blocks?

A
  1. Epidural hematoma
  2. Epidural abscess.
  3. Chemical nerve injury
  4. Needle trauma
  5. Positioning injury
  6. Post Dural Puncture Headache (PDPH).
  7. High or total spinal anesthesia.
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4
Q

T/F: Epidural hematoma can only occur with placement of the catheter and not removal?

A

False; can occur both periods of time so must be coagulating normally for placement and removal.

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5
Q

What is lowest acceptable platelet count for epidural placement?

A

100,000

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6
Q

Which parturients are safe to receive neuraxial blocks?

A

No hx of bleeding. No si/sx of PIH.

And no anticoagulation

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7
Q

If a parturient has PIH what is the lowest acceptable platelet and coags?

A

Platelets >100k and normal PT/PTT

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8
Q

Wait for neuraxial block for how many hours if therapeutically anticoagulated?
Prophylactically anticoagulated?

A

24hrs

12 hrs

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9
Q

What are 4 si/sx of epidural hematoma?

A
  1. Bilat leg weakness
  2. Incontinence
  3. Absent rectal sphincter tone
  4. Back pain
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10
Q

What is tx if suspected or confirmed epidural hematoma?

A
  1. Stat CT or MRI.

2. Surgical decompression within 6 hrs

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11
Q

If an epidural abscess/infection is present, how many days before symptoms?

A

4-10 days for pain and loss of function to occur

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12
Q

What is tx for epidural abscess?

A
  1. ABX

2. Laminectomy within 6-12 hrs of symptoms

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13
Q

What are the 5 symptoms of epidural abscess?

A
  1. Sever back pain worse with flexion
  2. Local tenderness
  3. Fever/malaise/meningitis-like H/A and neck stiffness
  4. Lab changes- WBC/ESR increase, + blood cx
  5. Progression of si/sx over hours to days
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14
Q

How is the epidural space so resistant to toxicity?

A
  1. Very vascular

2. Intact membrane between it and the SA space.

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15
Q

What drugs have been known to cause chemical nerve injury?

A

Thiopental, ephedrine, oxytocin, atropine, zantac, KCl,

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16
Q

What are si/sx of TNS (Transient Neurological SYmptoms)?

A

Pain and dysethesia in buttocks, legs, calves following SAB

17
Q

What is most common cause of TNS?

A

High dose Lidocaine spinals and associated with lithotomy positioning.

18
Q

Where is the conus of the spinal cord located?

19
Q

Why should regional blocks not be done on sleeping patients?

A

Risk of needle trauma because they are unable to react to pain

20
Q

What are two common compression injuries parturients are susceptible to?

A
  1. Common peroneal nerve

2. Femoral/obturator nerve

21
Q

What typically causes common peroneal nerve compression?

A

Lithotomy stirrups

22
Q

What two nerve injuries can cause postpartum foot drop?

A
  1. Common peroneal nerve

2. Brow compression of lumbosacral trunk

23
Q

What will patient have difficulty doing if femoral nerve neuropathy?

A

Difficulty climbing stairs.

24
Q

Where would patient experience dec sensation if obturator neuropathy?

A

Upper inner thigh, and week hip adduction.

25
Q

What is typically onset of Post-Dural Puncture Headache (PDPH)?

A

48hrs (12-48)

26
Q

What 5 things increase risk of PDPH?

A
  1. Larger gauge needle
  2. Cutting edge needle.
  3. Younger age
  4. Cephalad or caudal orientation of Quincke needle
  5. Hx of PDPH or migraine.
27
Q

What is the mechanism of PDPH?

A

Loss of CSF causes sagging of intracranial contents and stretching of the pain sensitive tissues when the patient is in an upright posture.

28
Q

Which two needles have the lowest risk of PDPH?

A
  1. 24g Sprotte

2. 25g Whitacre

29
Q

What is the most common cause of peri-operative headache?

A

Caffeine withdrawal.

30
Q

Si/Sx of total spinal anesthesia?

A
  1. Hypotension
  2. Dyspnea
  3. Aphonia
31
Q

What is management of a suspected total spinal?

A
  1. Place pt left trendelenberg
  2. Early resuscitation,ventilation, and circulatory support
  3. Epi
  4. Naloxone for intraspinal opioid
  5. Intensive fetal/maternal monitoring
  6. May require urgent C-section
32
Q

What specifically accounts of 1/3 of anesthetic lawsuits in obstetric population?

A

Aspiration of gastric contents

33
Q

What are 5 preventative measures for aspiration in the parturient?

A
  1. Cricoid pressure
  2. Fasting/Elective c section (at least 6 hrs if regional planned)
  3. Na Citrate
  4. H2 blockers
  5. Reglan
34
Q

What is treatment of aspiration? 7

A
  1. ETT w/ pos press vent and PEEP
  2. Suction airway
  3. Rigid bronch
  4. Prophylactic ABX controversial
  5. NO prophylactic steroids
  6. Lavage is sometimes recommended
  7. Hypovolemia is expected= treat

Obstetrics (9 decks)

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