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Anesthesia based on Nebuchanedzzer II > ITE OB 2 > Flashcards

ITE OB 2 Flashcards

1
Q

Bupivacaine has (high/low) placental transfer

A

low

- bc it is highly protein bound

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2
Q

Determinants of local anesthetic placental transfer (2)

A
  1. degree of ionization at physiological pH

2. amt of protein binding

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3
Q

Protein bound drugs are (readily/unable) to cross the uteroplacental barrier

A

unable to cross

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4
Q

the ___ is the pH at which a drug has equal [ ] of ionized (protonated) and nonionized (nonprotonated) forms

A

pKa

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5
Q

drugs can freely pass the placenta in the (ionized/nonionized) state

A

nonionized

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6
Q

____ fetal drug accumulation d/t pH differences btwn maternal and fetal blood, esp in fetal acidosis

A

ion trapping

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7
Q

Bupivacaine has a pKa of ___, so at physiological pH of ___ (lower than the drugs pKa), there is more drug in the (ionized/unionized) state

A

8.1, 7.4

ionized form
- unable to cross placenta

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8
Q

Most amide local anesthetics are (highly/poorly) lipid soluble

A

highly

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9
Q

Why is lidocaine and 2-chloroprocaine not used for maintenance of epidural anesthesia?

A

tachyphylaxis
- rapidly diminishing response to successive doses, making it less effective

*use bupi and ropi instead

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10
Q

Preeclampsia is associated with (increase/decrease) thromboxane A2 levels and (increase/decrease) prostacyclin levels

A

increase
- hypercoagulability

decrease
- vasoconstricted state

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11
Q

Preeclampsia is characterized by global vascular hyperreactivity leading to ___ (4)

A
  1. intravascular volume depletion
  2. high systemic vascular resistance
  3. uterine vasoconstriction
  4. decreased uterine and placental blood flow
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12
Q

amniotic fluid embolism leads to pulmonary (vasoconstriction/vasodilation) and generally causes ____ shock

A

intense pulmonary vasoconstriction

cardiogenic from RHF

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13
Q

Two stages of amniotic fluid embolism

A
  1. pulmonary vasospasm and RHF

2. pulmonary edema and LHF

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14
Q

a healthy fetus has a relatively (high/low) pH when compared to its mother

A

low (7.35) vs 7.43

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15
Q

a (acidic/basic) drug (ie. local anesthetic) that crosses the placenta in the unionized form accepts a H+ and becomes ionized and trapped

A

basic
- ie: lidocaine as pKa of 7.8 and more will exist in its ionized (charged, non-lipophilic) fraction as pH decreases below 7.8

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16
Q

Drugs that do not cross the placenta

A

He Is Going Nowhere Soon

  • Heparin
  • Insulin
  • Glycopyrrolate
  • Nondepolarizing muscle relaxants
  • Succinylcholine
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17
Q

(Glycopyrrolate/Neostigmine) does not cross the placenta

A

Glycopyrrolate

  • neostigmine will and fetus can become bradycardic
  • use atropine instead
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18
Q

Loss of fetal heart rate variability is an early sign of _____

A

fetal hypoxia

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19
Q

Head compression can ppt _______, which require which type of intervention?

A

early decels

none

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20
Q

what FHT is a response to hypoxemia?

A

late decels

- lag 10-30 sec behind uterin contractions

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21
Q

DIC is associated with elevated ____ with decreased _____ and ____

A

PTT

platelets, fibrinogen

*other factors like fibrin, fibrinogen are already elevated in pregnancy

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22
Q

Most common causes of DIC

A 
preeclampsia
placental abruption
sepsis
postpartum hemorrhage
Amniotic fluid embolism
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23
Q

Most likely cause of shivering after epidural infusion?

A

redistribution of core heat to the periphery

24
Q

fetal scalp pH of ___ is suggestive of fetal acidosis and distress

A

< 7.20

- fetus cannot compensate when uteroplacental blood flow is reduced and will become acidotic

25
Q

Preeclampsia is d/t (paternal/maternal) factors

A

both

26
Q

two ways to provide uterine relaxation

A
  1. volatile anesthetics via GA

2. IV or sublingual nitroglycerin

27
Q

How long can you wait after delivery of baby for the delivery of the placenta?

A

60 min in absence of hemorrhage

30 min with manual extraction with severe hemorrhage

28
Q

The _______ block is effective regional anesthesia for first stage analgesia, by blocking lower uterine and cervical visceral afferent sensory fibers that join L2 and L3

A

lumbar sympathetic

29
Q

The second stage of labor begins with ____ and ends with ______

A

complete dilation of the cervix

birth of baby

30
Q

The _______ is effective regional anesthesia for the first and second stage of labor.

A

epidural analgesia

spinal analgesia

31
Q

___ to ____ spinal segment coverage is needed to relieve pain of contractions and cervical dilation

A

T10-L1

32
Q

___ to ___ spinal segment coverage is needed to relieve pain of vaginal and perineal distention

A

S2-S4

*second stage of labor

33
Q

_____ nerve block helps relieve the pain during second stage of labor by covering somatic nerve fibers from ___ to ___

A

pudendal

S2-S4

34
Q

Dose of nitroglycerin if shoulder dystocia leading to fetal life threatening emergency requiring uterine relaxation

A

0.4 mg sublingual

50-200 mcg IV

35
Q

_____ can help with postpartum hemorrhage, but can cause severe bronchospasm and should be avoided in asthmatics

A

carboprost (aka hemabate)

- prostaglandin analogue

36
Q

______can help with postpartum hemorrhage, but can cause significant HBP and pulmonary vascular resistance

A

Methergine

- ergot alkaloid

37
Q

Why is oxytocin used after the baby is delivered?

A

hormone derived in posterior pituitary

- increases uterine muscle tone

38
Q

What is preeclampsia?

A

multi-organ syndrome with new onset HTN occurring after 20 weeks

can include

  • proteinuria
  • thrombocytopenia
  • hepatic dysfunction
39
Q

What is severe preeclampsia?

A

HTN above systolic 160

  • worsening thrombocytopenia
  • impaired liver function
  • renal insufficiency
  • pulmonary edema
  • new onset visual disturbances
40
Q

_____ decelerations are the most common type of decelerations and are transient decreases in FHR. This is most commonly a result of ______.

A

Variable decelerations,

umbilical cord compression -> decreased umbilical blood flow

41
Q

Pregnancy (does/does not) significantly alter the rate of gastric emptying

A

Does not, maayyybe in advanced labor.

42
Q

Pregnant women are more likely to have a difficult airway than nonpregnant women. The best way to optimize pregnant pts for GA would be to:

A

Avoid solid foods, antacids, H2 receptor antagonists, metoclopramide before C/S

43
Q

Timing of PDPH is _____ after a dural puncture

A

usually 6-72 hours

up to 5 days

44
Q

After a dural puncture with an epidural needle, the risk for PDPH is ~ __%, whereas after puncture with a spinal needle, the risk is __%

A

50%,

1-10%

45
Q

Other sx assoc with PDPH (6)

A 
Tinnitus, 
hearing loss, 
photophobia, 
diplopia (traction on 6th CN), 
nausea, 
neck pain
46
Q

Pencil point needles such as ____ and ____ have less risk at causing a PDPH than a cutting needle such as ____.

A

Sprotte, Whitacre. Quincke

47
Q

Beat to beat variability in FHR is indicative of ______

A

Normal finding, healthy ANS, cardiac responsiveness

*Beat to beat variability AKA short term variability (variation from one beat to another from 5-25 bpm)

48
Q

Pregnancy can exacerbate these 3 physiologic derangements in pts with SCD

A
  1. Physiologic anemia intensified d/t hemolysis
  2. Increased risk for sickling d/t increased oxygen demand and low oxygen tension
  3. Hypercoagulable state with higher chance of vaso-occlusive crises
49
Q

Tenants of care for pregnant SCD pts

A

Avoid:

  • Hypercarbia
  • Hypoxemia
  • Acidosis
  • Dehydration
  • Hypotension
  • Pain
50
Q

Pt has HTN that developed after 20 weeks gestation, can be _____ or _____

A

Gestational HTN, preeclampsia

51
Q

In setting of emergent C/S for terminal decelerations, it is best to perform this type of anesthetic ______

A

RSI and Intubation with a fast acting antihypertensive (nitroglycerin, esmolol, remifentanil).

Prolonged attempts at neuraxial anesthesia can cause fetal brain hypoxia and brain death.

52
Q

Nonobstetric surgery in pregnant pts should be done in the _____ trimester to prevent the risk of miscarriage

A
  • Second
53
Q

Pregnant women with placenta previa (painless vaginal bleeding and nl uterine tone) are at increased risk for ______, especially if there is a h.o previous c/s.

A

Placenta accrete (>60% if pt had 3/m C/S)

54
Q

Painful vaginal bleeding and increased uterine tone are classic signs of ______

A

Placental abruption

55
Q

Inhaled Nitrous Oxide is (safe/unsafe) in labor analgesia.

A

Safe, can be delivered up to 50% mixture with oxygen

56
Q

Because nitrous oxide is 35x more soluble than nitrogen in the blood, it tends to increase the pressure of air containing cavities. Therefore, contraindicated in _____ (4)

A

VAE, pneumothorax, pneumoperitoneum, pulmonary air cyst

Anesthesia based on Nebuchanedzzer II (38 decks)

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