Labor analgesia

Question 1

Neuroaxial labor anesthesia is most associated with an increased risk of which of the following?
1. C/S rate 2. Maternal N/V, 3. Maternal Fever, 4. Respiratory depression

Answer 1

(3) The mechanism is unknown but not associated with adverse outcome.

Question 2

Decrease necessary dose of spinal or epidural in advanced pregnancy: Why?

Answer 2

Engorgement of epidural veins

Question 3

Why Chlorprocaine is rapid onset? Disadvantages:

Answer 3

High concentration, interfere with action of epidurally administered opioids due to it antagonizes mu and gamma receptor. Interfere with subsequent epidural bupivacaine, ingredient of EDTA chelate Ca and cause arachnoiditis.

Question 4

Which respiratory parameter can be decreased when parturient have spinal anesthesia up to the level of T3?
(a) IRV (b) ERV (c) RV, (d) Inspiratory capacity

Answer 4

(b)
Inspiratory muscle function is relatively preserved (due to spared phrenic nerve function). Expiratory muscle function is affected if spinal level above T6.

Question 5

Post-dural puncture headache: Prevention

(a) Caffein (b) Cosyntropin (c) Acetoaminophen (d) Naloxone

Answer 5

(b) Synthetic ACTH and only works for prevention

Question 6

Spinal anesthesia for elective c/s. Which of the following outcomes is most likely if she receives a high dose intrathecal morphine (200mcg) compared to a low dose (100mcg)?
(a) same rate of PONV (b) same rate of pruitis (c) the time to request for supplement analgesia will be longer

Answer 6

(c)

High risk of PONV, Pruritis, but less frequent supplement doses of analgesia.