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Obstetrics > Labor Analgesia and Pharmacology > Flashcards

Labor Analgesia and Pharmacology Flashcards

1
Q

What is the pain source for 1st stage labor pain?

A

Mainly lower uterine segment from contractions

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2
Q

What is the pain source for 2nd stage labor pain?

A

Perineal structures via pudendal nerve

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3
Q

What dermatomes are involved in 1st stage labor pain?

2nd stage?

A

1st stage= T10-L1

2nd stage= S2-S4

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4
Q

T/F: Hypnosis works in 100% of the population?

A

False; 15% are easy to hypnotize, 15% are impossible

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5
Q

What is the name of the education and behavioral techniques such as breathing and eye focus exercises?

A

Lamaze (psychoprophylaxis).

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6
Q

What is the biggest reason why morphine is not used in parturients?

A

Immature blood brain barrier increases risk of resp depression in the neonate.

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7
Q

What are the 3 issues with using meperidine (Demerol) in the parturient?

A
  1. Causes frequent N/V
  2. Contraindicated in pt with seizures or renal failure.
  3. Long half life and active metabolites.
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8
Q

Describe the neonatal resp depression associated with meperidine administration?

A

Unlikely if given less than 1 hour prior to delivery.

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9
Q

What is a secondary use of Nalbuphine (Nubain) besides pain control?

A

Opioid induced pruritus.

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10
Q

Which two medications have a ceiling effect on respiratory depression?

A

Nalbuphine and Butorphanol.

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11
Q

Why are volatile anesthetics not used often in parturients?

A
  1. Risk of pulmonary aspiration.

2. Decreased uterine tone

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12
Q

What is the mechanism of action for nalbuphine?

A

Mu Opioid antagonist, Kappa Agonist.

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13
Q

Which nerve block is typically used in 1st stage of labor?

A

Paracervical block

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14
Q

Describe the technique of a paracervical block?

A

5cc of LA injected submucosally at 3 and 9 o’clock position beside cervix

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15
Q

What are three risks with paracervical block?

A
  1. Accidental injection into uterine artery
  2. Fetal LA toxicity
  3. Nerve injury/hematoma
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16
Q

Which nerve block is typically used for 2nd stage of labor?

A

Pudendal block.

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17
Q

Why would a pudendal block be performed?

A

For certain patients with contraindication for neuraxial blockade.

18
Q

Describe the technique of a pudendal block?

A

Needle is placed bilaterally via transvaginal approach under the ischial spines.

19
Q

What are the 3 risks of pudendal blocks?

A
  1. Fetal injury
  2. Infection
  3. Hematoma
20
Q

Which LA is associated with PABA as an allergen?

A

Esters

21
Q

Which LA are metabolized by the liver?

A

Amides

22
Q

T/F: All LA are strong bases?

A

False; weak bases

23
Q

What is the pKa?

A

The pH where 50% of LA is polar and 50% is uncharged.

24
Q

T/F: The closer the pKa is from physiological pH, the slower the onset?

A

False; faster the onset.

25
Q

How would you artificially raise the pH to be closer to pKa?

A

Add Bicarbonate.

26
Q

Lipid solubility or protein binding: Which affects duration? Which affects potency?

A

Potency=Lipid solubility

Duration=Protein binding

27
Q

How would you adjust your dose for a parturient?

A

Smaller dose of LA, and will have a faster onset of blockade

28
Q

Which three LA are commonly used for labor epidurals?

A
  1. Bupivacaine
  2. Ropivacaine
  3. Lidocaine
29
Q

Which 2 LA are commonly used for operative epidurals?

A
  1. Lidocaine

2. 2-Chloroprocaine

30
Q

Which 2 LA are commonly used for spinal anesthesia?

A
  1. Tetracaine

2. Bupivacaine

31
Q

Which patient can you not use 2 Chloroprocaine and why?

A

Patients with atypical pseudocholinesterases because is is metabolized by pseudocholinesterases.

32
Q

Which has more motor block 2 Chloroprocaine or Bupivacaine?

A

2- Chloroprocaine.

33
Q

What is the dose of bupivacaine for labor epidurals?

A

15-20mg, infusion of 8-12mg/hr

34
Q

Why are there bupivacaine analogs?

A

Levobupivacaine and Ropivacaine are both less cardiotoxic.

35
Q

What dermatomes are we ultimately trying to cover with neuraxial blocks?

A

T10- S4

36
Q

At what level should spinals be performed?

A

Below L3

37
Q

What is the transverse line passing across the lumbar spine between the posterior iliac crests?

A

Tuffier’s Line

38
Q

What are 7 contraindications to neuraxial blockade?

A
  1. Patient refusal
  2. Infection at site
  3. Coagulopathy
  4. Intracranial mass lesion
  5. Aortic stenosis
  6. Existing spinal or neurological pathology
  7. Hemodynamic instability.
39
Q

What is the average depth of epidural space?

A

4.75cm

40
Q

What are 7 things associated with Central Nervous System LA toxicity?

A
  1. Tinnitus
  2. Light-headedness
  3. Metallic taste
  4. Circumoral numbness
  5. Convulsions
  6. Loss of consciousness
  7. Respiratory arrest.
41
Q

How is the CV system affected with LA Toxicity?

A
  1. Inhibits Na+ channels
  2. Decrease depolarization rate in Purkinje and ventricular muscle
  3. Decrease duration of action potential
  4. Decrease effective refractory period.
42
Q

What is dose of Intralipid for LA toxicity?

A

1.5ml/kg followed by 0.25ml/kg/min for 1 hr

Obstetrics (9 decks)

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