Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Advanced Principles A (Spring 2025) Cooper > Labor Anesthesia & Analgesia (Cooper) > Flashcards

Labor Anesthesia & Analgesia (Cooper) Flashcards

1
Q

What is the definition of Term in labor terminology?

A

Birth at ≥ 37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does Preterm refer to in labor terminology?

A

Birth at < 37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Primip in the context of pregnancy.

A

Pregnant for the first time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the meaning of Multip in pregnancy terminology?

A

Delivered at least one child >20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does SROM stand for?

A

Spontaneous rupture of membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does AROM refer to in labor?

A

Artificial rupture of membranes/amniotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the significance of intact amniotic membranes?

A

Protect uterine contents from bacteria and provide mechanical protection for fetus & umbilical cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differentiate the time frames for duration of the 1st stage of labor in Primip and Multip patients.

A

Primip: 8-12 hrs

Multip: 5-8 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the phases of the First Stage of Labor?

A

Latent Phase and Active Phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What characterizes the Latent Phase of the First Stage of Labor?

A

Cervical effacement, minor cervical dilation (2-4 cm), contractions every 5-7 mins for 30-40 secs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What defines the Active Phase of the First Stage of Labor?

A

Cervical dilation to 10 cm, contractions every 2-5 mins for 50-70 secs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the duration of the Second Stage of Labor?

A

15 - 120 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How would you classify the second stage of labor?

A
  • Full cervical dilation (10 cm)
  • Contractions every 1.5-2 mins (60-90 secs)
  • Fetal descent
  • Ends when baby is pooped out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What indicates a prolonged Second Stage of Labor?

A

If > 3-4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are potential risks associated with a prolonged Second Stage of Labor?

A

Fetal trauma
Cephalopelvic Disproportion
Severe umbilical cord compression
Maternal trauma (physical & emotional)
Increased risk for post hemorrhage
Increased risk for infection
Increased admission to NICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does the Third Stage of Labor entail?

A

Begins after delivery and ends with delivery of placenta

15-30 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the duration of the Fourth Stage of Labor?

What are parturients at the greatest risk of experiencing in this phase?

A

1st hour postpartum

Uterine atony & PP Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the characteristics of Labor Pain?

A

Variable & complex
influenced by genetic factors, pelvic size & shape, fetal presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How are the mechanoreceptors stimulated in the first stage of labor?

A

Stretching & distention of lower uterine segment & cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the type of pain experienced in the First Stage of Labor.

Where does this pain enter the spinal cord?

A

Visceral pain transmitted by small, unmyelinated C nerve fibers, hard to localize

T10 - 12 (Latent)
T12 - L1 (Active)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of pain becomes prominent in the Second Stage of Labor?

A

Somatic pain transmitted by myelinated A Delta fibers via Pudendal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What dermatome level is responsible for the pain in the second stage of labor?

A

T12 - S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some “other” non-pharm modalities to help with labor pain?

A

Intradermal H2O injections
Counterirritation (Gate control theory)
Counterpressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the receptors in which Nitrous Oxide has effects at?

A
  • Inhibits NMDA Glutamate receptors
  • Stimulation at Opioid/dopaminergic
  • Stimulation at alpha 1 and 2 adrenergic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the side effects of Nitrous Oxide during labor?
*Nausea* *Dizziness* *Paresthesias* *Dry mouth*
26
Potential side effects when combining opioids with Nitrous Oxide? How can this be made worse?
Hypoxia, LOC, loss of protective airway reflexes If the patient recieves a pudendal nerve block
27
Side effects of using Ketamine in labor anesthesia? When would we NOT want to use Ketamine?
Elevated BP, HR Visual/auditory hallucinations Not for pts with preeclampsia/HTN
28
Doses for Ketamine in labor anesthesia:
Dose: 0.2-0.5 mg/kg - IV; onset 30 seconds; duration 5-10 mins - IM onset 2-8 mins; duration 10-20 mins Infusion - Loading 0.2 mg/kg over 30 minutes - Infusion 0.2 mg/kg/hr
29
Benzos side effects in labor anesthesia:
- Maternal & neonatal respiratory depression - Neonatal hypotonicity & impaired thermoregulation - Amnesia
30
Does Meperidine cross the placenta easily?
YES
31
Remifentanil dose in labor anesthesia:
PCA: Bolus 20 – 40 mcg w/lockout 2-3 minutes
32
*This* drug has Improved analgesic scores over Fentanyl. What is the dose?
Butorphenol: - 1-2 mg q3-4 hrs
33
Nalbuphine can cause ____ but is responsive to ____.
Fetal bradycardia Naloxone | 5-20 mg q 4-6
34
What is the most common fetal complication associated with Paracervical Block? What about most severe?
Fetal bradycardia Fetal Local Anesthetic Systemic Toxicity (LAST)
35
While attempting to perform multimodal analgesia for a patient in labor, the CRNA understands that the use of this medication can cause premature constriction of the ___.
Toradol Promotes premature constriction of **fetal ductus arteriosus**
36
How deep should the needle be inserted into the mucosa when performing a paracervical block?
2-4 mm
37
Which nerve blocks are preferred for the 1st and 2nd stages of labor?
1st: Paracervical 2nd: Pudendal
38
What is the goal of a Pudendal Nerve Block?
Minimize urge to push during the Second Stage of Labor
39
What emergency medications should be available if performing neuraxial anesthesia to a parturient?
- Ephedrine - Neo - Atropine - Epi - Naloxone - Calcium - Na Bicarb
40
What are the benefits to using the lateral position in neuraxial anesthesia?
- Less risk of intravascular catheter - Epidural veins decompressed - May be easier for parturient
41
How does the parturient patients anatomy change due to pregnancy?
Apex of T-Spine curvature shifts from **T8-T6** - Increased risk of Cephalad spread Decreased Intervertebral Gap - Associated w/ lumbar lordosis Forward Rotation of pelvis - Touffier's line elevated
42
What are the absolute contraindications for Neuraxial Anesthesia?
*Patient refusal* *Uncooperative patient* *Uncontrolled hemorrhage with hypovolemia* *Epidural site infection* *Clotting Disorder/Anticoagulation*
43
Risks if epidural is placed too early?
* Instrumented delivery * Prolonged 2nd Stage * Ineffective epidural that needs to be replaced
44
List the five options for Neuraxial Anesthesia.
*Epidural (CLE)* *Dural puncture epidural (DPE)* *Combined spinal-epidural (CSE)* *Single shot spinal/intrathecal* *Continuous spinal/intrathecal*
45
Placement location for Epidural (CLE):
L2-L5
46
Disadvantages for CLE:
Slower onset of analgesia (10-15 mins) Larger Amount of LA/opioids required Risk of sacral “sparing” or slow blockade Greater risk for maternal LAST Greater fetal drug exposure
47
Although there is not much of a difference in saline vs air LOR, there is a risk of these 2 things with LOR using air:
- Pneumocephalus - "Patchy" block
48
Standard test dose for epidural catheter:
Lido 1.5% + 1:200k epi in 3 mls (15 mg/ml of LA + 5mg/ml of epi x 3 mls = 45 mg of LA & 15 mcg of epi)
49
While performing a CLE, the CRNA could differentiate whether or not they are intravascular or intrathecal based on these effects for each space:
Intravascular: Increase in HR by 20 bpm withing 1 min. Intrathecal: Motor blockade within 3-5 mins (risk for high spinal)
50
What are the main advantages of the Combined Spinal-Epidural technique?
- Rapid onset of analgesia (2-5 minutes) - Low dose of LA/Opioids - Decreased risk of failed epidural
51
What are the risks associated with the Combined Spinal-Epidural technique?
*Increased risk of fetal bradycardia* *Increased risk of PDPH* *Increased risk of postpartum neuraxial infection*
52
Th DPE technique is similar to a CSE, however what makes it different?
No medication is injected
53
What is bradycardia associated with in the context of neuraxial anesthesia?
Due to degree of sympathetic block and maternal hypotension.
54
What is the increased risk associated with dural puncture epidural?
Increased risk of PDPH and postpartum neuraxial infection.
55
What are the advantages of Dural Puncture Epidural?
* Faster onset than an epidural without a DP * Transdural migration of medications injected into epidural space * More rapid sacral analgesia than traditional epidural * Decreased risk of maternal hypotension & fetal bradycardia compared to CSE.
56
What is a disadvantage of Dural Puncture Epidural?
Increased risk of PDPH and postpartum neuraxial infection.
57
What defines Single Shot Spinal/Intrathecal labor analgesia?
Spinal analgesia with duration of action based on local anesthetic & opioid administered.
58
What are the advantages of Single Shot Spinal/Intrathecal?
* Rapid onset of analgesia * Immediate sacral analgesia * Low local anesthetic & opioid dosages.
59
What are the disadvantages of Single Shot Spinal/Intrathecal?
* Limited duration of analgesia * Increased risk of maternal hypotension/fetal bradycardia * Increased risk of PDPH.
60
What are the advantages of Continuous Spinal?
* Continuous analgesia * Low doses of local anesthetic/opioid * Rapid onset of analgesia.
61
What is a significant disadvantage of Continuous Spinal?
Large dural puncture → risk of PDPH.
62
What is the most commonly used local anesthetic for labor?
Bupivacaine & Ropivacaine.
63
What are the advantages of Bupivacaine?
* Differential block between motor and sensory neurons * Long duration of action * Safety with low concentrations unlikely to cause toxicity.
64
What is a disadvantage of Bupivacaine?
Slow onset time (10 – 15 mins) and risk of CV & neuro toxicity.
65
What is the initial dose range for Bupivacaine?
0.0625% - 0.25% with 10-20 mL depending on concentration.
66
What is an advantage of Ropivacaine over Bupivacaine?
Greater differential sensory-motor blockade and less risk for toxicity.
67
What is the disadvantage of Lidocaine as a labor analgesic?
Poor differential block and significant motor involvement/blockade.
68
What are some indications for using Lidocaine?
* Identifying non-functional catheter * Rapid sacral analgesia. * Instrumented Vaginal Delivery (also 2-chloro) * Emergent Operative delivery
69
This LA is not typically used for labor anesthesia because of these reasons:
2- Chloroprocaine: - Short DOA - Poor differential blockade - **Interference with bupivicaine and other opioids**
70
What is the role of opioids in epidural medications?
Direct action at spinal & supraspinal opioid receptors, **decreasing local anesthetic dose by 20-30%.** Improves duration and quality of block
71
What is an advantage of adding Clonidine/precedex to epidural medications?
Decreases local anesthetic requirements and improves block quality & duration.
72
What are the disadvantages of Clonidine/precedex as an additive?
Maternal HoTN, Bradycardia for clonidine and sedation for both
73
What is the dosing range for Bupivacaine in continuous epidural infusion?
0.05-0.125% at 8-15 mL/hr.
74
What does PCEA stand for in epidural dosing?
Patient Controlled Epidural Analgesia.
75
What is a benefit of background infusion in PCEA?
Better analgesia & increased maternal satisfaction.
76
Can you use opioids as a solo agent for a spinal? If so, how does this work on our nerve impulses?
YES! Blocks afferent input from A-Delta and C-fibers to the spinal cord Efferent impulses are NOT affected
77
True or False: Using epi in a spinal will not increase the density of the motor blockade
FALSE: In higher doses (100-200 mcg) it can. Traditionally we dont use this high of a dose so it is not common to think of epi as increasing block density
78
What are the side effects of neuraxial anesthesia?
* Hypotension * Failed analgesia * Pruritus.
79
What is the usual first complaint by a parturient when they begin to get hypotensive?
Intense Nausea
80
What is the most common side effect if opioids are administered?
Pruritus.
81
Which of the following two drugs would be the best treatment for complaints of pruritis related to an opioid adjunct in an epidural? A. Benadryl B. Claritin C. Naloxone D. Naltrexone
C. Naloxone D. Naltrexone The itching has nothing to do with histamine release, therefore, the Histamine antagonists will not help.
82
What are the treatments for unintended dural puncture (wet tap)?
- Intrathecal Cath/replace epidural - Epidural blood patch if headache develops (also conservative tx)
83
What might we see if we accidentally cannulate a vein?
Tinnitus, Oral numbness Difficulty speaking --> Siezures --> LOC
84
Treatment for inadvertant intravascular cannulation:
Lipid Emulsion Bolus: - 1.5 ml/kg over 2-3 min Benzos
85
What is the treatment for high spinal complications?
* Assist ventilation * Volume resuscitation * Vasopressors.
86
Dermatome levels for the following anatomical structures: Cardioaccelerator Fibers: Diaphragm: Pinky Finger:
Cardioaccelerator Fibers: T1-T4 Diaphragm: C3-C5 Pinky Finger: C8
87
What might we see if we accidentally thread a subdural catheter?
1. Patchy, high blockade 2. Hypotension 3. Minimal motor blockade 4. Alteration in some cranial nerves 5. Horner's Syndrome 6. Apnea (possible LOC)
88
What are the s/s of Horner's Syndrome:
- Ptosis - Miosis - Anhidrosis
89
What should be regularly assessed post-intervention in neuraxial anesthesia?
* Quality of analgesia * Progress of labor * Maternal vital signs.
90
True or False: Bupivacaine has a rapid onset time.
False.
91
What is the treatment for pruritus due to opioid administration?
Centrally acting mu-opioid antagonist like Naloxone.

Advanced Principles A (Spring 2025) Cooper (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions