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Advanced Principles A (Spring 2024) > Labor Anesthesia & Analgesia Pt. 1 (Exam III) > Flashcards

Labor Anesthesia & Analgesia Pt. 1 (Exam III) Flashcards

1
Q

What does SROM stand for?

A

Spontaneous Rupture of Membranes

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2
Q

What does AROM stand for?

A

Artificial Rupture of Membranes

Also known as Amniotomy.

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3
Q

Is OA or OP preferred for delivery?

A

OA (Occiput Anterior)

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4
Q

How long will the first stage of labor last for a woman having her first baby?

A

If Primiparous, 8 - 12 hours typically.

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5
Q

How long will the first stage of labor last for a woman having already had a child before?

A

If Multiparous, 5 - 8 hours typically.

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6
Q

What are the two phases of the first stage of labor?

A
  • Latent Phase
  • Active Phase
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7
Q

What characterizes the Latent phase of labor?

A
  • Cervical Effacement
  • Minor (2-4cm) cervical dilation
  • Contractions q5-7 min w/ 30 sec duration
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8
Q

What characterizes the active phase of the first stage of labor?

A
  • Cervical dilation up to 10cm
  • Contractions q2-5min w/ 60sec duration
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9
Q

How long does the 2ⁿᵈ stage of labor last?

A

Typically 15 - 120 min

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10
Q

What characterizes the 2ⁿᵈ stage of labor?

A
  • Full (10cm) cervical dilation
  • Contractions q 2min w/ 60-90s duration
  • Fetal Descent
  • Ends with Delivery
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11
Q

What event characterizes the end of the 2ⁿᵈ stage of labor?

A

Fetal Delivery

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12
Q

The 2ⁿᵈ stage of labor is considered prolonged if it lasts more than….

A

3 - 4 hours

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13
Q

How long does the 3rd stage of labor last?

A

15 - 30 min

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14
Q

When does the 3rd stage of labor begin?

A

Begins after fetal delivery

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15
Q

The 3rd stage of labor is prolonged if it lasts more than ….

A

30 minutes

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16
Q

What marks the end of the 3rd stage of labor?

A

Delivery of the placenta

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17
Q

In what stage of labor is the highest risk of uterine atony and post-partum hemorrhage present?

A

4th stage

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18
Q

When does the 4th stage of labor occur?

A

1 hour post-partum

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19
Q

What causes pain via mechanoreceptor stimulation in the 1st stage of labor?

A

Stretching and distention of lower uterine segment and cervix

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20
Q

What causes the visceral pain associated with the 1st stage of labor?

A

C-fibers entering spinal cord at T10 - L1

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21
Q

What spinal levels are primarily affected during the latent phase of the 1st stage of labor?

A

T10 - T12

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22
Q

What spinal levels are primarily affected during the active phase of the 1st stage of labor?

A

T12 - L1

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23
Q

What type of pain becomes more predominant in the 2ⁿᵈ stage of labor?
What are the characteristics of this pain?

A

Somatic Pain
- Sharp, easily localized
- Caused by stretching & compression of pelvic/perineal structures

24
Q

What nerve fibers are responsible for the somatic pain characteristic of the 2ⁿᵈ stage of labor?

A

Aδ fibers of the pudendal nerve

25
What spinal levels are relevant to the somatic pain associated with the 2ⁿᵈ stage of labor?
T12 - S4
26
What inhaled anesthetic can a patient use to "self-anesthetize"?
N₂O
27
What receptors does N₂O work on?
- Inhibits: NMDA glutamate - Stimulates: dopaminergic, opioid, and αlpha
28
How much does N₂O depress uterine contractility?
Trick question. It does not.
29
Does N₂O causes neonatal depression?
No
30
What nerve block is often used in conjunction with N₂O ?
Pudendal nerve block
31
What are adverse effects associated with N₂O?
N/V, Dizziness, Paresthesias, Xerostomia
32
Combination of N₂O and _______ can result in hypoxia, LOC changes, and loss of airway reflexes.
Opioids
33
Volatile anesthetic agents will cause uterine smooth muscle ________ in a dose-dependent modality.
relaxation
34
Preeclampsia and hypertension prevent this use of this drug.
Ketamine
35
What is the obstetric dose of ketamine?
0.2 - 0.5 mg/kg
36
What is the IV onset & duration of ketamine?
Onset: 30 seconds Duration: 5-10 min
37
What is the IM onset & duration of ketamine?
Onset: 2-8 min Duration: 10 - 20 min
38
What is the ketamine infusion loading dose and rate?
Loading: 0.2 mg/kg (over 30 min) Infusion: 0.2 mg/kg/hr
39
What are the neonatal consequences of benzodiazepines?
- Neonatal respiratory depression - Neonatal hypotonicity - Neonatal impaired thermoregulation
40
What is the IM dose of meperidine?
50 - 100mg IM q4hours
41
What is the IV dose of Meperidine?
25 mg IV q2-4 hours
42
What is the weight based dose of IV morphine?
0.05 - 0.1 mg/kg IV
43
What is the weight based dosing of IM morphine?
0.1 - 0.2 mg/kg IM
44
What is the active metabolite of morphine than can accumulate in the neonate?
Morphine-6-glucuronide
45
What is the PCA dosing of remifentanil?
20 - 40mcg (lockout of 2-3 min)
46
What is the IV/IM dose of butorphanol?
1-2mg IV/IM q3-4 hours
47
What is the dose of nalbuphine?
5 - 20 mg IV/IM/SQ
48
What opioid can result in significant fetal bradycardia?
Nalbuphine
49
Why is toradol typically not used in labor?
- Suppresses uterine contractions - Premature constriction of DA - Inhibits PLT aggregation
50
What nerve block is typically provided by the OBGYN during the 1st stage of labor?
Paracervical Block
51
What are the two fetal complications that can occur with paracervical block?
Fetal LAST (more severe) Fetal Bradycardia (more common)
52
What nerve block is an alternative to pharmacologic pain management in the 2ⁿᵈ stage of labor?
Pudendal nerve block
53
What form of anesthesia covers both 1st and 2ⁿᵈ stage of labor?
Neuraxial
54
Epidural veins are decompressed in what position?
Lateral lying *Harder to place*.
55
What is there an increase for cephalad spread of neuraxial LA in pregnant patients?
Due to apex of thoracic curvature shifting from T8 to T6. *Also from epidural vein engorgement*.
56
What are absolute contraindications to neuraxial anesthesia?
- Refusal - Uncooperative patient - Uncontrolled hemorrhage w/ ↓volume - Epidural site infection - Bleeding issues/disorder - Anticoagulated
57
What are the risks associated with epidural placement that is too early in labor?
- ↑ risk for instrumented delivery - Prolonged 2ⁿᵈ stage of labor - Risk of ineffective epidural and need for replacement

Advanced Principles A (Spring 2024) (11 decks)

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