Labor Anesthesia & Analgesia pt5 Flashcards
What is the dose of spinal dexmedetomidine?
2.5 - 10mcg
What is the purpose of spinal dexmedetomidine ?
- Prolongs duration of analgesia
- ↓ latency (faster onset)
What is spinal dose of epinephrine?
2.25 - 100mcg
What is the purpose of intrathecal epinephrine?
- Prolonged analgesia
- increased motor blockade (with higher dosing: 100-200mcg)
What would a higher dose of spinal epinephrine (100 - 200mcg) do?
↑ motor blockade
How is neuraxial hypotension typically treated?
- IV fluids
- Positioning
- Vasopressors (last)
What is the most common complaint associated with neuraxial opioids?
Pruritus (most common side effect from opioids)
Why does pruritus occur with neuraxial opioid administration?
Central μ-opioid receptors
What dose of diphenhydramine (Benadryl) is used for neuraxial opioid pruritus?
Trick question. Itching is not due to histamine release. Benadryl typically will not work.
What drugs are used to treat neuraxial opioid pruritus?
Centrally acting μ-opioid antagonist
- Naloxone 40 - 80mcg IV
- Naltrexone 6mg PO
Partial Agonist-Antagonist
- Nalbuphine 2-5mg IV
- Butorphanol 1-2mg IV
What are the conservative treatment options for a “wet tap” (unintended dural puncture) resulting in PDPH?
- Caffeine
- NSAIDS
- Laying down (positioning)
What are the more invasive treatment options for PDPH?
- Epidural blood patch
- sphenopalatine block
Should CSF be reinjected after wet-tap occurs with a Tuohy needle?
No. ↑ risk for infection/pneumocephalus
Why is bupivacaine 0.75% not used for epidural blocks?
Risk for CV toxicity if injected intravascularly
increased risk from engorgement of epidural veins
What are the mild/moderate signs/symptoms of LAST or Intravenous administration of LA?
- Tinnitus
- Circumoral numbness
- Restlessness
- Difficulty speaking
Severe: seizures or LOC
What is the treatment for LAST?
- 1.5 mL/kg Lipid emulsion bolus & benzodiazepines (to protect from seizures)
- followed by lipid emulsion infusion 0.25mL/kg/min
What are the signs/symptoms of a high spinal?
- Agitation
- Dyspnea/apnea
- Inability to speak
- Profound hypotension
- LOC
How is a high spinal treated?
- Ventilation assistance
- Volume resuscitation
- Vasopressors
Pinky/hand numbness is associated with what spinal level?
C8
Cardioaccelerator fibers originate from what spinal levels?
T1-T4
“T1-T4 are your cardioacceleratOrs”
Diaphragmatic innervation comes from which spinal levels?
C3-C5
“C3-C5 keep the diaphragm alive”
Thumb numbness is associated with what spinal level?
C6
What are the signs/symptoms of a subdural block?
- Unexpectedly high blockade w/ patchiness
- Profound HoTN
- Minimal motor blockade
- Horner’s syndrome (Pto,anhidro,mio)
- Apnea
- LOC changes
What are some other general side effects/complications from neuraxial anesthesia?
- shivering
- urinary retention
- meningitis/infection
- neuro deficits
- excess motor block
- epidural hematoma/bleeding
