OB (10/10) Flashcards
complications of neuraxial analgesia
- inadequate
- unintentional dural puncture
- Respiratory depression
- intravascular injeciton
- high spinal
- extensive motor block
- prolonged block
- sensory changes
- back pain
- pelvic floor injury
epidural analgesia can prolong which stage of labor
2nd stage (pushing stage)
you performed a combined spinal epidural, you dosed the spinal when you placed but did not use the epidural. 1 hour later you come back to start the epidural, what is the first thing you do?
do another test dose
common dose of bupivicaine in epidural
0.0625-0.125 %
dose of bupivicaine in spinal
1.25-2.5 mg
dose of ropiv in epidural
0.08-0.2%
dose of ropiv in spinal
2.5-4.5 mg
dose of levobupiv in epidural
0.0625 - 0.125%
dose of levobupiv in spinal
2.5-4.5 mg
dose of lido in epidural
0.75-1%
dose of fentanyl in epidural
50-100 mcg
dose of fentanyl in spinal
15-25 mcg
dose of sufenta in epidural
5-10 mcg
dose of sufenta in spinal
1.5-5 mcg
dose of morphine in spinal
0.125-0.25 mg
common indications for C/S
- dystocia
- malpresentation
- non-reassuring fetus
- previous C/S
- maternal request
- OB discretion
- previa
- placental or uterine abruption
- active gential herpes
- multiple gestation
- prolapsed umbilical cord
- deteriorating maternal condition
TOLAC
- trial of labor after C-section
- someone trying to have vaginal delivery after C/S
VBAC
vaginal birth after C/S
ECV
external cephalic version (baby is breech)
C/S complications
- hemorrhage
- infections
- thromboemboli
- ureteral/bladder injury
- abdominal pain
- future uterine rupture
- death
_______________ C/S has a greater risk of maternal morbidity and severe maternal mortality rates
non-elective (emergent)
what are some ways a C/S can be prevented/avoided
- adequate labor epidural
- external cephalic version (rotating the bby)
- intrauterine resuscitation (optimize maternal position, O2, IVF/vasopressors, D/C pitocin, consider tocolytic)
- TLC from CRNA
T/F: well functioning labor epidural can still be used if have to convert to C/S
true
mom has a CLE but is having to be converted to C/S, what should you do before dosing the CLE
check the level of your block
aspiration prophylaxis for C/S
- bicitra/alka-seltzer (non particulate antacid)
- pepcid
- reglan
- prilosec (omeprazole)
Abx for C/S
- 2 gms of ancef (<120 kg)
- 3 gm of ancef (> 120 kg)
________________ is the preferred anesthesia for C/S
neuraxial
what are the options for anesthesia during C/S
- labor epidural dosed for anesthetic block
- spinal block
- GA
epidural doses of local anesthetics & opioids are _________x ____________ than spinal doses
5-10 higher
T/F: there is more systemic absorption of local/opioids with epidural than spinal
true - d/t epidural spaces proximity to engorged venous plexus
benefits of epidural for C/S
- already in place (was placed for labor epidural)
- slower onset –> less hotn
- more titration allowed for level, density, and duration
- quicker start to surgery
what are the local anesthetics that are used in epidural during C/S
- 2% lido + 5 mcg/mL epi
- chloroprocaine 3%
- Bupiv 0.5%
- ropiv 0.5%
what is the dose of 2% lidocaine + 5 mcg/mL of epi in epidural for C/S
300-500 mg
20 mL of this = 400 mg
what is the duration of action of 2% lidocaine with 5 mcg/mL of epi used in epidural for C/S
75-100 min
what is the dose of 3% chloroprocaine used in epidural for C/S
450-750 mg
in 20 mL = 600 mg
what is the dose of 0.5% bupivicaine used in epidural for C/S
75-125 mg
what is the dose of 0.5% ropiv used in epidural for C/S
75-125 mg
what is the DOA of 3% chloroprocaine dose in epidural for C/S
40-50 min
**wears off fast!
what is the DOA of 0.5% bupivicaine & 0.5% ropivicaine used in epidural for C/S
120-180
what is the dose of fentanyl used in epidural for C/S
50-100 mcg
what is the dose of sufenta used in epidural for C/S
10-20 mcg
what is the dose of morphine used in epidural for C/ S
3-4 mg
what is the dose of meperidine used in epidural for C/S
50-75 mg
what is the DOA of fentanyl and sufenta in epidural for C/S
120 -240 min
what is the DOA of morphine when dosed in epidural for C/S
720-1440 min
what is the DOA of meperidine when dosed in epidural for C/S
240-720 min
what other medications can you give when epidural is not sufficient for surgical pain during C/S
- N2O
- IV duramorph
- more LA
- propofol
- ketmaine
- precedex
- OK anesthesia (ondansetron and ketorolac)
- verbal reassurance
*if this still is not enough, you will have to convert to GA
your pt is having to be sent back for emergency C/S, she has a CLE providing adequate analgesia to T10; what volume of anesthetic would be required to extend this level of block to the T4 level
10-20 mL of LA
benefits of adding epi to LA
- minimizes systemic absorption
- increases density of sensory and motor block
- increases DOA of LA
benefit of adding bicarb to LA
speeds onset and augments quality of block d/t more LA being in non-ionized state on injection
common dose of bicarb added to LA
2 mEq
baricity of LA = ______________/____________
density of LA / density of CSF
LA movment within CSF is depdent on ____________ in relation to CSF at 37 C
specific gravity
LA in dextrose = _______________baric
hyper
LA in water = ____________baric
hypo
LA in NS = ___________baric
iso
spinal marcaine is always _____________baric
hyper (mixed in dextrose)
