OB Flashcards
what is the test dose when doing an epidural?
1.5% Lidocaine with 1:200,000 epi (ready with filter), give 3 mLs
if we give 3 mLs, then its: 45 mg of lidocaine + 15 mcg of epi
what is the bolus dose for an epidural at ARMC?
0.2% Ropivacaine
* 2 boluses
* 4 mL each
* 5 mins apart
for T10 level
Epidural is in, bolus given… now, what is the infusion concentration and rate for the epidural if patient is 5’1”?
Using 0.15% Ropivacaine with 2mcg/mL fentanyl,
set infusion rate at 8 mL/hr
With our known epidural infusion concentration and rate, if our patient is 5’1”, how much ropivacaine and fentanyl are they receiving every hour?
Using our 0.15% Ropivacaine with 2mcg/mL fentanyl,
and we set infusion rate at 8 mL/hr:
* ropivacaine = 1.5 mg/ml x 8 mL = 12 mg / hr
* fentanyl = 2 mcg/mL X 8 mL = 16 mcg / hr
what is the infusion concentration and rate for the epidural if patient is 5’6”?
0.15% ropivacaine with 2 mcg/mL fentanyl
at 10 mL/hr
what is the infusion concentration and rate for the epidural if patient is 5’8”?
0.15% ropivacaine with 2 mcg/mL fentanyl
at 12 mL/hr
what do you do if pt has inadequate analgesia with epidural?
- bolus 5-6 mLs of LA to reestablish
- increase gtt 2-4 mL/hr
- consider fentanyl
what’s in a bang stick for epidural?
2 vials (20 mL) of 2% lidocaine, add 0.1 mL epi (1:200,000 aka 5 mcg/mL)
what should you document when placing an epidural? (2 things specifically)
- time of epidural request
- fetal HR on anesthesia record
what are some risks of an epidural?
HA, HoTN, infection, bleeding, parasthesis, failure, LAST, total spine and nerve injury
what short-acting LA is used for labor analgesia
3% chloroprocaine
onset of 3% 2-chloroprocaine?
10-15 mins
duration of 3% 2-chloroprocaine (plain)?
60 mins
duration of 3% chloroprocaine (with epi)?
90 - 120 mins
what is the onset of lidocaine used for CSE labor analgesia?
10-20 mins
what is duration of 1.5% lidocaine (plain vs with epi)?
plain: 30-60 mins
with epi: 60-120 mins
what is the common concentration of bupivacaine for epidural at ARMC?
0.125% bupivacaine
what is the duration of 0.125% bupivacaine used for epidural?
2.5+ hours
what is the concentration of bupivacaine used for spinal (c-section) analgesia?
0.5 - 0.75%
what is the duration of plain bupivacaine used for spinal (c-sections) analgesia?
2.5 - 4 hours
what is the duration of bupivacaine with epi used for spinal (c-sections) analgesia?
3-4 hours
degree of angle of a Tuohy needle?
30%
degree of angle of a Hustead needle?
15%
degree of angle of a Crawford needle?
0%
Name the cutting-point needle:
Quincke
Name the 2 pencil point needles:
Whitacre
Sprotte
Name the rounded bevel needle:
Greene
what spinal level do we want our spinal block at for c-sections?
T4 - T6
as soon as baby is delivered and cord is clamped, what do we do with pitocin?
- Add 20 units to maintenance bag and run wide open!
- Notify surgeon
After we’ve given the first 20 units of pitocin and notified surgeon, what’s next?
- Next 20 units of pitocin will go into the next maintenance fluid and run at 125 mL/hour
- watch for HoTN!
what 2 antibiotics will we give for c-section?
Cefoxitin: 2 Gs in 10 mL
Azithromycin: reconsititute in 250 mL NS
antiemetic for c-section?
zofran 4 mg
dose of glycopyrrolate for c-section?
0.2 mg
dose of methergine for PPH?
200 mcg IM
vasoconstrictor/HTN
dose of hemabate for PPH?
250 mcg (IM?)
can cause bronchospasm in asthma?
dose of bicitra?
30 mL PO - but no more than 30 mins before!
what is our dose of bupivacaine for spinal (c-sections)?
0.75% Bupivacaine + 25 mcg Fentanyl
- coverage for about 2 hrs
ends up being 10-12 mg of bupivacaine depending on height
how many mLs of 0.75% bupivacaine do we give for our spinal if patient is:
- 5’1”?
- 5’6”?
- 5’8”?
- 5’1” : 1.2 mL (9 mg of 0.75% Bupivacaine)
- 5’6” : 1.4 mL (10.5 mg of 0.75% Bupivacaine)
- 5’8” : 1.6 mL (12 mg of 0.75% Bupivacaine)
