OB (7/10) Flashcards
an epidural test dose consists of __________ lidocaine and ___________ epi
1.5%; 1:200000
if your epidural catheter is in the epidural vein, after test dose your HR would raise by _____________
20-40 bpm
if your epidural catheter is in the subarachnoid space, when you administer your test dose, what would happen
rapid spinal block in 3-5 min
T/F: loading doses into epidural should be given as bolus
false; should be incremental
what are your options for loading dose epidural after you get a negative test dose
- 0.25% bupivicaine
- infusion solution (0.125% bupiv/2 mcg/mL fentanyl)
- 100 mcg of fentanyl (gives fast onset while waiting on LA)
- lidocaine 1-2%
which is more accurate in assessing the level of a regional block - etoh swab or pin prick?
pin prick
if your epidural block seems adequate except in the sacral area, how should you intervene?
consider large volume of local (1% lido in 15 cc)
if your pt is having breakthrough pain with epidural, but the sensory block seems adequate ________________ of the block may be inadequate; therefore you should use a ________________ of local
density; more concentrated
pt with epidural is having decreased efficacy of pain control with repeated doses of LA. how should you intervene?
pt is experiencing tachyphylaxis - switch to different LA
which organ system is more susceptible to LAST ?
CNS
tx for LAST
- stop LA
- maintain ABGs
- iv infusion of 20% lipid emulsion
- tx arrhythmias
- Bz for seizures
- IV fluids/vasopressors (epi preferred)
- avoid: CCB, LA, BB, vasopressin
progression of sx you may see with LAST
- numbness of tongue (1st sxs)
- lightheadedness
- muscular twitch
- loss of consciousness
- convulsions
- coma
- respiratory arrest
- CVS depression (last sx)
________________ is the most common anesthetic used for C-section
spinal anesthesia
indications for spinal anesthesia in OB
- cerclage (incompetent cervix - has to be sutured to prevent early opening)
- non-OB surgery during pregnancy
- instrumental vaginal delivery
- C-section
- removal of retained placenta
- postpartum tubal ligation or salpingectomy
- labor analgesia
how long does a laboring spinal typically last
70-120 minutes
laboring spinal
- single shot LA into SA space during labor
- smaller doses to avoid motor block
laboring spinal is ideal for which patient
spontaneous labor in multiparous pt with advanced dilation
what are the different htn d/o that can be experienced during pregnancy
- preeclampsia
- eclampsia
- gestational Htn
- chronic htn
________________ is a pt who did not have htn prior to pregnancy, but because htn during pregnancy but do not have any features of preeclampsia
gestational HTN
_________________ is new onset of hypertension after 20 weeks gestation
preeclampsia
preeclampsia affects _______% of pregnancies
4
what is the only effective and definitive tx of preeclampsia
delivery of infant and placenta
what is the leading cause of pre-term deliveries
preeclampsia
______________ can present as maternal syndrome with or without fetal syndrome
preeclampsia
what is the maternal syndrome experienced with preeclampsia
htn and proteinuria
what are the fetal syndromes that can exist due to preeclampsia
- fetal growth restriction
- oligohydraminos
- abnormal oxygenation
pregnant woman > 20 wks gestation with htn + proteinuria = definitive diagnosis of __________________
preeclampsia
htn without proteinuria must present with what to be diagnosed as pre-eclampsia
- persistant epigastric pain or RUQ pain
- peristent cerebral sx - HA, visual disturbances, confusion
- fetal growth restriction
- thrombocytopenia
- elevated liver enzymes
what is the leading risk factor for preeclampsia
nulliparity (first pregnancy)
risk factors for preeclampsia
- 1st pregnancy (nulliparity)
- women with preeclampsia with previous pregnancy
- women of advanced maternal age
- maternal or paternal family hx
- women with hx of previous placental abruption, IUGR, or fetal death
- non-hispanic blacks
what are some maternal comorbidities that increase the risk of preeclampsia
- obesity
- chronic HTN
- DM
- metabolic syndrome (obesity, hyperglycemia/insulin resistance, htn)
for every _________ pt increase in BMI, risk of preeclampsia increases ___________ fold
5-7; 2
T/F: smokers are at increased risk for preeclampsia
false; non smokers at higher risk
preeclampsia is known to be a 2 stage disorder that is _________________ at the first stage and ______________ at the 2nd stage
asymptomatic; symptomatic
T/F: the exact pathogenic mechanism of preeclampsia is not known
true - do know there is some failure of trophoblastic invasion though
urine protein: urine Creatinine > ___________ = preeclampsia
0.3
urine protein > __________ in 24 hour sample = preeclampsia
0.3 gm
what defines mild preeclampsia
- BP >/= 140/90 after 20 wks gestation
- proteinuria > 0.3 gm on 24 hour urine
what defines severe preeclampsia
- BP >/= 160/110
- proteinuria > 5 g/24 hour
and at least one of the following:
3. increased serum Cr
4. pulmonary edema
5. oliguria
6. IUGR
7. HA
8. visual disturbances
9. epigastric pain or RUQ pain
10. signs of HELLP
trophoblastic invasion of the spiral arteries causes the loss of _____________ ability of vessels to ___________ which explains the __________ resistance nature of the uteroplacental circulation
smooth muscle; constrict; low
pre-eclampsia prophylaxis
- ASA
- Calcium
- antioxidant supplements
how does pre-eclampsia affect the airway
- increased edema which could lead to obstruction
- pulmonary edema (3%)
- decreased tracheal size
how does preeclampsia affect the CV system
- hyperdynamic
- BP and SVR increased
- increased vascular tone
- vasospasm of vessels
- exaggerated response to catecholamines
- edema everywhere
- plasma volume decreased by 40% (so do not even get benefits of increased plasma volume with preg)
how does preeclampsia affect the hepatic system
increased risk of liver rupture –> hemorrhage and death
how does preeclampsia affect the kidneys
- decreases GFR
- proteinuria
T/F: decreased UOP is an early sign of pre-eclampsia
false; it is a late sign
how is the hematologic system affected by pre-eclampsia
- hypocoagulable (increased bleeding risk)
- risk of DIC
how do you manage pre-eclampsia
- fetal monitoring
- tx of htn (typically hydralazine and/or labatelol + mg + epidural)
- seizure prophylaxis (magnesium gtt)
- delivery decisions
- betamethasone
what sx should you be assessing for when pt comes in with pre-eclampsia
- HA
- visual disturbances
- AMS
- SOB
- abdominal pain
- N/V
- decreased UOP
- seizures
what is the plasma magnesium level goal for the pt with pre-eclampsia
5-9 (remember normal is 1.7-2.7)
