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