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Anes Final > OB Anes > Flashcards

OB Anes Flashcards

1
Q

Maternal changes

total blood volume

A

5% increase

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2
Q

Maternal changes

HR

A

15 beats/min increase

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3
Q

Maternal changes

CO

A

40% increase

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4
Q

Maternal changes

SV

A

30%

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5
Q

Maternal changes

uterine blood flow

A

500 mL/min increase

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6
Q

Maternal changes

SVR

A

15% decrease

SVR = systemic venous return

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7
Q

Why does SVR decrease in pregnant women?

A

aortocaval compression

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8
Q

Which is the only CVA parameter that decreases in pregnancy?

A

SVR

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9
Q

The enlarging uterus impinges on what vessels?

A

abdominal aorta and IVC

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10
Q

what is the ideal position of a pregnancy patient?

A

left lateral tilt

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11
Q

why is left lateral tilt the ideal position in pregnancy?

A

to prevent aortocaval compression producing supine hypotensive syndrome

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12
Q

what are two possible clinical implications of CVS changes in pregnant woman?

A

. possible decompensation of cardiac patients

. supine hypotensive syndrome

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13
Q

in hypotensive pregnant patient, what should be given and why?

A

glucose-free solutions

blood sugar increase results to insulin releases which crosses the placenta and the fetus will become hypoglycemic

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14
Q

what fluid loading solution will be given to pregnant patients with hypotension?

A

D5LR, D10W

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15
Q

maternal changes and why

02 consumption

A

20% increase (100% during labor)

increase metabolic rate

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16
Q

maternal changes and why

minute ventilation/FEV1

A

50% increase

increased TV

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17
Q

maternal changes and why

arterial pCO2

A

decreased

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18
Q

maternal changes and why

FRC

A

decreased (functional reserve capacity)

. decreased mechanically by enlarging uterus
. leads to decreased oxygen reserve

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19
Q

maternal changes and why

airway mucosa

A

edema and venous engorgement

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20
Q

what is the importance of decreased FRC in pregnancy

A

oxygen comes from FRG in between breaths, so decrease could lead to hypoxia

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21
Q

preoxygenation in pregnancy is (less/more) effective

A

preoxygenation in pregnancy is LESS effective

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22
Q

(slower/faster) intake of inhalation agents in pregnancy

A

FASTER intake of inhalation agents in pregnancy

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23
Q

(lower/higher) inhalation agent requirement in pregnancy

A

LOWER inhalation agent requirement

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24
Q

(decrease/increase) of MAC 25 to (X) in pregnancy

A

DECREASE of MAC to 40%

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25
(worse/better) Mallampati score in pregnancy
WORSE Mallampati score
26
(lower/higher) incidence of difficult/failed intubation in pregnancy
HIGHER incidence of difficult/failed intubation
27
need (smaller/larger) endotracheal tube
need SMALLER endotracheal tube
28
the higher the Mallampati score the (less/more) difficult to intubate
`the higher the Mallampati score the MORE difficult to intubate
29
visualization of the soft palate, uvula, and pillars Mallampati Class I Class II Class III Class IV
Class I
30
visualization of the soft palate and uvula Mallampati Class I Class II Class III Class IV
Class II
31
visualization of the soft palate and the base of the uvula Mallampati Class I Class II Class III Class IV
Class III
32
soft palate is not visible at all Mallampati Class I Class II Class III Class IV
Class IV`
33
in pregnancy, epidural veins are (narrowed/distended)
epidural veins are DISTENDED
34
what is the importance of distended epidural veins in pregnancy
the drug is injected in the epidural space. the distended veins occupy a portion of the space, thereby lessening the drug delivery
35
pregnant patients are given (less/more) spinal anesthesia. why?
pregnant patients are given LESS spinal anesthesia. decreased CSF volume means there is faster onset
36
in pregnant patients (less/more) local anes is needed
in pregnant patients LESS local anes is needed
37
in pregnancy, (decreased/increased) gastric volume and acidity
DECREASED gastric volume and acidity
38
in pregnancy, (shorter/longer) gastric emptying
SHORT gastric emptying
39
4 clinical implications of GIT changes in pregnancy with anes
. gastric reflux/heartburn . all are considered on "full stomach" . increased risk of aspiration . aspirational prophylaxis for CS
40
what are the aspirational prophylaxis given for CS
. clear antacid | . h2 blocker or metoclopramide
41
what is moa of metoclopramide as an aspirational prophylaxis
gastrokinetic which enhances the movement of the gut
42
the perineum is supplied by which nerve that originates from?
pudendal nerve which originates from S2 to S4
43
what is the anesthetic consideration in second stage delivery?
you have to increase the dose of the anesthetic because in addition to T10 to L1, you also have to block S2 to S4
44
what are the nociceptive pathways involved in pain of childbirth?
. T10 to L1 during labor . S2 to S4 for delivery (plus T10 to L1) . T10 to S4 for short mothers
45
psychological stress from pain can cause what (2) things? What is the implication?
. increased levels of catecholamines . hyperventilation . both may result in decreased uterine blood flow leading to hypoxia and acidosis in the fetus
46
factors affecting pain perception in labor (10)
``` . mental prep . family support . medical support . cultural expectations . parity . size and presentation of fetus . maternal pelvic anatomy . medications ```
47
important consideration of opioid analgesics and sedatives in pregnancy
nearly all parenteral opioid analgesics and sedatives readily cross the placenta and can affect the fetus
48
(hardly any/most) opioid analgesics and sedatives cross the placenta
MOST opioid analgesics and sedatives cross the placenta
49
(regional/general) anesthesia is preferred for management of labor pain
REGIONAL anesthesia is preferred for management of labor pain
50
what is the most versatile and most commonly employed anesthetic technique used during labor
continuous lumbar epidural anesthesia
51
(single shot/continuous lumbar epidural anesthesia) allows better control over the sensory block level during labor
continuous lumbar epidural anesthesia allows better control over the sensory block level
52
danger of lumbar epidural anesthesia
danger of having inadvertent intravasclar or intrathecal anesthesia in epidural anesthesia
53
how is the risk of systemic toxicity in EA minimized in pregnancy?
by slowly administering dilute solutions for labor pain and by fractionating the total dose for CS into 5 ml increments
54
what is the fractionated dosing of anes in CS?
5 ml per for a total of 15 ml
55
what is done in during labor to significantly reduce drug requirement?
local anesthetic-opioid mixture
56
what maybe be given to patients experiencing severe pain during labor?
combined spinal-epidural technique
57
in combined spinal-epidural technique for labor, what is the purpose of each?
spinal - rapid onset | epidural - longer duration
58
what is the advantage of SAB in labor?
more rapid, predictable onset, more dense block without the potential for serious systemic drug toxicity
59
onset of spinal anes
5 min
60
onset of epidural anes
15 min
61
what is a common side effect of regional anesthesia in labor? how is it treated?
hypotention; treated aggressively with vasopressors, supplemental O2, left uterine displacement, and IV fluid boluses to prevent fetal compromise
62
what vasopressor is used in regional anesthesia in labor?
ephedrine sulfate
63
why is left uterine displacement done?
to prevent aortocaval compression and promote venus return
64
what type of anes is preferred in CS? why?
spinal or epidural anesthesia because of their association to lower maternal mortality
65
types of analgesia for labor and delivery (4)
non-pharmacological, parenteral, inhalational, regional
66
non-pharmacological analgesics for delivery (7)
``` . breathing exercises . autohypnosis . acupuncture . white noise/music . massage/walking . TENS . water bath ```
67
3 major classes of parenteral analgesics for delivery
. narcotics . sedatives/antianxiety . ketamine
68
narcotics used in delivery (5) - acronym
MeN FeM . meperidine . nalbuphine . fentanyl . morphine
69
advantage and disadvantage of narcotics in labor
pro: relatively good analgesia con: nausea, vomiting, sedation, neonatal depression, short duration of action
70
sedatives/anti-anxiety used in labor (3) - acronym
BPH . benzodiazepines . promethazine . hydroxyzine
71
disadvantage of sedatives/anti-anxiety used in labor
respiratory depression
72
4 considerations of ketamine in labor
. can increase HR (all other used are depressants) . contraindicated for hypertensive . sometimes given with benzodiazepine . at large dose can produce hypertonic uterine contraction
73
inhalation analgesics in pregnant pt
EIN . enflurane 1% . (low dose) isoflurane in oxygen 0.7% . nitronox
74
what is the preparation of nitronix in pregnant pt and why?
50:50 mixture of oxygen and nitrous oxide; NO can produce hypoxia so it's combined with oxygen
75
what is the advantage of inhalation analgesics?
. awake patient with protective laryngeal reflexes; even if they vomit will not aspirate
76
overdose of inhalation analgesics indicated by
confusion, excitement, drowsiness
77
what are the regional techniques of anesthesia
epidural, spinal, combined spinal-epidural
78
6 advantages of regional tech in pregnant patient
. excellent pain control . minimal impact on progress of labor with low doses (especially epidural) . less drug transfer to fetus . improved uterine blood flow . decrease in birth trauma (use of forceps) . minimal neonatal depression
79
4 disadvantages of regional technique in pregnant patient
. invasive . side effects . nerve damage . infection
80
what are the side effects of regional anesthesia in pregnant patient
hypotension, headache, itching, nausea, urinary retention, limited mobility
81
the uterovaginal plexus is also known as
frankenhauser plexus
82
anesthesia to the frankenhauser plexes is also known as
paraservical block
83
how is the paracervical bock done?
3 o'clock and 9 o'clock
84
what is possible complication for paracervical block?
if artery is hit, it can cause retroperitoneal hematoma compromising blood flow which would produce acidosis in the baby
85
maternal consideratons in anes
. altered physiology . altered response to anesthesia and other drugs . decrease in MAC . increased sensitivity to neuraxial agents . decreased plasma cholinesterase . decreased protein binding (more free drug)
86
(few/many) anesthetic agents are proven teratogens
none are
87
what are some anesthetic agents deemed safe for use on pregnant patient
thiopental, morphone, meperidine, fentanyl, succinylcholine, NDMRs
88
succinylcholine is a (depolarizing/nondepolarizing) muscle relaxant
succinylcholine is a DEPOLARIZING muscle relaxant
89
question
answer
90
6 considerations in anesthetic management in the prturient
``` . Avoidance of hypoxemia . Avoidance of hyotension . Avoidance of acidosis . Maintain PaCO2 in the normal range . Minimize effects of aortocaval compression . Prevent aspiration ```
91
what is preffered anestheic technique for CS in pre-eclamptic patient? Why?
epidural is preferred since there is a grdual decrease in BP; SAB not contraindicated if you can manage the sudden drop in BP
92
what is preffered anestheic technique for CS in patient with seizures? Why?
general anesthesia because you have to wait 15-30 min for epidural to take effect
93
CS prep for anes
. Premeds (antacids: sodium nitrate) . IV access and fluid bolus within 30 min of operating . Left lateral tilt with wedge under righ pelvis . Routine monitors: ECG, NOBP, pulse ox, fetal monitoring . Monitor for GA: ETCO2, nerve stimulator, temp probe
94
what premed is giving before anes for CS?
antacid: sodium nitrate
95
what position is partruient patient placed in for CS?
left lateral tilt
96
what are the routine monitors used in CS?
ECG, NIBP, pulse ox, fetal monitoring
97
anesthetics techniques for CS
. Local infiltration by surgeon . Regional anesthesia . General anesthesia
98
with local infiltration how must it be done?
via midline incision, gentle retrction, no exteriorization
99
what is the technique of choice for uncomplicatred elective CS and many emergency CS?
regional spinal
100
when is regional epidural anesthesia used in CS?
. When a slower onset is needed . Used when already placed for labor analgesia . Allows prolongation fo block should surgery be complicated
101
potential complication of regional spinal anesthesia (12) in CS
``` . Hypotension . Headahce . Backache . Nausea, vomiting . Urinary retention . Neurological damage . Anaphylaxis . Hypotension . Unintentional spinal injection . Intrvascular injection of local anesthetic . Neurological damage . Infection ```
102
when is regional combined spinal-epidural used in CS?
when the speed and density of a spinal anesthetic, with the flexibility of prolonging the block by supplemental increments of local anesthesia via the epidural cathertor is required
103
indications for GA in CS
. Fetal distress during the second stage . Tetanic uterine contractions . Breech extraction . Version and extraction . Manual removal of a retained placenta . Replacement of an interted uterus . Psychiatric patients who became uncontrollable
104
effects of GA on fetus
. Lower APGAR score at 1 minute but no difference at 5 minutes . No significant alteration in neurobehavioral scores as compared to regional techniques
105
how are the effects of GA on fetus minimized?
by limiting time between uterine incision and delivery to less than 3 minutes
106
what is the anesthesia of choice in pegnancy-induced hypertension?
epidural anesthesia
107
mitral valve disease CS regional anesthesia general anesthesia
regional anesthesia
108
aortic insufficiency CS regional anesthesia general anesthesia
regional anesthesia
109
congenital lesions with left to right shunting CS regional anesthesia general anesthesia
regional anesthesia
110
aortic stenosis CS regional anesthesia general anesthesia
general anesthesia
111
congenital lesions with right to left shunting CS regional anesthesia general anesthesia
general anesthesia
112
congenital lesions with right to bidirectional shunting CS regional anesthesia general anesthesia
general anesthesia
113
CS regional anesthesia general anesthesia
general anesthesia
114
primary pulmonary hypertension CS regional anesthesia general anesthesia
general anesthesia
115
why is GA in preferred in obstetric patient with aortic stenosis?
the outflow of blood is low; regional anesthesia causes hypotension thereby aggrevating the condition
116
CSF clue subarachnoid block epidural block
subarachnoid
117
< 5 min onset subarachnoid block epidural block
subarachnoid
118
2 to 4 ml subarachnoid block epidural block
subarachnoid
119
LOR clue subarachnoid block epidural block
epidural
120
HDM clue subarachnoid block epidural block
epidural
121
3o min onset subarachnoid block epidural block
epidural
122
15 to 20 ml subarachnoid block epidural block
epidural

Anes Final (3 decks)

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