OB Anesthesia Flashcards
Ritodrine
Beta agonist. Slows contractions
Betamethasone
Steroid to mature fetal lungs
Side FX of: 1) Pitocin 2) methergine 3) hemabate 4) Cytotec/Misoprost
Pit: hypoTN, tachy, SIADH
Methergine: HTN
Hemabate: Asthma/bronchoconstriction
Cytotec: ?
preop GI ppx in pregnancy
H2 blocker (famotidine)
non-particulate antacid (bicitra)
dopamine agonist (metoclopromide)
Spinal Bupivicaine dose
1) C/S
2) labor intrathecal pump
1) 1.4-1.8 mL at 0.75%
2) 1 mL/hr at 0.25%
Spinal duramorph dose
0.1 mg Duramorph (provides analgesia as well as up to 0.4 and has less puritis)
spinal fentanyl dose
10-25 mcg
Category 1 tracing
110-160 bpm,
moderate variability (6-25),
no lates/variables
Category 2 tracing
anything that falls in the grey area that isn’t defined by either Cat 1 or Cat 3
Category 3 tracing
any bradycardia, absent baseline variability
recurrent late or variable decelerations
ACOG MTP ratio
6 pRBC: 4 platelets : 1 jumbo FFP
Contraindications to Spinal anesthesia
Absolute Contraindications
• Patient refusal
• Infection at the site of injection
• Uncorrected hypovolemia
• Allergy
• Increased intracranial pressure
Relative Contraindications
• Coagulopathy
• Sepsis
• Fixed cardiac output states
• Indeterminate neurological disease
What are the system-by-system effects of pre-E? (Canned answer)
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Spinal levels 1st stage labor
T10 - L1
Spinal levels 2nd stage labor
S2 - S4
What drug can you give to help relax a uterus (tx for uterine inversion, retained placenta)
Nitroglycerin
Can you place an epidural if chorioamnionitis is suspected?
Yes, if abx have been given
List of drugs to avoid in pregnancy (cross placenta AND have bad effects)
BZDs (1st trimester)
Ephedrine (fetal acidosis)
Local anesthetics (ion trapping)
Atropine or neostogmine alone (both cross and affect the heart. Can give together. Just don’t give glucose with neo)
BBs (esmolol ok b/c short acting)
Important physical exam step before co-loading
Listen to lungs. Make sure they aren’t “wet”
Vasopressor of choice for spinal induced hypotension. Why?
Phenylephrine. Ephedrine causes fetal acidosis
Pre-E pt wants an epidural. What labs do you want? Are you going to treat her BP prior to epidural placement?
Plt count, LFTs, coags.
No! Epidural will drop pressure. Can TX after I’d you still need to.
Special consideration: uterine atony 2/2 magnesium or tocolytics. What can you give?
Calcium gluconate
What are you worried about with molar pregnancy?
Molar can cause hypertension and thyrotoxicosis (bHCG mimics TSH).
CHF, DIC (no neuraxial), and PE.
