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Anesthesia > OB anesthesia > Flashcards

OB anesthesia Flashcards

0
Q

Deceleration

A

Early: head compression w/ Vagal stimulation
Late: fetal hypoxemia w/ Vagal stimulation or myocardial failure
Variable: umbilical cord compression w/ Vagal stimulation

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1
Q

Causes of fetal bradycardia

A
  1. Hypoxemia
  2. Acidosis
  3. Complete heart block
  4. Drugs: neostigmine+glycopyrrolate
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2
Q

Fetal tachycardia

A 
Infection
Fever
Maternal smoking
Fetal SVT
Drugs: ritodrine, terbutaline, atropine
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3
Q

Cerebral palsy: etiology of CP occurs most frequently

A

Antepartum

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4
Q

Pregnancy diabetes

A

Type I: 1 of 700-1000

Gestational: 2-5% pregnancies

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5
Q

PDPH

A

Positional
Bilateral
N/v
Neckstiffness
Ocular (photophobia, diploma, difficulty in accommodation)
Auditory( hearing loss, hype racists, tinnitus)

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6
Q

Shivering in normal delivering

A

Epidural: sufentamol 50 mcg, fentanyl 100mcg, or meperidine 25 mg / LA
Warming iv fluids——can decrease rate

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7
Q

Normal values from umbilical cord blood

A

ph/ Pco2/ PO2/ bicar (mEq/L)
Arterial: 7.25/50/20/22
Venous: 7.35/40/30/20

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8
Q

Severely depressed 3 kg term newborn

A

Clearing airway, drying and stimulating. If apneic, positive pressure ventilation (40 to 60 bpm) x 30 s, if HR<60, CPR: 1:3 breath: compression x 30s, if not improving, epi: 0.1 to 0.3 ml/kg of 1:10,000 solution. (ETT: 0.3 to 1ml/kg).
If need volum: 10ml/kg over 5-10 min, can repeat. If anemia: o- pRBC. If narcotic-induced, naloxone 0.1 mg/kg iv or im. If severe metabolic acidosis, but adequate ventilation, bicar: 2 mEq/kg, slow

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9
Q

NO naloxone

A

Newborn if mom addicted to narc, or on methadone maintenance,

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10
Q

PIH (pregnancy-induced HTN)

A

High: <20yo, twins, DM I, polyhydramnios, hydatidiform mole, high BMI
Low: smoking

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11
Q

Aortocaval syndrome

A

Vena cava: Hypotention, n/v, pallor, changes in cerebration

Aorta: decrease UBF

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12
Q

Cocaine abusing pregnant pt

A 
Urine + 24 to 72 hrs
Life threatening: GA>RA
Induction of GA: HTN
MAC: increase in acute; decrease in chronic
RA: risk of Hypotention
Ephedrine: not effective d/t depletion
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13
Q

Infiltration anesthesia

A

Emergency c/s, contra to GA &RA

LA: 100ml, 0.5% lidocaine or ?% chloroprocaine (NOT Bupivacaine)

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14
Q

Hypotention post SA or EA in pregnant pt

A
  1. LUD (left uterine displacement)
  2. Fluid
  3. Vasopressors: phenylephrine > ephedrine
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15
Q

Threatened abortion

A

Uterine bleating w/o cervical dilation before 20 weeks gestation

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16
Q

Inevitable abortion

A

Cervical dilation &/or ROM

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17
Q

Incomplete abortion

A

Partial expulsion of tissue

Need D&E

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18
Q

Epidural narcotics is antagonized by prior or concomitant ?

A

Chloroprocaine

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19
Q

Marcaine = sensorcaine = ?

A

Bupivacaine

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20
Q

Chirocaine

A

Levobupivacaine

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21
Q

Naropin

A

Ropivacaine

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22
Q

TNS (transient neurologic syndrome)

A 
SA w/ lidocaine ( xylocaine )
Back pain radiating to buttocks & legs
Post block resolve
No motor or sensory loss or EMG change
Resolve w/i 1 to 4 day typically
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23
Q

Prilocaine = citanest

A

Methemoglobinemia

24
Q

LMWH

A

Low dose: >12 hrs waiting for neuraxial techniques;
High fose: >24 hrs
If back pain + unexpecred neurologic paralysis–>work for hematoma.

25
Q

Chloroprocaine

A

Nesacaine
Ester-hydrolyzed by pseudocholinesterase
T1/2: 21 sec in maternal, 43 sec in fetal blood
in homozygous atypical cholinesterase: t1/2 = 2 min

26
Q

Horner’s syndrome post epidural Anesthesia

A

occasionally development even highest dermatome below T5

27
Q

preeclampsia

A

SBP>140 or DPB>90 plus proteinuria >300 mg /24 hr.
Usually >24 wks, unless hydatidiform mole
5-9% of pregancies
Higher: hydatidiform mole, multiple gestations, obesity, polyhydramnios or DM
If 1st pregancy w/ –>33% in subsequent pregnancies
Before EA: check Plt

28
Q

Mg

A 
1.5-2 mEq/L: Normal level
4 to 8 mEq/L: Therapeutic range
10 mEq/L: loss deep tendon reflexes
15 mEq/L: respiratory paralysis
>25 mEq/L: cardiac arrest
Note: 1 mEq/L = 1.2 mg/dl.
decrease release of Ach and sensitivity of motor endplate to ACh; Antagonist aplpha-adrenergic effect, antagonize NMDA receptor.
29
Q

normal FHR

A

120-160

30
Q

Leading direct cause of pregnancy related deaths in US

A

hypertensive disorders of pregancy

31
Q

side-effects of methylergonovine and hemabate

A

methylergonovine: HTN, bronchospasm (rarely)

hemabate (carboprost): bronchospasm

32
Q

P50 of Fetal hemoglobin at term

A

19-21 mmHg (note: in adult 27 mmHg)

33
Q

Side effects of beta-agonists (ritodrine, terbutaline)

A

tachycardia, hypOtension, myocardial ischemia, pulmonary edema, hypoxemia (inhibitiion of hypoxic pulmonary vasoconstriction), hyperglycemia, metabolic (lactic) acidosis, hypokalemia, anxiety, nervousness.

34
Q

CO

A 
1st trimester: increase to 30 to 40%
At term: 50%
Latent phase: another 10 to 15%
Active phase: 25 to 30%
Expulsive stage: 40 to 45%
Immediately after delivery: greatest increase (autotransfusion and increased venous return d/t uterine involution).
2 wks: back to nonpregnant value.
35
Q

GA induction in Emergent C/S

A

RSI: sevo not good for induction, versed too slow for induction, for mild asthma: ketamine, thiopental or propofol, but thiopental not for severe asthma (d/t release histamine). Ketamine not good for HTN.

36
Q

asthma for GETA

A

adequate GA before ETT

37
Q

UBF at term pregancy

A

700 to 900ml/min (i.e., >1 U blood /min)

50 to 100 ml/min before pregnancy

38
Q

HIV infected parturient

A
  1. EA, SA, CSE or blood patch: safe
  2. vertical transmission: untreated–>15 to 40%; treat + C/S–>2%
  3. Needlestick–>develop HIV 0.3% (HBV 30%, HCV 2 to 4 %).
  4. protease inhibitor—>(-)cytochrome P-450 –> prolong benzodiazepines and narcotics.
39
Q

At term

A
  1. No change: CVP, PCWP, PADP, LVESV
  2. Increase: LVEDV, SV, EF, HR, CO
  3. Decrease: SVR
40
Q

AFE (amniotic fluid embolism)

A
  1. acute hypoxemia: pulmonary edema, cyanosis
  2. hemodynamic collapse: severe hypotension, cardiopulmonary arrest
  3. coagulopathy
41
Q

Fetus: most susceptible to teratogenic agents

A

15 th to 56 th days (3 to 8 wks) of gestation <—organogenesis

42
Q

New born respiratory depression from chronic narcotic mother

A

controlled ventilation, but NOT naloxone <—acute withdrawal

43
Q

Respiratory in pregnancy

A
  1. Increase: MV, Vt, PaO2 (d/t fall in PaCO2), O2 consumption
  2. decrease: serum bicarb.
44
Q

Uterine

A
  1. Bartiturates: dose-dependent reduction in contraction
  2. Diazepam & N2O: no effect
  3. Ketamine: oxytocic during 2nd trimester, but NO at term
  4. LA: IV increase in tone, at high level—>tetanic
45
Q

Normal term fetus

A
  1. approx. 3 kg
  2. O2 consumption: 7 ml/kg/min–>21 ml/min
  3. O2 store: 42ml–>but d/t compensatory–>survive 10 min
46
Q

Parturient–>GA for no-obstetric surgery

A
  1. maternal safety
  2. avoid teratogenic: current anesthetic drugs OK
  3. avoid fetal asphyxia
  4. prevent induction of preterm labor: abd surgery
47
Q

MG (masthenia gravis)

A
  1. IgG vs ACh-R: only on skeletal muscle

2. Newborns: 10 to 20% affected maternal IgG metabolized.

48
Q

DIC

A 
placental abruption: MCC
dead fetus syndrome
AFE
G- sepsis
severe pregnancy-induced hypertension
Note: not placenta previa<--bleeding not induce coagulopathy.
50
Q

Eisenmenger’s syndrome–>epi in SA?

A
  1. Avoid increase PVR: hypercabia, acidosis, hypoxia
  2. Avoid decrease SVR:
  3. Narcotic-based analgesic: spinal or epidural
  4. CVP, A-line, evaluate shunt
  5. Caution with central LA: decrease pre and after load
  6. Avoid epi in EA or SA: decrease SVR or increase PVR.
51
Q

h/o c/s + current placenta previa

A

increase risk of placenta accrete—>emergency cesarean hysterectomy

52
Q

Neonatal brain damage

A

MC injury in ASA-closed claim project regarding OB anesthesia claims

53
Q

epidural morphine

A

slow onset (30 to 60 mim @7.5 mg); pruritus, N/V, drowsiness—>not routinely for labor epidural

54
Q

meconium-stained amniotic fluid

A

if vigorous (i.e., strong respiratory efforts, good muscle tone, HR>100)—->not treatment.

55
Q

Difficult airway + hypovolemic—>emergent C/S

A

infiltration local anesthetic

56
Q

Epinephrine in local anesthetics

A
  1. check for IV placement of epidural cath
  2. decrease vascular uptake of LA
  3. increase intensity and duration of block
    Note: more lipid-soluble the LA, more less effect
57
Q

LA + narcotic effets

A

meperidine

58
Q

diazepam

A

Not used in 1st trimester d/t unproven side effect on fetus

59
Q

I.t. opiates (morphine, fentanyl or sufentanil)

A
  1. very effective in relieving visceral pain in 1st stage

2. inadequate for 2nd stage.

Anesthesia (11 decks)

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