OB/Pediatrics Exam Flashcards
In the United States, the leading cause of maternal death associated with a live birth is:
Pulmonary Embolism (21%)
In the United States, the SECOND leading cause of maternal death associated with a live birth is:
Pregnancy Induced Hypertension (19%)
In the United States, the THIRD leading cause of maternal death associated with a live birth is:
Other medical causes (17%)
On a per kilogram basis, ventilatory parameters that remain unchanged from birth through adulthood include:
Dead space
What are the 2 ventilatory parameters that remains UNCHANGED from birth through adulthood?
Tidal volume
Dead space
Well-oxygenated fetal blood from the placenta has a PaO2 of approximately:
40 mmHg
During a normal pregnancy, umbilical vein blood has a PaO2 of approximately
40 mmHg.
A preterm (33 week gestation) neonate is delivered emergently by cesarean section. The baby shows tachypnea, grunting, intercostal retractions and is cyanotic. The most likely cause of the cyanosis is:
insufficient surfactant production
Signs of Insufficient surfactant production are
Tachypnea
Grunting
Intercostal retractions
Cyanosis
The most common cause of respiratory distress in preterm neonates is the
Respiratory distress syndrome (RDS) also known as hyaline membrane disease.
What is hyaline Membrane disease?
Respiratory distress syndrome in preterm neonates
The syndrome is responsible for 50 - 75% of deaths in preterm neonates
Respiratory distress syndrome or HYALINE membrane disease
What is Respiratory distress syndrome (aka Hyaline membrane disease)
It is the result of deficient production and secretion of surfactant, which is produced by type II pneumocytes.
In neonates, mature levels of surfactant are not present
until 35 weeks of gestation.
Surfactant are produced by what type of cells?
Type II pneumocytes
Electrocardiographic changes associated with the third trimester of pregnancy include:2 changes
left axis deviation and T wave changes
Left axis deviation is associated with when in pregnancy?
3rd trimester.
ECG changes with pregnancy are
Elevation of the diaphragm shifts the heart position in the chest resulting in the appearance of an enlarged heart on a plain chest film and in left axis deviation and T wave changes on the electrocardiogram.
Seen with pregnancy on XRAY?
Enlarged heart
After delivery of a 4.0 kg neonate recurrent bradycardia is noted. An umbilical artery catheter is placed at which time the neonate becomes asystolic. An appropriate dose of epinephrine would be:
Epinephrine 0.01 - 0.03 mg/kg is indicated for neonatal bradycardia (< 60 bpm) and asystole. This is usually delivered as a 1:10,000 solution.
Epinephrine for neonatal bradycardia which is
< 60bpm
What is the concentration of epinephrine for neonates?
1: 10,000 solution
The most common morbidity encountered in OBSTETRICS is:
severe hemorrhage
The most common morbidities encountered in obstetrics are
severe hemorrhage (6.9/1000) severe preeclampsia (3.9/1000).
9-year-old patient with a history of cerebral palsy is scheduled for release of contractures of the Achilles tendons. The patient is receiving phenytoin for control of seizures. Anesthetic considerations in this patient include:
the likelihood of gastroesophageal reflux disease
Cerebral palsy common scheduled surgeries include
Release of contractures of the Achilles tendons.
Management of anesthesia in children with cerebral palsy includes
tracheal intubation because of the propensity for GERD and poor function of laryngeal and pharyngeal reflexes.
2 reasons why CP patients should have tracheal intubation>
Poor function of laryngeal and pharyngeal reflexes
Propensity for GERD.
Is there an increase in the incidence of MH in CP patients
NO
Is it safe to use Volatile anesthetics in CP patients.?
Yes
CP patients on anticonvulsants and anesthetic considerations?
If they are receiving anticonvulsants they may be more resistants to the effects of nondepolarizing relaxants.
CP and muscles exhibits
Skeletal muscle spasticity
Does succinylcholine release abnormal potassium in Cerebral palsy patients?
No, it does not.
You are asked to evaluate 31-year-old G3P2 woman for a repeat cesarean section. Her past medical history is significant for 2 previous cesarean sections. She has been laboring for the previous 7 hours with little progress despite an oxytocin infusion. During the interview, the patient complains of SUDDEN SEVERE continuous abdominal pain radiating to her left shoulder. These symptoms are most consistent with:
uterine rupture
Signs and symptoms of Uterine rupture
Sudden, severe continuous abdominal pain radiating to Left SHOULDER.
Why do patients with uterine rupture pain have pain that radiates to their left shoulders?
Because of subdiaphragmatic irritation by intra-abdominal blood.
Uterine rupture is associated with
Uterine scars
Excessive OXYTOCIN stimulation
Current recommendations for VBAC
Discourage VBAC in women with 2 or more previous uterine incisions.
As compared to regional anesthesia, the risk of maternal death from general anesthesia is approximately:
sixteen times greater
Maternal mortality from general anesthesia is approximately. In comparison,
pg. 892
32 per 1,000,000 live births
Mortality from Regional anesthesia is only
1.9 per 1,000,000 live births.
In the fetus, blood entering the right atrium from the inferior vena cava is preferentially directed to the:
foramen ovale
Right atrial anatomy preferentially directs blood from the inferior vena cava through
the foramen ovale into the left atrium.
Functional residual capacity is decreased in the neonate as a result of:
decreased lung compliance and increased chest wall compliance
FRC in the neonate is
Decreased
What reduces lung compliance in neonates and infants?
The small and limited number of alveoli in neonates and infants
What makes chest wall compliant in neonates and infants?
their cartilaginous rib cage makes their chest wall very compliant.
The combination of these two characteristics (decreased lung compliance and increased chest wall complicance ) promotes
chest wall collapse during inspiration and relatively low residual lung volumes at expiration.
Of the following, the lowest degree of placental drug transfer occurs with the use of what local anesthetic?
chloroprocaine
Why does CHLOROPROCAINE has the least amount of placental transfer,?
Because it is rapidly broken down by plasma cholinesterase in the maternal circulation.
Post-intubation laryngotracheobronchitis (croup) is most commonly seen in children of:
1 - 4 years of age
What causes Laryngotracheobronchitis (croup)?
Glottic or tracheal edema.
Factors associated with Laryngotracheobronchitis (croup ?
Repeated intubation attempts Large ET tubes Prolonged surgery Head and neck surgery Excessive movement of the ET tube.
Treatment of Laryngotracheobronchitis (croup) is
Nebulized racemic epinephrine.
Renal changes seen during pregnancy include a reduction in:
The tubular threshold for glucose and amino acids
Renal vasodilation leads to ______RBF; _____GFR; _______Renal plasma flow
increases renal blood flow, glomerular filtration and renal plasma flow.
What happens to renin during pregnancy?.
Increases
What happens to aldosterone levels during pregnancy?
Increases
During pregnancy; Increased renin and aldosterone levels promote
sodium retention
In pregnancy, A decreased renal tubular threshold for glucose and amino acids is common and often results in
mild glycosuria or proteinuria.
The appropriate endotracheal tube diameter for a full-term neonate is approximately:
3.0 mm
For pediatric patients, the appropriate diameter of the endotracheal tube can be estimated by the formula:
Tube diameter = 4 + (age/4)
Excepttion for ET tube formula is
Premature neonates (2.5 - 3.0 mm) and full-term neonates (3.0 - 3.5 mm).
Premature neonates tube diameter is
2.5-3.0mm
Full term neonates tube diameter is
3.0-3.5mm
Pain during the latent phase of labor is usually confined to dermatomes:
T11 - T12
Pain during the first stage of labor is mostly resulting from uterine contractions and cervical dilatationduring the latent phase,
visceral pain
Pain during the first stage of labor is mostly visceral resulting from
uterine contractions and cervical dilatation.
Pain during the first stage of labor is mostly visceral initially confined to the
T11 - T12 dermatomes
Pain during the first stage of labor is mostly visceral initially confined to the T11-T12 during what phase?
Latent phase
Pain during the first stage of labor involves T11-T2 but eventually involves ______During what phase______?
The T1- - L1 dermatomes as the labor enters the active phase.
A 12-year-old patient is scheduled for an excision of a sellar craniopharyngioma. Suspected preoperative laboratory abnormalities in this patient include:
hypernatremia
What is the most common intracranial tumor of NON-GLIAL origin in the pediatric population?
Craniopharyngioma
Craniopharyngioma tumors can affect ______therefore what is common?
Pituitary; endocrine dysfunction is common
Intracranial tumor of non glial origin such as craniopharyngioma should put the anesthetist on alert for possible other dysfunction such as
Secondary hypothyroidism
Growth hormone deficiency
Secondary hypocortisolism
Diabetes insipidus
Diabetes insipidous can present preoperatively as
Hypernatremia
Post intracranial tumor surgery, DI may be seen when and why ?
4-6 hours post op due to surgical damage to the pituitary.
A 34-year-old patient presents to the emergency room in labor with contractions occurring every 4 minutes. She is at 32 weeks of gestation. Pharmacologic inhibition of uterine contractions can be accomplished with:
intravenous ritodrine therapy
What are 3 most commonly used tocolytics?
β2-agonists (ritodrine or terbutaline) and magnesium.
2 Beta agonists tocolytics?
Terbutaline
Ritodrine
May be given to induce fetal production of surfactant, it
Betamethasone
Not effective as a tocolytic agent.
Betamethasone
More recently, this medication has show effectiveness in patients of greater than 28 weeks gestation.
oxytocin antagonist, atosiban,
At 20 weeks’ gestation, frequently found changes in heart sounds include:
presence of a third heart sound
What can cause a split 1st heart sound during pregancny?
Early closure of the mitral valve may cause a split first heart sound.
During pregnancy, early closure of the mitral valve may cause a
Split 1st Heart sound
A third heart sound can be heard in most women by
20 weeks’ gestation.
Common heart murmur in pregnancy ?.
A benign grade I or II systolic murmur is also common
Pathologic during pregnancy are
Diastolic murmurs are pathologic.
As compared to the non-pregnant patient, the incidence of pulmonary aspiration of gastric contents in the obstetric patient is:
4 - 5 times greater
Pulmonary aspiration of gastric contents is 4 - 5 times greater in the obstetric patient with an incidence of
1:400 - 500 as compared to an incidence of 1:2000 in the non-pregnant patient
The position of the larynx in the neonate is at approximately:
C4
Neonates and infants have : (Comment on heads, tongue) laryn
proportionately larger head and tongue, a long epiglottis and a short trachea.
Neonates and infants have (comment on larynx and nasal passageways)
narrow nasal passages, an anterior and cephalad larynx (at vertebral level C4 versus C6 in adults),
Neonates and infants have (comment on Epiglottis and trachea)
a long epiglottis and a short trachea.
Clinically significant placental drug transfer has NOT been shown to occur with the use of:
glycopyrrolate
Anesthetic adjuncts and placenta?
Most commonly used anesthetic adjuncts readily cross the placenta
Maternally administered ecross the placenta in clinically signifcant amounts.(LEEVAMAPS)
Labetalol Esmolol Ephedrine Vasodilators Antihistamine Metoclopramide Atropine Phenothiazines Scopolamine
Glycopyrrolate Does not cross placenta why?
quaternary ammonium structure, results in only limited placental transfer.
A 38-postconception week neonate is scheduled for an emergent repair of an incarcerated inguinal hernia. The patient was delivered at 34 weeks of gestation. Anesthetic management of this patient should include:
maintenance of oxygen saturation between 89 - 94%
In this preterm neonate (Delivered at 34 weeks gestation) there exists a substantial risk for the development of
retinopathy of prematurity.
Because the optimal intraoperative oxygen saturation for these infants (premature infants) is not known, it is prudent to
limit oxygen supplementation during the period of retinal vascularization (up to 44 weeks postconception).
For premature infants, efforts should be made to maintain PaO2 and PaCO2 and pulse ox at what levels?
PaO2 between 50 - 80 mmHg and PaCO2 between 35 - 45 mmHg. This results in a pulse oximetry target of 89 - 94%.
Pulmonary aspiration during the induction of general anesthesia in the pregnant patient is more likely as a result of:
placental gastrin secretion
Why is the GastroEsophateal sphincter incompetent during pregnancy?
Upward and anterior displacement of the stomach by the uterus promotes incompetence of the GE sphincter.
What reduces the TONE of the Gastroesophageal sphincter during pregnancy?
Elevated progesterone levels reduce the tone of the GE sphincter.
What causes hypersecretion of GASTRIC acid during pregancy?
Placental gastrin secretion causes hypersecretion of gastric acid.
What pressure remains UNCHANGED during pregnancy in the GI system?
Intragastric pressure is unchanged during pregnancy.
What is more likely during the induction of general anesthesia in the pregnant patient ?
Pulmonary aspiration
A 10-kg child is scheduled for a resection of a skin lesion of the right thigh. The anesthetic plan calls for the use of a laryngeal mask airway. The appropriate size of the LMA for this patient is:
2
Age : infant, weight < 6.5kg LMA size is
1
LMA size 1 cuff volume is
2-4mL
Age :child, weight 6.5k - 20 Kg LMA size is
2
Age: small adutl >10 Kg LMA size is
3
LMA size 2 cuff volume is
Up to 10 mL
LMA size 3 for who
Small Adult > 30kg
LMA size 3 cuff volume is
up to 20ml
LMA size 4 for who
Adult less than 70kg
LMA size 4 and 5 cuff volume is
up to 30 ml
LMA size 5 for who??
Adult > 70 kg
Morphine is infrequently used as an analgesic during labor because at
equianalgesic doses it appears to cause: a higher incidence of fetal respiratory depression as compared to fentanyl
Seldom used for maternal analgesia because in equi-analgesic doses it appears to cause greater respiratory depression in the fetus than meperidine or fentanyl.
Morphine
Factors complicating the airway management in the patient with trisomy 21 include:
occipitoatlantoaxial instability
What Is the most common human chromosomal syndrome?
Trisomy 21 or Down syndrome
Airway management in Trisomy 21 (Down syndrome ) these patients can be difficult due to
Maminamu
macroglossia
micrognathia
narrow hypopharynx
muscular hypotonia.
Risk with spinal cord with trisomy 21 Down syndrome patients?
There is also a risk of spinal cord compression due to occipitoatlantoaxial instability.
2 MAIN Pathophysiologic events associated with preeclampsia include:
A production imbalance between prostacyclin and thromboxane A2
Pregnancy-induced hypertension (PIH) encompasses a range of disorders, including
Gestational hypertension
Preeclampsia and
Eclampsia.
Three principal mechanisms serve as the etiology of PIH
PIA
Placental vasculitis
Imbalance in the production of vasoactive prostaglandins (thromboxane A2 and prostacyclin).
Abnormal sensitivity of vascular smooth muscle to catecholamines
At term, maternal plasma volume has:
increased by approximately 50%
Maternal blood volume increases to between
85 and 100 ml/kg at term.
Maternal: Increases occur in both
plasma volume (50%) and Blood cell mass and (up to 20%).
Why is there dilutional anemia ?
Because the increase in plasma volume is greater, a relative dilutional anemia occurs.
Treatment of cardiac toxicity secondary to unintentional intravascular bupivacaine injection should include:
. The use of calcium channel blockers is not recommended. The administration of a 20% lipid solution at an initial dose of 4 mL/kg has been found to improve survival.
the administration of a 20% lipid solution
Cardiac toxicity from bupivacaine may be difficult to treat. What should be immediately instituted?
Hyperventilation with oxygen
With LA cardiac toxicity, Ventricular dysrhythmias may need large and multiple doses of
electrical cardioversion, epinephrine, vasopressin and amiodarone
What medication is not recommended when treating Cardiac toxicity associated with LA?
Calcium channel blockers
LA cardiotoxicity what has been found to improve survival?
20% lipid solution at an initial dose of 4ml/kg
In children under 5 years of age, the narrowest point of the airway is the:
cricoid cartilage
In the adult, the narrowest point of the airway is
the glottis.
In the parturient, uterine hypertonus has been associated with the use of large induction doses of:
ketamine
Ketamine in the parturient has been associated with
Uterine Hypertonus
Uterine hypertonus may occur with ketamine at doses
> 2 mg/kg.
Has been reported after the intravenous administration of drugs to neonates which contain the preservative benzyl alcohol
Kernicterus
Kernicterus has been reported after the intravenous administration of drugs to neonates which contain the preservative:
benzyl alcohol
Benzyl alcohol has been implicated in causing kernicterus how?
By displacing bilirubin from albumin and facilitating its entry into the brain
Can contain benzyl alcohol and should be avoided in the neonate.
Certain preparations of propofol and normal saline flush
Certain preparations of propofol and normal saline flush can contain benzyl alcohol and should be avoided in what population?
in the neonate.
At term, pseudocholinesterase activity is:
decreased by 30%
A 25 - 30% decrease in serum pseudocholinesterase activity is present at term, but
rarely produces significant prolongation in the action of succinylcholine.
A 12-kg child is scheduled for repair of an inguinal hernia. The patient had an upper respiratory infection 2 weeks ago, but now has full resolution of symptoms. At this time, this patient is at
increased perioperative risk for: all of the above
A viral infection within 2 - 4 weeks before general anesthesia and endotracheal intubation appears to place the child at risk for perioperative pulmonary complications such as (BLAH)
Bronchospasm (10 fold)
Laryngospasm (5 fold),
Atelectasis.
Hypoxia
Nonsteroidal antiinflammatory agents, such as ketorloac, are not recommended as analgesics during labor because they are associated with:
suppression of uterine contractions
Are not recommended as analgesics during labor
Nonsteroidal antiinflammatory agents, such as ketorloac
Nonsteroidal antiinflammatory agents are not recommended because they suppress uterine contractions and
promote closure of the fetal ductus arteriosus.
Treacher-Collins syndrome: is often associated with. These patients present extreme difficulty with airway management and facilities for surgical airway placement should be part of the anesthetic plan.
other craniofacial abnormalities such as cleft palate
Is the most common of the mandibulofacial dysostoses.
Treacher-Collins syndrome
Inheritance of TREACHER-COLLINS syndrome is as an
autosomal dominant trait.
TREACHER COLLINS what Can result in early airway problems?
Hypoplasia of the mandible with posterior displacement of the tongue (glossoptosis)
Treacher-Collins syndrome is associated with CVOG
Cleft palate
Ventricular septal defect
Ossicular chain
Gross deformities of the external ear canals
TREACHER COLLINS These patients present
extreme difficulty with airway management and facilities for surgical airway placement should be part of the anesthetic plan.
In the patient with pregnancy-induced hypertension, epidural analgesia during labor has been associated with:
improved uteroplacental blood flow
Epidural analgesia is the preferred technique for labor analgesia in the patient with PIH if not contraindicated by
coagulopathy.
Is the preferred technique for labor analgesia in the patient with PIH
Epidural analgesia
Why is epidural anesthesia good for PIH? (for MOM)
Epidural analgesia reduces maternal catecholamine levels and facilitates blood pressure control.
Why is epidural anesthesia good for PIH? (for fetus)
Epidural analgesia improves intervillous blood flow thus improving uteroplacental performance and fetal well-being.
At term, maternal red cell mass has
increased by up to 20%
You are asked to evaluate a 28-year-old female complaining of a headache following an uneventful vaginal delivery with continuous epidural analgesia. Likely causes for the headache include:
the injection of significant amounts of air during epidural placement
Frequently follows unintentional subdural puncture in parturients.
Headache
However, a self-limited headache may occur without dural puncture; in such instances, what is the possible cause?
injection of significant amounts of air into the epidural space may be responsible.
In neonates and infants, variations in cardiac output are largely the result of changes in
Heart rate
Stroke volume with infants?
Is relatively fixed by a noncompliant and poorly developed left ventricle in neonates and infants.
The cardiac output for infants is
very dependent on heart rate.
INFANTS: sympathetic nervous system and baroreceptor reflexes
sympathetic nervous system and baroreceptor reflexes are not fully mature and less able to compensate for changes in blood pressure
The beginning of the second stage of labor is defined by:
the presence of full cervical dilatation
The second stage begins with full cervical dilatation, is characterized by
fetal descent, and ends with complete delivery of the fetus.
The most common metabolic abnormality in the neonate is:
hypoglycemia
What are the important factors in the newborn’s susceptibility to hypoglycemia?
Inadequate glycogen stores and deficient gluconeogenesis
The incidence of newborn HYPOGLYCEMIA is highest in
small-for-gestational age neonates and in neonates of diabetic mothers.
During pregnancy, the level of which of the following clotting factors may be decreased?
XI
Pregnancy is associated with a
hypercoagulable state.
What increases in pregnancy as far as factors?
Fibrinogen and factors VII, VIII, IX, X and XII concentrations all increase;
The only factor that decreases with pregnancy is
only factor XI may decrease.
An 8-kg infant is to receive general anesthesia with endotracheal intubation. Current recommendations concerning the preoperative fasting of this patient include: for breast milk?
breast milk may be given up to 4 hours prior to surgery
Current fasting recommendations for children include: Solids,, and clear liquids
are prohibited within 6 - 8 hours of surgery
Current fasting recommendations for children include: Formula?
formula within 6 hours
Current fasting recommendations for children include: breast milk
breast milk within 4 hours
Current fasting recommendations for children include: Clear liquids?
within 2 hours of surgery.
Pain relief during the second stage of labor requires neural blockade from
T10 to: S4
Sensory innervation of the perineum is provided by
the pudendal nerve (S2 - S4)
Pain during the second stage of labor involves the
T10 - S4 dermatomes.
An increased incidence of malignant hyperthermia is seen in children with:
central core disease
Linkage of MH with other diseases has been problematic: only central core disease appears to be truly linked. In Duchenne’s muscular dystrophy, the balance of opinion has shifted from.
an association with MH to an anesthesia-induced rhabdomyolysis
2 central core diseases that are not associated with an increased incidence of MH
Cerebral palsy and malignant neuroleptic syndrome
May mimic MH and is part of the differential diagnosis.
malignant neuroleptic syndrome
Maternal mortality associated with amniotic fluid embolism is:
> 80%
Even with immediate and aggressive treatment, mortality due to amniotic fluid embolism remains
higher than 80%.
At term, commonly found changes in maternal blood pressure include:
little change in systolic pressure with decreased diastolic pressure
Overall, at term, systolic blood pressure changes little. what happens to MAP and pulse pressure?
decrease in diastolic blood pressure of 15 mmHg may occur resulting in a decrease in mean pressure and an increase in pulse pressure.
You are called to deliver anesthesia for an emergent cesarean section in a 28-year-old, 100-kg female with umbilical cord prolapse. After intravenous induction, several attempts at endotracheal intubation are unsuccessful. The most appropriate management at this time should include:
placement of an LMA while maintaining cricoid pressure
In the face of severe fetal distress, what is indicated?
general anesthesia is indicated.
With emergent C-section, If initial attempts at intubation fail,
ventilation should be attempted with either the face mask or LMA, while continuing cricoid pressure.
Intraoperative heat loss is greater in _____than ____why?
neonates versus adults as a result of: a larger surface to core ratio in the neonate
Pediatric patients have a_____ surface area per kilogram than adults.
larger
Contribute to greater heat loss in the neonate.
Thinner skin and a lower fat content
Not an important method of thermogenesis in the neonate
Shivering
The greatest strain on the maternal heart occurs:
immediately after delivery
The greatest strain on the heart occurs immediately after deilvery, why?
Intense uterine contraction and involution suddenly relieve inferior vena caval obstruction and increase cardiac output as much as 80% above pre-labor values.
Upon delivery of a 3.2 kg male, the neonate is noted be cyanotic, with a scaphoid abdomen. Auscultation of the chest reveals bowel sounds in the left hemithorax. Management of this infant should include:
decompression of the stomach with a orogastric tube
Administration of oxygen
Neonate’s signs and symptoms are consistent with congenital diaphragmatic hernia.
Cyanosis
SCAPHOID ABDOMEN
BOWEL SOUNDS in Left hemithorax.
Neonate’s signs and symptoms are consistent with congenital diaphragmatic hernia, what should be avoided?
Positive pressure by mask should be avoided as it may cause stomach distention and further compromise pulmonary function.
Neonate’s signs and symptoms are consistent with congenital diaphragmatic hernia, what should be performed to manage airway? WHat should the airway pressure be?
Awake intubation should be performed, but positive airway pressures should not exceed 25 - 30 mmHg as it can precipitate damage to the normal lung and pneumothorax.
During pregnancy, the level of which of the following hormones steadily increases?
insulin
Pregnancy is a _______as far as endocrine system goes?
diabetogenic
Although it is common for the thyroid gland to become hypertrophied during pregnancy, what remains normal?
Levels of free T4, free T3 and TSH remain normal.
In children with right-to-left intracardiac shunting, inhalation induction is expected to be:
slower than in healthy children
A right-to-left shunt and VA
slows the inhaled induction of anesthesia because anesthetic concentration in the arterial blood increases more slowly.
A left-to-right shunt
has little effect since the decreased delivery of anesthetic to the target tissues negates the increased uptake with this type of shunt.
The administration of a β2 stimulant to the laboring parturient will cause:
a decrease in uterine tone
Uterine muscle and receptors.
Uterine muscle has both α- and β-receptors.
Uterine receptors stimulation and responses.
α1-Receptor stimulation causes uterine contraction, whereas β2-receptor stimulation produces relaxation..
The most common congenital cardiac abnormality in infants and children is:
ventricular septal defect
Ventricular septal defect is the most common congenital cardiac abnormality, constituting approximately
35% of all congenital cardiac abnormalities.
A 26-year-old female with a history of mitral stenosis is in labor. Beneficial effects of epidural analgesia in this patient include:
reduced incidence of pain-induced maternal tachycardia
the most common type of cardiac valvular defect seen in pregnant patients
Mitral stenosis
Epidural analgesia during labor and delivery reduce pain-induced tachycardia allowing______. What shoud be done to manage heart volume ?
more time for left ventricular filling. Preload should be maintained and causes of pulmonary vasoconstriction (hypoxia) should be avoided.
At term, the MAC of inhaled anesthetic agents is:
decreased by approximately 40%
MAC and pregnancy
The MAC progressively decreases during pregnancy - at term by as much as 40% - for all general anesthetic agents.
When does MAC return to NORMAL after delivery?
MAC returns to normal by the third day after delivery.
Breech presentations are associated with
are associated with an increased incidence of cord prolapse
Breech presentations complicate 3 - 4% of deliveries and significantly
increase both maternal and fetal morbidity and mortality rates.
Breech presentation also increases the incidence of
cord prolapse to 10%.
A 3.2-kg term neonate is scheduled for a pyloromyotomy. The estimated blood volume of this neonate is approximately:
280 mL
Full-term neonates have a blood volume of
85 - 90 mL/kg.
Low dose ( < 0.75 MAC) of volatile anesthetic agent has been shown to:
cause little change in the effects of oxytocin on the uterus
Low dose ( < 0.75 MAC) of volatile anesthetic agent has been shown to:
Cause little change in the effects of oxytocin on the uterus
VA doses that do not interfere with the effect of oxytocin on the uterus.
Low doses (< 0.75 MAC) of these agents,
Higher doses of VA can result in
uterine atony and increase blood loss at delivery.
Nitrous oxide and uterine effects
Nitrous oxide has minimal if any effects.
The most common form of tracheoesophageal fistula consists of:
a blind upper esophageal pouch with a fistula between the trachea and distal esophagus (Type III B)
Anesthetic management of TEF ideally consists of an
awake intubation with placement of the ETT distal to the fistula, but above the carina.
MOST COMMON TEF:
Approximately 86% of tracheoesophageal fistulas are of Type III B,
At term, uterine blood flow represents approximately:_____of the CO
10% of the cardiac output
At term, uterine blood flow represents approximately:_____of the CO
10% of the cardiac output
CO at term and
There is an increase in cardiac output of approximately 40% at term
CO and Uterine blood flow
about 10% or 600 - 700 mL/min represents the uterine blood flow.
In order to maintain euglycemia, in the neonate, it is recommended that intravenous fluid therapy include glucose infused at a rate
3 - 5 mg/kg/min
Neonates require________ glucose infusion to maintain euglycemia;
3 - 5 mg/kg/min
Premature neonates require________Glucose infusion to maintain euglycemia.
5 - 6 mg/kg/min.
In contrast to the single-hole epidural catheter, the multiholed catheter: is associated with
a lower incidence of unilateral block
Use of a multiholed catheter appears to be associated with fewer unilateral blocks and
greatly reduces the incidence of false-negative aspiration for intravascular catheter placement.
Advancing a multiholed catheter to where?
7 - 8 cm into the epidural space appears to be optimal for obtaining adequate sensory levels.
Hypercyanotic attacks associated with the tetralogy of Fallot are best treated with:
W
phenylephrine
Treatment of hypercyanotic attacks is influenced by the cause of the
pulmonary outflow obstruction.
When symptoms reflect a dynamic infundibular obstruction what is the best treatment?.
beta-blockers are appropriate treatmen
For dynamic infundibular obstruction, If the cause is decreased systemic vascular resistance, treatment is_____what should not be used?
Intravenous fluids and/or phenylephrine. Sympathomimetic drugs with β-agonistic properties or vasodilators should not be used.
In the absence of drug administration, sustained decreased baseline variability in the fetal heart rate suggests:
fetal distress
Fetal heart rate varies
5 to 20 bpm in the normal fetus.
Fetal distress due to arterial hypoxemia, acidosis or CNS damage is associated with
minimal to absent beat-to-beat variability.
Fetal distress associated with absent beat to beat variabiliyt
Arterial Hypoxemia
Acidosis
CNS damage.
Obstruction of the inferior vena cava by the enlarging uterus results in:
decreased spinal cerebrospinal fluid volume
Obstruction of the inferior vena cava by the enlarging uterus.
distends the epidural venous plexus and increases epidural blood volume
What are the three major effects of INCREASES Epidural blood volume:
(1) decreased CSF volume
(2) decreased potential volume of the epidural space and (3) increased epidural space pressure.
During pregnancy, The MAC requirements generally begins to decrease by the
8th or 10th week of pregnancy. Pregnant patients are also more sensitive to local anesthetics. In general, the dose of any local anesthetic should be reduced by about 25% at any stage of pregnancy. A supine patient should be placed in left lateral tilt to avoid supine hypotensive syndrome.
