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OB (Wolfe Summer 24") > OB: Vaginal/C-Section and Complications (Mermigas) > Flashcards

OB: Vaginal/C-Section and Complications (Mermigas) Flashcards

1
Q

Stage 1 Labor:

A

-lower uterine segment/cervix

-T10-L1

Non-neuraxial = Paracervical

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2
Q

Stage 2 Labor :

A

-Pelvic Floor

Perineum: S2-S4

Non-neuraxial = Pudendal

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3
Q

Total coverage for labor analgesia =

A

T10-S4

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4
Q

Steps for Combined Spinal Epidural :

A
  1. get loss with epidural needle
  2. insert spinal needle
  3. dose spinal
  4. take needle out
  5. thread epidural catheter
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5
Q

Which ligament gives us loss?

A

Ligamentum Flavum

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6
Q

Order of spinal ligaments from superior to deep:

A
  1. Supraspinous ligament
  2. Interspinous ligament
  3. Ligamentum Flavum
  4. Posterior Longitudinal ligament
  5. Anterior Longitudinal ligament
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7
Q

Cranial border:

A

Foramen Magnum

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8
Q

Caudal Border:

A

Sacrococcygeal ligament

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9
Q

Anterior:

A

Posterior longitudinal ligament

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10
Q

Lateral Border:

A

Vertebral pedicles

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11
Q

Posterior Borders:

A

Ligamentum flavum and vertebral lamina

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12
Q

Site of Action for Local: Spinal

A

Subarachnoid space: myelinated preganglionic

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13
Q

Site of Action of Local: Epidural

A

Must diffuse through the Dural Cuff before –> Nerve Roots

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14
Q

Neuraxial Insertion for Epidural and Spinal:

A

L3-L4
Safest: below L2-L3

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15
Q

Where does the spinal cord end in adults?

A

L1-L2

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16
Q

How deep for epidural needle “engagement”?

A

Around 3cm

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17
Q

Average needle depth for Epidural?

A

around 5cm

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18
Q

If you get “loss” at 5cm you would add ____ for catheter.

A

Add another 5cm after loss for catheter

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19
Q

Higher risk of PDPH: Patient Factors

A

-younger age
-female
-pregnancy

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20
Q

Higher risk of PDPH: Practitioner Factors

A

-cutting tip needle
-larger diameter needle
-using air for LOR with epidural
-needle perpendicular to long-axis of the neuraxis

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21
Q

Lower Risk of PDPH: Patient factors

A

-older age
-male
-non-pregnant

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22
Q

Lower Risk of PDPH: Practitioner Factors

A

-Non-cutting tip needle
-smaller diameter needle
-using fluid for LOR with epidural
-needle parallel to long-axis of neurosis
-Continuous spinal catheter(if placed after wet tap)

23
Q

No effect on risk of PDPH:

A

-early ambulation
-continuous spinal catheter (if placed after spinal block)

24
Q

PDPH Treatment:

A

-Bed rest
-Caffeine
-NSAIDS
-Epidural Blood Patch

25
Q

Epidural Blood Patch:

A

Definitive treatment of PDPH (only way to be 100% sure)

10-20cc sterile blood injected into epidural space

26
Q

Simple test for PDPH

A

-If patient lies down and the headache goes away it is probably a PDPH.

27
Q

Presentation of Total Spinal:

A

Hypotension and Dyspnea!!

28
Q

CONTRAINDICATIONS TO NEURAXIAL:

A

-PATIENT REFUSAL
-COAGULOPATHY PLT <100,000
-INCREASED ICP (THINK TUMORS?)
-SEPSIS
-INFECTION AT SITE
-HYPOVOLEMIA (RELATIVE)
-FIXED VALVE LEISONS SEE BLOW
-AORTIC STENOSIS, SEVERE MITRAL STENOSIS

29
Q

What is NOT a contraindication for Neuraxial block?

A

-Back pain
-Previous back surgery
-Lower back tattoos

30
Q

Risks of non-OB surgery:

A

difficult airway
“full stomach” - 18 weeks!

31
Q

What is the highest risk of teratogenicity?

A

First trimester

32
Q

Highest risk for preterm delivery

A

Third trimester

33
Q

Best time for non-OB surgery

A

2nd trimester (ideally delayed until 2-6 weeks after delivery)

34
Q

SAFE SEDATION GUIDELINES

A

-Early pregnancy up to 17 weeks
-Avoid Midazolam
-Use propofol and opioids

35
Q

Best procedures for spinal anesthesia for OB pts.

Dosing for spinal?

A

-Ortho cases (broken ankles
-kidney stones, stents etc.

-Small dose spinal!
1.0 cc of bupivicaine

36
Q

GI meds for 18-20 weeks OB surgery (full stomach!)

A

-non particulate antacid (sodium citrate 15-30 mins within induction)

-H2 antagonist (ranitidine 1 hr before induction)

Gastro pro kinetic agent (Reglan) 1 hr before induction

37
Q

RSI past _____ weeks

A

18

38
Q

ETT size and why?

A

6.0-7.0 ETT for ENGORGEMENT

39
Q

LUD (left uterine displacement)

A

15-30 degrees to left

40
Q

Other OB anesthesia considerations

A

-TIVA w/ propofol (uterine blood flow)
-Gas is also sage
-Avoid N20 (not well studied)
AVOID MIDAZOLAM

41
Q

Meds OK to use for parturient

A

opioids, muscle relaxants, inhaled agents (except N20)

42
Q

Condition O considerations:

A

-Case by case- avoid general anesthesia typically

-Can patient sit for spinal?

-Existing epidural?

43
Q

Dosing for Condition O epidural

A

20cc 2% lido w/ 1:200k epi

44
Q

Most common cause of maternal death in General Anesthesia (C-section)
-Prevention?

A

AIRWAY!

-Need experienced provider, Glidescope/McGrath

-Aspiration prophylaxis and LUD

45
Q

Induction guidelines for General w/ C-section:

A

PREP AND DRAPE BEFORE ANY DRUGS ARE PUSHED!!!!

PREOXYGENATE DURING THIS TIME

SILENT ROOM DURING INDUCTION

Anesthesia team will confirm end tidal and direct surgical team to make incision

Incision SHOULD NOT BE MADE UNTIL ANESTHESIA CONFIRMS END TIDAL AND SECURE AIRWAY.

46
Q

Meds for AFTER baby is delivered in General w/ C-section

A

-pitocin
-opioids
-midazolam

47
Q

VEAL CHOP

A

Variable deceleration
Early deceleration
Accelration
Late acceleration

Cord Compression
Head compression
Okay!
Placental insufficiency

48
Q

VEAL CHOP

A
49
Q

Contraindication for neuraxial

A

coagulopathy

50
Q

Why/When for C-section

A

FHR/tracing issues (think back to VEAL CHOP- THIS IS ON BOARDS/SEE EXAM)

Maternal hemorrhage

coagulopathy/contraindication to neuraxial

Patient does not want neuraxial

51
Q

Meds that Do Not cross placenta

A

Neuromuscular blockers

Glycopyrolate

Heparin

Insulin

52
Q

Meds that DO cross placenta

A

LOCALS except chloroprocaine**— WHY???

opioids, Benzos

Atropine

Beta blockers

Magnesium (not lipophilic but its small

53
Q

Drugs that favor transfer to placenta (characteristics)

A

-low molecular weight
-high lipid solubility
-non ionized

OB (Wolfe Summer 24") (3 decks)

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