Obs Anesthesia

Question 1

Epidural is CI in:

Answer 1

1) coagulopathies
2) AS
2) spinal surgeries

Question 2

Bupivacaine (morcaine)S.E.:

Answer 2

• angina pain

-

Question 3

analgesia for pain relief during labour:

Answer 3

Parenteral opioids, such as fentanyl, diamorphine, are recommended options for healthy pregnant women requesting pain relief during labour.

Question 4

Pethidine and labor !

Answer 4

Despite being widely available and used, pethidine is not the preferred opioid option, as shorter-acting opioids tend to have fewer undesirable side-effects.

Question 5

potential side-effects of opioids

Answer 5

maternal drowsiness, nausea and vomiting, and neonatal respiratory depression.

Question 6

Opioids-alternative pain relief options like

Answer 6

paracetamol+ NSAIDS

Question 7

Pethidine toxicity:

Answer 7

• Not reversed by naloxone like other opioids !

- similar to labor s&s tachy and hypertension !!!

Question 8

The GDG agreed that for women who suffer from current or previous opioid addiction, non-opioid methods of pain relief are preferred.

Answer 8

You can see such cases in sickler cases who are over treated !

Question 9

two accepted methods for performing a para-vaginal pudendal block.

Answer 9

1- Position your index finger on the ischial spine and run the needle guard in between your index and middle fingers. Place the end of the needle guard 1 cm posterior and medial to the ischial spine.
2- Position your middle finger on the ischial spine and run the needle guard in between your index and middle fingers. Place the end of the needle guard 1 cm anterior and medial to the ischial spine.

Question 10

Level of Anesthesia in CS

Answer 10

T4

Question 11

Parental agent anesthesia used in labor

Answer 11

Meperidine 50- 100 mg + promethazine (phenergan) 25 mg
Butophanol 1-2 mg IV (causes transient sinusoidal pattern)
Nalbuphine 10-20 mg IV or IM or SC (small doses can be used in cases of pruritus associated with neuroaxial opiods)
Fantanyl 50-100 mcg IV (short acting requires frequent dosing or IV infusion pump)
Remifentanyl (reported to cause maternal apnea)

Question 12

immediate actions Taken if there is High or total spinal Blockade

Answer 12

1 - Left uterine Displacement
2- Effective ventilation ( tracheal intubation)
3- IVF+ Vasopressors

Question 13

Absolute contraindications of neuroaxial analgesia

Answer 13

1) maternal coagulopathy
2) thrombocytopenia (variously defined)
3) LMWH within 12 hrs
4) untreated maternal bacteraemia
5) skin infection over site of needle placement
6) increased ICP due to mass lesion
7) obstetrical complications associated with maternal hypovolemia and hypotension like severe hge

Question 14

Complete analgesia for labor and vaginal delivery pain necessitate block form T(?) To S(?) While Cesarean from T(?) To S(?)

Answer 14

Complete analgesia for labor and vaginal delivery pain necessitate block form T10 To S5 While Cesarean from T4 To S1

Question 15

Pain during labor results from: (afferent nerve origin):

Answer 15

Visceral pain at levels T10–L1 spinal segments results from cervical dilation and uterine contractions. Pressure from descent of the fetal head into the pelvis (S2–S4 spinal segments) also causes pain.

Question 16

The most common complications of epidural anesthesia are

Answer 16

fever in nulliparous women (result of increased levels of interleukin-6 rather than infection)
hypotension,
transient fetal heart rate decelerations,
pruritus.
More serious complications, such as epidural hematoma, complete spinal blockade, abscess, meningitis, and neurotoxicity, occur in less than 0.001% of cases,

Question 17

A postdural puncture headache can be relieved with a blood patch in approximately

Answer 17

61–75% of cases.

Question 18

in treating opioid-induced pruritus

Answer 18

Nalbuphine provided greater efficacy in treating opioid-induced pruritus when compared with placebo, control, or other pharmacologic agents such as diphenhydramine, naloxone, and propofol.

Question 19

Most intravenous (IV)Anesthesia induction agents have a relatively negligible effect on blood glucose, although a notable exception is the induction agent ——-?

Answer 19

Etomidate is known to cause less hypotension during induction and generally fewer hangover-like effects upon recovery. Review of the etomidate mechanism shows suppressed adrenocortical function mediated by blocking the activity of 11-beta-hydroxylase, ultimately causing decreased steroidogenesis. In fact, the literature reports that acute adrenocortical insufficiency and crisis may occur after a standard induction dose of etomidate. However, due to diminished cortisol secretion, etomidate triggers a subsequent decrease in the hyperglycemic response to surgery

Question 20

In the first stage of labor, pain travels via

Answer 20

sympathetic nerve fibers (going through the inferior hypogastric plexus on the way to the sympathetic chain) that originate from the T10-L1 segments of the spinal cord (referred to the back as well as abdominal wall).

Question 21

Pain for the second stage is transmitted via

Answer 21

the pudendal nerve (S2-4)

Question 22

75% incidence of fetal sinusoidal HR associated with which Aesthetic medications

Answer 22

butorphanol

Question 23

Premedications

Answer 23

• Benzodiazepines
• Antihistamines Diphenhydramine (25-50 mg PO) can be given as prophylaxis for allergic reactions (atopy, dye studies), and should be administered in conjunction with an H2-antagonist (ex. famotidine).
• Clonidine, S.E. bradycardia and dry mouth.
• Antiemetics
• Anticholinergics (not routine)
• GI Medication

Question 24

In Anesthesia Relative Contraindications to Depressant Premedication

Answer 24

Newborn (< 1 year of age)
Elderly
Decreased level of consciousness
Intracranial pathology
Severe pulmonary disease

Question 25

Atropine and scopolamine can produce a central anticholinergic syndrome, what is the treatment ?

Answer 25

physostigmine, 1-2 mg IV (neostigmine and pyridostigmine do not pass into the CNS).

Question 26

Lung functions physiological changes in pregnancy

Answer 26

Tidal volume increases by ~ 30-50%

Respiratory rate increases to 15-17

Minute volume increasesby 20-50%.

TLC is reduced by about 5%

IC is increased by about 10%

FRC is decreased by about 20%

Question 27

Anaesthesia consultation in advance of delivery:

Answer 27

1. marked obesity
2. severe edema or anatomical anomalies of face and neck
3. protuberant teeth, small mandible, or difficulty in opening mouth
4. short stature or neck, arthritis of neck
5. large thyroid
6. asthma, chronic pulmonary or cardiac disease
7. bleeding disorder
8. severe preeclampsia-eclampsia
9. previous history of anesthetic problem
10. other significant medical or obstetrical disorder