Obs Anesthesia Flashcards
Epidural is CI in:
1) coagulopathies
2) AS
2) spinal surgeries
Bupivacaine (morcaine)S.E.:
- angina pain
-
analgesia for pain relief during labour:
Parenteral opioids, such as fentanyl, diamorphine, are recommended options for healthy pregnant women requesting pain relief during labour.
Pethidine and labor !
Despite being widely available and used, pethidine is not the preferred opioid option, as shorter-acting opioids tend to have fewer undesirable side-effects.
potential side-effects of opioids
maternal drowsiness, nausea and vomiting, and neonatal respiratory depression.
Opioids-alternative pain relief options like
paracetamol+ NSAIDS
Pethidine toxicity:
- Not reversed by naloxone like other opioids !
- similar to labor s&s tachy and hypertension !!!
The GDG agreed that for women who suffer from current or previous opioid addiction, non-opioid methods of pain relief are preferred.
You can see such cases in sickler cases who are over treated !
two accepted methods for performing a para-vaginal pudendal block.
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.
Level of Anesthesia in CS
T4
Parental agent anesthesia used in labor
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)
immediate actions Taken if there is High or total spinal Blockade
1 - Left uterine Displacement
2- Effective ventilation ( tracheal intubation)
3- IVF+ Vasopressors
Absolute contraindications of neuroaxial analgesia
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
Complete analgesia for labor and vaginal delivery pain necessitate block form T(?) To S(?) While Cesarean from T(?) To S(?)
Complete analgesia for labor and vaginal delivery pain necessitate block form T10 To S5 While Cesarean from T4 To S1
Pain during labor results from: (afferent nerve origin):
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.
The most common complications of epidural anesthesia are
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,
A postdural puncture headache can be relieved with a blood patch in approximately
61–75% of cases.
in treating opioid-induced pruritus
Nalbuphine provided greater efficacy in treating opioid-induced pruritus when compared with placebo, control, or other pharmacologic agents such as diphenhydramine, naloxone, and propofol.
Most intravenous (IV)Anesthesia induction agents have a relatively negligible effect on blood glucose, although a notable exception is the induction agent ——-?
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
In the first stage of labor, pain travels via
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).
Pain for the second stage is transmitted via
the pudendal nerve (S2-4)
75% incidence of fetal sinusoidal HR associated with which Aesthetic medications
butorphanol
Premedications
- 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
In Anesthesia Relative Contraindications to Depressant Premedication
Newborn (< 1 year of age) Elderly Decreased level of consciousness Intracranial pathology Severe pulmonary disease
Atropine and scopolamine can produce a central anticholinergic syndrome, what is the treatment ?
physostigmine, 1-2 mg IV (neostigmine and pyridostigmine do not pass into the CNS).
Lung functions physiological changes in pregnancy
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%
Anaesthesia consultation in advance of delivery:
- marked obesity
- severe edema or anatomical anomalies of face and neck
- protuberant teeth, small mandible, or difficulty in opening mouth
- short stature or neck, arthritis of neck
- large thyroid
- asthma, chronic pulmonary or cardiac disease
- bleeding disorder
- severe preeclampsia-eclampsia
- previous history of anesthetic problem
- other significant medical or obstetrical disorder
