Obstetric Anaesthesia Flashcards
DEFINITION OF TERMS
Analgesia – Lack of _____
Anaesthesia - Lack of __________.
pain
sensation
Conscious sedation – Administration of drugs that induce a __________ which allows for procedures to be carried out
tranquil state
Physiological changes in pregnancy
_____ cardiac output
___________ compression
Physiological ________
Hyper_______
______ FRC, ______ O2 consumption Hyper_________ → _____________
_____ Gastric reflux, _____ gastric emptying
↑; Aorto-caval; anaemia
coagulability; ↓; ↑
ventilation; respiratory alkalosis
↑; ↓
Physiological changes in pregnancy
_____________ of the airway
______ Susceptibility of nerve fibres to local and general anaesthetic agents
MAC of Volatile AA is _____ed
Engorgement of _______ veins → reduction in the _______ available for the spread of LAA within the vertebral canal
Capillary engorgement; ↑; ↓
epidural; volume
Drugs used in the epidural/subarachnoid space
Local anaesthetic agents
- ________
- ________
- ________
Adjuvants
opioids:_______,______ , diamorphine
- non-opioids:______,_______, dexmetomidine
- Bupivacaine
- Ropivacaine
- Lidocaine
fentanyl, morphine
ketamine, clonidine
The ‘walking’ epidural
•Associated with (shorter or longer?) labour, (lower or higher ?)caesarean section rates, (lower or higher?) dose of medication and (lesser or greater?) maternal satisfaction
shorter ; lower
lower ; greater
The ‘walking’ epidural
Disadvantages include: less _______, may have to switch to the ____________ epidural, does not eliminate ______ of the procedure
Additional resources are required
pain relief
traditional
risk
Regimens for epidural top-ups
______________ physician or nurse __
______________________ (PCEA)
_______________________________ (PIEB)
______________________
Intermittent ;bolus
Patient Controlled Epidural Analgesia
Programmed Intermittent Epidural Boluses
Continuous infusion
Pudendal nerve block
Pudendal nerve arises from the ________(______) and supplies the _______,______, and ________
A pudendal nerve block can provide analgesia for the ______ stage of labour or instrumental delivery
Success rate of achieving effective analgesia is (low or high?) as there is often ________ to allow the LAA to be effective
sacral plexus (S2 – S4)
perineum, vulva and vagina
2nd; low; limited time
Operative delivery
Caesarean section
A surgical procedure in which an incision is made through a _________ and _________ to deliver one or more babies
Usually performed when a _______________________________ , although in recent times it has been performed on request
mother’s abdomen and uterus
mother’s or baby’s life or health is at risk
Obstetrician should communicate degree of urgency to all staff
Emergency : there is ???.
Urgent: ????.
Early: ???
Elective :???
**Choice of Anaesthetic technique is determined by ________
immediate threat to the life of mother or foetus
maternal + foetal compromise not immediately life threatening
no maternal or foetal compromise, but needs early delivery
delivery timed to suit mother and staff
urgency
Anaesthesia for C/S
With __________ cases, there is often less time to achieve anaesthesia.
Management involves preoperative, intraoperative and postoperative periods.
emergency
Preoperative Management
Preoperative review
History, physical examination,_______ guidelines, relevant investigations
Premedication – ____________ is a risk
Other drugs e.g. antihypertensives, anti- coagulant therapy
Anaesthetic plan
- Mode of Anaesthesia
fasting; acid aspiration
Mode of Anaesthesia
_______ Anaesthesia
_________ Anaesthesia
- ________
- ________
- ________________
General; Regional
- Spinal
- Epidural
- Combined spinal-epidural
General anaesthesia
Rarely used now but may be necessary especially in ————- situations
Immediate threat to life of mother and foetus
- Foetal ______
- _______________
-_________ haemorrhage with ________ compromise
Other indications
-___________,_________,___________
Previous _________ damage, patient refusal,_______ block, maternal request
emergency
distress; Cord prolapse
Ante-partum; haemodynamic
Bleeding dyscrasias, allergy to LA, placenta abnormalities
neurological; failed
