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
Problems of General anaesthesia
Risk of __________ and _________ of ______ contents
Risk of ______________ as the pregnant patient is a potential difficult airway.
Risk of _____________ from general anaesthetic agents
Risk of __________________ during anaesthesia
regurgitation and aspiration
gastric; oesophageal intubation
foetal depression; maternal awareness
Regional Anaesthesia
Safer than GA
Improved safety for mother , _____ risk of difficult intubation and aspiration of gastric contents.
Alert neonate → _________ and __________________
(More or Less?)‘ hangover’ than after GA.
Better post-op _______ + earlier ___________
↓
early bonding and breastfeeding
Less; analgesia; mobilisation
Intraoperative management (GA or regional)
Patient transferred to the theatre in the __________ position
Confirm ________ has been given
Baseline vital signs recorded
__________ of anaesthesia
RSI using ______,_________, or _________ and ______________ for GA, ________ and __________
____________ of anaesthesia
___________ following delivery of the baby Neonatal resuscitation by midwife/neonatologist
IV __________
____________ from anaesthesia
left lateral ; premedication
Induction
STP, propofol or ketamine and suxamethonium
cricoid pressure and tracheal intubation
Maintenance; Uterotonics; analgesics
Emergence
Intraoperative management
For regional technique, observe strict ________
________ spinal needle preferred to ________
___________ to prevent _____tension following Spinal
Safe dose of ______________ for spinal
__________ improve the quality and duration
________ and _________ used to maintain BP
Standard _________ + ___________ (for regional), blood loss, urine output
asepsis; Pencil point; Quincke
Co-loading; hypotension
heavy bupivacaine; Adjuvants
Fluids and vasopressors
monitoring; verbal response
Vasopressors
List 4
phenylephrine, ephedrine, metaraminol, adrenaline, nor-adrenaline
Postoperative management
Patient transferred to _________
Monitoring of _______, ________
____________ is VERY important
PACU
vital signs ; vaginal pads
Analgesia
Post-operative management
multimodal analgesia
- Spinal morphine can produce post-op pain relief for approx. _________
- An indwelling epidural catheter can provide analgesia for up to _______
- TAP block, for somatic pain relief. Px will require _________ analgesics for visceral pain relief
24 hours; 72hours
parenteral
____________ can produce post-op pain relief for approx. 24 hours
Spinal morphine
_____________________ can provide analgesia for up to 72hours
An indwelling epidural catheter
