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Anaesthesia > Obstetric Analgesia > Flashcards

Obstetric Analgesia Flashcards

1
Q

What is the definition of analgesia?

A

Analgesia is the lack of pain.

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2
Q

What is anaesthesia, and how does it differ from analgesia?

A

Anaesthesia is the lack of sensation, often accompanied by analgesia; patients can be either unconscious or awake.

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3
Q

Define conscious sedation.

A

Conscious sedation involves administering drugs to induce a tranquil state allowing procedures.

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4
Q

Why is the obstetric patient unique?

A

The obstetric patient is unique because it involves two lives.

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5
Q

What physiological changes occur in pregnancy that affect analgesia?

A

Physiological changes in pregnancy include cardiovascular, respiratory, gastrointestinal, haematological changes, and airway alterations.

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6
Q

How does polypharmacy affect the foetus?

A

Polypharmacy can lead to CNS and respiratory depression in the foetus.

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7
Q

What are the cardiovascular changes in pregnancy relevant to obstetric analgesia?

A

Increased cardiac output and aorto-caval compression.

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8
Q

Describe respiratory changes during pregnancy.

A

Decreased functional residual capacity (FRC) and increased oxygen consumption.

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9
Q

What gastrointestinal changes occur during pregnancy?

A

Increased gastric reflux and reduced gastric emptying.

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10
Q

How does pregnancy affect the susceptibility of nerve fibres to anaesthetic agents?

A

Increased susceptibility of nerve fibres to anaesthetic agents.

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11
Q

What are the pain pathways during the first stage of labour?

A

Pain from the uterus and cervix is transmitted via T10 – L1 nerves.

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12
Q

Describe the pain pathways during the second stage of labour.

A

Pain from stretching of the birth canal and perineum is transmitted via S2 – S4 nerves.

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13
Q

How does pain affect the maternal cardiovascular system during labour?

A

Pain increases catecholamines, causing tachycardia, increased contractility, and systemic vascular resistance (SVR).

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14
Q

What is the impact of pain on maternal respiratory physiology?

A

Pain increases minute ventilation, leading to respiratory alkalosis.

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15
Q

How does pain influence placental function during labour?

A

Pain causes vasoconstriction of umbilical vessels, reducing placental blood flow.

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16
Q

How does pain affect the gastrointestinal system during labour?

A

Pain reduces gastric emptying, increasing aspiration risk.

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17
Q

Describe the metabolic effects of pain during labour.

A

Pain-induced catecholamine levels cause maternal hyperglycaemia and lipolysis, leading to foetal distress.

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18
Q

What factors contribute to the severity of labour pain?

A

Factors include being primigravid or having a history of dysmenorrhea.

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19
Q

Why is it important to relieve labour pain?

A

Effective pain relief has physiological, psychological, and physical benefits.

20
Q

What are the non-pharmacological methods of pain relief in labour?

A

Non-pharmacological methods include psychological support, massage, TENS, and aromatherapy.

21
Q

What are some examples of physical non-pharmacological pain relief techniques?

A

Examples include Lamaze technique, hydrotherapy, and acupuncture.

22
Q

Describe TENS and its use in labour.

A

TENS involves low-voltage electrical impulses via electrodes placed over specific dermatomes.

23
Q

What are the main pharmacological methods of pain relief in labour?

A

Pharmacological methods include opiate and non-opiate analgesics and inhalational agents.

24
Q

What are the common opiates used in labour analgesia?

A

Common opiates include pethidine, fentanyl, remifentanyl, pentazocine, and tramadol.

25
Q

How is pethidine used, and what are its side effects?

A

Pethidine is given intramuscularly; side effects include respiratory depression.

26
Q

Describe the properties and use of fentanyl in labour analgesia.

A

Fentanyl is a potent synthetic opioid with a rapid onset but can cause respiratory depression.

27
Q

What are the characteristics of remifentanyl?

A

Remifentanyl is an ultra-short-acting opioid with a rapid onset, often used in continuous infusions.

28
Q

What is the main advantage and disadvantage of pentazocine?

A

Pentazocine is an agonist-antagonist opioid with limited respiratory depression due to its ceiling effect.

29
Q

Describe the use and side effects of tramadol in labour.

A

Tramadol is a non-selective opioid receptor agonist with common side effects of nausea and sedation.

30
Q

What non-opiate analgesic is used in labour, and what are its common side effects?

A

Ketamine is a non-opiate analgesic with side effects including nausea and hallucinations.

31
Q

What is entonox, and how is it used in labour?

A

Entonox is a 50:50 mix of oxygen and nitrous oxide, providing rapid but limited analgesia.

32
Q

Describe the use of volatile anaesthetic agents in labour.

A

Volatile agents like isoflurane provide analgesia but can cause maternal sedation.

33
Q

What is the most effective form of labour analgesia?

A

Regional analgesia is the most effective form of labour analgesia.

34
Q

What are the pre-requisites for establishing regional techniques in labour?

A

Trained staff, equipment, IV access, and resuscitation facilities are required.

35
Q

What are the indications for regional anaesthesia in labour?

A

Indications include maternal request, pre-eclampsia, cardiac or respiratory disease.

36
Q

List the absolute contraindications for regional techniques in labour.

A

Absolute contraindications include maternal refusal, allergy, infection, and coagulopathy.

37
Q

What are the relative contraindications to regional techniques?

A

Relative contraindications include untreated infections and significant haemorrhage.

38
Q

What are the advantages of regional techniques in labour?

A

Advantages include reduced maternal exhaustion, maintained uteroplacental blood flow, and reduced foetal acidosis.

39
Q

List some disadvantages and complications of regional techniques.

A

Disadvantages include hypotension, shivering, and potential for instrumental delivery.

40
Q

What drugs are used in the epidural/subarachnoid space for labour analgesia?

A

Local anaesthetics used include bupivacaine and ropivacaine; adjuvants include opioids and non-opioids.

41
Q

Describe the ‘walking’ epidural and its advantages.

A

The ‘walking’ epidural allows mobility but may provide less pain relief.

42
Q

What are the regimens for epidural top-ups?

A

Regimens include intermittent boluses, patient-controlled epidural analgesia, and continuous infusion.

43
Q

What is a pudendal nerve block, and when is it used?

A

A pudendal nerve block provides analgesia for the second stage of labour or instrumental delivery.

44
Q

What are the anaesthesia options for caesarean section?

A

Options include general anaesthesia, spinal, epidural, or combined spinal-epidural techniques.

45
Q

What is the role of postoperative management in obstetric analgesia?

A

Postoperative management involves monitoring, analgesia, and managing vital signs and complications.

Anaesthesia (16 decks)

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