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ABA Advanced Exam > Obstetric Anesthesia > Flashcards

Obstetric Anesthesia Flashcards

1
Q

Are pregnant patients more or less sensitive to local anesthetics?

A

more sensitive

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2
Q

What is a normal ABG in pregnancy?

A

pH: 7.45 (mild alkalosis)

PaCO2: 30-32 (mild hypocarbia)

PaO2: normal

bicarb: 19 (mildly decreased)

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3
Q

Why is the maternal oxygen-hemoglobin disociation curve shifted to the right during pregnancy?

A

increased 2,3-DPG production

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4
Q

Why is the fetal oxygen-hemoglobin disociation curve shifted to the left?

A

inability to bind 2,3-DPG

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5
Q

Why are tidal volumes larger as pregnancy progresses?

A

increased A/P diameter of the chest

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6
Q

What is a typical oxygen tension in the placenta?

A

40 mmHg

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7
Q

Why don’t muscle relaxants cross the placenta?

A

They are large, charged, and hydrophilic

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8
Q

Why are most local anesthetics found in higher concentrations in the fetus than in the mother when delivered IV?

A

lower pH in the fetus protonates local anesthetics after they cross the placenta, ion trapping them in the fetus

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9
Q

Why is chloroprocaine NOT found in higher concentrations in the fetus after IV administration to the mother?

A

rapid metabolism by plasma esterases in the maternal circulation

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10
Q

Why are bupivacaine and ropivacaine NOT found in higher concentration in the fetus after IV administration to the mother?

A

high protein binding, limited placental transfer

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11
Q

What are the side effects of terbutaline used as a tocolytic?

A

tachycardia (ß1 agonist)

hypokalemia (ß2 agonist)

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12
Q

What are the signs of magnesium toxicity?

A

muscle weakness and loss of deep tendon reflexes

sedation

SA and AV nodal blockade leading to cardiac arrest

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13
Q

What are the theoretical concerns with ketorolac given for labor pain?

A

ductus arteriosus closure

tocolysis

increased bleeding

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14
Q

What is the mortality rate in parturients with Eisenmenger’s syndrome?

A

30-50%

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15
Q

Why should a sympathectomy during neuraxial anesthesia be avoided in patients with Eisenmenger’s syndrome?

A

Decreasing LV preload and afterload with a sympathectomy will worsen the R to L shunt and cause cyanosis.

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16
Q

Why should meperidine be avoided in patients with Eisenmenger’s syndrome?

A

Its weak local anesthetic properties could cause a sympathectomy

17
Q

Is neuraxial anesthesia safe and effective in patient’s with idiopathic intracranial hypertension?

A

Yes

18
Q

Why should nitrous oxide be avoided prior to delivery in a C-section under GA?

A

diffusion hypoxia of the newborn

*In breathing off nitrous oxide, it will diffuse from the fetal blood to the alveoli faster than O2 or CO2, filling the alveoli and causing hypoxia*

19
Q

What is a normal fetal scalp pH?

A

> 7.25

20
Q

What causes early decelerations?

A

increased fetal vagal tone in response to head compression

21
Q

What is the most common cause of mortality in pre-eclampsia?

A

cerebral hemorrhage

22
Q

What are the likely mechanisms of magnesium in preventing eclampsia?

A

calcium inhibition

NMDA receptor blockade

23
Q

How should magnesium toxicity be treated?

A

calcium

24
Q

What are the risk factors for placenta previa?

A

prior c-section

prior uterine surgery

multiparity

advance maternal age

25
Q

What are the risk factors for uterine rupture?

A

prior c-section

prior myomectomy

excess oxytocin

forceps delivery

26
Q

How is ACLS different in a pregnant patient?

A

manual left uterine displacement should be maintained

a viable fetus should be delivered within the first 4 minutes as irreversible neurologic injury begins around 5 minutes

compressions are performed slightly higher in the chest

27
Q

When should semi-elective surgery be performed during pregnancy? Why?

A

2nd trimester

*High risk of spontaneous abortion in the 1st trimester, and high risk of preterm labor in the 3rd trimester*

28
Q

What is the association between benzodiazepines and cleft palate?

A

Possible increase in babies whose mothers were taking chronic benzodiazepines during the first trimester (conflicting data)

ABA Advanced Exam (23 decks)

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