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Summer 2020 - APA Foundations 2 - OB > Obstetric Anesthesia & Complications - Quiz 1 > Flashcards

Obstetric Anesthesia & Complications - Quiz 1 Flashcards

1
Q

What are the Neuro Changes of Pregnancy?

A

Decreased MAC, Epidural Space, and CSF

Engorged Epidural Veins

Increased LA Sensitivity

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2
Q

What are the Respiratory Changes of Pregnancy?

A

↑TV (40%)

↑RR (15%)

↑Minute Ventilation (50%)

↓PaCO2

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3
Q

Which of the following is decreased during Pregnancy?

A. Vital Capacity

B. Total Lung Capacity

C. Functional Residual Capacity

D. Dead Space

E. Airway Resistance

A

↓FRC (20%)

↓Dead Space

↓Airway Resistance

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4
Q

What Respiratory changes helps delivery of oxygen to fetus?

A

Increase of P50 Hemoglobin from 27 to 30 mmHg

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5
Q

What happens to the Respiratory Mucosa during Pregnancy?

A

Congestion d/t Vasodilation

Mucosal Engorgement = ↑Mallampati

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6
Q

What makes the mother prone to hypoxia during pregnancy?

A

↓FRC & ↑O2 Consumption

Preoxygenate & RSI w/ Cricoid Pressure

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7
Q

Why should Hyperventilation be avoided in Pregnancy during Anesthesia?

A

Low PaCO2 causes uterine vasoconstriction decreasing placental blood flow & left HgbO2 shift

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8
Q

What Intubation equipment should be available for Pregnant Patients?

A

Smaller ETT

Shorter Handle

Avoid Nasal Intubation

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9
Q

How is Oxygen Delivery optimized during Pregnancy?

A

↑Cardiac Output

Right HgbO2 Shift

↓PVR d/t Increased Progesterone

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10
Q

How is Plasma Volume affected by Pregnancy?

A

Increased Plasma Volume d/t Increased Renin

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11
Q

What are the different phases of changes in Cardiac Output during Labor?

A
  • Latent Phase: ↑15%
  • Active Phase: ↑30%
  • Second Stage: ↑45%
  • Postpartum: ↑80%
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12
Q

What are the CV changes during Pregnancy?

A

Blunted Adrenergic Response

Cardiac Hypertrophy

Heart Murmurs

↓Plasma Colloid Osmotic Pressure

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13
Q

What is Supine Hypotension Syndrome?

A

Hypotension, Pallor, N/V, and Diaphoresis when Preggos lie flat

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14
Q

What is the best position for Supine Hypotension Syndrome?

A

Left Lateral Uterine Tilt

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15
Q

How does the blood change in a pregnant patient?

A

Depressed Cell-Mediated Immunity

Hypercoagulation

PT/PTT decreases by 20%

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16
Q

Which Coagulation Factors are Increased during Pregnancy?

A

1, 7, 8, 9, 10, 12

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17
Q

Which Coagulation Factors are Decreased during Pregnancy?

A

11 & 13

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18
Q

Which Coagulation Factors are uneffected by Pregnancy?

A

2 & 5

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19
Q

What are the Renal Changes during Pregnancy?

A

↑Blood Flow & Filtration

↓BUN & Creat

Mild Glycosuria & Proteinuria

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20
Q

How does Pregnacy affect the Gastroesophageal Sphincter?

A

Reduced Competence & Tone

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21
Q

What are the GI Changes during Pregnancy might increase Aspiration Risk?

A

Increased Acid Secretion & Gastric Fluid

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22
Q

How is the Gallbladder affected by Pregnancy?

A

Sluggish & Gallstones d/t decreased CCK

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23
Q

How is the Liver affected by Pregnancy?

A

Decreased Pseudocholinesterase

(No effect on Sux Duration)

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24
Q

How does Pregnancy affect Blood Glucose?

A

Insulin Resistance = ↑Blood Glucose transfer to Fetus

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25
What are the methods of transfer accross the Placenta?
Diffusion Bulk Flow Active Transport Pinocytosis Breaks
26
How long can the Fetus live without Oxygen?
10 minutes
27
What is the transfer of Oxygen to the Fetus dependent on?
Maternal Uterine Blood Flow vs. Fetal Umbilical Blood Flow
28
How much Oxygen is stored and consumed by the Fetus?
Stored O2: 42 mL Consumed O2: 21 mL/min
29
How does the Fetus compensate for the Placental PaO2 of 40 mmHg?
Mom: Right HgbO2 Shift Fetus: Left HgbO2 Shift & More Hgb
30
How is CO2 transfered across the Placenta?
Simple Diffusion Fetal Hgb has lower CO2 affinity than Mom
31
Normal Uterine blood flow is 50 mL/min. How much is that increased during Pregnancy?
600-700 mL/min (10% of Cardiac Output) 80% of that goes to Placenta; the rest to Myometrium
32
What factors affect Uterine Blood Flow (UBF)?
BP Uterine Vasoconstriction Uterine Contractions
33
What anesthetic agents and drugs can decrease Uterine Blood flow?
Thiopental Propofol Gases \> 1 MAC
34
How does Ketamine, Opioids, and N2O affect Uterine Blood FLow?
Little to No Effect
35
How does high serum Local Anesthetics affect the Uterus?
Uterine Vasoconstriction, but **Neuraxial Analgesia can reduce** Vasoconstriction
36
What happens to infant's heart & lungs at birth?
Oxygen filling lungs ↓Pulm. Vascular Resistance ↑LAP closes Foramen Ovale ↑Oxygen Tension closes Ductus
37
What can happen if the Ductus remains open w/ Hypoxia or Acidosis?
Downward Spiral of Hypoxia & Acidosis d/t increase R-to-L Shunt
38
When does normal Labor begin?
40 +/- 2 weeks after LMP
39
What happens in the 1st Stage of Labor?
* **Latent Phase:** Minor Dilation 2-4cm & Infrequent Contractions * **Active Phase:** Progressive Dilation to 10cm & Regular Contractions q3-5 min
40
When is the 2nd Stage of Labor?
From Complete Dilation to Delivery
41
What is the 3rd Stage of Labor?
From Infant Delivery to Placenta Delivery
42
What is happening here?
Head Compression
43
What is happening here?
UteroPlacental Insufficency Compression of Vessels
44
What is happening here?
Umbilical Cord Compression
45
What is the most common cause of Materal Palsy?
Cephalopelvic Disproportion - causes lumbosacral trunk compression
46
What are the complications of Neuraxial Blocks?
Nerve Injury Postdural Puncture Headache (PDPH) High/Total Spinal Anesthesia
47
What are the types of Nerve Injuries that can happen from Neuraxial Blocks?
Epidural Hematoma & Abscess Chemical Nerve Injury Needle Trauma Positioning Injury
48
What kind of patients get Epidural Hematomas?
Patients w/ Coagulopathy during block placement or catether removal
49
What must the coags be for a patient with Pregnacy-Induced HTN to get a Neuraxial Block?
Platelet \> 100K & Stable Normal PT/PTT IV Analgesia if on Heparin
50
What are the Neuraxial Block guidelines for a patient on Heparin?
* Avoid block for 24 hr if therapuetic * Avoid block for 12 hr if prophylactic * Remove Catheter 12 hr after last dose * Dont give Heparin until 2-4 hr after block placed * Avoid concurrent NSAIDs * Alter Dose or Monitor Anti-Xa
51
What are the Signs and Symptoms of an Epidural Hematoma?
Leg Weakness Incontinence Back Pain Get CT or MRI Must be decompressed w/in 6 hrs
52
What are some sources of an Epidural Abscess?
Colonization of Iodine Bottles or Epidural Catheters
53
When would you see symptoms of an Epidural Abscess?
4-10 days Pain & Loss of Fxn
54
What is the Treatment for an Epidural Abscess?
Abx or Laminectomy w/in 6-12 hrs
55
What are the Symptoms of an Epidural Abscess?
Back pain w/ Flexion Fever Meningitis-like Headache Stiff Neck Neuro Deficits Osteomyelitis
56
What makes the Epidural Space resistant to Toxicity?
Vascularity & Intact Membrane
57
What are Transient Neurological Symptoms (TNS)?
Pain & Dysesthesia in butt & legs after Lidocaine Subarachnoid Block & Lithotomy Position
58
How can Needle Trauma happen?
Pain from hitting cord w/ needle at the conus (T12-L3) OK if withdrawn immediately Dont do regionals on sleeping patients
59
How can the Lithotomy position cause Nerve Injury
Compresses Common Peroneal, Femoral, and Obturator Nerves Recovery from days to years depending on severity
60
What is the onset and duration of Post-Dural Puncture/Spinal Headaches?
12- 48 hrs after dura puncture & lasts days to weeks
61
How does a Post-Dural Puncture cause Headache?
Loss of CSF volume as little a 20cc Intracranial Sagging & Stretching of Pain Tissues Cerebral Vasodilation
62
What are Post-Dural Puncture Headache Risk Factors?
Young Big Sharp Needle Hx of PDPH or Migraine
63
What are Post-Dural Puncture Headache Risk Factors when using an Epidural Needle?
Little Experience LOR Technique Haste
64
What is the chance of a Post-Dural Puncture Headache using a 16-18 ga. Epidural?
75-80%
65
What is the chance of a Post-Dural Puncture Headache using a 22 ga. Quincke vs. a 25 ga. Quincke?
22 ga. : 30-50% 25 ga. : 8-10%
66
What is the chance of a Post-Dura Puncture Headache using a 24 ga. Sprotte?
3-5 %
67
What is the chance of a Post-Dura Puncture Headache using a 25 ga. Whitacre?
1-2 %
68
What are the best type of needles to use to avoid Post-Dura Puncture Headaches?
Pencil Point needle w/ Side Hole Pushes Dura Fibers instead of cutting
69
What is the Hallmark of a Post-Dura Puncture Headache?
Continuous head pain when sitting or standing fully relieved by recumbence
70
What is the most common cause of PeriOperative Headaches?
Caffeine Withdrawal
71
What is a Pneumocephalus Headache?
Instant headache w/ short duration when air injects intrathecal
72
What is a Cortical Vein Thrombosis Headache?
Throbbing head ache not relieved by bed rest w/ possible Seizure
73
What should you look for if a Subarachnoid Hemorrhage is suspected?
Focal Neurological Deficits
74
What are Arnold-Chiari related Subdural Hematomas?
CSF leak causes lower brainstem to move down causing headaches, focal neuro signs, and blood vessel tears causing a subdural hematoma
75
What can happen if Post-Dura Puncture Headaches are left untreated?
Chronic Headache Permanent Impairment Convulsions Coning & Brainstem Death
76
What are the Non-Invasive Treatments for PDPH?
Bed Rest IV Fluids Abdominal Binder Pain Meds Cerebral Vasoconstrictors ACTH
77
What is the Definitive Treatment for PDPH?
Epidural Blood Patch - Inject pt's own blood into epidural space Inject slowly until headache stops Repeat blood patches increase success to 90%
78
What are the risks for Epidural Blood Patches?
Same as epidural, but with more chance of backache
79
How are Prophylactic Epidural Blood Patches given?
Thru Epidural Catheter May result in Total Spinal
80
How do Epidural Blood Patches work?
Clotting factors in blood seal dura hole and compresses CSF
81
What are signs of a High or Total Spinal Anesthesia?
Hypotension Dyspnea Aphonia - Cant Speak
82
What are some causes of a High or Total Spinal Anesthesia?
Migrated Epidural Catheter Unrecognized Dural Puncture Subarachnoid Block (SAB) after failed Epidural
83
What should be done once a Total Spinal is recognized?
* Left Uterine Displacement or Trendelenburg Position * Early Resuscitation, Ventilation, and Circulatory Support * Give Epinephrine * Give Narcan (For Opioid) * Monitor Mom & Baby Closely * Maintain Sedation
84
What might be the cause of Hypoxia, Pulmonary Edema, and Bronchospams for a Pregnant Patient?
Aspiration
85
What are ways to prevent Aspiration in the Pregnant Patient?
Cricoid Pressure Fasting Sodium Citrate H2 Blockers Reglan
86
What should be done if the Pregnant pt aspirates?
Intubate & Positive Pressure Ventilation Use necessary amt of O2 Suction Rigid Bronchoscopy

Summer 2020 - APA Foundations 2 - OB (4 decks)

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