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Prodigy Quick Review > Obstetric Anesthetic Techniques > Flashcards

Obstetric Anesthetic Techniques Flashcards

1
Q

What is the advantage of combining opioids with
local anesthetics in combined spinal/epidural
analgesia?

A

The combination of small doses of opioids and local anesthetics
(fentanyl 10-15 mcg and bupivacaine 1.25-2.5 mg) can provide
excellent analgesia without producing significant motor block.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1151.

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2
Q

What supplies should be in the patient’s room prior

to beginning an epidural on a laboring patient?

A

Oxygen, resuscitation supplies, and suction. Intravenous
access must also be secured prior to beginning an epidural
anesthetic.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1137.

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3
Q

Why is ropivacaine better suited for a lumbar
epidural anesthetic for a laboring parturient than
bupivacaine?

A

Ropivacaine has been demonstrated to produce less motor
block than bupivacaine at equipotent doses.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1137.

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4
Q

How does the toxicity profile of ropivicaine compare

to that of bupivacaine among maternal patients?

A

Studies have shown that the fatal dose for ropivicaine is twice
that of bupivicaine. It is 25% less toxic and produces fewer
CNS symptoms when administered.
Chestnut DH, Polley LS, Tsen LC, Wong CA. Chestnut’s
Obstetric Anesthesia. Philadelphia, PA: Mosby Elsevier; 2009:
252.

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5
Q

In what circumstance would the lateral position be
more advantageous than the sitting position for
placement of an epidural in a laboring patient?

A

If the patient is having difficulty holding still during contractions,
the lateral position may help limit movement of the lumbar spine.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1138.

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6
Q

What is the typical composition of an epidural test

dose?

A

It usually consists of lidocaine 45 mg and 15 mcg of epinephrine.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1138.

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7
Q

What are the cautions regarding the use of

epinephrine as an epidural test dose?

A

Although epinephrine reliably increases the heart rate in
pregnant patients, it is less specific in laboring patients because
the heart rate varies widely during and between labor
contractions.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1138-1139.

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8
Q

What is a reliable test for inadvertant intrathecal or
intravascular epidural catheter placement that does
not use epinephrine?

A

Aspiration of the catheter prior to injection and observing for the
presence of CSF or blood has been shown to have a 0% falsepositive
rate and 0.2% false-positive rate.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1139.

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9
Q

You are administering chloroprocaine via an
epidural. What would give the suspicion that the
epidural was placed intravascularly?

A

After the intravascular administration of about 100 milligrams of
chloroprocaine, the patient would begin to experience CNS
symptoms such as tinnitus, dizziness, and circumoral
numbness.
Chestnut DH, Polley LS, Tsen LC, Wong CA. Chestnut’s
Obstetric Anesthesia. Philadelphia, PA: Mosby Elsevier; 2009:
437.

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10
Q

What is the most common complication of neuraxial

anesthesia in the parturient?

A

Hypotension
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1150.

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11
Q

Why is it recommended that an epidural anesthetic
not be administered to a laboring parturient
exhibiting cervical dilation less than 4 cm?

A

The administration of an epidural anesthetic during the latent
stage of labor (cervical dilation < 4cm) may result in dystocia.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1150.

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12
Q

What is the recommended epidural catheter infusion
rate of bupivacaine for continuous analgesia in a
laboring parturient?

A

Bupivacaine 0.0625% to 0.125% can be administered at a rate
of 8-12 mL/hour to provide continuous analgesia during labor.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1140.

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13
Q

What is the recommended epidural catheter infusion
rate of ropivacaine for continuous analgesia in a
laboring parturient?

A

Ropivacaine 0.1-0.2% can be administered via an epidural
catheter at a rate of 8-12 mL/hour to provide continuous
analgesia during labor.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1140.

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14
Q

Can a laboring parturient with an epidural catheter

ambulate?

A

A laboring parturient in the first stage of labor can ambulate if
she is hemodynamically stable, does not require continuous
fetal monitoring, and has preserved motor function.
Observation for 30 minutes after the epidural is started is
required to ensure stability of both the mother and fetus.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1151.

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15
Q

What is the advantage of using a combined spinalepidural

anesthetic for a laboring patient?

A

A combined spinal-epidural anesthetic provides the rapid onset
of a spinal anesthetic with the longer duration and flexible
dosing of an epidural catheter.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1151.

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16
Q

What is the leading anesthesia-related cause of

maternal death?

A

Inability to intubate or ventilate at the induction of general
anesthesia is the leading cause of death followed by respiratory
failure and high spinal or epidural block.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1154.

17
Q

What nerve roots transmit pain during the second

stage of labor?

A

The pain experienced during the second stage of labor is
primarily perineal, which is transmitted through the T10-S4
segments. The pain experienced during the first stage of labor
is transmitted primarily through the T10 - L1 dermatomes.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 846.

18
Q

What nerve roots transmit pain during the first stage

of labor?

A

Pain during the first stage of labor is transmitted through the
T10 - L1 dermatomes.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1149.

19
Q

A patient arrives in the obstetric ward in labor. She
has experienced severe nausea and vomiting over
the past few days and feels dizzy when she stands.
You would like to perform an epidural catheter
placement for analgesia. What concerns do you
have regarding this patient?

A

This patient may be experiencing orthostatic hypotension due to
hypovolemia from protracted vomiting. Hypovolemia should be
corrected prior to performing a neuraxial anesthetic.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1135.

20
Q

In general, what platelet count is considered too low
to proceed with a neuraxial anesthetic for an
obstetric patient?

A

A platelet count less than 100,000 is considered too low to
perform to perform a neuraxial anesthetic.
Nagelhout JJ, Zaglaniczny KL. Nurse Anesthesia. 4th ed.
Philadelphia, PA: WB Saunders Company; 2010: 979.

21
Q

How does a diagnosis of abruptio placentae affect
your decision to employ a regional anesthetic and
why?

A

The diagnosis of abruptio placentae with or without fetal
distress is a contraindication to regional anesthesia. The
sympathectomy and resulting hypotension produced by
neuraxial anesthesia would jeopardize uterine blood flow and
fetal oxygenation.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1103.

22
Q

A co-worker plans on maintaining the general
anesthetic of a parturient undergoing emergency
cesarean section with 0.5 MAC and 50% nitrous
oxide. What is the salient point brought to mind by
this technique?

A

0.5 MAC and 50% nitrous oxide is associated with a high
incidence of awareness in this population. Higher
concentrations of volatile anesthetic are required to maintain
general anesthesia.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1153.

23
Q

What are the disadvantages of single-shot

subarachnoid injection for labor analgesia?

A

A single-shot spinal anesthetic will not deliver the duration of
analgesia necessary for most laboring patients. In the
primiparous patient, multiple injections would be necessary.
Even in the multiparous patient, the potential for emergency
cesarean section would require a new anesthetic for
performance of the procedure.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1151.

24
Q

Is a defasciculating dose of nondepolarizing muscle
relaxant employed prior to the administration of
succinylcholine in a parturient undergoing general
anesthesia?

A

No. A defasciculating dose is not used in induction of general
anesthesia of these patients.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1153.

25
Q

What sensory level block would be appropriate for
performing a cesarean section under epidural
anesthesia?

A

A T4 level is sufficient for performing a cesarean section under
epidural anesthesia.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 856.

26
Q

What is the most common method of performing a

spinal anesthetic for cesarean delivery?

A

The administration of 1.6-1.8 mL of hyperbaric bupivacaine
0.75% is the most commonly used anesthetic employed for
cesarean delivery. It will provide 1.5-2 hours of anesthesia.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1152.

27
Q

Why is spinal anesthesia the most common

anesthetic utilized for cesarean delivery?

A

It has a fast onset, is reliable, and simple to perform.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1152.

28
Q

What are the most common causes for cesarean

delivery?

A

Arrest of dilation, potentially deleterious fetal changes,
cephalopelvic disproportion, malpresentation, prematurity, prior
cesarean delivery, and previous uterine surgery.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1152.

29
Q

How is a pudendal nerve block performed and what

areas does it anesthetize?

A

A pudendal block is performed by injecting 10 mL of dilute local
anesthetic transvaginally behing each sacrospinous ligament. It
anesthetizes the vaginal vault, rectum, perineum, and part of
the bladder (S2-S4 nerve roots). A pudendal block will provide
short-term anesthesia that is suitable for perineal procedures,
forceps delivery, or episiotomy.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1071-1072.

30
Q

What are the indications for a paravertebral lumbar

sympathetic block in the laboring patient?

A

A paravertebral lumbar sympathetic block can often be used to
provide analgesia during the first stage of labor when
contraindications to traditional neuraxial analgesia exist. It
blocks the transmission of painful stimuli from the cervical and
uterine nerves.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1151.

31
Q

What drugs and corresponding doses are most
commonly employed for the induction of general
anesthesia for cesarean section?

A

A rapid-sequence induction is performed with propofol 2 mg/kg,
ketamine 1 mg/kg, or etomidate 0.2-0.3 mg/kg and
succinylcholine 1-1.5 mg/kg.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1153.

32
Q

What pain medications may be be administered for

labor pain for a vaginal delivery?

A

IV or IM meperidine is used although it beginning to fall out of
favor. Fentanyl and remifentanil may also be used, but their
short duration of action makes them less suitable unless used in
a patient controlled analgesia system. Butorphanol and
nalbuphine are also used frequently with production of
adequate analgesia.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1149-1150.

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