Obstetric Patient Part 2

Question 1

The following factors influence a woman’s decision regarding labor & delivery analgesia

Answer 1

natural childbirth training
anxiety about neuraxial analgesia
desire for medication-free delivery

Question 2

Absence of pain does not guaratee

Answer 2

a satisfying experience

Question 3

The best analgesic technique is one that allows a woman

Answer 3

to “cope” with pain

Question 4

In addition to reducing pain & anxiety, a good analgesic

Answer 4

reduces maternal hyperventilation which can cause reduced fetal oxygen tension
limit increases in maternal CO, hypertension, and catecholamine release*

Question 5

Choice of analgesic may include

Answer 5

simple analgesic techniques
non-pharmacologic
pharmacologic
neuraxial

Question 6

Simple analgesic techniques include

Answer 6

support
breathing and relaxation
touch and massage
music 
hydrotherapy
acupuncture 
hypnosis 
aromatherapy

Question 7

Non-pharmacologic techniques for analgesic include

Answer 7

TENS
sterile water blocks
*the gate theory)

Question 8

Pharmacologic techniques for analgesia include

Answer 8

systemic medications

inhalational agents

Question 9

Advantages of systemic medications relate to

Answer 9

patient acceptability and ease of administration

Question 10

Nearly all _______ readily cross the placenta

Answer 10

opioid analgesics & sedatives

Question 11

Concerns over _____ limits its use to early labor or when regional anesthesia is not available or contraindicated

Answer 11

fetal depression

Question 12

Systemic medications given to parturient may include

Answer 12

fentanyl
morphine
butorphanol & nalbuphine
ketamine (have to give with versed)
remifentanil (not a great option)

Question 13

Inhalational agents used for analgesia include

Answer 13

nitrous oxide

halogenated agents

Question 14

The gold standard in achieving analgesia for laboring women is

Answer 14

neuraxial techniques

Question 15

Patient considerations for neuraxial techniques include

Answer 15

H&P- allergies, airway assessment, coagulation studies, preexisting and/or pregnancy related
informed consent- emancipation
contraindications

Question 16

Studies show epidural labor analgesia may prolong

Answer 16

second stage labor
can affect the incidence of forceps delivery
is NOT associated with increased rates of cesarean section

Question 17

Epidural dosing goal is

Answer 17

T10-L1 dermatome level

Question 18

Epidural management of maintaining analgesia includes

Answer 18

intermittent boluses
continuous infusion
PCEA
programmed intermittent boluses

Question 19

A single shot spinal can be performed or reserve for

Answer 19

multiparous patients in advanced second stage
those with poor pain control to facilitate epidural placement
mother laboring without analgesia requiring an instrumented delivery

Question 20

A continuous spinal anesthetic can be indicated for

Answer 20

morbid obesity
history of previous spinal surgery
inadvertent dural puncture

Question 21

Dosing of continuous spinal is

Answer 21

.5-1.0 mL of 0.25% isobaric bupivacaine

Question 22

Side effects of neuraxial opioids include

Answer 22

respiratory depression
itching
urinary retention
nausea & vomiting

Question 23

Cesarean section now accounts for

Answer 23

nearly 30% of all deliveries

Question 24

Common indications for cesarean section icnlude

Answer 24

cephalopelvic disproportion
non-reassuring fetal status 
arrest of dilation 
malpresentation 
prematurity 
previous caesarean section or uterine surgery

Question 25

The choice of anesthesia for cesarean section depends on

Answer 25

maternal status urgency of surgery fetal condition patient's desires

Question 26

Anesthesia for cesarean section may include

Answer 26

``` neuraxial anesthesia (preferred choice) general anesthesia ```

Question 27

The advantages of neuraxial anesthesia over general anesthesia for cesarean section includes

Answer 27

decreased risk of mortality due to failed intubation decreased risk of aspiration of gastric contents better neonatal outcomes ability of mother to participate in the birth

Question 28

Regardless of technique, ______ is essential

Answer 28

left uterine displacement

Question 29

To provide adequate anesthesia for C-section using spinal/epidural, _____ dermatome level must be achieved.

Answer 29

T4-6

Question 30

Preoperatively before C-section, patients should receive

Answer 30

aspiration prophylaxis antibiotic administration standard monitoring nasal oxygen

Question 31

Single-shot spinal is the most common anesthetic technique for C-section because

Answer 31

simple to perform rapid onset reliable block less toxic

Question 32

The LA of choice for a spinal for C section is

Answer 32

0.75% hyperbaric bupivacaine 13 mg with a duration of 90-120 minutes fentanyl & duramorph for analgesia

Question 33

The dermatome level of a spinal is determined primarily by

Answer 33

spine curvature

Question 34

80% of patients who receive a spinal develop hypotension. If untreated we will see

Answer 34

N/V decreased level of consciousness uteroplacental hypoperfusion CV collapse

Question 35

Treatment of hypotension for a spinal may include

Answer 35

pre-load vs. co-load crystalloid & HES vs. crystalloid alone ephedrine vs. phenylephrine

Question 36

Disadvantages of a spinal include

Answer 36

fixed duration of action | hypotension

Question 37

An epidural is not a first-choice option for elective C-section because of

Answer 37

slow onset & higher dose of LA required to achieve surgical level

Question 38

Advantages of epidural anesthesia include

Answer 38

less abrupt BP changes | ability to re-dose catheter

Question 39

_________ is required to achieve T4-6 level with an epidural

Answer 39

10-15 mL (only 5 cc given at a time)

Question 40

A labor patient who requires multiple doses for breakthrough pain is a significant predictor for

Answer 40

subsequent failure for surgical anesthesia

Question 41

If an insitu catheter is deemed not reliable:

Answer 41

early recognition replace (CSE) single-shot spinal general anesthetic

Question 42

Advantages of CSE include

Answer 42

lower spinal dose can be used | ability to augment with epidural catheter

Question 43

Disadvantages of CSE include

Answer 43

potential lower block height | delay the start of surgery

Question 44

Indications for general anesthesia for C-section include

Answer 44

neuraxial not in place, urgent delivery required patient refusal of neuraxial coagulopathy

Question 45

______ is common in obstetric patients

Answer 45

difficult airway - airway changes as labor progresses - rapid desaturation following induction

Question 46

Induction should not begin until

Answer 46

patient is prepped and draped | -sufficient de-nitrogenation and pre-oxygenation

Question 47

Induction includes

Answer 47

rapid sequence induction with cricoid pressure propofol vs. etomidate vs. ketamine succinylcholine vs. rocuronium

Question 48

Maintenance practices for obstetric patients includes

Answer 48

nitrous oxide & oxygen avoid hyperventilation MAC less than 1.0

Question 49

_______ blocks can be placed postoperatively in patients who have not received neuraxial anesthesia or intrathecal morphine.

Answer 49

Transversus abdominus plane blocks

Question 50

TAP blocks target sensory nerves

Answer 50

T5-11 | does not provide visceral pain relief

Question 51

Obstetric complications include

Answer 51

``` postpartum hemorrhage preeclampsia- HELLP obesity amniotic fluid embolus prematurity abnormal placental implantation- placenta previa, placenta accrete, placenta abruption ```