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Advanced Principles 2 > Obstetric Patient Part 2 > Flashcards

Obstetric Patient Part 2 Flashcards

1
Q

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

A

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

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2
Q

Absence of pain does not guaratee

A

a satisfying experience

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3
Q

The best analgesic technique is one that allows a woman

A

to “cope” with pain

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4
Q

In addition to reducing pain & anxiety, a good analgesic

A

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

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5
Q

Choice of analgesic may include

A

simple analgesic techniques
non-pharmacologic
pharmacologic
neuraxial

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6
Q

Simple analgesic techniques include

A 
support
breathing and relaxation
touch and massage
music 
hydrotherapy
acupuncture 
hypnosis 
aromatherapy
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7
Q

Non-pharmacologic techniques for analgesic include

A

TENS
sterile water blocks
*the gate theory)

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8
Q

Pharmacologic techniques for analgesia include

A

systemic medications

inhalational agents

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9
Q

Advantages of systemic medications relate to

A

patient acceptability and ease of administration

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10
Q

Nearly all _______ readily cross the placenta

A

opioid analgesics & sedatives

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11
Q

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

A

fetal depression

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12
Q

Systemic medications given to parturient may include

A 
fentanyl
morphine
butorphanol & nalbuphine
ketamine (have to give with versed)
remifentanil (not a great option)
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13
Q

Inhalational agents used for analgesia include

A

nitrous oxide

halogenated agents

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14
Q

The gold standard in achieving analgesia for laboring women is

A

neuraxial techniques

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15
Q

Patient considerations for neuraxial techniques include

A

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

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16
Q

Studies show epidural labor analgesia may prolong

A

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

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17
Q

Epidural dosing goal is

A

T10-L1 dermatome level

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18
Q

Epidural management of maintaining analgesia includes

A

intermittent boluses
continuous infusion
PCEA
programmed intermittent boluses

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19
Q

A single shot spinal can be performed or reserve for

A

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

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20
Q

A continuous spinal anesthetic can be indicated for

A

morbid obesity
history of previous spinal surgery
inadvertent dural puncture

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21
Q

Dosing of continuous spinal is

A

.5-1.0 mL of 0.25% isobaric bupivacaine

22
Q

Side effects of neuraxial opioids include

A

respiratory depression
itching
urinary retention
nausea & vomiting

23
Q

Cesarean section now accounts for

A

nearly 30% of all deliveries

24
Q

Common indications for cesarean section icnlude

A 
cephalopelvic disproportion
non-reassuring fetal status 
arrest of dilation 
malpresentation 
prematurity 
previous caesarean section or uterine surgery
25
Q

The choice of anesthesia for cesarean section depends on

A

maternal status
urgency of surgery
fetal condition
patient’s desires

26
Q

Anesthesia for cesarean section may include

A 
neuraxial anesthesia (preferred choice)
general anesthesia
27
Q

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

A

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

28
Q

Regardless of technique, ______ is essential

A

left uterine displacement

29
Q

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

A

T4-6

30
Q

Preoperatively before C-section, patients should receive

A

aspiration prophylaxis
antibiotic administration
standard monitoring
nasal oxygen

31
Q

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

A

simple to perform
rapid onset
reliable block
less toxic

32
Q

The LA of choice for a spinal for C section is

A

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

33
Q

The dermatome level of a spinal is determined primarily by

A

spine curvature

34
Q

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

A

N/V
decreased level of consciousness
uteroplacental hypoperfusion
CV collapse

35
Q

Treatment of hypotension for a spinal may include

A

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

36
Q

Disadvantages of a spinal include

A

fixed duration of action

hypotension

37
Q

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

A

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

38
Q

Advantages of epidural anesthesia include

A

less abrupt BP changes

ability to re-dose catheter

39
Q

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

A

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

40
Q

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

A

subsequent failure for surgical anesthesia

41
Q

If an insitu catheter is deemed not reliable:

A

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

42
Q

Advantages of CSE include

A

lower spinal dose can be used

ability to augment with epidural catheter

43
Q

Disadvantages of CSE include

A

potential lower block height

delay the start of surgery

44
Q

Indications for general anesthesia for C-section include

A

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

45
Q

______ is common in obstetric patients

A

difficult airway

  • airway changes as labor progresses
  • rapid desaturation following induction
46
Q

Induction should not begin until

A

patient is prepped and draped

-sufficient de-nitrogenation and pre-oxygenation

47
Q

Induction includes

A

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

48
Q

Maintenance practices for obstetric patients includes

A

nitrous oxide & oxygen
avoid hyperventilation
MAC less than 1.0

49
Q

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

A

Transversus abdominus plane blocks

50
Q

TAP blocks target sensory nerves

A

T5-11

does not provide visceral pain relief

51
Q

Obstetric complications include

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

Advanced Principles 2 (42 decks)

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