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Anesthesia In-Service Examination > Obstetrical anesthesia > Flashcards

Obstetrical anesthesia Flashcards

1
Q

Case fatality rate of general anesthesia in pregnant women over neuraxial anesthesia?

A

17%

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2
Q

Preeclampsia is considered severe if accompanied with? (3)

A
  1. Proteinuria
  2. Severe hypertension
  3. End-organ damage
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3
Q

Leading cause of maternal mortality worldwide?

A

Antepartal hemorrhage

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4
Q

Leading non-obstetric cause of maternal mortality?

A

Heart disease

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5
Q

3 most common heart conditions related to pregnancy changes:

A
  1. PACs
  2. Paroxsymal SVTs
  3. Ventricular arrhythmias
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6
Q

How many degrees of tilt for left lateral decubitus?

A

15

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7
Q

What hormone induces increase in minute ventilation?

A

Progesterone

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8
Q

Reduction of partial carbon dioxide pressure by? mmHg

And increase of oxygen by?

A

32 mmHg

106 mmHg

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9
Q

What causes development of hypoxemia during periods of apnea? (2)

A
  1. Decreased FRC

2. Increased metabolic rate

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10
Q

What predisposes toward hyperglycemia and ketosis? (2)

A
  1. HPL

2. Cortisol

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11
Q

Describe the Fick principle and where is it used?

Q/t = KA (Cm-Cf)/D

A 
Q/t: rate of diffusion
K: constant
A: surface area
Cm: free drug (maternal)
Cf: free drug (fetal)
D: thickness of diffusion barrier

3 principles that drugs can cross placenta easily

  1. Smaller (<500 Da)
  2. More lipid soluble
  3. More ionized
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12
Q

There is only one drug that is metabolized in the fetal blood so rapidly that even in acidosis, substantial accumulation in the fetus is avoided.

A

2-chlorprocaine

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13
Q

True or false?

Elimination half-life is prolonged in the newborns due to a greater volume of distribution of the drug

A

True

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14
Q

A drug which has been implicated as a possible cause of neonatal jaundice because of its high affinity for fetal eruthrocyte membranes may lead to a decrease in filterability and deformability, redering them more prone to hemolysis.

A

Bupivacaine

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15
Q

Pain during labor are carried by what type of fibers?

A

Visceral afferent type C fibers

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16
Q

During the first stage of labor, pain is referred to what range of segments?

A

T10 - L1

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17
Q

During the late first and second stages of labor, additional pain impulses from distention of the vaginal vault and perineum are carried by the pudendal nerves composed of what range of segments?

A

S2 to S4

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18
Q

3 most frequently chosen methods for relieving pain of parturition?

A
  1. Psychoprophylaxis
  2. Systemic medication
  3. Regional anesthesia
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19
Q

Meperidine side effects on the FHR (2)

A
  1. Decreased beat to beat variability

2. Mild tachycardia

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20
Q

Most common complication of central neuraxial block?

A

Hypotension

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21
Q

Prolonged time of the 2nd stage of labor for how many hours in nulliparous? multiparous?

A

3 hour

2 hours

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22
Q

Effective epidural anesthesia may be achieved by blocking sengments? range

A

T10 to L1

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23
Q

Analgesia volumes for
1. Bupivacaine or Ropivacaine (0.125%)

Maintenance (8 to 12 mL/hr) concentrations

  1. Bupivacaine
  2. Ropivacaine
A
  1. 5 to 10 mL
  2. (0.0625% to 0.1%)
  3. (0.08 to 0.15%)
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24
Q

Most commonly used inhalational agent for analgesia during labor

A

Nitrous oxide 50%

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25
Q

Most commonly used local anesthesia for spinal block

A

Bupivacaine 0.75% (12.5 to 13.5 mL)

Surgical anesthesia for 90 to 120 minutes

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26
Q

Intrathecal morphine will provide anesthesia fro how many hours?

A

12 to 18 hours

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27
Q

In denitrogenation, how many breaths must be performed to prevent hypoxemia?

A

4 breaths with 100% O2

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28
Q

Cause of epigastric pain in preeclampsia

A

Subcapsular hemorrhage of the liver

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29
Q

Mainstay of anticonvulsant therapy in eclampsia

A 
Magnesium sulfate (LD: 4g in 20% solution in 5 mins)
(MD: 1 to 2 g/H)
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30
Q

Most commonly used vasodilator in preeclampsia

A

Hydralazine

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31
Q

Ideal in the treatment of hypertensive emergencies

A

Nitroprusside

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32
Q

Leading cause of cesarean hysterectomy

A

Placenta accreta

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33
Q

Predisposing factors to uterine atony (8)

A
  1. Multiple gestation
  2. Labor induction
  3. CS
  4. Polyhydramnios
  5. Chorioamnionitis
  6. Retained products of conception
  7. Hpn disorders of pregnancy
  8. Antepartal hemorrhage
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34
Q

Cardiac decompensation in patients with heart disease commonly occurs during (3)

A
  1. 3rd trimester of pregnancy
  2. Labor and delivery
  3. Immediate post partum period
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35
Q
  1. Condition which occurs when uncorrected, left to right shunt results in pulmonary hypertension, which when severe, reverses flow to a right to left shunt.
  2. What anesthetic plan is suitable for cesarean delivery?
A
  1. Eisenmenger’s syndrome

2. General anesthesia

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36
Q

_______ which occurs in 10% of pregnant women, occurs because the supine position leads to vena cava occlusion and thus decreased preload to the heart, resulting in lowered cardiac output and blood pressure, tachycardia, maternal mental status changes, nausea, and presyncope.

A

Supine hypotensive syndrome

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37
Q

What hormone causes the increase in minute ventilation?

A

Progesterone

38
Q

Ventilation returns to normal within?

A

1-3 weeks

39
Q

What hormone decreases the tone of the LES during pregnancy?

A

Progesterone

40
Q

RSI is recommended starting what how many weeks AOG?

A

20 weeks

41
Q

What nerve increases susceptibility to lidocaine block?

A

Median nerve

42
Q

Drugs cross biologic membranes by simple diffusion, the rate of which is determined by what principle?

A

Fick = Q/t = KA(Cm − Cf )/D

where Q/t is the rate of diffusion, K is the diffusion constant, A is the surface area available for exchange, Cm is the concentration of free drug in maternal blood, Cf is the concentration of free drug in fetal blood, and D is the thickness of the diffusion barrier

  1. smaller molecular size (<500)
  2. more lipid soluble
  3. Less ionized
43
Q

What sizeof molecules can cross the placenta?

A

< 500 Da

44
Q

What is the first fetal organ perfused by the umbilicous blood?

A

Liver

45
Q

Because of this unique pattern of fetal circulation, continuous administration of anesthetic concentrations of nitrous oxide during elective cesarean sections caused newborn depression only if the induction-to-delivery interval exceeded?

halothane, enflurane,and isoflurane?

A

5 to 10 minutes

1 minute

46
Q

What metabolite in meperidine causes neonatal depression?

A

Normeperidine

47
Q

A nerve derived from the lower sacral nerve roots

(S2 to S4), supply the vaginal vault, perineum, rectum, and parts of the bladder

A

Pudendal nerve

48
Q

Blockade of what dermatome is necessary for cesarean section?

A

T4

49
Q

The most common complications of neuraxial anesthesia is?(2)

A

Hypotension

Decreased uteroplacental perfusion

50
Q

Leading cause of maternal death related to anesthesia

A

Inability to intubate the trachea and provide effective ventilation

51
Q

Usual blood loss during cearean delivery is?

A

750 to 1,000 mL

52
Q

How much coloading should you give (crystalloids)?

Colloids?

A

1,000 to 1,500 mL

500 mL

53
Q

Amount of caffeine IV and oral to decrease PDPH?

A

IV: 500 mg
Oral: 300 mg

54
Q

Amount of blood patch to decrease PDPH?

A

20 mL

55
Q

Most symptoms of pre-eclampsia may result from an imbalance between?

A

Prostacyclin and thromboxane

56
Q

______is central to the development of preeclampsia and occurs as a result of reduced placental perfusion and a production and release of substances (possibly ____ )

A

Endothelial injury

Lipid preoxidases

57
Q

Placental ischemia results in a release of uterine ___and an increase in ______?

A

renin and angiotensin

58
Q

In preeclampsia, there is believed to to have a decreased production of ____, secreted in the trophoblast, which normally would balance the hypertensive effects of the renin–angiotensin system.

A

Prostaglandin E

59
Q

The mainstay of anticonvulsant therapy is?

A

magnesium sulfate

intravenous loading dose of 4 g in a 20% solution over 5 minutes

60
Q

Most commonly used vasodilator in preeclampsia?

A

Hydralazine

61
Q

A condition when extravasated blood dissects between the myometrial fibers

A

Couvelaire uterus

62
Q

Stillbirth likely occurs when placental separation is at how many %?

A

> 50%

63
Q

Pulmonary hypertension has a mean pulmonary pressure over ____ at rest or ___ with exercise.

A

25 mmHg

30 mmHg

64
Q

Maternal mortality from primary pulmonary hypertension is due to?

A

Right heart failure

65
Q

Cardiomyopathy of pregnancy is?

A

Left ventricular failure

66
Q

Left ventricular failure with

A

25%

67
Q

MI in pregnancy: artery usually affected?

A

Left anterior descending artery

68
Q

Guidelines for management of pregnant diabetics focus on?

A

Glycemic control

69
Q

A blood sugar of _____ is desirable and insulin therapy is needed if fasting blood sugar levels are _____

A

60 to 120 mg/dL

>100 mg/dL

70
Q

Preterm infants with breech presentation are usually delivered by cesarean as are very lowbirth-weight infants (<1,500 g). If neuraxial anesthesia is used, _____ should be available for uterine relaxation.

If vaginal delivery occurs with a breech infant and there is head entrapment, _______ may be needed for uterine relaxation.

A

nitroglycerin

general anesthesia or nitroglycerin

71
Q

There is compelling interest to prevent vertical transmission of HIV from the mother to the fetus. The risk of intrauterine infection is: %

A

4.4 %

72
Q

Intrapartum transmission accounts for ___ % of the risk of peripartum transmission and the remainder is through _________.

A

60%

breastfeeding

73
Q

_____is the most commonly abused substance in pregnancy.

A

Smoking

74
Q

Smoking is protective in the development of what condition in pregnancy?

A

Preeclampsia

75
Q

How much alcohol consumption does the mother take to develop fetal alcohol syndrome?

A

> 3 oz of absolute alcohol per day

76
Q

Neurobehavioral deficit and IUGR have been demonstrated in infants of moderate drinkers (___ oz/day)

A

102

77
Q

‘Electric fetal monitoring: During the active
phase, contractions should occur every ____ minutes, with peak intrauterine pressures of _____ mmHg and resting pressures of _____ mmHg.

A

2 to 3 minutes
50 to 80 mm Hg
5 to 20 mm Hg

78
Q

Normally, contractions occur at a rate of ______ in ____ minutes.

A

five contractions in 10 minutes

79
Q

To rule out esophageal atresia, a suction catheter is inserted into the stomach. Gastric contents are aspirated; volume in excess of ___ mL after vaginal delivery and ___ mL after cesarean delivery may result from an abnormality of the upper gastrointestinal tract.

A

12 mL

20 mL

80
Q

The 2 most common indications for EXIT procedure?

A
  1. Large fetal neck masses

2. Reversal of tracheal occlusion

81
Q

The most frequent nonobstetric procedures are (4)

A
  1. excision of ovarian cysts
  2. appendectomy
  3. breast biopsy
  4. surgery related to trauma
82
Q

Teratogenic effect of high doses of diazepam

A

Cleft palate

83
Q

A fall in maternal mean arterial pressure >___ mm Hg decreases uterine blood flow.

A

25

84
Q

Placental transfer is accomplished by

A
  1. Simple diffusion
  2. Active transport
  3. Bulk flow
  4. Facilitated diffusion
  5. Breaks in the chorionic membrane
85
Q

What are most commonly used for obstetric

epidural analgesia local anesthetic?

A

Bupivacaine (most common)

Ropivacaine

86
Q

What is the safest of the commonly used local anesthetics for labor.

A

Chloroprocaine

87
Q

The therapeutic range of magnesium sulfate is?

A

4 to 8 mEq/L

88
Q

With hypomagnesemia, deep tendon reflexes are absent at what range?

A

10 mEq/L

89
Q

With hypomagnesemia, sinoatrial block and

respiratory paralysis occur when concentrations are at?

A

15 mEq/L

90
Q

With hypomagnesemia, cardiac arrest occurs at?

A

25 mEq/L

91
Q

Magnesium toxicity is treated with?

A

Calcium

92
Q

What is the most common coagulopathy in preeclampsia?

A

Thrombocytopenia

Anesthesia In-Service Examination (64 decks)

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