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Anaesthesia 2.0 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

State the nerve root that innervates the uterus

A

T10-L2

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2
Q

State the nerve root for the vagina

A

S2-4

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3
Q

Why is regional anaesthesia preferred over general anaesthesia in obstetrics

A

General anaesthesia leads to: increased risk of aspiration, crosses the placenta more, females are more likely to desaturate quickly due to reduced FRC and there is increased airway oedema in pregnancy which makes intubation difficult

Regional: Allows for the partner to be present and bonding with their baby

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4
Q

State the antacid prophylaxis given during c section

A

Sodium citrate
Ranitidine
Metoclopramide

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5
Q

State the prophylactic antibiotic given during Csection

A

Cefazolin: Prevent wound infection

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6
Q

What is considered adequate spinal anaesthesia?

A

The anaesthesia should block T4 dermatome

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7
Q

How is the level reached by the spinal measured?

A

A cold spray or assessing pain sensation

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8
Q

How to prevent post spinal headaches?

A

Use thin 25g whitacre needles rather than thick ones

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9
Q

State three contraindications of spinal anaesthesia

A

Hypotension risk
Risk of bleeding
Raised intracranial pressure and seizures

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10
Q

List four conditions during pregnancy that increase the risk of bleeding

A

HEELP syndrome
Low platelets
Anticoagulant
INR>1.5

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11
Q

List 4 causes of hypotension during pregnancy

A

Haemorrhage such as placenta prevail and abruptio placentae
Supine hypotension syndrome(Inferior vena cava obstruction)
Valvular heart disease
Peripartum cardiomyopathy

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12
Q

State the spinal anaesthesia used in obstetrics

A

Bupivacaine plus dextrose plus fentanyl

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13
Q

Outline the layers that the spinal anaesthetic needle passes until it reaches the subarachnoid space

A

Skin>subQ tissue>supra and interspinous ligaments>ligamentum lavum>Dura mater>subarachnoid space

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14
Q

How is aortocaval compression prevented during delivery?

A

Tilt the patient 30° left side down

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15
Q

How to assess the cerebral perfusion of the patient after administration of a spinal anaesthesia?

A

Talking to the patient

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16
Q

What is the first symptom of spinal induced hypotension?

A

Nausea and vomiting

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17
Q

State the treatment of spinal induced hypotension.

A

Phenylephrine

Alternative is ephedrine

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18
Q

Why is phenylephrine preferred than ephedrine in obs?

A

Leads to less fetal acidosis

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19
Q

Name the drug used to encourage uterine contractions after umbilical cord clamping.

A

Oxytocin

Alternative: Misoprostol and ergometrine

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20
Q

List three contraindications of ergometrine

A

Chronic hypertension
Pre eclampsia
Ischemic heart disease

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21
Q

When should colloids be used for C section?

A

If replacement is more than 3 litres to replace blood loss

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22
Q
A
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23
Q

Name coagulation factors that increase inpregnancy

A

Factor 1,7, 8,9,10&12

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24
Q

Name a coagulation factor that decrease in pregnancy.

A

Antithrombin 3

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25
State by how much does cardiac output increase in pregnancy
50% Note: by 75% prelabour
26
When does the blood pressure show a more pronounced drop in pregnancy?
2nd trimester Note: return to normal at term
27
State a factor that guides uteroplacental blood flow
Maternal blood pressure
28
What is the uterine blood flow by term?
700-900 ml/min Note: It is 50-100 before pregnancy
29
By how much does the plasma volume increase during pregnancy?
50%
30
By how does the red blood cells increase during pregnancy?
30%
31
When does the uterus start to compress the aorta and IVC in pregnancy?
From 13-16 weeks
32
In which week of pregnancy should a patient be tilted 30° left side down by placing a wedge under the right hip? And state why
After 20 weeks: to prevent aortocaval compression Note: In 10% of patient right tilt is better
33
By how much does the functional residual volume decrease in pregnancy?
20%
34
State why It is difficult to intubate pregnant people. 3
Airway oedema Large breast Obesity
35
By how much does the oxygen consumption increase?
60%
36
State a metabolic change due to pregnancy
Respiratory alkalosis with partial metabolic compensation (bicarbonate of approximately 20)
37
State two causes of hyperventilation in labour
Pain and anxiety
38
Does tidal volume increase during pregnancy?
Yes
39
By how much does partial pressure of CO2 drop during pregnancy?
30%
40
State a respiratory complication that occurs at term when pregnant people are lying supine.
Atelectasis during tidal volume breaths
41
State the change in gastric acid production and volume during pregnancy.
No changes
42
State three causes of decreased gastric emptying during labour
Pain,anxiety and opioids
43
How long after delivery does the gastric emptying rake to return to normal?
18 hours
44
By how much does the MAC decrease during pregnancy
25-40%
45
By how much does the local anaesthetic dose requirements decrease in pregnancy And why?
By 40% Why: In pregnancy there is increased progesterone which increases the sensitivity of local and general anaesthetics
46
Is there changes in albumin during pregnancy?
Yes it is decreased which affects the drug delivery to tissues
47
State why normal doses of suxamethonium can be used in pregnancy even though there is decreased Pseudocholinesterase?
There is increased blood volume which conteracts that
48
What is the best analgesia for Labour?
Epidural low dose bupivacaine (0.1%)
49
Why is epidural anaesthesia not preferred for C section?
Prolongs the 2nd stage of labour
50
What is the reversal agent for opioids?
Naloxone
51
52
What is the preferred,ode of administration of opioids during labour?
Intramuscular: Less side effects
53
Name 5 analgesia for labour
Regional epidural low dose bupivacaine Opioids with antiemetics Others: Entonox, TENS and Lamaze massage technique
54
Name a very short acting analgesia for labour
Entonox: Nitrous oxide mixed with oxygen 50:50 mix To be maximally effective, the patient needs to take a deep breath at the beginning of a contraction as it takes a few seconds to work Note: It is self-administered by the patient a
55
Why is spinal preferred over general anaesthesia
To avoid the following risks: (a) Increased risk of difficult intubation, (b) More rapid desaturation and hypoxaemia, (c) Increased risk of regurgitation in the pregnant woman (d) Effects of the general anaesthetic on the unborn fetus
56
List three further benefits of regional anesthetics in obstetrics in addition to avoiding the risk of GA.
allowing the partner to be present, and allowing the mother to participate in the birth, encouraging early bonding and breast-feeding.
57
Should mothers drink clear fluids during labour?
Yes, they are encouraged to hydrate well to reduce maternal exhaustion and dehydration Note: No solids are allowed
58
Should people undergoing regional anaesthesia get antacid prophylaxis?
Yes, anyone undergoing anaesthesia should get it.
59
State the drugs used for antacid prophylaxis during labour
Sodium citrate 30 ml PO within 30 minutes of delivery Metoclopramide 10 mg PO 2 hours pre-operatively or IV within 30 minutes of operation and/or Ranitidine 300 mg PO 2 hours pre-operatively
60
State the antibiotic prophylaxis for C section
Cefazolin 1 g IV if < 80 kg, or 2 g if > 80 kg, ideally 30-60 minutes before skin incision.
61
What is the safest method of anaesthesia for C section?
Spinal(subarachnoid block/intrathecal block)
62
What is the preferred needle size for IV access in obstetrics anaesthesia?
At least 18 G
63
State the IV fluid that should be given during labour after anaesthesia
Ringers lactate/Plasmolyte at 20 m/kg freely while performing the block

Anaesthesia 2.0 (9 decks)

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