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Apex Review > Obstetrics 2 > Flashcards

Obstetrics 2 Flashcards

1
Q

All of the following are appropriate for pain relief during the first stages of labor EXCEPT a/an:
a. paracervical block
b. pudendal block
c. paravertebral sympathetic lumbar block
d. epidural block

A

b. pudendal block
the first stage of labor should seek to anesthetize T10-L1; Pudendal nerve derives from S2-S4- this would be more appropriate during the second stage

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2
Q

The first stage of labor pain originates from

A

T10-L1

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3
Q

The second stage of labor pain originates from

A

T10-S4

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4
Q

Analgesic options that target the first stage of labor pain includes

A

neuraxial blockade, paravertebral lumbar sympathetic block, and paracervical block

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5
Q

Analgesic options that target the second stage of labor pain include

A

neuraxial blockade and pudendal nerve block

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6
Q

______________ has made a resurgence as a non-invasive alternative for labor analgesia

A

Inhaled nitrous oxide

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7
Q

The ______ technique provides the dual benefit of a rapid onset of spinal anesthesia and the ability to prolong the duration of anesthesia with an indwelling epidural catheter

A

CSE

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8
Q

Pin in the first stage of labor begins in the

A

lower uterine segment and the cervix

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9
Q

The second stage of labor adds in pain impulses from the

A

vagina, perineum, and pelvic floor

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10
Q

Describe the quality of perineum pain in the second stage of labor.

A

sharp, well-localized

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11
Q

Describe the afferent pathway of perineum pain.

A

pudendal nerve

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12
Q

Describe the afferent pathway of the uterus and cervix.

A

visceral C fibers hypogastric plexus

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13
Q

Describe the quality of pain originating form the uterus and cervix.

A

Dull
diffuse
cramping

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14
Q

Describe two consequences of uncontrolled pain.

A

increased maternal catecholamines
maternal hyperventilation

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15
Q

What is the downslope effect of increased maternal catecholamines?

A

Hypertension and reduced uterine blood flow

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16
Q

What is the downslope effect of maternal hyperventilation?

A

leftward shift of oxyhemoglobin curve–> reduced delivery of oxygen to the fetus

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17
Q

How does a 50/50 N2O + O2 mixture affect uterine contractility?

A

it does not impair uterine contractility

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18
Q

What is the epidural extension technique?

A

Injection of saline into the epidural space immediately after the local anesthetic is administered into the subarachnoid space; allows for rostral spread of local anesthetic

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19
Q

Which local anesthetic reduces the efficacy of epidural morphine?
a. etidocaine
b. ropivacaine
c. levobupivacaine
d. 2-chloroprocaine

A

d.- 2- chloroprocaine antagonizes mu and kappa receptors in the spinal cord; this reduces the efficacy of epidural morphine
No other local anesthetics do this

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20
Q

Common local anesthetics used in obstetrics include

A

bupivacaine
ropivacaine
lidocaine
2-chloroprocaine

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21
Q

_________ is contraindicated via epidural due to the risk of toxicity with IV injection.

A

0.75% bupivacaine

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22
Q

Compared to bupivacaine, _______ has a lower risk of CV toxicity.

A

ropivacaine

23
Q

When administered alone, neuraxial opioids confer the following benefits:

A
  • no loss of sensation or proprioception
    -no sympathectomy (i.e. superior hemodynamic stability)
    -they do not impair mom’s ability to push
24
Q

Meperidine has ______ properties

A

local anesthetic

25
Q

Side effects of neuraxial opioids include

A

pruritus (most common)
N/V
sedation
respiratory depression
they do not meaningfully depress the fetus

26
Q

Which local anesthetics that are used for neuraxial technique have a long duration?

A

bupivacaine
ropivacaine
levobupivacaine

27
Q

Which local anesthetics that are used for neuraxial technique have an intermediate duration of action?

A

lidocaine

28
Q

Which local anesthetics that are used for neuraxial technique have a short duration of action?

A

2-chloroprocaine

29
Q

Which local anesthetic is not popular for labor analgesia due to strong motor block (which makes it good for C-section)?

A

lidocaine
risk of neurotoxicity if given in the SAH

30
Q

Levobupivacaine has ________ compared to bupivacaine but is

A

less CV toxicity but is not available in the US

31
Q

Ropivacaine when compared to bupivacaine has

A

less risk of CV toxicity
less potency
less motor block

32
Q

This medication is useful for emergency C-section when epidural is already in place due to its very fast onset

A

2-chloroprocaine

33
Q

2-chloroprocaine has a risk of ______ when used for spinal anesthesia due to preservatives

A

arachnoiditis

34
Q

2-chloroprocaine solutions without ______ and ________ do not cause neurotoxicity

A

methylparaben and metabisulfite

35
Q

Bupivacaine has _____ placental transfer

A

low placental transfer due to increased protein binding and ionization

36
Q

Bupivacaine has _____ sensory block relative to other LAs

A

greater

37
Q

Cardiac toxicity with bupivacaine is more common with

A

R-enantiomer

38
Q

______ occurs before seizures

A

cardiac toxicity

39
Q

Lidocaine is not typically used for continuous infusion because _______ is more likely to develop, and it crosses the placenta to a greater degree than the alternatives.

A

tachyphylaxis

40
Q

What is the spinal bolus for bupivacaine?

A

1.25-2.5 mg

41
Q

What is the spinal bolus for ropivacaine?

A

2-3.5 mg

42
Q

What is the spinal bolus for levobupivacaine?

A

2-3.5 mg

43
Q

What is the epidural bolus for bupivacaine?

A

0.0625-0.125%

44
Q

What is the epidural bolus for ropivacaine?

A

0.08-0.2%

45
Q

What is the epidural bolus for levobupivacaine?

A

0.0625-0.125% (same as for bupivacaine!)

46
Q

What is the epidural bolus dose for lidocaine?

A

0.75-1%

47
Q

The loading volume for an epidural bolus is

A

10-15 mL in divided doses

48
Q

What is the epidural continuous infusion rate for both bupivacaine and levobupivacaine?

A

0.05-0.125%

49
Q

What is the epidural continuous infusion for ropivacaine?

A

0.08-0.2%

50
Q

What is the epidural continuous infusion for lidocaine?

A

0.5-1%

51
Q

What is the lumbar infusion rate for continuous epidural infusion?

A

8-15 mL/hr.

52
Q

Describe the spinal bolus, epidural bolus, and epidural continuous infusion for fentanyl?

A

spinal: 15-25 mcg
Epidural: 50-100 mcg
Epidural continuous: 1.5-3mcg/mL

53
Q

Describe the spinal bolus, epidural bolus, and epidural continuous infusion for morphine.

A

spinal: 125-250 mcg
epidural: NA
Epidural continuous: NA

Apex Review (224 decks)

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