Obstetrics 4 Flashcards
_______ is indicated for induction or augmentation of labor, stimulating uterine contraction (c-section), and combating uterine hypotonia and hemorrhage
Oxytocin
Side effects of oxytocin include
water retention, hyponatremia, hypotension, reflex tachycardia, and coronary vasoconstriction
Rapid IV administration of oxytocin can cause
cardiovascular collapse
The second-line uterotonic is typically
Methergine
Methergine is administered
IM
If methergine is given IV it can cause
significant vasoconstriction, hypertension, and cerebral hemorrhage
Prostaglandin F2 side effects include
N/V, diarrhea, hypotension, and bronchospasm
The dose of methergine is
0.2 mg IM
The half-life of methergine is
2 hours
Methergine is metabolized
hepatically
The third line uterotonic is
Prostaglandin F2 (hemabate or carboprost)
The dose of prostaglandin F2 is
250 mcg IM or injected into the uterus
During a C-section, oxytocin is administered
after the delivery of the placent
The half-life of oxytocin is
4-17 minutes
Oxytocin is metabolized
hepatically
Oxytocin is primarily synthesized in the
paraventricular nuclei of the hypothalamus
Oxytocin is stored in and released from
the posterior pituitary gland
Endogenous oxytocin is released following stimulation of
the cervix, vagina, and breasts
____ is the synthetic equivalent of oxytocin
Pitocin
Anesthetic implications for cesarean section under general anesthesia include:
a. administration of a dopamine agonist
b. prolonged neonatal respiratory depression
c. increased MAC
d. rapid sequence induction
D.
What situations would be appropriate for a general anesthetic for a Cesarean delivery?
maternal hemorrhage
fetal distress
coagulopathy
patient refusal of regional anesthesia
contraindications to regional anesthesia
In the obstetric population, mortality is ________ with a general anesthetic
17 x higher
When choosing a general anesthetic for a parturient, plan for
a difficult intubation
Aspiration prophylaxis for a C-section for a general anesthetic is
sodium citrate
H2 receptor antagonist
gastrokinetic agent
_________ should be used to minimize aortocaval compression
Left uterine displacement
When performing general anesthesia for C-section, allow the surgical team to
prep and drape the patient before induction
For general anesthesia for a C-section, preoxygenate for
3-5 minutes or give four vital capacity breaths
Describe the HELP position for the general anesthetic C-section patient.
Head elevated laryngoscopy position
Emergent C-sections carry a high risk of
recall
Volatile agents reduce
uterine contractility, but be sure to use enough agents to produce amnesia
The risk of neonatal acidosis increases when the time between uterine incision and delivery
exceeds 3 minutes
How should C-section patients be extubated?
fully awake!
still considered a full stomach and is at risk for airway obstruction
Sodium citrate is used to
neutralize gastric acid
H2 receptor antagonist (ranitidine) is used to
reduce gastric acid secretion
Gastrokinetic agents (metoclopramide) is used to
hasten gastric emptying and increase LES tone
With succinylcholine, pregnancy reduces the risk of
myalgia
Describe the induction doses of propofol, etomidate, and ketamine for the C-section general anesthetic patient.
propofol 2-2.5 mg/kg
etomidate 0.3 mg/kg
ketamine 1 mg/kg
Consider the use of ________ & ______ after the baby is delivered for general anesthesia for C-section.
opioid and benzodiazepine
Normal amniotic fluid volume is ______, so keep this in mind when assessing blood loss for C-section.
700 mL
Describe the concentration of anesthetic gases to use for general anesthesia for a C-section
low concentration of volatile agent (0.8 MAC) + 50% nitrous oxide
List the 3 benefits of a GA during a c-section.
speed of onset
secure airway
greater hemodynamic stability
An obstetric patient at 33-weeks gestation requires a laparoscopic appendectomy. What drug presents the GREATEST risk to fetal well-being?
A. ketorolac
B. succinylcholine
C. Propofol
D. Morphine
A.- after the first trimester, NSAIDs can close the ductus arteriosus
Approximately _____ of parturients undergo non-obstetric procedures involving anesthesia each year.
2%
The most significant maternal risks for non-obstetric surgery during pregnancy include
difficult intubation & aspiration
The best time for surgery for the pregnant patient is
ideally 2-6 weeks after delivery
otherwise- second semester
_______ is linked to congenital defects in animal studies, but many practitioners avoid _____ altogether during the first two trimesters.
Nitrous oxide
The most significant fetal risks for non-obstetric surgery during pregnancy include
growth restriction
low birth weight
demise
increased incidence of preterm labor
The highest incidence of preterm labor in the non-obstetric parturient surgical patient is
intraabdominal and pelvic surgery
Iatrogenic hyperventilation reduces
placental blood flow (risk of fetal asphyxia)
Avoid ______ after the first trimester, as they potentially close the ductus arteriosus.
NSAIDs
At approximately _______, pregnant patients are considered a “full stomach”.
18-20 weeks gestation
Teratogenicity can occur at any time during pregnancy, however, the risk is highest during
organogenesis (day 13-60)
Normal maternal PaCo2 is
~30 mmHg
Anesthesia and surgery do not increase the incidence of
congenital anomalies
What drugs have a long track record of safety for the parturient patient?
opioids
inhalational agents
all muscle relaxants
thiopental
