Pain Pathways (Dr. Mo material) Flashcards
At 15-20 weeks, which test can indcate neural tube defects or downs syndrome?
Maternal alpha-fetoprotein
Increased in neural tube defects
Decerased in Downs Syndrome
Cx dilatation, level of descent, and orientation of ________ presentation during various stages of labor.
Cx dilatation, level of descent, and orientation of occipitoanterior presentation during various stages of labor.
Define the 3 Stages of Labor:
Stage 1 –> Beginning of regular contractions to full cervical dilation (10 cm)
Latent: Regular Uterine Contractions-4 cm dilation
Active: 4cm - 10 cm (complete dilation)
Stage 2 –>complete cervical dilation-delivery of baby
Stage 3 –> Delivery of baby - delivery of placenta
Hyperventilation –> decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and ____ ____.
Hyperventilation –> decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and fetal acidosis
In first stage of labor, _________ caused by uterine contraction and Cx dilatation
In first stage of labor, Visceral pain caused by uterine contraction and Cx dilatation
During second stage of labor:
- Pain through by _____ _____ (S2-S4)
- _______ _____ caused by stretching of vagina and perineum by descent of fetus
During second stage of labor:
- Pain through by pudendal nerve (S2-S4)
- Somatic pain caused by stretching of vagina and perineum by descent of fetus
A.During late 1st and 2nd stage, pain impulses travel via ________ ______ and enter the neuraxis at the S2,3,4. Cause of pain is distension of lower vagina, vulva and perineum.
A.During late 1st and 2nd stage, pain impulses travel via pudendal nerves and enter the neuraxis at the S2,3,4. Cause of pain is distension of lower vagina, vulva and perineum.
_____and ______ from the genitalia are mediated by the ________ (not lateral spinothalamic tract)
Pain and temperature from the genitalia are mediated by the autonomic nervous system (not lateral spinothalamic tract)
What is the level of anesthesia for C-Section?
A.Level of anesthesia for C-section is T4
Picwickian Syndrome Treatment?
A.Obesity-hypoventilation syndrome leading to
- Hypercapnia
- Hypoxemia
- Somnolence; poor sleep at night
- Pulmonary HTN
- Systemic HTN
- RVH / LVH
- Dependent edema
- Cyanosis-induced polycythemia
- Rales
- Pulmonary edema
B.Treatment
- Oropharyngeal appliances
- Positive pressure nasal mask
- Surgery
What kind of lung disease do PFT indicate in obesity?
1.PFT indicative of “restrictive lung disease”
1.In morbid obesity, closing capacity exceeds FRC –> V/Q mismatch –> _____ ______
1.In morbid obesity, closing capacity exceeds FRC –> V/Q mismatch –> arterial hypoxemia
Signs of Fetal Distress
- Repetitive late deceleration
- Loss of beat-to-beat variability
- Fetal heart rate < 80
- Fetal scalp pH < 7.20
- Meconium stained amniotic fluid
- Oligohydramnios
- Intrauterine growth retardation
In management of regional anesthesia complications what would you do for hypotension?
A.Hypotension
1.Ephedrine, oxygen, left uterine displacement and IV fluids. Small doses of phenylephrine can also be used
In management of regional anesthesia complications what would you do for unintentional IV injection?
A.Unintentional IV injection
- Place supine with left uterine displacement
- Thiopental or propofol to stop seizures
In management of regional anesthesia complications what would you do for unintentional Intrathecal injection?
A.Unintentional intrathecal injection
- Place supine with left uterine displacement
- Ephedrine and fluids
- Intubation and ventilation in high spinal
In management of regional anesthesia complications what would you do for a post dural puncture headache?
A.Postdural puncture headache
- Bed rest
- Hydration
- Oral analgesic
- Caffeine
Then blood patch if not resolved
A.Inhalation agents
1.Cause uterine ______ –> increase blood loss
A.Inhalation agents
1.Cause uterine ______ –> increase blood loss
A.Parentral agents
1.Opioids ________decrease progression of labor
A.Parentral agents
1.Opioids minimally decrease progression of labor
What does alpha 1 and beta 2 stimulation to to the uterus?
D.Vasopressors
- a1 stimulation –> uterine contraction
- b2 stimulation –> uterine relaxation
- Small dose on phenylephrine INCREASE blood flow by INCREASE BP
What is oxytocin for?
Complications?
D.Oxytocin
- Use to induce labor and to prevent postpartum blood hemorrhage
- Complication: fetal distress, uterine tetany, maternal water retention, hypotension, reflex tachycardia
What are used to treat uterine atony?
D.Ergot alkaloids
1.Use to treat uterine atony
What are Prostaglandins used to treat?
D.Prostaglandins (PG F2a)
1.Use to treat PPH
Magnesium: MOA, S/E, Tx for toxicity.
H.Magnesium
- Use to stop premature contraction and to prevent eclamptic seizures
- Side effects: hypotension, heart block, muscle weakness and sedation. Also INCREASES blockage of non-depolarizing agents. Cardiac and respiratory arrest can occur
ØTreatment
a. D/C
b. Calcium
c. Lasix
WHat are beta 2 agonist for?
H.b2 agonist
1.Use to stop premature contractions
In first stage of labor where is it initially?
THen progresses to where?
1.Pain is initially T11-T12 then progress to T10-T12 and L1 during active labor.
Fisrst Stage Pain Pathway
- Latent: little dilatation, softer Cx
- Active: regular dilatation in response to uterine contractions
1.Pain is initially T11-T12 then progress to T10-T12 and L1 during active labor.
2.Visceral pain caused by uterine contraction and Cx dilatation
3.Level of spinal anesthesia is needed for T10-L1
Second Stage Pain Pathway
A.Second stage: Begins at fully dilated Cx (10 cm) and ends with expulsion of fetus
1.Pain through by pudendal nerve (S2-S4)
2.Somatic pain caused by stretching of vagina and perineum by descent of fetus
3.Pain involves T10- S4 dermatomes
4.Level of spinal anesthesia is needed for S2-S4
A.1st stage: Cause of pain is uterine contractions and exceeds _______pressure and dilate Cx.
A.1st stage: Cause of pain is uterine contractions and exceeds 25 mmHg pressure and dilate Cx.
A.Visceral afferent accompanying sympathetic nerves entering where?
A.Visceral afferent accompanying sympathetic nerves entering T10, T11, T12 and L1
Uterus and Cx pain pathway?
Uterus and Cx
T10 to L1-2
Pain impulses carried in visceral afferent C fiber
Perineum path pathway?
Perineum
S2,S3,S4
Pain impulses carried by somatic nerve fiber; pudendal nerves
