Parturient Surgery & Coexisting Disease - Quiz 3 Flashcards
What are indications for a C-Section?
Failure to Progress
Fetal Distress
Malpresentation
Previous C/S
Mom’s or Baby’s Condition making Vaginal Delivery Unsafe
What is Local Infiltration?
Surgeon places Local
Rare and in Extreme Cases
Midline Incision w/ No Uteral Exteriorization
Supplements Regional
What is the most common type of Anesthesia for C-Sections?
Regional
Safer than General
Epidural Cath already in
Less Baby Depression
Mom can witness birth
What are indications for General Anesthesia for a C-Section?
Severe Fetal Distress
No time for block
Epidural Catheter Nonfunction
Inadequate Regional
Patient Refusal of Block
While under General, what should be avoided in the Parturient?
Hypotension
Hypoxia
Acidosis
Hyperventilation
How does General Anesthesia affect the baby’s Apgar?
Lower @ 1 Minute
Same @ 5 Minutes
What should be done for a Parturient who has a difficult airway?
Early Induction of Epidural Analgesia
&
Consider Awake Fiberoptic Intubation
What are some Aspiration Prophylaxis meds?
- Antacid - Sodium Citrate - Lasts 15 min & give to all
- Ranitidine (Zantac) - H2 blocker
- Reglan - decrease gastric volume, antiemetic, & inhibited by opioids
- NPO x 6 hrs
Since parturients have Increased O2 consumption & Decreased FRC, what is critically important before Induction?
Preoxygenate & Denitrogenate w/ 100% O2 x 3 minutes
What is the Induction dose for Propofol?
2 - 2.8 mg/kg
Crosses placenta
Which Induction agent is useful for a Hemorrhaging Parturient?
Ketamine 1 - 1.5 mg/kg
Causes HTN & Dysphoria
Which inductions meds are NOT normally used for induction in the Parturient?
Versed - more neonatal depression than other meds
Etomidate - Adrenal supression of baby
N2O - Interferes w/ B12 Metabolism
Why are all NMBs safe for the Parturient?
Hydrophillic charged = little placental transfer
Atypical Pseudocholinesterse = paralyzed baby
How is Anesthesia maintained During & After delivery under General?
- Before Delivery:
- 50% N20 + 2/3 MAC before delivery
- 1.2 MAC + 2-3 mcg/kg Fentanyl
- After Delivery
- N2O + 0.5 MAC + Versed
How does General vs. Regional affect Neonatal Depression?
No difference
Only the time from Uterine Incision to Delivery matters d/t Uterine Artery Spasm
What are the Advantages of Epidurals for C-Sections?
Tailored Dose
Prolong block for longer procedures
Post-Op Pain Control
Hemodynamic Stability
What are Disadvantages to Epidurals for C-Sections?
Contraindications
Block not as good as Spinal
Still may need General for Surgery
What is the highest cause of death associated w/ Regionals for C-Sections?
LA Toxicity, then High Spinals
What are the CV effects of a High Block?
Sympathectomy of Lower Extremity & Splanchnic Beds
↓Venous Return
↓BP
↓HR
↓Contractility
What are the Pulmonary Effects of Epidurals?
Inspiration: None
Expiration: Low Pressures & Flows = Feeling of Dyspnea
Reassure Patient
What is the Ideal Height of an Epidural Block for a C-Section?
T4 - T8
How should pain be managed w/ an Epidural before a C-Section Incision?
Fentanyl 100 - 150 mcg
How should breakthrough pain be managed during a C-Section?
5cc Local Bolus
Fentanyl
N2O
Ketamine 10mg
Local Infiltrate by Surgeon
Convert to GA
Why are Spinals sometimes used over Epidurals for C-Sections?
Dense block w/ single shot
Defined Endpoint: CSF Flow = Good
No Risk for Intravascular Injection
Easy & No Catheter
What are Disadvantages of Spinals vs. Epidurals for C-Sections?
Finite - cant give more
PDPH risk
Total Spine Risk
Maternal Hypotension
Laboring women have less hypotension w/ Spinals than Non-Laboring women: True or False?
True
How effective is Prehydration in the Parturient w/ preventing Hypotension?
Not effective - does not stay intravascular long + ANP increase causes diuresis
What is the drug of choice in treating Hypotension in the Parturient?
Phenylephrine
&
Also Ephedrine, but increases risk of fetal acidosis
What are some considerations w/ using Tetracaine?
Slow Onset
Long Duration
Unreliable
What are some considerations w/ using Lidocaine?
Short Acting
&
Neuro Symptoms
What are some considerations w/ using Bupivacaine?
Best Choice
Fast Onset
Intermediate Duration