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Summer 2020 - APA Foundations 2 - OB > Parturient Surgery & Coexisting Disease - Quiz 3 > Flashcards

Parturient Surgery & Coexisting Disease - Quiz 3 Flashcards

1
Q

What are indications for a C-Section?

A

Failure to Progress

Fetal Distress

Malpresentation

Previous C/S

Mom’s or Baby’s Condition making Vaginal Delivery Unsafe

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2
Q

What is Local Infiltration?

A

Surgeon places Local

Rare and in Extreme Cases

Midline Incision w/ No Uteral Exteriorization

Supplements Regional

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3
Q

What is the most common type of Anesthesia for C-Sections?

A

Regional

Safer than General

Epidural Cath already in

Less Baby Depression

Mom can witness birth

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4
Q

What are indications for General Anesthesia for a C-Section?

A

Severe Fetal Distress

No time for block

Epidural Catheter Nonfunction

Inadequate Regional

Patient Refusal of Block

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5
Q

While under General, what should be avoided in the Parturient?

A

Hypotension

Hypoxia

Acidosis

Hyperventilation

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6
Q

How does General Anesthesia affect the baby’s Apgar?

A

Lower @ 1 Minute

Same @ 5 Minutes

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7
Q

What should be done for a Parturient who has a difficult airway?

A

Early Induction of Epidural Analgesia

&

Consider Awake Fiberoptic Intubation

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8
Q

What are some Aspiration Prophylaxis meds?

A
  • 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
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9
Q

Since parturients have Increased O2 consumption & Decreased FRC, what is critically important before Induction?

A

Preoxygenate & Denitrogenate w/ 100% O2 x 3 minutes

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10
Q

What is the Induction dose for Propofol?

A

2 - 2.8 mg/kg

Crosses placenta

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11
Q

Which Induction agent is useful for a Hemorrhaging Parturient?

A

Ketamine 1 - 1.5 mg/kg

Causes HTN & Dysphoria

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12
Q

Which inductions meds are NOT normally used for induction in the Parturient?

A

Versed - more neonatal depression than other meds

Etomidate - Adrenal supression of baby

N2O - Interferes w/ B12 Metabolism

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13
Q

Why are all NMBs safe for the Parturient?

A

Hydrophillic charged = little placental transfer

Atypical Pseudocholinesterse = paralyzed baby

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14
Q

How is Anesthesia maintained During & After delivery under General?

A
  • Before Delivery:
  • 50% N20 + 2/3 MAC before delivery
  • 1.2 MAC + 2-3 mcg/kg Fentanyl
  • After Delivery
  • N2O + 0.5 MAC + Versed
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15
Q

How does General vs. Regional affect Neonatal Depression?

A

No difference

Only the time from Uterine Incision to Delivery matters d/t Uterine Artery Spasm

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16
Q

What are the Advantages of Epidurals for C-Sections?

A

Tailored Dose

Prolong block for longer procedures

Post-Op Pain Control

Hemodynamic Stability

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17
Q

What are Disadvantages to Epidurals for C-Sections?

A

Contraindications

Block not as good as Spinal

Still may need General for Surgery

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18
Q

What is the highest cause of death associated w/ Regionals for C-Sections?

A

LA Toxicity, then High Spinals

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19
Q

What are the CV effects of a High Block?

A

Sympathectomy of Lower Extremity & Splanchnic Beds

↓Venous Return

↓BP

↓HR

↓Contractility

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20
Q

What are the Pulmonary Effects of Epidurals?

A

Inspiration: None

Expiration: Low Pressures & Flows = Feeling of Dyspnea

Reassure Patient

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21
Q

What is the Ideal Height of an Epidural Block for a C-Section?

A

T4 - T8

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22
Q

How should pain be managed w/ an Epidural before a C-Section Incision?

A

Fentanyl 100 - 150 mcg

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23
Q

How should breakthrough pain be managed during a C-Section?

A

5cc Local Bolus

Fentanyl

N2O

Ketamine 10mg

Local Infiltrate by Surgeon

Convert to GA

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24
Q

Why are Spinals sometimes used over Epidurals for C-Sections?

A

Dense block w/ single shot

Defined Endpoint: CSF Flow = Good

No Risk for Intravascular Injection

Easy & No Catheter

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25
What are Disadvantages of Spinals vs. Epidurals for C-Sections?
Finite - cant give more PDPH risk Total Spine Risk Maternal Hypotension
26
Laboring women have less hypotension w/ Spinals than Non-Laboring women: True or False?
**True**
27
How effective is Prehydration in the Parturient w/ preventing Hypotension?
Not effective - does not stay intravascular long + ANP increase causes diuresis
28
What is the drug of choice in treating Hypotension in the Parturient?
**Phenylephrine** & Also Ephedrine, but increases risk of fetal acidosis
29
What are some considerations w/ using Tetracaine?
Slow Onset Long Duration Unreliable
30
What are some considerations w/ using Lidocaine?
Short Acting & Neuro Symptoms
31
What are some considerations w/ using Bupivacaine?
Best Choice Fast Onset Intermediate Duration
32
How much Pitocin should be given after C-Section Delivery?
20 units of Pitocin in 1L Bag or 30 units of Pitocin in 500cc Bag
33
What are the risks to the fetus during Non-OB surgeries in the Parturient?
Effect of Disease Fetal Development d/t Anesthetic Agents Uterine Blood Flow Preterm Labor Abortion
34
How does Pregnancy affect Anesthesia?
↑Sensitivities to Neuraxial Agents ↓MAC ↓Plasma Cholinesterase ↓Protein Binding
35
Which drug was shown to have teratogenic effects in rats?
N2O Other gases not teratogenic in humans
36
When is it safe for patients to have elective surgery after giving birth?
6 weeks after delivery
37
Hyperthyroidism causes the Myocardium to be sensitive to \_\_\_\_\_\_\_\_\_\_
Hyperthyroidism causes the Myocardium to be sensitive to **catecholamines**
38
What are the Anesthetic considerations for caring for a Parturient w/ Hyperthyroidism?
May be on Propranolol which exacerbates Hypotension from Subarachnoid Block & Titrate pressors carefully - more sensitive
39
What can Pheochromocytoma look like particularly in the Parturient?
Preeclampsia Epidural Preferred DONT Beta-Block before Alpha Blocking first
40
How does pregnancy affect Bronchial Asthma?
May improve d/t Bronchodilation Give Methylxanthines, Steroids, B-Adrenergics Prefer Epidural \> Spinal \> GA
41
What drugs should be avoided in Parturients w/ Bronchial Asthma?
General Anesthesia H2 Blockers - Rinitidine, Cimetidine Desflurane
42
What Induction meds should be used for parturients w/ Bronchial Asthma?
Ketamine & Atropine or Robinul
43
Paraplegic Parturients have Autonomic Hyperreflexia & Preterm Labor Risk, what are the symptoms?
Triggered by Skin Stimulation & Bladder/Uterus Distension Pilomotor Erection Sweating Flushing Severe HTN Bradycardia
44
How is Autonomic Hyperreflexia prevented in the Paraplegic Parturient?
_Early_ Epidural Analgesia preferred over SAB Avoid Sux d/t Hyperkalemia Risk
45
What are the two presenting patterns of Multiple Sclerosis?
**Exacerbating Remitting** - abrupt attacks resolving over months & **Chronic Progressive**
46
What are symptoms of Multiple Sclerosis?
Loss of CNS Myelin Weakness Impaired Vision Ataxia Bladder/Bowel Dysfunction Labile Emotions
47
How is Multiple Sclerosis treated?
No Cure Immunosupression
48
How does pregnancy affect Multiple Sclerosis?
Slight Relapse Risk d/t stress, exhaustion, infection, and fever No negative effects overall
49
What are concerns regarding Neuraxial blocks w/ Multiple Sclerosis?
Toxicity d/t Demyelinated Spinal Cord Dont use \> 0.25% Bupivacaine
50
What should be avoided in parturients w/ Multiple Sclerosis?
Avoid Sux - muscles already weak & Maintain normal temps
51
What is the main concern w/ Parturients who have Brain Tumors?
Brain Herniation & Death Avoid Dural Puncture Consider IV pain control, Lumbar & Pudendal Blocks, or GETA
52
What is Pseudotumor cerebri?
Benign Intracranial Hypertension _unrelated_ to a mass OK for Epidural/Spinal
53
What special considerations should you take for Parturients w/ Epilepsy?
None - Proceed as normal
54
What is the pathophysiology of Myasthenia Gravis?
Progressive muscle weakness ACTH receptor destruction Effects Women 3x \> Men Treat w/ Neostigmine or Edrophonium
55
How does pregnancy affect Myasthenia Gravis?
Exacerbation Cholinergic Crisis - may need more Neostigmine
56
What meds are Contraindicated for Parturients w/ Myasthenia Gravis?
Some ABX's Mag Sulfate Propranolol Quinidine Beta-Adrenergerics - Ritodrine, Terbutaline Lithium Penicillamine Quinine
57
How does Myathenia Gravis affect Anesthetic Management?
1/2 MAC 1/2 Intubation Doses More sensitive to NMBs, Opioids, & Locals
58
What are symptoms of a Cholinergic crisis related to Myathenia Gravis?
Profound Muscle Weakness Resp. Failure Loss of Bowel/Bladder Function Disorientation Diplopia
59
What is used to treat a Cholinergic Crisis?
IV & IM Atropine
60
What is Sickle Cell Disease?
Recessive Gene Blood Disorder RBCs are abnormal, rigid, sickle shaped - pain, viscosity, auto-amputation Shortened Life Span
61
Which form of Sickle Cell Disease causes the most problems for Parturients?
**Homozygous/Rare Sickle Cell (HgbSS/HgbSC)** - severe anemia & preeclampsia Heterozygous (HgbAS) - no problems
62
What factors may cause a Sickle Cell Crisis?
Hypoxia Hypotension Dehydration Hypothermia Acidosis Tourniquet
63
What is the most common type of VonWillebrand Disease (vWF)?
Type 1 - Treat w/ DDAVP DONT use DDAVP w/ Type 3 - worsens bleed _Relative_ contraidication to Neuraxial blocks
64
What is Factor V Leiden?
Factor V CANNOT be inactivated by Protein C = Hypercoagulability
65
How are parturients w/ Factor V Leiden managed?
* Early pregnancy Lovenox, then Heparin * **Prophylactic** Heparin - Hold 12 hrs before block * **Therapuetic** Heparin - Hold 24 hrs before block * Evaluate Anti-Xa
66
What do Protein C & Protein S do?
Work w/ Factors Va & VIIIa to inhibit clot formation
67
What might Phospholipid & Cardiolipid Antibodies suggest?
Hypercoagulability
68
What causes Diffuse Inflammation in Lungs, Pericardium, Pleura, Sclera, and Subcutaneous nodular lesions?
Rheumatoid Arthritis
69
What are Anesthetic problems related to Rheumatoid Arthritis?
Difficult airway d/t ↓Neck Mobility & Hardened Arytenoids Difficult Epidural/Spinal needle placement Restrictive Lung Disease
70
What are the CV issues regarding Rheumatoid Arthritis?
Pericarditis Valvulitis CAD MI Stroke Atypical Angina
71
What is Lupus?
Multisystem Inflammatory Disease d/t Auto-Antibodies against cell membrane Effects Black, Asian, and Native American Women in childbearing years
72
What are problems with Maternal Opioid Addiction?
Difficult IV Access Mom & Baby Withdrawal Symptoms ↑O2 Consumption ↑Preterm Labor & Low Birth Weight ↑Maternal Hypovolemia & Adrenal Insufficiency
73
What are the risks invovled w/ Maternal Alcohol Addiction?
Hemorrhage Clotting Abnormalities Cardiomyopathy Neuropathy ↑Gastric Volume & Acidity
74
What are problems w/ Maternal Amphetamine Addiction?
↑MAC & Gas = Uterine Atony & Catecholamine Depletion
75
What does cocaine do to the parturient & baby?
Vasoconstricts - ↓UBF Thrombocytopenia HTN & Tachycardia ↑PTL ↑Congenital Abnormalities Growth Retardation Low Birth Weight
76
How does Cocaine affect Local Anesthetics?
↓Plasma Cholinesterase - prolongs NMB & LA
77
How does HIV affect Pregnancy?
No Effect, but can cause paralysis, ataxia, encephalitis, and coma
78
How can HIV cause a difficult airway?
Pharyngeal Lymphatic Hypertrophy
79
In parturients w/ Cardiac Disease, what can reverse a L -\> R shunt & Cyanosis?
Hypotension - be careful w/ SAB's w/ these patients

Summer 2020 - APA Foundations 2 - OB (4 decks)

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