Pregnant Anaesthesia

Question 1

Aorta-caval compression?

Answer 1

When T3 lying on back, get hypotension

Response: sympathetic response

Question 2

Blood volume in Preg?

Answer 2

Increases, plasma more 50%
RBC more 30%
Physiological dilution
Clotting factors increase 800%

Question 3

Biggest cause of materal death?

Answer 3

Suicide, post partum depression, puerperal psychosis

Question 4

Why reflux in preg?

Answer 4

Diaphragm is pushed up and when breathing, doesn’t pinch off the sphincter as well – reflux

Question 5

Why pregnant women get oedema?

Answer 5

Concentration of protein, albumin, globulin decrease
Decrease plasma oncontic pressure
Oedema

Question 6

CNS in preg?

Answer 6

More sensitive to narcotics
Local a aesthetics
General gases
Increased endorphins

Question 7

Post delivery circulation mother?

Answer 7

Increase after load, increase venous return after low shunt placenta is gone, likely to have heart failure in the first 5 minutes of birth

Question 8

Longer term probs of post delivery

Answer 8

DVT if told to lie in bed

Question 9

Challenges of pregnant anaesthesia

Answer 9

Weight gain
Fluid retention
Laryngeal oedema
Breast enlargement (laryngoscopes)

Question 10

Clinical implications of pregnant anaesthesia?

Answer 10

-Body is at end of reserve point:
More risk of:
-hypoxia
-failed intubation
-aspiration
-risk of embolism

Question 11

Visceral, dull pain in preganancy from where in first stage in preg

Answer 11

T10-L1-2

Poorly localized

Question 12

Second stage of labour from where?

Answer 12

S2-4, well localized

Distension of outlet, vagina, vulva

Question 13

Non pharma pain relief

Answer 13

Antenatal classes
Hypnosis: only 1/4 of ppl
Acupuncture: 25% ppl
TENS

Question 14

Pharma analgesia for preg?

Answer 14

Nitrous Oxide
OpioIds - Pethidine(no longer) Morphine 1/10dose of Pethidine,
Fentanyl, Remifentanil (ultrashort)

Question 15

Probs with IM morphine?

Answer 15

N/V
Respiratory depression
Dysphoria

Useful for early labour

Question 16

Fentanyl if can’t do epidural then?

Answer 16

PCA

Question 17

Remifentanil probs? PCA?

Answer 17

Narrow safety margin, between relief and Resp depression

Question 18

Epidural indications:

Answer 18

Cardiac disease
Preeclampsia
Reduce delivery trauma
So it reduced pain

Question 19

Contraindication epidural

Answer 19

Patient refusal
Hypovolaemia
Coagulopathy
Sepsis: localized/Generalised
Active neurological disease
Dental distress

Question 20

Advantage of epidural

Answer 20

Pain relief
No sedation
Improves placental flow
Allows instrumental delivery

Question 21

Epidural complications immediate.

Answer 21

Hypotension

Sympatholysis:

Question 22

Delayed epidural complications?

Answer 22

Post dural head ache

Blood patch

Question 23

Epidural cause long term back ache?

Answer 23

NOPE. lOcalized only

Question 24

Epidural drugs given?

Answer 24

Bupivacaine

Ropivacaine (more common) and Fentanyl synergistic

Question 25

Caesarean How to anesthetize?

Answer 25

Regional
Spinal
Or epidural top-up

GA if needed immediately