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Obstetrics > Surgery in the Parturient > Flashcards

Surgery in the Parturient Flashcards

1
Q

What is the most common surgery in the parturient?

A

Cesarean Section

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2
Q

What is safer for C/S, regional or general?

A

Regional

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3
Q

What are 5 indications of GETA for C/S?

A
  1. Acute fetal distress with no time for block
  2. non-functioning epidural catheter
  3. Partuerient has contraindications to regional block
  4. Regional block inadequate
  5. Patient refusal of block
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4
Q

What are the changes in APGAR scores with GA?

A

Lower Apgar at 1 min, but no difference at 5 mins.

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5
Q

4 Options to decrease aspiration risk?

A
  1. NPO 6 hrs
  2. Sodium citrate
  3. Zantac (H2 Blocker)
  4. Reglan
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6
Q

Why is preoxygenation so important in the parturient?

A
  1. Lower FRC

2. Increased O2 Consumption

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7
Q

Which induction medication should be given for severe asthmatics?

A

Ketamine

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8
Q

T/F: Midazolam is the induction agent of choice for parturients?

A

False; causes neonatal depression

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9
Q

Why is etomidate not used in parturients?

A

Can cause transient adrenal suppression in the neonate (and mother).

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10
Q

Why is uterine incision to delivery interval important?

A

Causes uterine artery spasm.

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11
Q

What are the advantages of epidural anesthesia over spinal for C/S?

A
  1. Dose can be tailored as time goes on
  2. Ability to prolong block
  3. Can provide post-op analgesia
  4. More gradual block with less rapid hemodynamic changes
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12
Q

If high spinal to mid thoracic region, what will the hemodynamic effects be?

A

Decrease venous return, decreased BP, tachycardia in response to hypotension

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13
Q

If block extends to T1 (or t1-t4), what will the hemodynamic effects be?

A

Continued hypotension with BRADYcardia.

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14
Q

T/F: Neuraxial anesthesia has no effect on expiration, but can decrease inspiratory effort?

A

No effect on inspiration, but reduces expiratory strength.

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15
Q

What is the ideal block height for C/S?

A

T4-T8 (T8 should be fine).

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16
Q

What can be given via epidural to speed onset of lidocaine/2-chloroprocaine?

A

NaHCO3

17
Q

What percent of C/S patients have breakthrough pain even with epidural?

A

10-50%

18
Q

Treatment options for C/S breakthrough pain with epidural?

A
  1. Bolus of 5cc LA
  2. Epidural or IV Fentanyl
  3. Nitrous Oxide
  4. Ketamine or Propofol
  5. Ask surgeon to infiltrate local
  6. Convert to GA
19
Q

Currently, what is now considered the drug of choice to treat hypotension in the parturient?

A

Phenylephrine

20
Q

Why is tetracaine not used often?

A

Delayed onset, long duration, unreliable

21
Q

What is a typical dose for spinal?

A

12-14mg bupivacaine with 10-25mcg fentanul and 0.1-0.3mg Duramorph

22
Q

What are the effects of duramorph (good and bad)?

A

Provides long acting analgesia (12+hrs), but increases risk of resp depression and causes nausea and pruritis

23
Q

Once delivery of baby, what medication is typically given ?

A

Pitocin 30u/500cc on Alaris pump

24
Q

What are the two most common surgeries for parturients other than C/S?

A

Appendectomy 1:1500

Cholecystectomy 1:5000

25
Q

What are the 4 altered responses to anesthesia in the parturient?

A
  1. Decreased MAC
  2. Increased sensitivity to LA
  3. Decreased plasma cholinesterases
  4. Decreased protein binding (more free drug).
26
Q

T/F: No anesthetic agent is a proven teratogen in humans?

A

True

27
Q

At how many weeks gestation should fetal heart rate monitoring be done during surgery?

A

20 weeks gestation or greater

28
Q

What does nitrous oxide interfere with?

A

B12 Metabolism

29
Q

When should benzos absolutely not be used during pregnancy?

A

Between weeks 3-8 organogensis occurs

Obstetrics (9 decks)

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