Surgery in the Parturient Flashcards
What is the most common surgery in the parturient?
Cesarean Section
What is safer for C/S, regional or general?
Regional
What are 5 indications of GETA for C/S?
- Acute fetal distress with no time for block
- non-functioning epidural catheter
- Partuerient has contraindications to regional block
- Regional block inadequate
- Patient refusal of block
What are the changes in APGAR scores with GA?
Lower Apgar at 1 min, but no difference at 5 mins.
4 Options to decrease aspiration risk?
- NPO 6 hrs
- Sodium citrate
- Zantac (H2 Blocker)
- Reglan
Why is preoxygenation so important in the parturient?
- Lower FRC
2. Increased O2 Consumption
Which induction medication should be given for severe asthmatics?
Ketamine
T/F: Midazolam is the induction agent of choice for parturients?
False; causes neonatal depression
Why is etomidate not used in parturients?
Can cause transient adrenal suppression in the neonate (and mother).
Why is uterine incision to delivery interval important?
Causes uterine artery spasm.
What are the advantages of epidural anesthesia over spinal for C/S?
- Dose can be tailored as time goes on
- Ability to prolong block
- Can provide post-op analgesia
- More gradual block with less rapid hemodynamic changes
If high spinal to mid thoracic region, what will the hemodynamic effects be?
Decrease venous return, decreased BP, tachycardia in response to hypotension
If block extends to T1 (or t1-t4), what will the hemodynamic effects be?
Continued hypotension with BRADYcardia.
T/F: Neuraxial anesthesia has no effect on expiration, but can decrease inspiratory effort?
No effect on inspiration, but reduces expiratory strength.
What is the ideal block height for C/S?
T4-T8 (T8 should be fine).
What can be given via epidural to speed onset of lidocaine/2-chloroprocaine?
NaHCO3
What percent of C/S patients have breakthrough pain even with epidural?
10-50%
Treatment options for C/S breakthrough pain with epidural?
- Bolus of 5cc LA
- Epidural or IV Fentanyl
- Nitrous Oxide
- Ketamine or Propofol
- Ask surgeon to infiltrate local
- Convert to GA
Currently, what is now considered the drug of choice to treat hypotension in the parturient?
Phenylephrine
Why is tetracaine not used often?
Delayed onset, long duration, unreliable
What is a typical dose for spinal?
12-14mg bupivacaine with 10-25mcg fentanul and 0.1-0.3mg Duramorph
What are the effects of duramorph (good and bad)?
Provides long acting analgesia (12+hrs), but increases risk of resp depression and causes nausea and pruritis
Once delivery of baby, what medication is typically given ?
Pitocin 30u/500cc on Alaris pump
What are the two most common surgeries for parturients other than C/S?
Appendectomy 1:1500
Cholecystectomy 1:5000
What are the 4 altered responses to anesthesia in the parturient?
- Decreased MAC
- Increased sensitivity to LA
- Decreased plasma cholinesterases
- Decreased protein binding (more free drug).
T/F: No anesthetic agent is a proven teratogen in humans?
True
At how many weeks gestation should fetal heart rate monitoring be done during surgery?
20 weeks gestation or greater
What does nitrous oxide interfere with?
B12 Metabolism
When should benzos absolutely not be used during pregnancy?
Between weeks 3-8 organogensis occurs
