Unit 3 Module 4 Labor A&A (Exam 3) Flashcards
..are we already on Exam 3?
Yes.
Now remember to drink water and everything is going to be ok.
don’t tell me what to do
What fetal position is associated with a more difficult delivery?
A. Occiput Anterior
B. Occiput Posterior
C. Occiput Transverse
D. Occiput Superior
B. Occiput Posterior
The back of the baby’s head is facing the spine aka “sunny side up”
slide 3
Which of the following is the preferred fetal position for delivery?
A. Occiput Superior
B. Occiput Posterior
C. Occiput Anterior
D. Occiput Transverse
C. Occiput Anterior
The back of the baby’s head is facing the anterior abdomen
Slide 3
AROM is best defined as:
A. Amniotic rupture of muscle
B. Artificial rupture of membranes
C. Acute rupture of membranes
D. Abnormal rupture of membranes
B. Artificial rupture of membranes
“Amniotomy”
Slide 3
What does the acronym SROM stand for?
A. Surgical rupture of membranes
B. Scheduled rupture of membranes
C. Sudden release of mucus plug
D. Spontaneous rupture of membranes
D. Spontaneous rupture of membranes
Slide 3
New Terminology Matching
Example: G2 P0101
Gravida (pregnancies) and then the numbers after the Para you have TPAL
A → 2 Term >37wks
B → 1 Preterm <37wks
C → 3 Abortions (Miscarriage or other loss)
D → 4 Living Children
Therefore a G2 P0101 = G2 pregnancies, P = 0 term births, 1 preterm, 0 abortions and 1 living child
Slide 4
What does G4 P2102 indicate?
A. 4 pregnancies, 2 term births, 1 preterm, 0 abortions, 2 living children
B. 4 pregnancies, 2 term births, 1 abortion, 0 preterm, 2 living children
C. 4 pregnancies, 1 term birth, 2 preterm, 0 abortions, 2 living children
A. 4 pregnancies, 2 term births, 1 preterm, 0 abortions, 2 living children
Gravida, Para = (Term, Preterm, Abortions, Living)
slide 4
Which of the following is a function of intact amniotic membranes?
A. Stimulates uterine contractions
B. Allows oxygen exchange to the fetus
C. Prevents maternal weight gain
D. Protects uterine contents from bacteria
D. Protects uterine contents from bacteria
Slide 5
What is one major risk if the amniotic sac remains ruptured for more than 12 hours?
A. Chorioamnionitis
B. Protection of the fetus
C. Normal birth
D. OP presentation of fetus
A. Chorioamnionitis
slide 5
What is the typical duration of the first stage of labor for a primiparous patient?
A. 2–4 hours
B. 5–8 hours
C. 8–12 hours
D. 12–16 hours
C. 8–12 hours
Slide 6
What is the typical duration of the first stage of labor for a multiparous patient?
A. 2–4 hours
B. 5–8 hours
C. 8–12 hours
D. 10–14 hours
B. 5–8 hours
slide 6
First stage - Latent phase
Which of the following statements is TRUE regarding the latent phase of labor?
A. It begins after the cervix is fully dilated
B. It includes rapid fetal descent and minor dilation
C. It involves minor cervical dilation and effacement
D. It involves effacement and rapid fetal dscent
C. It involves minor cervical dilation and effacement (cervical thinning out)
slide 6
Which of the following best describes cervical dilation during the first stage - latent phase of labor?
A. 0–1 cm
B. 2–4 cm
C. 5–7 cm
D. 8–10 cm
B. 2–4 cm
slide 6
In the first stage of labor, the latent phase is characterized by:
Select 2
A. Contractions every 8-10min
B. Contraction duration of 30–40 seconds
C. Cervical dilation from 4 to 7 cm
D. Contraction duration of 30-60 seconds
E. Contractions every 5-7min
B. Contractions lasting 30–40 seconds
E. Contractions every 5-7min
Slide 6
First Stage - Active Phase
What cervical dilation range defines the active phase of labor?
A. 0–2 cm
B. 2–4 cm
C. 4–6 cm
D. Up to 10 cm
D. Up to 10 cm (complete)
Cervical dilation ‘ramps up’
slide 7
Which of the following contraction patterns is consistent with the active phase?
A. Every 10–15 minutes, lasting 20 seconds
B. Every 5–7 minutes, lasting 30–40 seconds
C. Every 2–5 minutes, lasting 50–70 seconds
D. Every 60seconds, lasting 2 minutes
C. Every 2–5 minutes, lasting 50–70 seconds
slide 7
Second stage
What is the typical duration range of the second stage of labor?
A. 5–60 minutes
B. 15–120 minutes
C. 2–6 hours
D. 30–180 minutes
B. 15–120 minutes
Slide 8
Which of the following marks the beginning of the second stage of labor?
A. Delivery of the placenta
B. Cervical dilation of 4 cm
C. Full cervical dilation to 10 cm
D. Rupture of membranes
C. Full cervical dilation to 10 cm
Slide 8
During the second stage of labor, how often do contractions typically occur and how long do they last?
A. Every 5.5–7 minutes, lasting 30–40 seconds
B. Every 3–4.5 minutes, lasting 40–60 seconds
C. Every 2–3.5 minutes, lasting 50–70 seconds
D. Every 1.5–2 minutes, lasting 60–90 seconds
D. Every 1.5–2 minutes, lasting 60–90 seconds
Slide 8
Which of the following occurs during the second stage of labor?
A. Cervical effacement
B. Fetal descent
C. Formation of the mucus plug
D. Placental separation
B. Fetal descent through the birth canal
Ace Ventura pet detective :)
Slide 8
The second stage of labor ends with:
A. Full cervical dilation
B. Expulsion of the placenta
C. Delivery of the fetus
D. Onset of active labor
C. Delivery of the fetus
Pushing only happens once the cervix is completely dilated!
Slide 8
When is the second stage of labor considered prolonged?
A. If it lasts longer than 1-2 hour
B. If it lasts longer than 2-3 hours
C. If it lasts longer than 3–4 hours
D. If it lasts longer than 5-6 hours
C. If it lasts longer than 3–4 hours
Slide 9
Which of the following are risks associated with a prolonged second stage of labor?
Select 2
A. Cephalopelvic disproportion
B. Postpartum hemorrhage
C. Elevated blood glucose
D. Polyhydramnios
E. Hypocalcemia
A. Cephalopelvic disproportion
B. Postpartum hemorrhage
Slide 9
Which fetal or maternal outcomes are possible with a prolonged second stage of labor?
Select 3
A. NICU admission
B. Neonatal hypoglycemia
C. Severe umbilical cord compression
D. Polycythemia
E. Maternal trauma
A. NICU admission
C. Severe umbilical cord compression
E. Maternal trauma (physical & emotional)
Slide 9
Which of the following are increased risks due to a prolonged second stage?
Select 2
A. Uterine fibroids
B. Increased risk for infection
C. Ovarian cyst rupture
D. Retained placenta
E. Fetal trauma
B. Increased risk for infection - d/t aminiotic sac rupture for long time - chorio
E. Fetal trauma
Slide 9
Third stage
When does the third stage of labor begin?
A. With the onset of active labor
B. With full cervical dilation
C. After delivery of the placenta
D. After delivery of the baby
D. After delivery of the baby
Slide 10
What event marks the end of the third stage of labor?
A. Delivery of the fetus
B. Delivery of the placenta
C. Uterine involution
D. Cord clamping
B. Delivery of the placenta
Slide 10
The third stage of labor is considered prolonged if it lasts longer than:
A. 10 minutes
B. 20 minutes
C. 30 minutes
D. 60 minutes
C. 30 minutes
Slide 10
Fourth Stage
True or False
The fourth stage is considered the 1st hour postpartum
True
Slide 11
The fourth stage of labor is the time of highest risk for _____.
A. Umbilical cord prolapse
B. Uterine rupture
C. Uterine atony
D. Cervical insufficiency
C. Uterine atony
Slide 11
Which of the following is the primary clinical concern during the fourth stage of labor?
A. Postpartum hemorrhage
B. Hypertension
C. Fetal distress
D. Premature rupture of membranes
A. Postpartum hemorrhage (PPH)
Especially if their 2nd stage of labor has been prolonged
Slide 11
Which of the following best describes labor pain?
A. Predictable and mild
B. Uniform and easily managed
C. Caused only by fetal distress
D. Variable and complex
D. Variable and complex
slide 13
Which factors can affect the perception and intensity of labor pain?
Select 3
A. Genetic influence
B. Natural vs. induced labor
C. Amniotic fluid index
D. Fetal weight percentile
E. Pelvic size and shape
A. Genetic influence
B. Natural vs. induced labor (augmented with pitocin)
E. Pelvic size and shape
Slide 13
Which of the following are TRUE statements about labor pain?
Select 2
A. It is always mild during natural labor
B. It is influenced by fetal presentation
C. Women rarely report pain during pushing
D. Severe during contractions & pushing
E. It is more intense with a smaller pelvis
B. It is influenced by fetal presentation
D. Severe during contractions & pushing
slide 13
Labor pain: Stage 1
During the first stage of labor, _______ are stimulated due to _______ of the lower uterine segment and cervix.
A. Baroreceptors; pressure and stretching
B. Mechanoreceptors; stretching and distention
C. Chemoreceptors; inflammation and distention
D. Mechanoreceptors; pressure and temperature
B. Mechanoreceptors; stretching and distention
slide 15
What type of pain is experienced during the first stage of labor?
A. Somatic pain
B. Neuropathic pain
C. Sharp localized pain
D. Visceral pain
D. Visceral pain
“diffuse- not specific”
Slide 15
Which characteristics describe the nerve fibers involved in transmitting the first stage labor pain?
Select 2
A. Unmyelinated
B. Myelinated
C. A-delta fibers
D. C fibers
E. Large-diameter sensory fibers
A. Unmyelinated
D. C fibers
Small
Slide 15
Pain signals from the first stage of labor enter the spinal cord at levels _____.
A. T4–T6
B. L3–L5
C. T10–L1
D. S2–S4
C. T10–L1
slide 15
What is one reason why visceral pain from labor can be difficult to treat with opioids?
A. It is transmitted through thick, myelinated nerves
B. It is not mediated by neural pathways
C. It is hard to localize
D. It does not activate mechanoreceptors
C. It is hard to localize
“could be from the back, sacrum, abdomen”
Slide 16
Pain during the active phase of labor is primarily carried through spinal levels associated with _______.
A. T12–L1
B. L1–L3
C. S1–S3
D. L3–L5
A. T12–L1
Slide 16
Pain from the first stage of labor can be challenging to treat with _________ due to its diffuse nature, but may respond to blockade of peripheral __________.
A. Muscle relaxants; afferents
B. Opioids; afferents
C. Corticosteroids; efferents
D. Antiemetics; efferents
B. Opioids; afferents
Slide 16
Labor pain: Stage 2
Which type of pain becomes more prominent during the second stage of labor?
A. Visceral pain
B. Neuropathic pain
C. Somatic pain
D. Referred pain
C. Somatic pain
Still have visceral pain as contractions continue
Slide 19
Somatic pain during the second stage of labor is transmitted by _______ fibers, which are _______.
A. C fibers; unmyelinated
B. B fibers; sympathetic
C. A-beta fibers; unmyelinated
D. A-delta fibers; myelinated
D. A-delta fibers; myelinated
Slide 19
Which nerve is primarily responsible for transmitting second stage labor pain?
A. Sciatic nerve
B. Pudendal nerve
C. Femoral nerve
D. Ilioinguinal nerve
B. Pudendal nerve
Slide 19
Somatic labor pain in the second stage is generally described as:
A. Diffuse and aching
B. Dull and poorly localized
C. Sharp and easily localized
D. Burning and radiating
C. Sharp and easily localized
Slide 19
Which factors contribute to second-stage somatic pain?
select 2
A. Compression of perineal structures
B. Cervical dilation
C. Stretching of the pelvis
D. Uterine involution
E. Rupture of membranes
A. Compression of perineal structures
C. Stretching of the pelvis
Slide 19
Second-stage pain travels through spinal segments from _______ to _______, reflecting sacral nerve involvement.
A. T10 to L1
B. T12 to S4
C. L3 to S1
D. T6 to L2
B. T12 to S4
Sacral dermatomes
Slide 19
Labor pain management
Which of the following describe the role of a doula?
Select 3
A. Provides emotional support
B. Administers IV fluids
C. Offers physical comfort measures
D. Performs vaginal exams
E. Serves as an advocate for the patient
A. Provides emotional support
C. Offers physical comfort measures
E. Serves as an advocate for the patient
Slide 22
What is a key difference between a doula and a nurse?
A. Doulas perform deliveries
B. Doulas are typically non-medical support persons
C. Doulas administer medications
D. Doulas assist only in emergency care
B. Doulas are typically non-medical support persons
They do not perform deliveries
Slide 22
Which of the following are considered complementary therapies for labor pain?
Select 2
A. Hypnosis
B. Amniotomy
C. IV narcotics
D. Aromatherapy
E. Spinal anesthesia
A. Hypnosis
D. Aromatherapy
Slide 23
Which complementary approaches may be used for emotional and physical support during labor? (select 2)
A. Continuous fetal monitoring
B. Music
C. Foley catheter insertion
D. Fundal massage
E. Acupressure
B. Music
E. Acupressure
..one of my friends watched Bob Ross painting videos on Youtube during her labor..
Slide 23
Complementary therapies such as _______ and _______ may help reduce anxiety and promote comfort during labor.
A. Pitocin; IV fluids
B. Oxygen; fundal pressure
C. Antibiotics; Foley catheter
D. Reflexology; massage
D. Reflexology; massage
Slide 23
Intradermal sterile water injections are a form of _______, which can trigger natural _______ release.
A. Massage; serotonin
B. Noxious stimulation; endorphin
C. Heat therapy; cortisol
D. Reflexology; dopamine
B. Noxious stimulation; endorphin
Slide 24
Which of the following are effective non-pharmacologic strategies for managing back pain in labor?
Select 3
A. Counterpressure
B. Stadol
C. Peanut ball
D. Epidural anesthesia
E. Supine positioning
F. Swaying
A. Counterpressure
C. Peanut ball
F. Swaying
Position changes
Slide 24
Which theory explains why techniques like squeezing a comb may reduce labor pain?
A. Gate control theory
B. Inflammatory theory
C. Central sensitization theory
D. Somatic referral theory
A. Gate control theory
- Small fibers: carry pain signals -> Gate opens = pain
- Large fibers: Carry touch/pressure signals -> Gate closes= Pain reduced
Physiologic distraction - Squeezing the comb activates large fibers and helps reduce pain by closing the gate.
Slide 24
Which of the following best describes the concept of counterirritation in labor pain management?
A. Applying pressure to the cervix to stimulate labor
B. Distracting stimulus to reduce perception of pain
C. Administering opioids to reduce inflammatory pain
D. Using epidural anesthesia to interrupt nerve transmission
B. Distracting stimulus to reduce perception of pain
Slide 24
Inhaled Anesthetics
Which of the following inhaled agents is currently used for labor pain management?
A. Chloroform
B. Sevoflurane
C. Nitrous oxide
D. Isoflurane
C. Nitrous oxide
Slide 25
Who was historically known for using chloroform during labor for Queen Victoria👸🏼?
A. Joseph Lister
B. John Snow
C. Ignaz Snow
D. William Morton
E. Hodor
B. John Snow
This guy
Slide 25
Why must sub-anesthetic concentrations be used for inhaled labor analgesia?
A. To avoid uterine hyperstimulation
B. To keep the partner alert
C. To ensure the parturient remains conscious
D. To prevent fetal scalp swelling
C. To ensure the parturient remains conscious
Partner/Coach is ALWAYS in verbal contact
Slide 25
During labor, nitrous oxide is used in a way that allows the patient to “_______” themselves.
A. Inject
B. Stimulate
C. Sedate
D. Dose
D. Dose
Slide 25
In ________, Stanislav Klikovitch described the use of nitrous oxide (N₂O) for labor analgesia in ________.
A. 1865; England
B. 1881; Russia
C. 1902; France
D. 1873; Germany
B. 1881; Russia
Slide 26
Which of the following best describes the mechanism of nitrous oxide in labor analgesia?
A. Inhibition at NMDA glutamate receptors
B. Direct stimulation of oxytocin receptors
C. Blocking of GABA receptors
D. Inhibition of voltage-gated calcium channels
A. Inhibition at NMDA glutamate receptors
Slide 26
Which of the following is TRUE about nitrous oxide use in labor?
Select 2
A. It decreases uterine contractility
B. It does not cause neonatal depression
C. It causes neonatal depression
D. It is associated with spinal cord suppression
E. It does not reduce uterine contractility
B. It does not cause neonatal depression
E. It does not reduce uterine contractility
Slide 26
Which of the following receptors are stimulated by nitrous oxide during labor analgesia?
Select 4
A. Opioid receptors
B. Dopaminergic receptors
C. Muscarinic receptors
D. Histaminergic receptors
E. ⍺2-adrenergic receptors
F. β2-antagonist receptors
G. ⍺1-adrenergic receptors
A. Opioid receptors
B. Dopaminergic receptors
E. ⍺2-adrenergic receptors
G. ⍺1-adrenergic receptors
Slide 26
What is the typical gas ratio used when patient is self administering nitrous oxide for labor analgesia?
A. 25% nitrous / 75% oxygen
B. 100% nitrous
C. 50% nitrous / 50% oxygen
D. 75% nitrous / 25% oxygen
C. 50% nitrous / 50% oxygen
Slide 27
Which best describes the activation mechanism of a nitrous oxide system during labor?
A. Activated by continuous flow
B. Triggered by anesthetist using a button
C. Activated by patient’s negative pressure
D. Administered via automatic ventilator
C. Activated by patient’s negative pressure
Demand valve connected to face mask or mouthpiece
Slide 27
What prevents overdose when using nitrous oxide during labor?
A. Intermittent delivery through IV tubing
B. Timer-controlled release
C. Rapid metabolism in the liver
D. Fast onset and offset
D. Fast onset and offset
“Patient just drops the mask and they wake up”
Slide 27
What happens to nitrous oxide use in some facilities after an epidural is placed?
A. It is converted to continuous administration
B. It is discontinued
C. It is given through the epidural catheter
D. The concentration is increased
B. It is discontinued
Slide 27
Which of the following are true side effects or precautions with nitrous oxide use during labor?
Select 3
A. May cause paresthesias
B. Causes muscle rigidity
C. Can cause dry mouth and dizziness
D. Always requires general anesthesia backup
E. Issues with nausea
A. May cause paresthesias
C. Can cause dry mouth and dizziness
E. Issues with nausea
Slide 28
What serious complication can result from combining opioids and nitrous oxide?
Select 2
A. Elevated blood pressure
B. Seizure activity
C. Hypoxia
D. Excessive uterine contractions
E. Loss of protective airway reflexes
C. Hypoxia
E. Loss of protective airway reflexes (aspiration risk d/t patient being considered full stomach)
Decreased LOC
Slide 28
Which nerve block can be used to augment nitrous oxide analgesia during labor?
A. Pudendal nerve block
B. Sciatic nerve block
C. Saphenous nerve block
D. Femoral nerve block
A. Pudendal nerve block
Slide 28
Volatile Anesthetics
Which of the following is a key requirement when using volatile agents for labor?
A. Continuous fetal monitoring only
B. Obstetrician must be present
C. Anesthesia provider must be present
D. Nitrous oxide must be administered simultaneously
C. Anesthesia provider must be present
Slide 29
True or False
Isoflurane, Sevoflurane are not as effective as Nitrous oxide for Labor
False
More effective than N2O
Volatile anesthetics cause _______ of uterine smooth muscle, which is _______ dependent.
A. Constriction; time
B. Relaxation; dose
C. Relaxation; pH
D. Spasm; temperature
B. Relaxation; dose
Slide 29
Why is a scavenging system required when using volatile anesthetics?
A. To prevent overdose in the fetus
B. To recycle the gas
C. To mix with oxygen
D. To reduce environmental pollution
D. To reduce environmental pollution
Slide 29
What is a significant maternal side effect of volatile anesthetics during labor?
A. Increased uterine tone
B. Maternal alertness
C. Loss of airway reflexes and amnesia
D. Fetal bradycardia
C. Loss of airway reflexes and amnesia
Slide 29
Volatile agents may be used for deliveries that require _______.
A. Cesarean section only
B. Spontaneous delivery
C. Instrumentation
D. Water birth
C. Instrumentation
Or a twin birth in the Operating Room..
Freeman addition to lecture
Slide 29
Acetaminophen is a _______ analgesic that works through _______ inhibition of COX enzymes.
A. Sedative; strong
B. Multimodal; weak
C. Single-use; selective
D. Antispasmodic; irreversible
B. Multimodal; weak
COX 1 & COX2
Slide 30
The maximum effect of acetaminophen occurs approximately _______ after administration.
A. 1 hour
B. 30 minutes
C. 15 minutes
D. 90 minutes
A. 1 hour
Slide 30
Ketamine provides analgesia primarily through which receptor mechanism?
A. GABA-A agonism
B. NMDA receptor antagonism
C. Alpha-2 adrenergic stimulation
D. Mu opioid receptor activation
B. (Noncompetetive) NMDA receptor antagonism
Nice read refresher
Slide 31
Ketamine is contraindicated in which patient population?
Select 2
A. Patients with preeclampsia
B. Patients with asthma
C. Patients receiving spinal anesthesia
D. Patients undergoing cesarean delivery
E. Patients with hypertension
A. Patients with preeclampsia
E. Patients with hypertension
Slide 31
Ketamine is a _______ derivative and acts as a noncompetitive NMDA receptor antagonist.
A. Morphine
B. Barbiturate
C. Phencyclidine
D. Diazepam
C. Phencyclidine
Slide 31
Which of the following effects may a patient experience with ketamine?
Select 3
A. Increased blood pressure
B. Decreased blood pressure
C. Hallucinations
D. Decreased Heart rate
E. Increased Heart rate
A. Increased blood pressure
C. Hallucinations 🍄
E. Increased Heart rate
“trippin’ down the k-hole”
Slide 31
When might ketamine be especially useful in obstetric anesthesia?
A. During a long cesarean section
B. For cervical ripening
C. During early labor induction
D. During fetal scalp electrode placement
A. During a long cesarean section
“A good time to use ketamine is during cesarean sections when neuraxial anesthesia is wearing off”
Slide 31
What is the typical IV dose range for ketamine used for analgesia or sedation?
A. 0.05–0.1 mg/kg
B. 0.2–0.5 mg/kg
C. 1–2 mg/kg
D. 3–5 mg/kg
B. 0.2–0.5 mg/kg
slide 32
What is the typical onset time after IV ketamine administration?
A. 1 minute
B. 45 seconds
C. 30 seconds
D. 15 minutes
C. 30 seconds
Slide 32
What is the duration of effect after a single IV dose of ketamine?
A. 1–2 minutes
B. 5–10 minutes
C. 15–30 minutes
D. 45–60 minutes
B. 5–10 minutes
Slide 32
Which of the following describes a proper loading dose for ketamine infusion?
A. 1 mg/kg over 5 minutes
B. 0.5 mg/kg over 15 minutes
C. 0.2 mg/kg over 30 minutes
D. 0.2 mg/kg/hr for 1 hour
C. 0.2 mg/kg over 30 minutes
Slide 32
IM ketamine has an onset of _______ minutes and a duration of _______ minutes.
A. 2–8; 10–20
B. 1–3; 30–60
C. 10–15; 45–60
D. 5–10; 60–90
A. 2–8 mins; 10–20 mins
Slide 32
After a ketamine bolus, the infusion dose is typically set at _______ mg/kg/hr.
A. 0.1
B. 0.2
C. 0.4
D. 0.6
B. 0.2 mg/kg/hr
Slide 32
Benzodiazepines
Benzodiazepines bind to a specific site on the _______ receptor, enhancing inhibitory neurotransmission.
A. NMDA
B. Dopamine
C. GABA
D. Nicotinic
C. GABA
Slide 33
Which of the following are true about IV benzodiazepine use in labor?
Select 3
A. Causes amnesia
B. Maternal respiratory depression
C. Does not cross the placenta
D. Increases neonatal tone
E. Crosses the placenta
A. Causes amnesia
B. Maternal respiratory depression
E. Crosses the placenta
Slide 33
Which of the following are potential effects on neonatals due to the use of maternal benzodiazepine use during labor?
Select 3
A. Neonatal hypotonicity
B. Decreased thermoregulation
C. Hyperreflexia
D. Enhanced alertness
E. Respiratory depression
A. Neonatal hypotonicity
B. Decreased thermoregulation
E. Respiratory depression
Slide 33
Opioids
Which of the following is an advantage of using IV or IM opioids for labor analgesia?
Select 2
A. Low cost
B. No placental transfer
C. Requires specialized monitoring
D. Ease of administration
E. No risk of nausea
A. Low cost
D. Ease of administration
No need for specialized equipment or personnel
Slide 34
Which of the following are disadvantages of IV/IM opioid use in labor?
Select 2
A. Itching
B. Requires an anesthesia provider
C. Placental transfer to fetus
D. Always leads to prolonged labor
E. Improves fetal tone
A. Itching
C. Placental transfer to fetus
Sedation, N/V
Slide 34
Meperidine
What is the typical IM dose of meperidine during labor?
A. 25–50 mg IM q2h
B. 50–100 mg IM q4h
C. 100–150 mg IM q6h
D. 10-50 mg IM q2h
B. 50–100 mg IM q4h
Slide 35
What is the typical IV dose of meperidine during labor?
A. 25 mg IV q2-4h
B. 50 mg IV q4-5h
C. 100 mg IV q5-6h
D. 10 mg IV q1-4h
A. 25 mg IV q2-4h
Slide 35
Meperidine is _______ soluble, allowing it to cross the placenta _______.
A. Water; poorly
B. Lipid; readily
C. Protein; slowly
D. Ionized; minimally
B. Lipid; readily
Slide 35
Meperidine can cause multiple side effects, including _______ and _______.
A. Seizures; fever
B. Tachycardia; urinary retention
C. Vomiting; bronchospasm
D. Respiratory depression; itching
D. Respiratory depression; itching
Slide 35
Which of the following is a significant active metabolite of meperidine?
A. Norhydromorphone
B. Norfentanyl
C. Normeperidine
D. Noroxycodone
C. Normeperidine
can cause seizures
Slide 35
Morphine
What is the typical IV dose of morphine used during labor?
A. 0.01–0.03 mg/kg
B. 0.05–0.1 mg/kg
C. 0.15–0.3 mg/kg
D. 1–2 mg/kg
B. 0.05–0.1 mg/kg
Slide 36
What is the typical IM dose range for morphine used during labor?
A. 0.01–0.05 mg/kg
B. 0.05–0.1 mg/kg
C. 0.1–0.2 mg/kg
D. 1–2 mg/kg
C. 0.1–0.2 mg/kg
Slide 36
The active metabolite of morphine, _____, can accumulate in neonates and contribute to respiratory depression.
A. Morphine-6-glucuronide
B. Morphine sulfate
C. Norfentanyl
D. Normeperidine
A. Morphine-6-glucuronide
Slide 36
Morphine is a _______ opioid, contributing to its _______ onset.
A. Lipophilic; rapid
B. Hydrophilic; slower
C. Hydrophobic; unpredictable
D. Fat-soluble; faster
B. Hydrophilic; slower
Slide 36
Fentanyl
What is the typical IV dose range of fentanyl per hour for labor analgesia?
A. 5–10 mcg/hr
B. 25–50 mcg/hr
C. 50–100 mcg/hr
D. 100–200 mcg/hr
C. 50–100 mcg/hr
Slide 37
Which of the following is true about fentanyl?
A. It has multiple active metabolites
B. It is hydrophilic and has a slow onset
C. It does not cross the placenta
D. It is lipophilic and works quickly
D. It is lipophilic and works quickly
Slide 37
One consideration with repeated fentanyl doses is that the drug may _______.
A. Accumulate
B. Cause uterine atony
C. Convert to normeperidine
D. Lose potency
A. Accumulate
Slide 37
True or False
Fentanyl has multiple metabolites
False
It has No metabolites
Slide 37
Remifentanil
What is the typical PCA bolus dose of remifentanil for labor analgesia?
A. 5–10mcg with 1-3 min lockout
B. 10–20mcg with 2-5 min lockout
C. 20–40mcg with 2–3 min lockout
D. 50–100mcg with 6-10 min lockout
C. 20–40mcg with 2–3 min lockout
Slide 38
What is the primary method of metabolism for remifentanil?
A. Hepatic cytochrome P450 enzymes
B. Renal excretion
C. Glucuronidation
D. Plasma esterases
D. Plasma esterases
Slide 38
Which of the following best describes remifentanil’s duration?
A. Prolonged effect
B. Ultra-short acting
C. Moderate duration
D. Unpredictable
B. Ultra-short acting
Slide 38
What is the dose of Butorphenol (stadol)?
A. 5-10mg IV/IM
B. 2-4mg IV/IM
C. 1.5-2.5 mg IV/IM
D. 1-2mg IV/IM
D. 1-2mg IV/IM
every 3-4 hours
slide 39
What is the half-life of butorphanol?
A. 1.5 hours
B. 2.7 hours
C. 4.6 hours
D. 8.2 hours
C. 4.6 hours
slide 39
True or false
Butorphenol is known for improved analgesic score over fentanyl
true
slide 39
What is the dose of Nalbuphine (nubain)
A. 1-2mg
B. 3-8mg
C. 5-20mg
D. 10-30mg
C. 5-20mg IV, IM, subq Q4-6 hours
slide 39
What is the half life of nalbuphine
A. 4 hours
B. 5 hours
C. 2 hours
D. 3.5 hours
B. 5 hours
slide 39
What can Nalbuphine cause?
A. fetal decelerations
B. fetal tachycardia
C. fetal demise
D. fetal bradycardia
D. fetal bradycardia
slide 39
What can help with fetal bradycardia caused by Nalbuphine
A.Glycopyrolate
B. Epinephrine
C. Naloxone
D. Phenylephrine
C. Naloxone
slide 39
Which drug will suppress uterine contractions, promote premature constriction of fetal ductus arteriosus and inhibit platelet aggregation?
A. toradol
B. fentanyl
C. stadol
D. nubain
A. toradol
NSAIDS
slide 40
What is the goal of the paracervical block?
A. block transmision to the postcervical ganglion
B. block transmision to the intracervical ganglion
C. block transmission thru paracervical ganglion
D. facilitate transmission thru paracervical ganglion
C. block transmission thru paracervical ganglion
slide 41
The paracervical block is normally administered by the _______ provider.
A. Doula
B. nurse
C. anesthesia
D. OB
D. OB provider
slide 41
The paracervical block is for short term pain relief in the ________ stage of labor
A.first
B.second
C.third
D.fourth
A. First
What are the 3 complications associated with the paracervical block? (select 3)
A. maternal bradycardia
B. injection into fetal scalp
C. maternal LAST
D. syncope
E. rupture of membrane
B. injection into fetal scalp
C. maternal LAST
D. syncope
also fetal LAST and fetal bradycardia
slide 41
Which complication is considered the MOST severe fetal complication
A. fetal demise
B. fetal LAST
C. fetal bradycardia
D. fetal tachycardia
B. Fetal LAST
slide 41
What is the most COMMON fetal complication
A. fetal demise
B. fetal LAST
C. fetal bradycardia
D. fetal tachycardia
C. fetal bradycardia
slide 41
Which patient populations is the paracervical block contraindicated in(select 2)
A. uteroplacental insufficiency
B. stage 2 of labor
C. non-reassuring fetal heart rate
D. anterior placenta
A. uteroplacental insufficiency
C. non-reassuring fetal heart rate
slide 41
The pudendal nerve block will (select 2)
A. minimize bleeding
B. reduce fetal movement
C. have rapid absorption of LA
D. minimize urge to push
C. have rapid absorption of LA
D. minimize urge to push
slide 43
The pudendal nerve block is an alternative to pharmacologic pain management in the _____ stage of labor
A. first
B. second
C. third
D. fourth
B. second
slide 43
What are the 3 risk factors of the pudendal nerve block (select 3)
A. injection into pudendal artery
B.LAST
C. fetal trauma or injections of LA
D. maternal bradycardia
E. fetal tachycardia
A. injection into pudendal artery
B.LAST
C. fetal trauma or injections of LA
slide 43
What is the only form of analgesia that provides complete analgesia for both stages of labor?
A. opioids
B.moderate anesthesia
C. general anesthesia
D. neuraxial anesthesia
D. neuraxial anesthesia
slide 44
true or false
Anesthesia consent is needed after the intervention
false … before
“ we normally do it when they come into the hospital”
slide 44
What is a preprocedural assessment required for neuroaxial anesthesia in healthy parturients
A. airway
B. routine lab
C. plt count
D. EF
A. airway
Routine lab testing is not required for HEALTHY partuients
slide 44
What medications should you have in the neuroaxial cart? (select 2)
A. precedex
B. vasopressors
C. glycopyrolate
D. emergency meds
B. vasopressors (ephedrine, phenylephrine)
D. emergency meds (atropine, epi, naloxone, calcium chloride, sodium bicarb)
slide 45
True or false
Induction agents and muscle relaxants need to be apart of preparation for neuroaxial anesthesia
true
Which of the following are also required for preparation of neuroaxial anesthesia? (select 4)
A. Sevoflurane
B. intralipids
C. ambu bag, O2, facemask
D. suction
E. airway equipment
F. neostigmine
B. intralipids
C. ambu bag, O2, facemask
D. suction
E. airway equipment
slide 46
Which of the following statements are true?
A. NPO status is not required for neuroaxial anesthesia
B. Informed consent is best during active labor
C. IV access is not optional
D. It is not necessary to preload or co load patient with fluids
C. IV access is not optional
NPO status for liquids and solids is needed
Informed consent is best before onset of labor or early labor
You do need to preload or co-load patient with fluids
slide 47
When monitoring a neuroaxial patient, blood pressure should be monitored how frequently?
A. 1-5 min during initial stage of dosing then 15 min after initial 20-30 min
B. 2-4 min during initial stage of dosing then 20 min after initial 30-40 min
C. 1-5 min during initial stage of dosing then 20 min after initial 30-40 min
D. 2-4 min during initial stage of dosing then 15 min after initial 20-30 min
A. 1-5 min during initial stage of dosing then 15 min after initial 20-30 min
slide 48
Which of the following are required monitoring devices for neuroaxial anesthesia (select 2)
A. EKG
B. blood pressure
C. pulse ox
D. arterial line
B. blood pressure
C. pulse ox
hosptial/ anesthesia department policy
slide 48
What monitoring is required on the fetal side when doing neuroaxial anesthesia (select 2)
A. Fetal heart tones
B. fetal blood pressure
C. none is required
D. fetal HR
A. fetal heart tones
D. fetal HR
continuous monitoring during and after, document pre and post FHR
slide 49
What are the 2 positions for neuroaxial anesthesia
A. supine
B. prone
C. sitting
D. lateral
C. sitting
D. lateral
slide 50
What is the advantage of sitting position for neuroaxial anesthesia
A. midline identification
B. less risk of intravascular catheter
C. easier for parturient
A. midline identification
B and C is lateral advantages
B because epidural veins decompressed
slide 50
Where is the apex of thoracic curvature shifted to from T8
A. T7
B.T4
C. T6
D. T10
C. T6
increased risk for cephalad spread
slide 51
What does epidural vein engorgement cause in the pregnant patient (select 2)
A. smaller epidural space
B. larger epidural space
C. risk for venous cannulation
D. decreased risk for venous cannulation
A. smaller epidural space
C. risk for venous cannulation
slide 51
Having lumbar lordosis in pregnancy can lead to? (select 2)
A. Touffiers line decreased
B. decreased intervertebral gap
C.increased intervertebral gap
D. forward rotation of pelvis
B. decreased intervertebral gap - tight spaces
D. forward rotation of pelvis -touffier’s line elevated
slide 52
… I’m sorry for this one
Match the following with absolute or relative contraindications
1.patient refusal
2.elevated ICP d/t mass lesion
3.local anesthetic allergy
4.uncooperative patient
5.language barrier w/o interpreter
6.severe fetal decompression
7.severe maternal cardiac dz
8.uncontrolled hemorrhage w/ hypovolemia
9.epidural site skin/soft tissue infection
10.active coagulopathy
11.untreated systemic infection
12.preexisting neurologic deficit
13.moderate to severe bleeding issues/ clotting disorder
14.anticoagulation
15.skeletal anomalies
16.hardware in spine
1.patient refusal - absolute
2.elevated ICP d/t mass lesion- relative
3.local anesthetic allergy -relative
4.uncooperative patient -absolute
5.language barrier w/o interpreter -relative
6.severe fetal decompression- relative
7.severe maternal cardiac dz - relative
8.uncontrolled hemorrhage w/ hypovolemia - absolute
9.epidural site skin/soft tissue infection- absolute
10.active coagulopathy - relative
11.untreated systemic infection - relative
12.preexisting neurologic deficit - relative
13.moderate to severe bleeding issues/ clotting disorder - absolute
14.anticoagulation- absolute
15.skeletal anomalies - relative
16.hardware in spine relative
slide 53 and 54 see you got 2 slide out of the way
What can happen if you place neuroaxial too early? (select 3)
A. risk for instrumented delivery
B. prolonged second stage of labor
C. Patient not longer get into good position
D. risk for epidural becoming ineffective
E.patient can no longer stay still
A. risk for instrumented delivery
B. prolonged second stage of labor
D. risk for epidural becoming ineffective and needing to be replaced
slide 55
What can happen if you place neuroaxial too late? (select 2)
A. risk for instrumented delivery
B. prolonged second stage of labor
C. Patient not longer get into good position
D. risk for epidural becoming ineffective
E.patient can no longer stay still
C. Patient not longer get into good position
E.patient can no longer stay still
slide 56
True or false
There’s 6 options for neuroaxial anesthesia
false: 5 options
slide 57
All the following are the options for neuraxial anesthesia except …
A. epidural
B. dural puncture epidural
C. combined spinal- epidural
D.paracervical block
E. single shot spinal/intrathecal
F.continuous spinal/ intrathecal
D. paracervical block … thats not neuraxial
slide 57
Where is the placement for continous labor epidural (select 3)
A. L3-4
B. L2-3
C. L4-5
D. L1-2
A. L3-4
B. L2-3
C. L4-5
slide 59
What are 3 advantages for the continuous labor epidural (select 3)
A. amount of local anesthetic/ opioids required
B.continuous analgesia
C. catheter for c-section use
D.no dural puncture required
E. faster onset of analgesia
B.continuous analgesia
C. catheter for c-section use
D.no dural puncture required
slide 59
Disadvantages of continuous labor epidural include all the following except (select 2)
A.slower onset
B. increased risk for PDPH
C.amount of local anesthetic/ opioids required
D. risk of sacral “sparing” or slow blockade
E. greater risk for maternal LAST
F. increased risk for fetal bradycardia
G. greater fetal drug exposure
B. increased risk for PDPH
F. increased risk for fetal bradycardia
slide 60
Epidural technique includes
A. aspiration of blood
B. aspiration of clear fluid
C. prone position
D. loss of resistance
D. loss of resistance
Air or saline
slide 62
true or false
Saline has shown evidence to be superior over air for loss of resistance
False
slide 62
What are 2 risk factors for loss of resistance using air (select 2)
A. patchy block
B. pneumocephalus
C. increased need for opioids
D. increased spread of block
A. patchy block
B. pneumocephalus
slide 62
What is the standard test dose for epidural
A.lidocaine 1.5% + 1:200K epi x3mL
B.bupivacaine 1.5% + 1:200K epi x3mL
C.lidocaine 4% + 1:200K epi x3mL
D.lidocaine 1.5% + 1:400K epi x2mL
A.lidocaine 1.5% + 1:200K epi x3mL
slide 63
What is the point in standard test dose for epidural
A. to ensure the pain will go away immediately
B. to make sure there is not allergy to the local
C. because its fun
D. recognize malpositioned epidural catheter
D. recognize malpositioned epidural catheter
risk for systemic toxicity is low
slide 63
What could you see a change in with epidural test dose Intravascularly? select 3
A. change in contractions
B.change in HR 20bpm in 1 min
C. change in pain level
D. change in O2 saturation
E. circumoral numbness
F. tinnitus
B. change in HR (increase 20bpm w/in 1 min)- is it due to epi or contractions?
E. circumoral numbness
F. tinnitus
slide 63 and 64
True or false
Intrathecal placement will be detected by motor blockage in 5-6 min with warm or heavy legs
False- Intrathecal: motor blockade in 3-5 min/ warm or heavy legs due to high dose of lido in intrathecal space, risk for high spinal
slide 64
What is the primary advantage of intrathecal (spinal) medication in combination with an epidural catheter placement?
A) Longer duration of action
B) Rapid onset of analgesia
C) Higher doses of local anesthetics
D) Increased risk of failed epidural
B. rapid onset of analgesia
low doses of local and opioid
slide 65
How quickly does the onset of analgesia occur after a single shot of intrathecal medication?
A) 30 minutes
B) 1 hour
C) 2-5 minutes
D) 10 minutes
c. 2-5 min
slide 65
Which of the following is an advantage of using a low dose of local anesthetic and opioid in the intrathecal medication?
A) Faster recovery time
B) Increased risk of side effects
C) decreased analgesia
D) Continuous analgesia via epidural catheter
D. Continuous analgesia via epidural catheter
slide 65
What is one of the potential uses of the epidural catheter after the intrathecal medication is administered?
A) Use for cesarean section (C-section)
B) Anesthesia for general surgery
C) Pain management during labor
D) Nerve block for extremities
A) Use for cesarean section (C-section)
slide 65
Which of the following is associated with a decreased incidence when using intrathecal medication followed by the placement of an epidural catheter?
A) Risk of complications during surgery
B) Incidence of failed epidural
C) Duration of the anesthesia effect
D) The need for additional medications
B) Incidence of failed epidural
slide 65
What is a potential risk associated with intrathecal medication and epidural catheter placement in terms of fetal health?
A) Increased risk of fetal tachycardia
B) No effect on fetal heart rate
C) Decreased fetal oxygenation
D) Increased risk of fetal bradycardia
D) Increased risk of fetal bradycardia
slide 66
What factor contributes to the increased risk of fetal bradycardia during this procedure?
A) Degree of sympathetic block and maternal hypotension
B) Maternal hypothermia
C) Use of high doses of anesthetic
D) Maternal fever
A) Degree of sympathetic block and maternal hypotension
slide 66
What is a potential complication that may increase after the administration of intrathecal medication and placement of an epidural catheter?
A) Postpartum depression
B) Postdural puncture headache (PDPH)
C) Nerve damage
D) Postoperative bleeding
B) Postdural puncture headache (PDPH)
slide 66
What is one of the risks associated with postpartum care following intrathecal medication and epidural catheter placement?
A) Increased risk of fever
B) Increased maternal hemorrhage
C) Decreased recovery time
D) Increased risk of postpartum neuraxial infection
D) Increased risk of postpartum neuraxial infection
slide 66
What is a challenge in ensuring proper epidural catheter placement after intrathecal medication is administered?
A) The catheter may be too deep to provide effective analgesia
B) Increased risk of puncturing the spinal cord
C) Uncertainty about “correct” catheter placement until block regression
D) Risk of catheter migration during the procedure
C) Uncertainty about “correct” catheter placement until block regression
slide 66
True or false
With a dural puncture epidural there is medication injected.
False
similar to CSE but NO medications injected
slide 67
Which of the following is an advantage of the Dural Puncture Epidural (DPE) technique compared to a traditional epidural without a DPE?
A) Increased risk of postpartum neuraxial infection
B) Faster onset of analgesia
C) Increased risk of maternal hypotension
D) Increased risk of PDPH
B) Faster onset of analgesia
slide 67
What is a benefit of the Dural Puncture Epidural in terms of medication delivery?
A) Decreased risk of sacral analgesia
B) Decreased efficacy of medications
C) No transdural migration of medications
D) Transdural migration of medications injected into the epidural space
D) Transdural migration of medications injected into the epidural space
slide 67
In comparison to Combined Spinal Epidural (CSE), the Dural Puncture Epidural (DPE) technique has which of the following advantages?
A) Decreased risk of maternal hypotension and fetal bradycardia
B) Increased risk of fetal bradycardia
C) Faster onset of labor
D) Increased risk of postpartum neuraxial infection
A) Decreased risk of maternal hypotension and fetal bradycardia
slide 67
What is a major disadvantage of the Dural Puncture Epidural (DPE)?
A) Faster onset of sacral analgesia
B)Decreased risk of maternal hypotension
C)Increased risk of PDPH (Post-Dural Puncture Headache)
D) Decreased risk of postpartum neuraxial infection
C)Increased risk of PDPH (Post-Dural Puncture Headache)
Increased risk for postpartum neuroaxial infection
slide 67
Single Shot Spinal/Intrathecal
For a labor intrathecal or spinal analgesia, the _____________ is based on local anesthetic and opioid administered.
A. levels blocked
B. duration of action
C. risk of infection
D. size of needle
B. duration of action
slide 68
Advantages of single shot spinal/ intrathecal include (select 3)
A. delayed sacral analgesia
B. rapid onset of analgesia
C. continuous medication infusion
D. immediate sacral analgesia
E. Low local anesthetic and opioid dosages
B. rapid onset of analgesia
D. immediate sacral analgesia
E. Low local anesthetic and opioid dosages
slide 68
Disadvantages of single shot spinal intrathecal include all the following except
A. limited duration of analgesia
B. immediate sacral analgesia
C. increased risk of maternal HoTN and fetal bradycardia
D. increased risk of PDPH
E. increased risk of postpartum neuroaxial infection
B. immediate sacral analgesia
Limited duration based on local anesthetic and opioid
PDPH dependent on needle type, size, and attempts
slide 69
Continuous spinal anesthesia is typically used:
A) Electively for routine labor analgesia
B) After unintentional dural puncture with a Tuohy needle
C) Only in patients requiring general anesthesia
D) For all patients undergoing a cesarean section
B) After unintentional dural puncture with a Tuohy needle
slide 70
Which of the following is an advantage of continuous spinal anesthesia?
A) Requires large doses of local anesthetic
B) Cannot be used for patients requiring a cesarean section
C) Has a slow onset of analgesia
D) Provides continuous analgesia
D) Provides continuous analgesia
low dose of LA/ opioid
rapid onset
can be used in patients requiring C-section
slide 70
A major disadvantage of continuous spinal anesthesia is:
A) Risk of mistaken identity between spinal catheter and epidural catheter
B) Low risk of PDPH (Post-Dural Puncture Headache)
C) Slow onset of analgesia
D) Limited use in cesarean sections
A) Risk of mistaken identity between spinal catheter and epidural catheter
high risk for PDPH
slide 70
Which of the following is a potential complication of continuous spinal anesthesia?
A) Increased risk of fetal bradycardia
B) Large dural puncture leading to an increased risk of PDPH
C) Difficulty in providing continuous analgesia
D) Prolonged onset of analgesia
B) Large dural puncture leading to an increased risk of PDPH
slide 70
Epidural local anesthetics block which type of pain?
A) Only visceral pain
B) Only somatic pain
C) Both visceral and somatic pain
D) Only pain from cervical dilation
C) Both visceral and somatic pain
slide 71
Epidural local anesthetics block visceral pain, which includes: (select 2)
A) Descent of the fetus into the birth canal
B)Cervical dilation
C) Lower uterine segment distention
D) Somatic pain from uterine contractions
B)Cervical dilation
C) Lower uterine segment distention
slide 71
Epidural local anesthetics help block somatic pain, which is associated with:
A) Cervical dilation
B) Lower uterine segment distention
C) Uterine contractions
D) Descent of the fetus into the birth canal
D) Descent of the fetus into the birth canal
slide 71
What are the most commonly used drugs for labor (select 2)
A. Bupivacaine
B. Ropivacaine
C. Lidocaine
D. Tetracaine
A. Bupivacaine
B. Ropivacaine
slide 71
Which of the following is an advantage of bupivacaine in epidural anesthesia?
A) It causes significant motor and sensory block together
B) It provides a differential block with separation between motor and sensory effects
C) It causes rapid tachyphylaxis
D) It has a very short duration of action
B) It provides a differential block with separation between motor and sensory effects
Long duration of action
Lack of tachyphylaxis
slide 72
What is a key feature of bupivacaine in terms of its effects on motor neurons?
A) It blocks both motor and sensory neurons equally
B)It has no effect on motor neurons
C) It only blocks A-α motor neurons
D) It spares A-α motor neurons while blocking sensory neurons
D) It spares A-α motor neurons while blocking sensory neurons
slide 72
One advantage of bupivacaine is:
A) It has a long duration of action
B) It has a short duration of action, ideal for short procedures
C) It causes rapid tachyphylaxis
D) It causes significant placental transfer
A) It has a long duration of action
Lack of tachyphylaxis
slide 72
Which of the following is true regarding the safety of bupivacaine?
A) High concentrations of bupivacaine are unlikely to cause toxicity
B) It causes significant tachyphylaxis with repeated doses
C) It has limited placental transfer
D) It readily crosses the blood-brain barrier
C) It has limited placental transfer
slide 72
Which of the following is an advantage of bupivacaine regarding toxicity?
A) High concentrations are likely to cause toxicity
B) Low concentrations of bupivacaine are unlikely to cause toxicity
C) It causes toxicity in both high and low concentrations
D) It has a high risk of toxicity regardless of the concentration
B) Low concentrations of bupivacaine are unlikely to cause toxicity
slide 72
Disadvantages of Bupivacaine include (select 2)
A. slow onset time
B. fast onset
C. risk of CV and neuro toxicity
D. risk of renal toxicity
A. slow onset time
C. risk of CV and neuro toxicity
slide 73
What is the onset time of Bupivacaine
A. 13-17min
B. 10-15min
C. 20-30min
D. 15-20min
B. 10-15min
slide 73
Latency of Bupivicaine is improved with _______ opioid
A. hydrophilic
B. lipophobic
C. highly protein bound
D. lipophilic
D. lipophilic
slide 73
Amide
Which factors influence the concentration and dose of Bupivacaine? (Select 4)
A. Provider
B. Practice setting
C. Fetal gender
D. Parturient height and weight
E. Stage and progression of labor
A. Provider
B. Practice setting
D. Parturient height and weight
E. Stage and progression of labor
Slide 74
Amide
The initial dose of Bupivacaine typically ranges from ____.
A. 0.5% - 1%
B. 0.1% - 0.3%
C. 0.0625% - 0.25%
D. 0.01% - 0.1%
C. 0.0625% - 0.25%
Slide 74
Amide
When using a ___ concentration of Bupivacaine, a ___ volume is typically administered.
A. higher, smaller
B. lower, larger
C. lower, smaller
D. higher, larger
B. lower, larger
When using a lower concentration of Bupivacaine, a larger volume is typically administered.
10-20 mL depending on concentration
Slide 74
Amide
The initial dose of Bupivacaine is usually followed by a ____ infusion.
A. bolus
B. rescue
C. maintenance
D. spinal
C. maintenance
Slide 74
Amide
Which of the following are advantages of Ropivacaine compared to Bupivacaine? (Select 2)
A. Fast onset time (3–5 minutes)
B. Better separation of sensory and motor block
C. Lower risk of heart and nerve toxicity
D. Works faster when given with a lipophilic opioid
E. More fat-soluble, so lower risk of toxicity
B. Better separation of sensory and motor block
C. Lower risk of heart and nerve toxicity
Slide 75
Amide
Which of the following are considered disadvantages or limitations of Ropivacaine? Select 3)
A. Slower onset time (10–15 minutes)
B. Requires co-administration with hydrophilic opioids to be effective
C. Potential for cardiovascular and neurologic toxicity
D. Latency can be improved with lipophilic opioids
E. Higher toxicity risk than lidocaine in equal doses
A. Slower onset time (10–15 minutes)
C. Potential for cardiovascular and neurologic toxicity
D. Latency can be improved with lipophilic opioids
Slide 75
Amide
What is the initial concentration range for Ropivacaine when used for analgesia?
A. 0.01%–0.05%
B. 0.0625%–0.25%
C. 0.1%–0.2%
D. 1%–2%
C. 0.1%–0.2%
Slide 75
Amide
When using a lower concentration of Ropivacaine, a ___ volume is typically administered.
A. larger
B. smaller
C. fixed
D. concentrated
A. larger
10 – 20 mL depending on concentration
Slide 75
Amide
The initial dose of Ropivacaine is usually followed by a ____ infusion.
A. bolus
B. rescue
C. maintenance
D. spinal
C. maintenance
Slide 75
Amide
Which of the following are reasons Lidocaine is not ideal for labor analgesia? (Select 4)
A. Poor differential block
B. Risk of tachyphylaxis
C. Increased placental transfer
D. Very short duration of action
E. Ion trapping in the fetus
A. Poor differential block
Significant motor involvement / blockade
Dependent on concentration & dose
B. Risk of tachyphylaxis
C. Increased placental transfer
E. Ion trapping in the fetus
Slide 76
Amide
To identify a non-functional epidural catheter, Lidocaine is commonly given at a concentration of ____ in a volume of ____.
A. 0.5%, 2–5 mL
B. 1%, 10–15 mL
C. 2%, 5–10 mL
D. 1.5%, 3–5 mL
C. 2%, 5–10 mL
Slide 77
Amide
When rapid sacral analgesia is needed, Lidocaine can be given at a concentration of ____ in a volume of ____.
A. 0.5–1%, 5–10 mL
B. 1–2%, 10–20 mL
C. 2%, 2–4 mL
D. 0.25%, 15–20 mL
A. 0.5–1%, 5–10 mL
Slide 77
Amide
For instrumented vaginal delivery or perineal repair, Lidocaine is typically given at a concentration of ____ with or without ____ in a volume of ____.
A. 0.5–1%, fentanyl, 3–5 mL
B. 2–3%, morphine, 10–15 mL
C. 1.5–2%, epinephrine, 5–10 mL
D. 0.25–0.5%, bupivacaine, 2–4 mL
C. 1.5–2%, epinephrine, 5–10 mL
Slide 77
Amide
For emergent operative delivery, Lidocaine is typically given at a concentration of ____ in a volume of ____ mixed with ___ to speed up onset.
A. 1%, 5 mL, fentanyl
B. 2%, 10–15 mL, bicarbonate
C. 0.5%, 20 mL, epinephrine
D. 2.5%, 15 mL, dextrose
B. 2%, 10–15 mL, bicarbonate
2 ml Bicarb mixed in a syringe of 18ml 2% Lido speeds up onset
Slide 77
Ester
The primary advantages of 2-Chloroprocaine include its ____ onset and ___ duration of action.
A. slow, long
B. rapid, short
C. moderate, extended
D. delayed, prolonged
B. rapid, short
Rapid onset
Short duration of action
Slide 77
True or False
2-Chloroprocaine provides a strong differential block, making it ideal for labor analgesia.
False
2-Chloroprocaine provides a poor differential block
Slide 78
Ester
One disadvantage of 2-Chloroprocaine is that it interferes with the action of ___ and ____.
A. Lidocaine
B. Ropivacaine
C. Bupivacaine
D. Opioids
E. Spinal anesthesia
C. Bupivacaine
D. Opioids
Slide 78
Ester
In which of the following clinical situations is Chloroprocaine considered useful?
A. Routine epidural maintenance during labor
B. Emergent instrumented or operative delivery and perineal repair
C. Long-duration cesarean section under spinal anesthesia
D. Postpartum pain management via PCA
B. Emergent instrumented or operative delivery and perineal repair
2-3% x 10 mL
Slide 79
Which of the following are benefits of epidural opioid use? (Select 3)
A. Decreases latency
B. Improves quality of analgesia
C. Increases the required dose of local anesthetic
D. Prolongs duration of analgesia
E. Slows the onset of analgesia
A. Decreases latency
B. Improves quality of analgesia
D. Prolongs duration of analgesia
Slide 80
___ opioids like fentanyl/sufentanil have a faster onset, while ___ opioids like morphine have a slower onset but provide longer postoperative pain relief.
A. Hydrophilic, lipophilic
B. Lipophilic, hydrophilic
C. Ionized, non-ionized
D. Natural, synthetic
B. Lipophilic, hydrophilic
Lipophilic will have faster onset (fentanyl/sufentanil) vs hydrophilic (morphine) will have a later onset
Slide 80
Clonidine is an ____ used as an epidural additive to enhance analgesia. The typical initial dose is ____.
A. alpha-1 blocker, 25–50 mcg
B. alpha-2 agonist, 75–100 mcg
C. beta-1 agonist, 50–75 mcg
D. calcium channel blocker, 100–150 mcg
B. alpha-2 agonist, 75–100 mcg
Slide 81
Which of the following are advantages of epidural Clonidine use? (Select 4)
A. Analgesic effect
B. No motor blockade
C. Increased requirement for local anesthetic
D. Improved block quality and duration
E. Decreases local anesthetic requirement
A. Analgesic effect
B. No motor blockade
D. Improved block quality and duration
E. Decreases local anesthetic requirement
Slide 81
Epidural Clonidine may cause maternal ____ and ____, along with an increased risk of maternal ____.
A. hypotension, reflex tachycardia, nausea
B. hypotension, bradycardia, sedation
C. hypotension, dizziness, nausea
D. hypotension, hypertension, respiratory depression
B. hypotension, bradycardia, sedation
Slide 81
Dexmedetomidine is an ____ used as an epidural additive. Its optimal dose range is ____ mcg/mL.
A. alpha-1 antagonist, 1–2
B. alpha-2 agonist, 0.25–0.5
C. beta-1 blocker, 2–4
D. NMDA antagonist, 0.5–1.0
B. alpha-2 agonist, 0.25–0.5 mcg/mL
Slide 82
Which of the following are benefits of epidural Dexmedetomidine? (select 3)
A. Decreases local anesthetic requirements
B. Increases latency
C. Prolongs duration of block
D. Shortens latency
E. Reduces need for opioid additives
A. Decreases local anesthetic requirements
C. Prolongs duration of block
D. Shortens latency
Slide 82
At ____ concentrations, Dexmedetomidine is associated with an increased risk of maternal _____.
A. low, agitation
B. moderate, hypotension
C. higher, sedation
D. standard, nausea
C. higher, sedation
At higher concentrations, Dexmedetomidine is associated with an increased risk of maternal sedation.
Slide 82
Continuous epidural infusion provides a ____ level of anesthesia and can be administered ____ the addition of opioids.
A. variable, only with
B. stable, with or without
C. intermittent, only without
D. incomplete, after opioid effects wear off
B. stable, with or without
Continuous epidural infusion provides a stable level of anesthesia and can be administered with or without the addition of opioids
Slide 83
Which of the following are features of an epidural continuous infusion system? (Select 3)
A. Designated infusion pump
B. Injection ports for emergency access
C. Color-coded and labeled tubing
D. Decreased risk of contamination
E. Must always contain opioids
A. Designated infusion pump
C. Color-coded and labeled tubing
D. Decreased risk of contamination
*No injection ports
Slide 83
Continuous Epidural Infusion: Dosing
(reference)
Slide 84
Which of the following are true about Patient-Controlled Epidural Analgesia (PCEA)? (select 3)
A. Similar to IV PCA
B. Can be used with or without background infusion
C. Increases demand on anesthesia provider
D. Improves patient control over analgesia
E. Requires constant manual bolusing by provider
A. Similar to IV PCA
B. Can be used with or without background infusion
D. Improves patient control over analgesia (Patient self-administers based on need)
Significant decrease in repeat dosing by provider
Slide 85
Which of the following are potential disadvantages of PCEA? (select 3)
A. Pump programming errors
B. Inappropriate patient clientele
C. Decreased patient autonomy
D. Non-patient initiated boluses
E. Excessive sedation due to background infusion
A. Pump programming errors
* Bolus dose volume
* Lockout interval
* Background infusion rate
* Max allowable dose/hour
B. Inappropriate patient clientele
D. Non-patient initiated boluses
Slide 86
Adding a background infusion to PCEA can lead to ____ analgesia and ____ maternal satisfaction, but it may also result in an ____ total drug dose.
A. poorer, decreased, reduced
B. better, increased, increased
C. inconsistent, improved, lower
D. stronger, unchanged, minimal
B. better, increased, increased
Better analgesia & increased maternal satisfaction
Increased total drug dose
Less attentiveness required by pt
Slide 87
What is a major disadvantage of periodic bolus dosing for epidural anesthesia?
A. Reduced need for provider involvement
B. Increased patient mobility
C. Recurring regression of analgesia
D. Consistent drug delivery
C. Recurring regression of analgesia
Slide 88
Periodic bolus dosing often leads to ____ provider and maternal satisfaction and ____ provider workload.
A. increased, decreased
B. decreased, increased
C. unchanged, stable
D. improved, lower
B. decreased, increased
- Decreased provider & maternal satisfaction
- Increased provider workload
Slide 88
Large bolus doses (8–12 mL of local anesthetic ± opioid) may result in ____ and increased risk of ____.
A. prolonged labor, tachycardia
B. dense motor blockade, hemodynamic instability
C. light anesthesia, fetal bradycardia
D. minimal motor impact, sedation
B. dense motor blockade, hemodynamic instability
Slide 88
The two baricity options for spinal Bupivacaine used in labor are ____ (%) and ____ (%).
A. Hyperbaric, 0.75%, Isobaric, 0.5%
B. Isobaric, 0.75%, Hyperbaric, 0.5%
C. Hypobaric, 0.5%, Isobaric, 0.75%
D. Isobaric, 0.25%, Hyperbaric, 0.75%
A. Hyperbaric, 0.75%, Isobaric, 0.5%
Slide 89
Ropivacaine is ____ used for spinal analgesia in the U.S., and when it is, the solution is typically ____ at a concentration of ____.
A. commonly, hyperbaric, 0.75%
B. not typically, isobaric, 0.5%
C. routinely, isobaric, 0.25%
D. widely, hypobaric, 1%
B. not typically, isobaric, 0.5%
Slide 89
Which of the following is NOT explicitly listed as a factor influencing spinal/intrathecal dosing for labor?
A. Provider judgment
B. Hospital/anesthesia department policy
C. Patient height and desired anesthetic level
D. Patient weight and body mass index
D. Patient weight and body mass index
Slide 90
A 5’6” female requiring T10 block =
~1.7ml 0.75% bupivacaine. Calculate the dosage.
0.75% solution x 10 = 7.5 mg/L
7.5mg/mL×1.7mL= 12.75mg
Slide 90-91
Spinal opioids produce analgesia without causing ____, ____, or ____.
A. numbness, motor blockade, sympathectomy
B. sedation, nausea, vomiting
C. hypotension, tachycardia, bradycardia
D. respiratory depression, weakness, ataxia
A. numbness, motor blockade, sympathectomy
May be used as solo agent. More commonly used as an additive to a spinal
Slide 92
Spinal opioids work by blocking afferent input from ____ and ____ fibers to the spinal cord.
A. A-alpha, B
B. C, D
C. A-delta, C
D. B, gamma
C. A-delta, C
Slide 92
True or False
Spinal opioids block efferent impulses while leaving afferent sensory input unaffected.
FALSE
Spinal opioids block afferent (sensory) input from A-delta and C fibers, but do not affect efferent (motor) impulses.
Slide 92
Which of the following are true regarding spinal dexmedetomidine? (select 3)
A. Typical dose range is 2.5–10 mcg
B. It decreases latency of block onset
C. It is primarily used to treat hypotension
D. It prolongs the duration of analgesia
E. It increases motor blockade at low doses
A. Typical dose range is 2.5–10 mcg
B. It decreases latency of block onset
D. It prolongs the duration of analgesia
Slide 93
Which of the following are true about spinal epinephrine use? (select 3)
A. Dosed from 2.25–100 mcg
B. Prolongs analgesia
C. Shortens latency
D. Higher doses can increase motor blockade
E. Typically used for anxiolysis
A. Dosed from 2.25–100 mcg
B. Prolongs analgesia
D. Higher doses can increase motor blockade
Slide 93
What is a key factor in determining a continuous spinal infusion dosing plan for labor?
A. Insurance coverage
B. Hospital policy and provider comfort level
C. Patient eye color
D. Type of IV fluids being administered
B. Hospital policy and provider comfort level
Initial bolus dose same as for CSE
Slide 94
Continuous spinal infusion dosing for labor typically uses ____ bupivacaine or ____ ropivacaine, with or without fentanyl 1–3 mcg/mL at a rate of 1–1.5 mL/hr.
A. 0.1–0.25%, 0.3–0.4%
B. 0.0625–0.125%, 0.1–0.2%
C. 0.25–0.5%, 0.5–0.75%
D. 0.02–0.05%, 0.06–0.08%
B. 0.0625–0.125%, 0.1–0.2%
0.0625 – 0.125% bupivacaine
0.1–0.2% ropivacaine
Slide 94
Which of the following should be regularly assessed following a labor epidural or spinal? (Select 4)
A. Quality of analgesia
B. Maternal respiratory rate only
C. Sensory level using ice or pinprick
D. Progress of labor
E. Intensity of motor blockade
A. Quality of analgesia
C. Sensory level using ice or pinprick
D. Progress of labor
E. Intensity of motor blockade
Slide 95
Post-intervention management includes regular assessment of maternal ___ and fetal ___ tracings.
A. intake; movement
B. blood sugar; oxygen saturation
C. vital signs; heart rate (FHR)
D. fluid output; scalp monitor
C. vital signs; heart rate (FHR)
Slide 95
True or False
Patient teaching and managing expectations is a key component of post-intervention care during labor analgesia.
True
Slide 95
What is the first step when addressing a patient’s complaint of pain during labor with an epidural in place?
A. Administer 5 mL of lidocaine
B. Give 100 mcg fentanyl
C. Increase the infusion rate
D. Assess the location of the epidural catheter
D. Assess the location of the epidural catheter
Slide 96
Which of the following are essential factors to evaluate before intervening for a patient’s labor pain while receiving neuraxial analgesia? (select 2)
A. Sensory level
B. Labor progress
C. Patient’s pain tolerance score
D. Height and weight
A. Sensory level to ice or pinprick
B. Labor progress (e.g., cervical dilation, fetal station)
Slide 96
Complaints of Pain
Local Anesthetic & Concentration x Volume matching
A. Lidocaine =
B. Bupivacaine =
C. Chloroprocaine =
- 2–3% x 5–10 mL
- 1–2% x 5–10 mL
- 0.25% x 5–10 mL
- 0.125% x 3–5 mL
- 0.5% x 5–8 mL
A → 2 Lidocaine 1-2% x 5-10 mL
B → 3 Bupivacaine 0/25% x 5-10 mL
C → 1 Chloroprocaine 2-3% x 5-10 mL
Slide 96
True or False
If a single-shot spinal dose fails, the recommended approach is to immediately repeat the intrathecal injection.
FALSE
Redo intrathecal is generally not recommended due to PDPH risk.
Slide 97
If a single-shot spinal/intrathecal fails, an alternative management strategy is to ___.
A. Administer another spinal dose
B. Place an epidural and dose per CLE guidelines
C. Switch to general anesthesia
D. Increase the IV fluids and wait
B. Place an epidural and dose per CLE guidelines
Slide 97
Which of the following are appropriate management steps for continuous spinal dosing during labor? (Select 2)
A. Use CLE guidelines for bolus dosing
B. Assess catheter location
C. Redo the intrathecal injection immediately
D. Use spinal/intrathecal dosing guidelines
B. Assess catheter location
D. Use spinal/intrathecal dosing guidelines
Slide 97
Which of the following is a primary cause of hypotension during neuraxial anesthesia?
A. Tachycardia
B. Increased cardiac contractility
C. Sympathetic blockade
D. Decreased parasympathetic tone
C. Sympathetic blockade
Slide 98
True or False
Hypotension after neuraxial anesthesia is often due to decreased venous return and peripheral vasodilation.
True
also increased venous capacitance
Slide 98
Neuraxial anesthesia–induced hypotension is defined as SBP < ___ mmHg or a ___% decrease from baseline SBP.
A. 120 mmHg; 10%
B. 100 mmHg; 30%
C. 90–100 mmHg; 20–30%
D. 85 mmHg; 15%
C. 90–100 mmHg; 20–30%
Slide 98
Which of the following are appropriate treatments for hypotension caused by neuraxial anesthesia? (Select 3)
A. Increase IV fluid administration
B. Positioning
C. Administer vasopressors
D. Administer beta blockers
E. Decrease the epidural rate
A. Increase IV fluid administration
B. Positioning patient with legs elevated or left uterine displacement
C. Administer vasopressors
Slide 98
Which of the following are signs of failed spinal or epidural analgesia? (select 3)
A. Unilateral or asymmetric block
B. Strong symmetrical bilateral motor block
C. Catheter dislodged from epidural / subarachnoid space
D. Patchy or absent block
E. High thoracic level block
A. Unilateral or asymmetric block
C. Catheter dislodged from epidural / subarachnoid space
D. Patchy or absent block
Slide 99
What is the most common side effect when opioids are administered via neuraxial anesthesia?
A. Nausea
B. Pruritus
C. Respiratory depression
D. Urinary retention
B. Pruritus
Central mu-opioid receptors
Unrelated to histamine release
Slide 100
Which of the following are effective treatments for pruritus caused by neuraxial opioid administration? (select 3)
A. Diphenhydramine
B. Naloxone 40–80 mcg IV bolus
C. Naltrexone 6 mg orally
D. Ibuprofen
E. Naloxone 1–2 mcg/kg/hr infusion
B. Naloxone 40–80 mcg IV bolus
C. Naltrexone 6 mg orally
E. Naloxone 1–2 mcg/kg/hr infusion
Centrally acting mu-opioid antagonist
Slide 100
Which of the following are recommended strategies to prevent an unintended dural puncture during epidural placement? (select 3)
A. Advance the Tuohy needle during contractions
B. Identify ligamentum flavum while advancing Tuohy
C. Estimate the probable depth of the epidural space
D. Keep Tuohy loaded with blood to ensure pressure
E. Maintain control of the needle-syringe at all times
B. Identify ligamentum flavum while advancing Tuohy
C. Estimate the probable depth of the epidural space
E. Maintain control of the needle-syringe at all times
Advance Tuohy b/t contractions
Clear Tuohy of blood clots
Slide 101
Which of the following are recommended treatments after an unintended dural puncture (wet tap)? (Select 3)
A. Place an intrathecal catheter
B. Reinject CSF from syringe
C. Apply an epidural blood patch if headache develops
D. Replace with an epidural catheter
E. Perform immediate spinal anesthesia
A. Place an intrathecal catheter
C. Apply an epidural blood patch if headache develops
vs. conservative treatment
D. Replace with an epidural catheter
- Do not reinject CSF from syringe – risk for contamination/pneumocephalus
Slide 101
Which local anesthetic is associated with increased risk of cardiovascular toxicity and is not recommended for epidural use?
A. Lidocaine 2%
B. Ropivacaine 0.2%
C. Bupivacaine 0.75%
D. Chloroprocaine 3%
C. Bupivacaine 0.75%
Slide 102
Intravascular cannulation risk increases due to _____ of epidural veins.
A. Thrombosis
B. Engorgement
C. Vasospasm
D. Hypovolemia
B. Engorgement
Slide 102
Which of the following is NOT a side effects/complications due to intravascular catheter cannulation (LAST syndrome)?
A. Tinnitus
B. Circumoral numbness
C. Restlessness
D. Diaphoresis
E. Difficulty speaking
F. Seizures
G. Loss of consciousness (LOC)
D. Diaphoresis
Siide 102
Which of the following are 2 appropriate treatments for local anesthetic systemic toxicity (LAST) caused by intravascular catheter cannulation?
A. Lipid emulsion bolus 1.5 mL/kg over 2–3 minutes
B. Administer benzodiazepines
C. Administer 1 mg epinephrine IV push
D. Increase patient stimulation to maintain alertness
E. Observe only—intervention is not usually necessary
A. Lipid emulsion bolus 1.5 mL/kg over 2–3 minutes
B. Administer benzodiazepines
Slide 102
Which of the following is NOT a typical symptom or complication of a high spinal block accotding to lecture?
A. Agitation and dyspnea
B. Inability to speak
C. Apnea
D. Profound hypotension leading to loss of consciousness
E. Bradycardia and poor oxygenation
E. Bradycardia and poor oxygenation
Slide 103
Which of the following are 3 appropriate treatments for a high spinal block?
A. Assist ventilation
B. Volume resuscitation
C. Administer vasopressors
D. Administer opioids for sedation
E. Reposition patient to upright to improve breathing
A. Assist ventilation
B. Volume resuscitation
C. Administer vasopressors
Slide 103
Match the spinal level with its corresponding function or symptom
A → 2 (T1–T4 = Cardioaccelerator fibers)
B → 3 (C3–C5 = Diaphragm)
C → 1 (C8 = Pinky/hand numbness)
Slide 104
The subdural space lies between the ____ and the ____.
A. Pia mater and spinal cord
B. Dura mater and arachnoid mater
C. Arachnoid mater and pia mater
D. Epidural space and dura mater
B. Dura mater and arachnoid mater
Slide 105
True or False
Subdural blocks typically result in profound motor blockade with rapid onset.
False
cause minimal motor blockade and have a slower onset (10–20 min)
Slide 105
Which of the following findings is most characteristic of a subdural block?
A. Immediate dense motor blockade
B. Symmetric sensory block
C. Cranial > caudal spread
D. Low sensory level with complete motor loss
C. Cranial > caudal spread
May involve cranial nerves
Slide 105
Which of the following are characteristic findings of a subdural block?
A. Dense bilateral motor blockade and rapid onset
B. Symmetrical sensory level with minimal hypotension
C. Unexpectedly high sensory block with patchiness and hypotension
D. Localized motor blockade with preserved sensory function
C. Unexpectedly high sensory block with patchiness and hypotension
Slide 105
Which of the following may be seen with a subdural block? (select 3)
A. Horner’s syndrome
B. Apnea
C. Loss of consciousness (LOC)
D. Hyperreflexia
E. Increased cardiac output
A. Horner’s syndrome
B. Apnea
C. Loss of consciousness (LOC)
Slide 105
Which group of symptoms is most consistent with neurologic complications following neuraxial anesthesia?
A.
Delayed gastric emptying
Nausea/vomiting
Shivering
B.
Back pain
Excessive motor block
Neuro deficits
C.
Urinary retention
Maternal fever
FHR abnormalities
D.
Meningitis
Epidural hematoma/abscess
Neuro deficits
Maternal fever
D.
Meningitis
Epidural hematoma/abscess
Neuro deficits
Maternal fever
Slide 106
Which of the following symptoms are most consistent with gastrointestinal complications of neuraxial anesthesia?
A.
Shivering
FHR abnormalities
Delayed gastric emptying
B.
Nausea/vomiting
Delayed gastric emptying
C.
Neuro deficits
Epidural abscess
Urinary retention
D.
Back pain
Maternal fever
Meningitis
B.
Nausea/vomiting
Delayed gastric emptying
* Assess blood pressure
* May be R/T neuraxial induced hypotension
Slide 106
Which of the following are primarily musculoskeletal complications of neuraxial anesthesia?
A.
Delayed gastric emptying
Nausea
Neuro deficits
B.
Back pain
Excessive motor block
Shivering
C.
Urinary retention
Epidural hematoma
Fever
D.
Meningitis
LOC
Nausea
B.
Back pain
Excessive motor block
Shivering
Slide 106
Which of the following symptoms are most consistent with other complications of neuraxial anesthesia?
A.
Urinary retention
FHR abnormalities
B.
Nausea/vomiting
Delayed gastric emptying
Assess blood pressure
C.
Neuro deficits
Epidural abscess
Urinary retention
D.
Back pain
Maternal fever
Meningitis
A.
Urinary retention
FHR abnormalities
Slide 106
figure out the test dose calculations?
3 ml 1.5% lidocaine
Step 1: Convert % concentration to mg/mL
1.5% lidocaine x 10 = 15 mg/mL
Step 2: Multiply by volume
15 mg/mL × 3 mL = 45 mg
Slide 107
figure out the test dose calculations?
3 ml 1:200,000 epi
Step 1: Convert 1:200,000 concentration to mcg/mL
1,000,000 / 200,000 = 5 mcg/ml
Step 2: Multiply by 3 mL
5 mcg/mL x 3mL = 15 mcg
Slide 107
