Unit 3 Module 5 Anes for Delivery (Exam 3) Flashcards by Kimberly Diane Hill

Which of the following best defines macrosomia?
A. Low birth weight infant
B. Fetus with excessive birth weight
C. Premature fetus
D. Small for gestational age

B. Fetus with excessive birth weight

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What does the acronym TOLAC stand for?
A. Trial of labor after cesarean
B. Total obstetric labor and care
C. Term of late active contractions
D. Time of labor and cesarean

A. Trial of labor after cesarean

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VBAC refers to:
A. Vaginal bleeding after cesarean
B. Vacuum birth after complications
C. Vaginal birth after cesarean
D. Vaginal birth and cesarean

C. Vaginal birth after cesarean

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PPH is a serious concern in the postpartum period. What does it stand for?
A. Prenatal pulmonary hypotension
B. Postpartum hemorrhage
C. Partial placental hemorrhage
D. Parenteral hormone hypersecretion

B. Postpartum hemorrhage

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SAB can refer to which of the following in clinical practice?
Select two

A. Spontaneous abortion
B. Surgical abdominal birth
C. Subarachnoid block
D. Suprapubic aspiration

A. Spontaneous abortion
C. Subarachnoid block

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Which of the following is an example of operative vaginal delivery?
Select 2

A. Cesarean section
B. Spontaneous vaginal delivery
C. Vacuum-assisted delivery
D. Induction with oxytocin
E. Forcep assisted delivery

C. Vacuum-assisted delivery
E. Forcep assisted delivery

Less use these days partly due to medico-legal concerns

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Operative vaginal delivery can shorten the __________ stage of labor.
A. First
B. Second
C. Third
D. Latent

B. Second

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Which of the following are indications for operative vaginal delivery?
Select 3

A. Arrested descent
B. Maternal exhaustion
C. Breech presentation
D. Nonreassuring fetal heart rate
E. Chorioamnionitis

A. Arrested descent
B. Maternal exhaustion
D. Nonreassuring fetal heart rate

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A denser sensory block may be needed for operative vaginal delivery and can be achieved using higher concentration local anesthetic such as __________.

A. Lidocaine 0.25%
B. Ropivacaine 0.2%
C. Bupivacaine 0.0625%
D. Lidocaine 2%

D. Lidocaine 2% 5-10ml

Through a in-situ epidural catheter

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Which of the following local anesthetics is appropriate for achieving a denser block during operative vaginal delivery?
A. Lidocaine 1%
B. Ropivacaine 0.2%
C. 2-Chloroprocaine 2–3%
D. Bupivacaine 0.0625%

C. 2-Chloroprocaine 2–3% 5-10ml

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True or false

Cesarean section is the most common surgery in the US.

True!

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What is the approximate national cesarean delivery rate in the U.S.?
A. 30%
B. 40%
C. 20%
D. 50%

A. 30%

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Compared to vaginal delivery, maternal mortality during cesarean delivery is:
A. Equal
B. 2 times greater
C. 5 times greater
D. 10 times greater

D. 10 times greater

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Which of the following is not a primary anesthesia-related cause of maternal mortality during cesarean delivery?
A. Pulmonary aspiration
B. Failed intubation
C. Uterine atony
D. Inadequate ventilation under GA

C. Uterine atony

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Which of the following are known contributors to rising cesarean delivery rates?
Select 4

A. Increased maternal age and delayed childbirth
B. Increased use of forceps and vacuum deliveries
C. Obesity
D. Increased use of electronic FHR monitoring
E. Fewer TOLAC attempts
F. Increased access to midwifery care

A. Increased maternal age and delayed childbirth
C. Obesity
D. Increased use of electronic FHR monitoring
E. Fewer TOLAC attempts

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Which factors have contributed to a decrease in vaginal delivery attempts and an increase in cesarean births?
Select 4

A. Increased fetal macrosomia
B. Decreased instrumented vaginal deliveries
C. Improved neonatal outcomes with vaginal delivery
D. Concern for malpractice litigation
E. Increased use of spontaneous vaginal delivery
F. Increased labor inductions

A. Increased fetal macrosomia
B. Decreased instrumented vaginal deliveries
D. Concern for malpractice litigation
F. Increased labor inductions

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True or False

Maternal request alone can be considered a valid indication for a cesarean delivery.

True

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True or False

Chorioamnionitis is an absolute contraindication to cesarean delivery.

False

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Which of the following hemorrhagic conditions may warrant a cesarean section?
Select 3

A. Cervical insufficiency
B. Placental abruption
C. Hemophilia
D. Vasa premoria
E. Uterine rupture
F. Placenta previa

B. Placental abruption
E. Uterine rupture
F. Placenta previa

Antepartum/intrapartum hemorrhage

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Which maternal conditions listed below could directly prompt a decision for cesarean delivery?
Select 4
A. Pre-eclampsia
B. Multiple gestation
C. Maternal obesity
D. Failed induction of labor
E. Previous classical uterine incision
F. Premature rupture of membranes

A. Pre-eclampsia Deteriorating maternal condition
B. Multiple gestation
D. Failed induction of labor
E. Previous classical uterine incision

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True or false

Active herpes simplex virus (HSV) lesions during labor are an indication for vaginal delivery.

False
Active HSV lesions are an indication for cesarean to prevent neonatal transmission.

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__________ is a common indication for cesarean delivery when labor has failed to progress despite adequate contractions.
A. Inactive HSV lesions
B. Arrested labor
C. Previous pfannenstiel incision
D. Maternal anorexia

B. Arrested labor

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Fetal Causes of Cesarean section

A __________ cord is an emergency indication for cesarean delivery due to risk of cord compression and fetal hypoxia.
A. Short
B. Nuchal
C. Prolapsed
D. Coiled

C. Prolapsed

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Fetal intolerance of labor may present as a __________ fetal heart rate pattern.
A. Sinusoidal
B. Category I
C. Category II
D. Category III

D. Category III

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A fetus in breech, transverse, or face presentation may be delivered by cesarean due to __________. A. Cystitis B. Gestational Diabetes C. Malpresentation D. Microsomia

C. Malpresentation ## Footnote Slide 9

Which of the following are fetal indications for cesarean delivery? Select 3 A. Suspected macrosomia B. Category II fetal heart tracing C. Fetal intolerance D. Prematurity E. Accelerations

A. Suspected macrosomia C. Fetal intolerance D. Prematurity ## Footnote Slide 9

# Match the grades to the description **Grades:** Grade 1 Grade 2 Grade 3 Grade 4 **Descriptions:** A. At a time to suit the woman and maternity team. B. Immediate threat to life of woman or fetus. C. Maternal or fetal compromise that is not immediately life-threatening. D. Needing early delivery but no maternal or fetal compromise.

Grade 1 → B (Emergency – Immediate threat to life of woman or fetus) Grade 2 → C (Urgent – Maternal/fetal compromise, not immediately life-threatening) Grade 3 → D (Scheduled – Early delivery needed, no compromise) Grade 4 → A (Elective – Planned at a convenient time) ## Footnote Slide 10

The anesthesia plan for an unscheduled cesarean delivery depends on multiple factors including **fetal condition, maternal comorbidities**, and __________. A. Fetal presentation B. Patient insurance C. Urgency of delivery D. Neonatal APGAR score

C. Urgency of delivery ## Footnote Slide 11

One consideration in anesthesia planning is whether or not an __________ epidural catheter is already in place. A. Intermittent B. In-situ C. Intraosseous D. Implanted

B. In-situ ## Footnote Slide 11

Which of the following best reflects the maternal wishes in anesthesia planning for an unscheduled cesarean section? A. Maternal wishes are irrelevant in emergencies and should not be considered. B. Maternal preferences are only considered when no comorbidities are present. C. Maternal wishes should be considered when clinically appropriate and time allows. D. Maternal wishes always override clinical urgency and fetal status.

C. Maternal wishes should be considered when clinically appropriate and time allows. ## Footnote Slide 11

# Skin Incisions Which skin incision is most commonly associated with **less postoperative pain and a lower risk of uterine rupture/dehiscence**? A. Classical vertical incision B. Low vertical/midline incision C. Low transverse incision D. Fundal incision

C. Low transverse incision | "Pfannenstiel incision" ## Footnote Slide 12

Which of the following is an advantage of the low vertical/midline incision? A. Least postoperative pain B. Cosmetic appeal C. Rapid access for fetal delivery D. Decreased risk of hernia

C. Rapid access for fetal delivery ## Footnote Slide 12

Which of the following are true about low vertical/midline incisions for cesarean delivery? Select 2 A. Associated with increased risk of umbilical hernia B. Least painful of the incision options C. Extends from umbilicus to pubic symphysis D. Lower instances of dehiscence

A. Associated with increased risk of umbilical hernia C. Extends from umbilicus to pubic symphysis ## Footnote Slide 12

# Uterine Incisions Which of the following are true about the **Low Transverse** uterine incision? Select 4 A. Uterine rupture risk ~10% B. TOLAC may be possible C. Lowest risk of uterine rupture in future pregnancies D. Less risk of bladder injury E. May be extended F. Most commonly used uterine incision

B. TOLAC may be possible C. Lowest risk of uterine rupture in future pregnancies D. Less risk of bladder injury F. Most commonly used uterine incision ## Footnote Slide 13

Which of the following are true about the **Low Vertical** uterine incision? Select 2 A. May be extended if needed B. No risk of uterine rupture C. Typically made in the upper uterine segment D. Incision made in the lower uterine segment E. TOLAC contraindicated

A. May be extended if needed D. Incision made in the lower uterine segment ## Footnote Slide 13

# True or false Low vertical uterine incision has a low risk of uterine rupture but is greater than Low Transverse uterine incision

true ;) ## Footnote slide 13

Which of the following are true about the **Classical uterine** incision? Select 4 A. Made in the lower uterine segment B. TOLAC is contraindicated C. Uterine rupture risk is ~10% D. Most commonly used for elective cesarean sections E. Upper uterine segment F. More risk of abdominal adhesions

B. TOLAC is contraindicated C. Uterine rupture risk is ~10% E. Upper uterine segment F. More risk of abdominal adhesions ## Footnote Slide 13

What is the most common complication associated with cesarean delivery? A. Infection B. Hemorrhage C. Embolism D. Anesthesia awareness

B. Hemorrhage ## Footnote Slide 14

Which of the following is a known contributor to increased blood loss during C-section under general anesthesia? A. Vasoconstriction B. Oxytocin resistance C. Use of GETA D. Regional anesthesia

C. Use of GETA ## Footnote Slide 14

Which of the following are considered among the ACOG “Four T’s” for postpartum hemorrhage causes? Select 4 A. Trauma B. Thrombocytopenia C. Tone D. Tissue E. Thrombin F. Tachysystole

A. Trauma C. Tone D. Tissue (retained placenta) E. Thrombin (coagulopathy) ## Footnote Slide 14

What is the very first priority when managing a maternal hemorrhage? A. Administer TXA B. Give oxytocin C. Call for help D. Start methylergonovine

C. Call for help **and get blood!** ## Footnote Slide 15

Which of the following are appropriate first-line interventions in the setting of maternal hemorrhage? Select 3 A. Open IV fluids B. Start a central line C. Give albumin D. Warm the blood products F. Delay fluids until labs return

A. Open IV fluids C. Give albumin D. Warm the blood products ## Footnote Slide 15

In the setting of maternal hemorrhage, which of the following is the most appropriate action? A. Place a single 20G IV and monitor for deterioration B. Insert a second large-bore IV and prepare for airway management C. Intubate all hemorrhaging patients immediately D. Place an epidural catheter to reduce the need for IV access

B. Insert a second large-bore IV and prepare for airway management ## Footnote Slide 15

What is the first-line medication for promoting uterine tone in the setting of postpartum hemorrhage due to uterine atony? A. Methylergonovine (Methergine) B. Misoprostol C. Carboprost (Hemabate) D. Oxytocin (Pitocin)

D. Oxytocin (Pitocin) ## Footnote Slide 15

Which secondary medications are used to promote uterine contraction and decrease postpartum hemorrhage if pitocin is not working? Select 2 A. Hemabate B. Magnesium sulfate C. Methylergonovine D. Esmolol

A. Hemabate (IM) C. Methylergonovine (Methergine) ## Footnote Slide 15

A 1-gram dose of TXA is typically administered over what time frame? A. 30 minutes B. 5 minutes C. 1 hour D. 10 seconds

B. 5 minutes ## Footnote Slide 15

A patient is actively hemorrhaging. She has already received 2 liters of fluid and 2 units of blood. Which of the following should be considered next? Select 2 A. Wait and observe B. Administer magnesium sulfate C. Administer calcium D. Start a beta-blocker E. Give coagulation factors

C. Administer calcium E. Give coagulation factors ## Footnote Slide 15

What is the purpose of a Bakri balloon in the setting of postpartum hemorrhage? A. To monitor intrauterine pressure B. To tamponade uterine bleeding C. To suction blood from the uterus D. To dilate the cervix for second-stage labor

B. To tamponade uterine bleeding *by applying direct pressure inside the uterus* ## Footnote Slide 16

The __________ suture is a surgical technique that compresses the uterus externally to reduce bleeding in cases of uterine atony. A. McDonald B. Kocher C. Lembert D. B-Lynch

D. B-Lynch ## Footnote Slide 16

__________ is considered the definitive surgical treatment for refractory postpartum hemorrhage when all other interventions have failed. A. Uterine artery embolization B. Uterine massage C. Hysterectomy D. Balloon tamponade

C. Hysterectomy **Uterine artery ligation** ## Footnote Slide 16

Which of the following is a possible complication involving the neonate during cesarean delivery? A. Fetal laceration B. Bladder prolapse C. Delayed cord clamping D. Cervical insufficiency

A. Fetal laceration ## Footnote Slide 17

During cesarean delivery, which structure is most at risk for surgical dissection due to its proximity to the uterus? A. Rectum B. Bladder C. Ovaries D. Spleen

B. Bladder ## Footnote Slide 17

Which of the following are recognized complications of cesarean section? Select 3 A. Bladder extrophy B. Wound infection C. Uterine artery aneurysm D. Uterocervical laceration E. Hysterectomy F. Ectopic pregnancy

B. Wound infection D. **Uterine/**Uterocervical laceration E. Hysterectomy ## Footnote Slide 17

__________ is the term for abnormal placental attachment that does not invade the myometrium but remains adherent to the decidua. A. Accreta B. Increta C. Percreta D. Previa

A. Accreta ## Footnote Slide 18

Placenta previa is defined as placental implantation __________. A. Into the myometrium B. Below the internal cervical os C. At the fundus of the uterus D. Across the cornua

B. Below the internal cervical os ## Footnote Slide 18

Which of the following best describes placenta increta? A. Placental villi partially invade the myometrium B. Placental villi adhere to the decidua without invading the myometrium C. Placental villi penetrate through the entire uterine wall and into adjacent organs D. Placenta covers the internal cervical os

A. Placental villi partially invade the myometrium ## Footnote Slide 18

Which of the following is a serious risk in future pregnancies after previous C-section? A. Cervical dysplasia B. Uterine rupture C. Vaginal stenosis D. Umbilical cord prolapse

B. Uterine rupture **and Hemrrohage** ## Footnote Slide 18

Which of the following are strategies to help prevent unplanned cesarean deliveries? Select 3 A. Adequate epidural analgesia for TOLAC patients B. Routine general anesthesia for breech deliveries C. Internal cephalic version for breech fetus D. Prompt correction of maternal hypotension E. Allowing prolonged fetal bradycardia before intervening F. Position changes in response to fetal decelerations

A. Adequate epidural analgesia for TOLAC patients D. Prompt correction of maternal hypotension F. Position changes in response to fetal decelerations ## Footnote slide 19

Non-reassuring fetal heart tones should prompt interventions such as position changes, IV fluids with pressors, and __________. A. Rapid delivery B. Continuous oxytocin infusion C. Maternal oxygen administration D. Epidural bolus

C. Maternal oxygen administration ## Footnote Slide 19

Why is external cephalic version performed during pregnancy? A. To induce labor early B. To reposition the baby C. To improve maternal circulation D. To stimulate fetal heart rate variability

B. To reposition the baby **to reduce risk of cesarean delivery** ## Footnote Slide 19

Why is neuraxial anesthesia typically preferred over general anesthesia for cesarean delivery? A. It reduces maternal cooperation B. It lowers risk for fetal trauma during delivery C. It is safer for both mother and baby D. It is faster than general anesthesia

C. It is safer for both mother and baby Most common ## Footnote Slide 20

Which of the following factors can influence the anesthesia plan for a C-section? A. Whether the case is scheduled or unscheduled B. Baby's weight C. Epidural placement in the third trimester D. Placental location only

A. Whether the case is scheduled or unscheduled ## Footnote slide 20

Which of the following are essential components of the anesthesia preoperative interview for a cesarean delivery? Select 3 A. NPO status B. Type of prenatal vitamins used C. Allergy history D. Vital signs and fetal heart tones E. Neuro screening

A. NPO status C. Allergy history D. Vital signs and fetal heart tones ## Footnote Slide 21

Which of the following should be included in a focused anesthesia pre-op interview before a cesarean section? A. Airway, lung and neuro check B. Heart, Visual acuity check C. Airway, heart, and lung exam D. Mental status, heart and lung exam

C. Airway, heart, and lung exam ## Footnote Slide 21

What is the significance of reviewing Gravida (G) and Para (P) during the preoperative anesthesia interview for a cesarean? A. To determine epidural catheter size B. To assess maternal nutrition C. To predict potential complications D. To calculate NPO status

C. To predict potential complications and understand OB history **Maternal health and previous anesthetics** ## Footnote Slide 21

A __________ is performed if antibodies are found on a Type & Screen, to ensure compatible blood is available. A. Crossmatch B. Rhogam test C. Coagulation panel D. Serum compatibility assay

A. Crossmatch ## Footnote Slide 22

A __________ and platelet count help guide the anesthesia plan, particularly in patients with preeclampsia or suspected coagulopathy. Select 2 A. BMP B. AST C. Hgb D. Hct

C. Hgb - Hemoglobin D. Hct - hematocrit Have blood available ## Footnote Slide 22

When planning for a cesarean section, it's important to assess whether the IV is __________ and in a reliable location. A. Flushed B. Heparin-locked C. Color-coded D. Large-bore

D. Large-bore Two good IV’s for any high-risk C-section! ## Footnote Slide 22

Which of the following maternal history features indicate a high-risk cesarean delivery? Select 2 A. First pregnancy B. Classical uterine incision C. Multiparity D. Epidural placement E. No prior surgeries

B. Classical uterine incision C. Multiparity Multiple previous c-sections, 2nd, 3rd, 4th ## Footnote slide 23

Which of the following are surgical or anatomic factors that increase the risk of complications during a C-section? (select 2) A. Multiple gestation B. Previous spinal anesthesia C. Classical incision D. Vaginal bleeding during labor E. Epidural bolus

A. Multiple gestation C. Classical incision ## Footnote Slide 23

Which of the following findings should prompt preparation for a high risk C-section? (select 2) A. Low-risk singleton term pregnancy B. Scheduled induction with Pitocin C. Maternal anemia D. Prior uncomplicated vaginal delivery E. Abnormal placental implantation

C. Maternal anemia E. Abnormal placental implantation ## Footnote Slide 23

Which of the following are valid reasons to consider placing a second IV and having blood available before a cesarean? Select 2 A. Scheduled repeat cesarean at 39 weeks B. Conversion to general anesthesia C. Patient has a strong epidural in place D. Unscheduled cesarean after labor attempt E. Baby estimated to weigh under 2500g

B. Conversion to general anesthesia D. Unscheduled cesarean after labor attempt ## Footnote Slide 24

When discussing the anesthetic procedure, what is important to include? A) The specific drugs used during the procedure B) Overview of the procedure and risks C) The expected length of the procedure D) The specific surgical steps

B) Overview of the procedure and risks ## Footnote slide 25

Informed consent during the preoperative interview is required for: (select 2) A) The surgical procedure only B) Anesthesia administration C) The use of EKG leads D) Blood products

B) Anesthesia administation D) Blood products ## Footnote slide 25

Which of the following is a key maternal concern that should be addressed during the preoperative interview? A) Understanding the sensation of pushing, pulling, tugging, and pressure B) Managing postoperative pain only C) The number of people allowed in the operating room D) The cost of the surgery

A) Understanding the sensation of pushing, pulling, tugging, and pressure ## Footnote slide 25

Which of the following risks is important to discuss with the patient before anesthesia administration? (select 2) A) Family support in the recovery room B) Blood loss during surgery C) Presence of support person D) Possibility of nausea

C) Presence of support person D) Possibility of nausea ## Footnote slide 25

Where should you place the EKG leads for a patient who would like to do skin to skin after the baby is born? A. on the chest B. on the abdomen C. on the back D. on the arms

C. on the back ## Footnote slide 25

# True or false You can spot check the oxygen saturation after baby is born to help facilitate skin to skin as long as the patient is stable

True | also give the family some space ## Footnote slide 25

All of the following are needed for preparation of C-section except A. Anesthesia machine on and ready B. Set up when needed C. vasopressors readily available D. Sucs and propofol available E. IV kits F. blood tubing G. airway equipment

B. set up when needed Check machine daily or q12 hours call blood bank and verify if blood is available ## Footnote slide 26

Which preop medications should be given to our C-section patients (select 4) A. Famotidine B. Metoclopromise C. Bicitra D. Propofol E. Antibiotics F. Versed

A. Famotidine B. Metoclopromise C. Bicitra E. Antibiotics (ancef, azithromycin) ## Footnote slide 27-29

Which are true regarding Famotidine (select 3) A. 10mg IV onset 10min/peak 30-60min B. H2 receptor antagonist C. decrease gastric acid production D. 20mg IV onset 30min/peak 60-90min E. H1 receptor antagonist F. increase gastric acid production | Pepcid

B. H2 receptor antagonist C. decrease gastric acid production D. 20mg IV onset 30min/peak 60-90min ## Footnote slide 27

Reglan is a dopmaine D2 antagonist mixed with 5-HT3 antagonist/ 5-HT4 agonist that will A. decrease gastric pH B. increases N/V C. slow gastric emptying D. increase LES tone

D. increase LES tone decrease n/v speeds gastic emptying | also has prokinetic/ promobility ## Footnote slide 27

How soon do you administer Reglan before anesthesia start A. 10-20min B. 15-30 min C. 30-45 min D. 5-15 min

B. 15-30min ## Footnote slide 27

Symptoms of metoclopromide A. extrapyramidal B. intrapyramidal C. N/V D. decrease in HR

A. extrapyramidal ## Footnote slide 27

What is Bicitra and what does it do? (select 2) A. H2 antagonist B. nonparticulate antacid C. decrease gastric pH D. increase gastric pH E. decrease gastric volume

B. nonparticulate antacid D. increase gastric pH ## Footnote slide 28

Which of the following anesthetic options may be discussed during the preoperative interview? A) General anesthesia B) Spinal anesthesia C) Epidural anesthesia D) Combined spinal-epidural (CSE) E) All of the above

E) all of the above ## Footnote slide 25

What is the dose of bicitra? A. 30mL B. 20mL C. 50mL D. 40mL

A. 30mL ## Footnote slide 28

When should you administer Bicitra? A. 20-40min B. 15-30min C. 20-30min D. 10-15 min

C. 20-30min ## Footnote slide 28

What decides which antibiotics to choose? (select 2) A. if it is an emergent B. if parturient is in labor C. if membranes have ruptured D. time of surgery

B. if parturient is in labor C. if membranes have ruptured ## Footnote slide 29

How soon do you give the antibiotics A. when surgery starts B. 2 hours of surgery start C. 30min of surgery start D. 1 hour of surgery start

D. 1 hour of surgery start ## Footnote slide 29

How should you administer antibiotics A. slowly B. IVP C. fast D. over an hour

A. slowly d/t risk of nausea and vomiting ## Footnote slide 29

When will you monitor FHR and maternal BP with a SAB placement A. Before only B. During only C. After only D. before and after

D. before and after ## Footnote slide 30

# True or false You will never use versed for the partuient patient

False it is discouraged BUT can be beneficial for highly anxious parturient ## Footnote slide 30

Why is versed discouraged in a parturient?(select 3) A. readily crosses placenta B. amnesia C. interferes with bonding D. increases anxiety

A. readily crosses placenta B. amnesia C. interferes with bonding ## Footnote slide 30

A FiO2 of _______ does not improve fetal oxygenation A. 0.5-0.6 B. 0.4-0.5 C. 0.6-0.7 D. 0.35-0.4

D. 0.35-0.4 ## Footnote slide 30

FiO2 of ___ in preparation for GETA is idea A. 1.0 B. 0.5 C. 0.35 D. 0.4

A. 1.0 ## Footnote slide 30

# True or false Oxygen is required to be on the patient during a C-section

False. May not be necessary during elective c-section ## Footnote slide 30

What are 3 advantages of neuroaxial anesthesia? A. maternal discomfort B. mother is awake C. protected airway D. early bonding E. presence of support person

B. mother is awake D. early bonding E. presence of support person also use of opioids (morphine and fentanyl) ## Footnote slide 31

What are the 2 disadvantages of neuroaxial anesthesia A. no use of morphine or fentanyl B. hypertension C. maternal discomfort D. hypotension

C. maternal discomfort D. hypotension ## Footnote slide 32 and 33

What are the factors that cause maternal discomfort during a C-section with neuroaxial anesthesia (select 4) A. nausea B. shoulder/chest pain C. sharp equipment D. cool cold irrigation E. pulling/ tugging

A. nausea B. shoulder/chest pain- from refereed utering exteriorization D. cool cold irrigation- under surface of diaphragm causing pain and nausea E. pulling/tugging ## Footnote slide 32

WHat is the shoulder/chest pain caused by in a c-section A. CO2 gas B. uterine exteriorization C. placenta previa D. delivery of baby

B. uterine exteriorization ## Footnote slide 32

Hypotension is caused by a sympathetic blockade which then ________ A. decrease SVR B. increase SVR C. decreases Afterload D. benzold-Jarisch reflex deactivated

A. decreased SVR decrease preload Bezold-Jarisch reflex ACTIVATED ## Footnote slide 33

The Benzold-Jarish reflex is caused by mechanoreceptors in the __ responing to ____ A. diaphragm, extra stretch B. LV, extra stretch C. diapragm, low stretch D. LV, low stretch

D. LV; low stretch ## Footnote slide 33

What is the triad associated with Bezold- Jarisch reflex A. vasoconstriction, hypotension, bradycardia B.vasodilation, hypotension, tachycardia C. vasodilation, hypotension, bradycardia D. vasoconstriction, hypertension, tachycardia

C. vasodialtion, hypotension, bradycardia ## Footnote slide 33

What is the primary mechanism of action of Ondansetron (Zofran) in preventing hypotension? A) Inhibits activation of the BJR by antagonizing 5-HT3 receptors B) Blocks alpha-adrenergic receptors to cause vasoconstriction C) Increases heart rate by stimulating beta-adrenergic receptors D) Decreases vascular permeability

A) Inhibits activation of the BJR by antagonizing 5-HT3 receptors ## Footnote slide 34

When should Ondansetron (Zofran) 4 mg IV be administered to prevent hypotension during a spinal anesthesia procedure? A) Immediately after the procedure B) 5 minutes before spinal anesthesia C) 10 minutes after spinal anesthesia D) At the time of hypotension onset

B) 5 minutes before spinal anesthesia ## Footnote slide 34

What is the effect of Phenylephrine 25-50 mcg/min infusion in preventing hypotension during spinal anesthesia? A) It induces vasodilation to lower blood pressure B) It stimulates the beta-adrenergic receptors to increase heart rate C) It causes vasoconstriction, helping to prevent hypotension D) It inhibits the 5-HT3 receptors to prevent bradycardia

C) It causes vasoconstriction, helping to prevent hypotension ## Footnote slide 34

Which of the following interventions helps prevent aortocaval compression and supine hypotension syndrome? A) Placing the patient in a left uterine displacement B) Administering Ephedrine bolus doses C) Raising the head of the bed by 30 degrees D) Using a higher dose of Ondansetron

A) Placing the patient in a left uterine displacement ## Footnote slide 34

Which of the following best describes the position that can help prevent hypotension during spinal anesthesia? A) Head down position (Trendelenburg) B) Left uterine displacement C) Full supine position D) Slight head-up position (10 degrees)

D) Slight head-up position (10 degrees) ## Footnote slide 34

How many large bore IVs should a patient have A. 4 B. 2 C. 3 D. 1

D. 1 1 vs. 2 IVs ## Footnote slide 35

When will rapid redistribution occur with cystalloid administration A. 20-30min B. 30-40min C. 15-20min B. 10-20min

A. 20-30min ## Footnote slide 35

Which colloids are available for administration to manage hypotension (select 2) A. Dextrose B. Lactated RIngers C. Albumin D. hetastarch

C. Albumin D. hetastarch ## Footnote slide 35

Why would albumin be picked over hetastarch (select 2) A. Hetastarch is expensive B. Albumin has been around longer C. risk for anaphylaxis for hetastarch D. patient do better with hetastarch

A. Hetastarch is expensive C. risk for anaphylaxis for hetastarch ## Footnote slide 35

What should you consider or be prepared for, for the anemic patient A. fluids B. blood products C. albumin D. hetastarch

B. blood products ## Footnote slide 35

What is the dose for ephedrine (select 2) A. 25mg IM B. 5-10mg IV C. 25mg IV D. 60mg IM

A. 25mg IM B. 5-10mg IV ## Footnote slide 36

Ephedrine is ______ adrenergic agonist A. alpha B. beta C. alpha and beta D. beta 2

C. alpha and beta ## Footnote slide 36

Ephedrine is known to readily cross the placenta. It also has the risk for _________ and ________ (select 2) A. reactive hypotension B. reactive hypertension C. umbilical vein metabolic alkolosis D. umbilical artery metabolic acidosis

B. reactive hypertension D. umbilical artery metabolic acidosis ## Footnote slide 36

Phenylephrine dose is A. 25-30mcg B. 150-300 mcg C.100-200mcg D. 50-100mcg

D. 50-100mcg ## Footnote slide 36

A coninuous infusion of phenylephrine can go at _______mcg/min A. 100-200 B. 75-150 C. 25-100 D. 50-100

C. 25-100 ## Footnote slide 36

Phenylephrine is a ____________ adrenergic agonist A. alpha 1 B. Alpha 2 C. beta 1 D. beta 2

A. alpha 1 ## Footnote slide 36

What level is optimal for neuroaxial anethesia for a c-section A. T2 B. T4 C. T6 D. T10

B. T4 ## Footnote slide 37

How is spinal anesthesia achieved (select 2) A. patient position B. baracity of LA C. opioids used D. reverse trendelenburg

A. patient position B. baracity of LA (hyperbaric, isobaric) ## Footnote slide 37

Which concentration of Lidocaine is hyperbaric A.10% B.15% C.20% D. 5%

D. 5% ## Footnote slide 35

What are 2 risk associated with Lidocaine 5% (select 2) A. tachycardia B. transient neurological syndrome C. pain in legs and back D. hypotension

B. transient neurological syndrome C. pain in legs and back ## Footnote slide 38

Which concentration of Bupivacaine is hyperbaric A. 0.75 B. 0.5 C. 0.25 D0.3

A. 0.75 most commonly used ## Footnote slide 38

# True or false You can only use 1 opioid in spinal anesthetics

false you can use more than one opioid in block is desired ## Footnote slide 39

Opioids used in spinal anesthesia has many benefits. These include all the following except A. improve quality of anesthetic block B. decreased incidence of intraoperative N/V C. decrease dose of LA D. prolongs postoperative analgesia E. helps the baracity of the block

E. helps the baracity of the block opioids may attenuate some of the sensations that trigger n/v may decrease need for post op IV or PO narcotics ## Footnote slide 39

Fentanyl is known for being __________ due to being _____ A. slow onset; lipophobic B. rapid onset; lipophilic C. slow onset; lipophilic D. rapid onset; lipophobic

B. rapid onset; lipophilic ## Footnote slide 40

Fentanyl in a spinal would be good for which pain relief A. intraoperative B. postoperative pain C. slow D. prolonged

A. intraoperative ## Footnote slide 40

What are some side effects of fentanyl in spinal anesthesia (select 2) A. n/v B. late respiratory depression C. pruritus D. early respiratory depression

C. pruritus D. early respiratory depression ## Footnote slide 40

Morphine PF dose is 100-150mcg in SAB and is________ A. hydrophilic B. hydrophobic C. lipophilic D. lipophobic

A. hydrophilic ## Footnote slide 41

Duramorph is good for what specifically mentioned in lecture A. emergency spinal B. postoperative analgesia C. intraoperative analgesia D. preoperative analgesia

B. postoperative analgesia ## Footnote slide 41

Duramorph has an onset of ________ and duration of ________ A. 20-30 min: 12-24hours B.30-60min; 24-48hrs C. 30-60 min; 12-24hrs D.15-20min; 24-48 hours

C. 30-60min; 12-24hrs ## Footnote slide 41

What are 2 side effects of Morphine PF mentioned in lecture A. long lasting pruritus B. N/V C. late respiratory depression D. early respiratory depression

A. long lasting pruritus (12-24 hours) C. late respiratory depression ## Footnote slide 41

Pruritis is a common complaint associated with Duramorph and is considered (select 2) A. treatable with nubain/stadol B. treatable with benadryl C. dose dependent D. worse then giving birth

A. treatable with nubain/stadol (treat with agonist-antagonist C. dose dependent Benadryl wont help but will make them sleepy can also use naloxone/naltrexone(cental mu opioid receptor) ## Footnote slide 41

When will you see respiratory depression with duramorph A. 5-10 hours B.30-45 min C. 1-2 hours D. 6-18 hours

D. 6-18 hours ## Footnote slide 41

Which patient would you use duromorph cautiously for? A. obese/ OSA B. placenta previa C. late term D. early labor

A. obese/OSA ## Footnote slide 41

What is the typical dose range for Epinephrine when used as an additive in spinal anesthesia? A) 0.1 – 0.2 mg B) 1 – 2 mg C) 5 – 10 mcg D) 0.5 – 1 mg

A) 0.1 – 0.2 mg ## Footnote slide 42

What is the primary action of Epinephrine in spinal anesthesia when used as an additive? A) Increases motor blockade B) Enhances sensory blockade C) Causes vasoconstriction and prolongs the block D) Reduces the incidence of postoperative pain

C) Causes vasoconstriction and prolongs the block by 15% or more ## Footnote slide 42

What is the typical dose of Dexmedetomidine used as an additive in spinal anesthesia? A) 0.1 – 0.2 mg B) 1 – 2 mg C) 10 – 20 mg D) 5 – 10 mcg

D) 5 – 10 mcg ## Footnote slide 42

What is one of the primary benefits of adding Dexmedetomidine to spinal anesthesia? A) It decreases the duration of the block B) It provides postoperative pain control and minimizes shivering C) It increases the risk of nausea and vomiting D) It increases the incidence of bradycardia and hypertension

B) It provides postoperative pain control and minimizes shivering ## Footnote slide 42

Which of the following is a potential adverse effect of using Dexmedetomidine in spinal anesthesia? A) Hypertension B) Tachycardia C) Bradycardia and hypotension D) Respiratory depression

C) Bradycardia and hypotension ## Footnote slide 42

Which of the following factors primarily determines the T4 sensory level in epidural anesthesia? A) Type of local anesthetic used B) Volume of the solution and concentration of the local anesthetic C) Rate of administration D) Duration of anesthesia

B) Volume of the solution and concentration of the local anesthetic ## Footnote slide 43

Compared to spinal anesthesia, how much higher are the doses of local anesthetics used in epidural anesthesia? A) 5-10 times higher B)2-3 times higher C) 20-30 times higher D) The same

A) 5-10 times higher ## Footnote slide 43

Which of the following best describes the onset of the block in epidural anesthesia? A) Rapid onset, similar to spinal anesthesia B) Onset depends on the patient’s age C) Immediate onset with no gradual phase D) Gradual onset of block

D) Gradual onset of block ## Footnote slide 43

Is epidural anesthesia commonly used for elective cesarean sections (C-sections)? A) Yes, it is the preferred method for elective C-sections B) No, it is not common for elective C-sections C) It is used for emergency C-sections only D) It is used for all types of C-sections

B) No, it is not common for elective C-sections ## Footnote slide 43

What is a potential issue with the reliability of epidural anesthesia when compared to spinal anesthesia? A) The block is always more dense than spinal anesthesia B) Epidurals are always less effective than spinal anesthesia C) It can be “less dense” or “patchy” compared to spinal anesthesia D) Epidurals provide more complete anesthesia than spinal anesthesia

C) It can be “less dense” or “patchy” compared to spinal anesthesia ## Footnote slide 43

In the case of an unplanned C-section, what is a common approach if an epidural is already in place? A) "Dose up" the existing epidural for operative anesthesia B) Convert to general anesthesia immediately C) Administer oral analgesics for pain control D) Perform a spinal anesthesia as a backup

A) "Dose up" the existing epidural for operative anesthesia ## Footnote slide 44

What should be done to assess the effectiveness of the epidural block during an unplanned C-section? A) Check the patient's vital signs regularly B) Perform a sensory level check and assess for "hot spots" C) Administer additional sedation D) Ask the patient about pain level without further testing

B) Perform a sensory level check and assess for "hot spots" ## Footnote slide 44

# Epidural Anesthesia Lidocaine 2% can be used with or without ____. A. Bicarbonate B. Epinephrine C. Opioids D. Pseudocholinesterase Lidocaine has a ____ onset, which is faster when bicarbonate is added. A. Slow B. Moderate C. Rapid D. Delayed Lidocaine has a ____ duration of action. A. Long B. Prolonged C. Intermediate D. Short Concentrations of Lidocaine less than 2% are _____ for surgical procedures. A. Ideal B. Common C. Not adequate D. Frequently used

Lidocaine 2% With or without **Epinephrine (B)** **Rapid (C)** onset, faster when bicarb is added **Short (D)** duration of action Concentrations < 2% **not adequate (C)** for surgical procedure ## Footnote Slide 45

# Epidural Anesthesia Bupivacaine 0.5% has an ____ onset of action. A. Rapid B. Intermediate C. Slow D. Delayed Bupivacaine 0.5% has a ____ duration of action. A. Short B. Moderate C. Long D. Variable Bupivacaine has a risk of ____ toxicity. A. Renal B. Pulmonary C. Hepatic D. Cardiac Bupivacaine 0.75% is not used in ____. A. Spinals B. Epidurals C. Peripheral nerve blocks D. Local infiltration

Bupivacaine 0.5% **Intermediate (B)** onset **Long (C)** duration of action Risk of **cardiac (D)** toxicity Bupivacaine 0.75% not used in **epidurals (B)** ## Footnote Slide 46

# Epidural Anesthesia 2-Chloroprocaine 2–3% has a ____ onset of action. A. Slow B. Moderate C. Very rapid D. Delayed 2-Chloroprocaine 2–3% has a ____ duration of action. A. Long B. Intermediate C. Extended D. Short 2-Chloroprocaine is metabolized by _____. A. Cytochrome P450 B. Monoamine oxidase C. Acetylcholinesterase D. Pseudocholinesterase 2-Chloroprocaine antagonizes _____ opioid receptors. A. Delta B. Sigma C. Mu & kappa D. Alpha 2-Chloroprocaine ____ the efficacy of epidural morphine. A. Enhances B. Has no effect on C. Reduces D. Doubles

2-Chloroprocaine 2-3% **Very rapid (C)** onset & **short (D)** duration of action Metabolized by **pseudocholinesterase (D)** Antagonizes **mu & kappa (C)** opioid receptors **Reduces (C)** efficacy of epidural morphine ## Footnote Slide 45

# Epidural Anesthesia Ropivacaine 0.5% has an ____ onset of action. A. Rapid B. Intermediate C. Slow D. Immediate Ropivacaine 0.5% has a ____ duration of action. A. Short B. Long C. Variable D. Brief Ropivacaine has ____ risk of cardiac toxicity than Bupivacaine. A. Greater B. Similar C. Less D. No

Ropivicaine 0.5% **Intermediate (B)** onset **Long (B)** duration of action **Less (C)** risk of cardiac toxicity than Bupivacaine ## Footnote Slide 46

# Epidural Anesthesia Fentanyl used in epidurals acts at which of the following sites? A. Only spinal B. Only supraspinal C. Peripheral nerve endings D. Spinal and supraspinal sites

D. Spinal and supraspinal sites | Fentanyl 50 – 100 mcg in epidural ## Footnote Slide 47

# Epidural Anesthesia What are the benefits of adding fentanyl to epidural anesthesia? (Select 2 that apply) A. Improved intraoperative anesthetic quality B. Denser block C. Prolonged motor blockade D. Faster recovery time E. Reduced need for oxygen supplementation

A. Improved intraoperative anesthetic quality B. Denser block ## Footnote Slide 47

# Epidural Anesthesia Which of the following is NOT a known side effect of epidural fentanyl? A. Pruritus B. Early respiratory depression C. Maternal somnolence D. Bradycardia

D. Bradycardia ## Footnote Slide 47

# Epidural Anesthesia Epidural morphine provides postoperative analgesia for approximately: A. 2–6 hours B. 4–8 hours C. 6–12 hours D. 12–24 hours

D. 12–24 hours | reservative-free morphine given 1-3 mg in epidural ## Footnote Slide 48

# Epidural Anesthesia True or False Epidural morphine commonly causes early respiratory depression and dose dependent pruritus.

FALSE Epidural morphine commonly causes **late** respiratory depression and *dose dependent* pruritus. ## Footnote Slide 48

# Epidural Anesthesia: Adjuncts Which of the following are potential maternal side effects of dexmedetomidine when used in epidural anesthesia? A. Tachycardia and hypertension B. Bradycardia and hypotension C. Fever and shivering D. Nausea and vomiting

B. Bradycardia and hypotension | Dexmedetomidine 4 – 5 mcg/mL local anesthetic ## Footnote Slide 49

# Epidural Anesthesia: Adjuncts Sodium bicarbonate increases the amount of local anesthetic in the (1) ____ state and (2) ____ the onset time. Choices: A. Ionized B. Non-ionized C. Protein-bound D. Speeds E. Slows F. Prolongs

1 → B. Non-ionized 2 → D. Speeds More local anesthetic in ***non-ionized** state **Speeds** onset time ## Footnote Slide 49

# Epidural Anesthesia: Adjuncts In which of the following clinical situations is sodium bicarbonate particularly useful in epidural anesthesia? A. When managing post-op pain B. When transitioning from regional to spinal anesthesia C. When there is an urgent need to dose up an epidural to avoid general anesthesia (GETA) D. When prolonging the duration of local anesthetics

C. When there is an urgent need to dose up an epidural to avoid general anesthesia (GETA) ## Footnote Slide 49

# In-situ Epidural What should you consider if a patient has a unilateral block after epidural placement? A. Add more fentanyl B. Replace the catheter if there is time C. Convert to spinal anesthesia immediately D. Decrease the dose of local anesthetic

B. Replace the catheter if there is time ## Footnote Slide 50

# In-situ Epidural Which of the following can be used to eliminate a “hot spot” in a patchy epidural block? A. 100 mcg morphine B. 5 mL sodium bicarbonate C. 50 mcg fentanyl in the epidural D. Dexmedetomidine infusion

C. 50 mcg fentanyl in the epidural | May be able to supplement with epidural opioids/adjuncts ## Footnote Slide 50

In an emergent C-section where time does not permit epidural supplementation, what is the likely course of action? A. Increase local anesthetic volume B. Wait for the block to settle C. Proceed with GETA (general endotracheal anesthesia) D. Add IV acetaminophen

C. Proceed with GETA (general endotracheal anesthesia) ## Footnote Slide 50

What volume of local anesthetic is typically used to dose up an epidural for surgical anesthesia? A. 5 mL B. 8–10 mL C. 10–15 mL D. 15–20 mL

C. 10–15 mL | ALWAYS assess level ## Footnote Slide 50

True or False The Allis test should be performed after the incision to assess block adequacy.

FALSE Allis test should be performed **before** the incision to assess block adequacy ## Footnote Slide 50

Which of the following are TRUE about the Combined Spinal Epidural (CSE)? (Select 3 that apply) A. Provides rapid onset of block B. Always requires sequential dosing C. Full SAB dose should be given D. Epidural catheter may be used if procedure is prolonged E. Slower onset compared to spinal anesthesia

A. Provides rapid onset of block C. Full SAB dose should be given D. Epidural catheter may be used if procedure is prolonged *Sequential dosing optional* *Refer to dosing for spinal & epidural* ## Footnote Slide 51

Which of the following is a common fetal indication for initiating GETA in obstetric anesthesia? A. Breech presentation B. Sustained fetal bradycardia C. Oligohydramnios D. Meconium-stained fluid

B. Sustained fetal bradycardia *Fetal distress* ## Footnote Slide 52

Which of the following is a maternal indication for general endotracheal tube anesthesia (GETA)? A. Mild gestational hypertension B. Maternal hemorrhage with hypovolemia C. Previous cesarean section D. Stable patient requesting elective cesarean under neuraxial block

B. Maternal hemorrhage with hypovolemia *Placental abruption* *Uterine rupture* ## Footnote Slide 52

Which of the following is NOT a valid reason to proceed with GETA during a cesarean section? A. Patient refusal of neuraxial anesthesia B. Maternal infection at injection site C. Well-tolerated spinal block D. Coagulopathy or thrombocytopenia E. Patient not tolerating

C. Well-tolerated spinal block *Failed block* ## Footnote Slide 52

Which of the following are benefits of general endotracheal tube anesthesia (GETA) in obstetric cases? (Select 3 that apply) A. Rapid onset B. Secured airway C. Decreased maternal mortality D. Hemodynamic stability E. Patient remains awake during delivery

A. Rapid onset B. Secured airway D. Hemodynamic stability ## Footnote Slide 53

Which of the following are disadvantages of general endotracheal tube anesthesia (GETA) in obstetric patients? (Select 4 that apply) A. Increased maternal mortality B. Difficulty with airway management C. Reduced likelihood of intraoperative bleeding D. Risk of aspiration E. Anesthesia recall F. Enhanced fetal neurologic assessment at delivery

A. Increased maternal mortality B. Difficulty with airway management *Failed oxygenation/ventilation *Risk of aspiration D. Risk of aspiration E. Anesthesia recall *Mother not awake during delivery* ## Footnote Slide 53

Which of the following are neonatal consequences of GETA during cesarean delivery? (Select 2 that apply) A. Neonatal respiratory & CNS depression B. 1-minute APGAR scores lower with GETA C. Improved muscle tone D. Enhanced neurological reflexes

A. Neonatal respiratory & CNS depression B. 1-minute APGAR scores lower with GETA ## Footnote Slide 53

What intraoperative limitation is associated with GETA that impacts the birthing experience? A. Increased motor blockade B. Inability to administer opioids C. No support person allowed in the OR (depending on policy) D. Continuous fetal monitoring

C. No support person allowed in the OR (depending on policy) ## Footnote Slide 53

# GETA: Induction Sequence Which of the following correctly describes the order of key steps in the GETA induction sequence prior to surgical incision for an emergent cesarean delivery? A. Surgical time-out → Cricoid pressure and RSI → Intubation with 6.0–7.0 mm ETT → Preoxygenation → Confirm ETT placement → State “OK to cut” → Incision B. Abdomen prep and drape → Preoxygenation and monitors → Surgical time-out → Succinylcholine administration → Intubation → Confirm ETT placement → State “OK to cut” → Incision C. Preoxygenation and apply monitors → Abdomen prep and drape (may “Splash & Slash” if emergent) → Surgical time-out → Cricoid pressure with RSI using induction agents and succinylcholine (1–1.5 mg/kg) → Intubate with 6.0–7.0 mm ETT → Confirm placement with EtCO₂ → State “OK to cut,” “Tube is in” → Incision D. RSI with induction agents → Preoxygenation → Surgical time-out → Abdomen prep and drape → Intubate → Confirm placement → Incision

C. Preoxygenation and apply monitors → Abdomen prep and drape (may “Splash & Slash” if emergent) → Surgical time-out → Cricoid pressure with RSI using induction agents and succinylcholine (1–1.5 mg/kg) → Intubate with 6.0–7.0 mm ETT → Confirm placement with EtCO₂ → State “OK to cut,” “Tube is in” → Incision *Ventilator & vaporizer on Secure ETT Place temperature probe Place orogastric tube Use warm air blanket* ## Footnote Slide 54-55

# GETA: Induction Sequence Which of the following should be documented by the anesthesia provider during a cesarean section under general endotracheal anesthesia (GETA)? A. Time of abdominal prep and surgical hand scrub B. Time of uterine incision and time of delivery C. Time of induction medication pharmacy verification D. Time the neonatal team enters the room

B. Time of uterine incision and time of delivery ## Footnote Slide 55

# GETA: Induction Sequence Why is Versed (midazolam) typically administered only after delivery during a cesarean section under GETA? A. It causes uterine relaxation B. It enhances maternal analgesia during incision C. It crosses the placenta and may affect the fetus if given before delivery D. It reduces bleeding during uterine closure

C. It crosses the placenta and may affect the fetus if given before delivery *Patients under GETA are at high risk for **intraoperative recall** if no amnestic agents are given* ## Footnote Slide 54

# GETA: Induction Sequence Which of the following are commonly used for postoperative pain control following GETA for cesarean delivery? (Select 4 that apply) A. Opioids B. Acetaminophen C. Toradol (ketorolac) D. Succinylcholine E. Midazolam F. Patient-controlled analgesia (PCA)

A. Opioids B. Acetaminophen C. Toradol (if not contraindicated) F. Patient-controlled analgesia (PCA) ## Footnote Slide 54

# GETA: Induction Sequence Which regional anesthesia technique may be used postoperatively to enhance pain control following cesarean delivery under GETA? A. Paravertebral block B. Interscalene block C. TAP block D. Stellate ganglion block

C. TAP block ## Footnote Slide 54

When should you initiate an oxytocin (Pitocin) infusion during a cesarean section under GETA? A. After skin incision B. Before uterine closure C. After delivery of the fetus D. After patient extubation

C. After delivery of the fetus *Announce that you are giving it* ## Footnote Slide 56

# GETA: Maintenance Why should the volatile anesthetic agent be decreased to 0.5–0.75 MAC after delivery of the fetus during a cesarean section under GETA? A. To minimize neonatal respiratory depression B. To enhance maternal analgesia C. To reduce the risk of uterine atony due to dose-dependent relaxation D. To facilitate faster extubation postoperatively

C. To reduce the risk of uterine atony due to dose-dependent relaxation *Consider adding N2O to decrease volatile agent *Consider benzodiazepine administration to decrease recall *Titrate in opioids for pain control ## Footnote Slide 56

# GETA: Maintenance During GETA for cesarean delivery, maintaining normocapnia is essential. Hypocapnia can result in ____, a shift of the ____ to the left, and ultimately compromised ____. Hypercapnia, on the other hand, may lead to maternal ____. A. Uteroplacental vasoconstriction Oxyhemoglobin dissociation curve Fetal oxygenation Tachycardia B. Uteroplacental vasodilation Myoglobin saturation curve Fetal heart rate Bradycardia C. Increased uterine tone Carbon dioxide curve Maternal perfusion Hypotension D. Fetal bradycardia Hemoglobin saturation graph Placental transfer Hypertension

A. Uteroplacental vasoconstriction Oxyhemoglobin dissociation curve Fetal oxygenation Tachycardia During GETA for cesarean delivery, maintaining normocapnia is essential. *Hypocapnia* can result in **Uteroplacental vasoconstriction**, a shift of the **Oxyhemoglobin dissociation curve** to the left, and ultimately compromised **Fetal oxygenation**. *Hypercapnia*, on the other hand, may lead to maternal **Tachycardia** ## Footnote Slide 57

# GETA: Maintenance Systemic opioids are administered after delivery during GETA primarily to achieve which of the following benefits? A. Enhanced maternal recall B. Increased uterine tone C. Reduced risk of neonatal respiratory depression D. Improved maternal respiratory rate

C. Reduced risk of neonatal respiratory depression ## Footnote Slide 58

# GETA: Maintenance Magnesium infusion can potentiate the effects of ____, requiring close monitoring of neuromuscular function. A. opioids B. benzodiazepines C. non-depolarizing muscle relaxants (NDMBs) D. volatile agents

C. non-depolarizing muscle relaxants (NDMBs) ## Footnote Slide 58

Following administration of succinylcholine, always check twitches to assess for prolonged neuromuscular blockade, which may indicate ____ deficiency that can occur in pregnancy. A. acetylcholinesterase B. pseudocholinesterase C. dopamine beta-hydroxylase D. G6PD

B. **pseudocholinesterase** deficiency *Always, ALWAYS check twitches after Succinylcholine * ## Footnote Slide 58

# GETA: Emergence/Postoperative patients undergoing GETA for cesarean delivery should be extubated ___ and only after suctioning the orogastric tube. A. deeply anesthetized B. semi-conscious C. awake D. in lateral decubitus position

C. awake ## Footnote Sllde 59

# GETA: Emergence/Postoperative Before administering ketorolac for postoperative pain, always confirm that it is acceptable to the ____. A. CRNA B. OB nurse C. anesthesiologist D. surgeon

D. surgeon ## Footnote Sllde 59

# GETA: Emergence/Postoperative Which of the following is NOT typically used as an antiemetic during emergence after GETA for cesarean delivery? A. Scopolamine B. Zofran C. Phenergan D. Ketorolac E. Droperidol

D. Ketorolac ## Footnote Sllde 59

Which of the following statements about Pitocin (Oxytocin) are true? (Select 3 that apply) A. It is usually 10 units/mL concentration B. It should be given 20 units in bag after the umbilical cord is cut C. It stimulates uterine contractions D. It can cause flushing and hypertension if given rapidly E. It is a prostaglandin derivative

A. It is usually 10 units/mL concentration B. It should be given 20 units in bag after the umbilical cord is cut C. It stimulates uterine contractions ## Footnote Slide 60

Methergine is an ergot alkaloid that is administered almost always__ and should be avoided or used cautiously in patients with__ A. IV; diabetes B. IM; hypertension C. SC; asthma D. PO; renal failure

B. IM; hypertension Methergine is an ergot alkaloid that is administered almost alway **IM** and should be avoided or used cautiously in patients with **hypertension** ## Footnote Slide 60

The typical dose of Methergine (Methylergonovine) used to treat uterine atony is ______. A. 0.1 mg IV B. 0.25 mg IM C. 0.2 mg IM D. 500 mcg SC

C. 0.2 mg IM (250 mcg IM) ## Footnote Slide 60

Match each uterotonic agent with its correct caution or side effect

(A → 2) Hemabate → Asthma (B → 3) Pitocin → Hypotension/Flushing (C → 1) Methergine → Hypertension Memory tric: Hemabate leads to intubate; Methergine sounds close to Hyperten; Pitocin sounds close to Potesion ## Footnote Slide 60

Hemabate (Carboprost) is administered as a: A. 500 mcg IV bolus B. 250 mcg IM dose C. 1 mg intrathecal injection D. 0.2 mg oral tablet

B. 250 mcg IM dose ## Footnote Slide 60

# C-Section Anesthesia Complications Which of the following are common causes of nausea and vomiting during cesarean section under anesthesia? (Select 3) A. Hypotension B. Surgical stimulation C. Use of regional anesthesia only D. Uterotonics/antibiotics E. Epidural catheter migration

A. Hypotension B. Surgical stimulation D. Uterotonics/antibiotics ## Footnote Slide 61

# C-Section Anesthesia Complications Which of the following mechanisms explain how hypotension during cesarean section can lead to nausea and vomiting? (Select 2 that apply) A. Cerebral & brainstem hypoperfusion, which stimulates the medullary vomiting center B. Gut ischemia and release of emetogenic substances from the intestines C. Renal perfusion and diuresis D. Enhancing uterine contractions through baroreceptor activation

A. Cerebral & brainstem hypoperfusion, which stimulates the medullary vomiting center B. Gut ischemia and release of emetogenic substances from the intestines ## Footnote Slide 61

# C-Section Anesthesia Complications Which of the following surgical factors can contribute to nausea and vomiting during cesarean section? (Select 3 that apply) A. Uterine exteriorization B. Intra-abdominal manipulation C. Peritoneal traction stimulating vagal fibers D. Epidural catheter placement E. Rapid bladder decompression

A. Uterine exteriorization B. Intra-abdominal manipulation C. Peritoneal traction stimulating vagal fibers ## Footnote Slide 61

# C-Section Anesthesia Complications Match each uterotonic agent with its associated mechanism contributing to nausea and vomiting:

(A → 1) Oxytocin → R/t hypotension (B → 2) Methylergonovine →Interaction with dopaminergic & serotonergic receptors (C → 3) Hemabate → Stimulation of GI tract smooth muscle ## Footnote Slide 61

# C-Section Anesthesia Complications Why is general endotracheal anesthesia (GETA) for emergent cesarean section associated with a high risk of awareness and recall? A. High doses of benzodiazepines are given early B. It prevents the patient from receiving oxygen C. Periods of lower MAC are common before delivery D. Spinal anesthesia is not used in emergencies

C. Periods of lower MAC are common before delivery *Give Benzodiazepines (2mg versed) as soon as baby is out* ## Footnote Slide 62

# C-Section Anesthesia Complications Hypotension during cesarean section under anesthesia can be caused by __________. A. Increased cerebral perfusion and parasympathetic stimulation B. Sympathetic blockade and bleeding C. Hypercapnia and elevated systemic vascular resistance D. High MAC levels and decreased catecholamine release

B. Sympathetic blockade and bleeding ## Footnote Side 62

# C-Section Anesthesia Complications Which of the following is an appropriate response to a failed or inadequate neuraxial block during cesarean section? A. Increase the MAC to 2.5% B. Immediately intubate and start GETA C. Supplement with ketamine, Precedex, nitrous oxide, and emotional support D. Start oxytocin infusion early

C. Supplement with ketamine, Precedex, nitrous oxide, and emotional support *if mom can't tolerate → GETA* ## Footnote Slide 63

# C-Section Anesthesia Complications High neuraxial block can lead to ___, requiring airway support and possibly GETA. A. Elevated heart rate and hypertension B. Increased awareness and anxiety C. Loss of consciousness, respiratory drive, or refractory hypotension D. Nausea from uterine manipulation

C. Loss of consciousness, respiratory drive, or refractory hypotension ## Footnote Slide 63

# C-Section Anesthesia Complications Which of the following may be used to manage intraoperative maternal shaking during cesarean section? (Select 3 that apply) A. Precedex B. Meperidine C. Warming the operating room to 80°F D. Giving mom something to squeeze in her hand E. Phenytoin

A. Precedex B. Meperidine D. Giving mom something to squeeze in her hand ## Footnote Slide 63

Match each medication or intervention with the correct timing of its use: Perioperative pain or Postoperative pain 1. Opioids 2. Precedex 3. Tylenol (Acetaminophen) 4. Ketorolac 5. PO Medications 6. IV PCA 7. TAP Block

1. Opioids → Perioperative pain 2. Precedex → Perioperative pain 3. Tylenol (Acetaminophen) → Perioperative pain 4. Ketorolac → Perioperative pain 5. PO Medications → Postoperative pain 6. IV PCA → Postoperative pain 7. TAP Block → Postoperative pain ## Footnote Slide 64

Pruritus after cesarean delivery is most commonly associated with the use of ____. A. Fentanyl boluses B. Intrathecal morphine C. General anesthesia D. NSAIDs

B. Intrathecal morphine ## Footnote Slide 64