Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles II- Josh > Vag and C-section PPT McDizzle's lecture > Flashcards

Vag and C-section PPT McDizzle's lecture Flashcards

Something to consider epidural analgesia is PAIN control, epidural is blocks LA

1
Q

ACOG

A

American Congress of Obstetricians & Gynecologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

on 1993 the ACOG committee on pain relief during labor number 118 stated what?

A

“…. maternal request is sufficient justification for pain releif during labor….”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ASA

A

American Society of Anesthesiologist (aka Anesthesiologist are a Sublevel of Anesthetists)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ingards to Mcd’s research on intrathechal and eidural analgesia he found out what?

A

that the length of labor was NOT prolonged using intrathechal or epidural opiods, and may shorten the 1st stage of labor in both primi and multiparious women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Regional anesthesia for child bearing is philosophy both _____ and _____

A
  • Safe

- Participatory (providing the opportunity for individual participation )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What occurs in the 1st stage of labor (5 main body changes)

A
  • Pressure on nerve endings of the uterus
    -Contraction of an ischemic myometrium and cervix
    -Vasoconstriction
    -inflammatory changes
    -Dilation of the cervix and lower uterine segment
    ( how to remember– 1st
    the PRESSURE on the nerve ending of the uterus cause VASOCONSTRICTION, which causes the contraction of an ISCHEMIC MYOMETRIUM AND CERVIX, which causes INFLAMMATORY CHANGES, and thus DILATION of the cervix and lower uterine segment)
    I dunno maybe it will help???
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What causes the 1st stage perceptions?

A

result of dilation, distention, and stretching of the cervix and lower uterine segment during contraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What Causes perception during the 2nd and 3rd stages of labor?

A

-Traction on the pelvic peritoneum and uterine ligaments
-Tension on the bladder and rectum
-tension on the ligamnets, fascia and muscles of the pelvis
-Pressue on lumbrosacral plexus
(how to remember- stage 2 and 3 the baby is moving down so the pain is lower and it STRETCHES everything by pulling it down)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Somatic pain in the 2nd stage of labor via vaginal and perineal in orgin are from what nerves

A

pudendal nerves S2-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What dermatomes cover the perineum

A

S2-S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what ligaments are stretched or placed under tension in stage 2 and 3 of labor

A
  • Round ligaments
  • Superior pubic ligaments
  • Broad ligament
  • Cardinal ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What factors can influance the perception of Pain r/t labor

A
  • pain tolerance
  • Pain threshold
  • Individual factors (Intrapersonal, interpersonal, societal)
  • Supportive structures
  • Cultural factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 3 NON-pharmacological pain releif THEORIES for prepared child birth?

A

Grantly Dick-Reed (childbirth without fear)
Lamaze (Psychoprophylaxis)
Fredrick Le Boyer (Birth without Violence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

explain Grantly Dick-Reed non-pharm pain relief for birth

A

(Childbirth without Fear)

  • Natural childbirth
  • Believed that pain was a result of not knowing what is happening during labor and delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain Lamaze non-pharm pain relief for birth

A

(Psychoprophylaxis)

-Relaxation and breathing techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Explain Fredrick Le Boyer non pharm pain relief for birth

A

(Birth without Violence)
- gentle approach to birthing using “bath” placing women into a bath to ease the transition from the womb to the real world

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 4 other non pharm pain releif for labor

A

Hypnosis
TENS
Acupunture
Alternative birthing options

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Advantages of systemic analgesics for labor.

5

A 
Ease of use
Staffing
no IV required (IM)
Minimal monitoring
Few complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Disadvantages of systemic analgesics for labor (5)

A 
effectivness
depression
respiratory decreases
N/V
Fetal depresion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Main disadvantage of systemic analgesics for labor

A

Don’t work very well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Opioids for labor with potency

A 
Demerol 0.1 (1/10)
Morphine 1 (of historic interest only)
Alfentanil 10-5
Fentanyl 75-125
Sufentanil 500-1000
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Opioid agonist/Antagonists for labor pains (with potency if u care)

A
  • Nalbuphine (nubain) 0.7-0.8
  • Butorphanol (Stadol) 5
  • Pentazozine (Talwin) 30-60 mg = 10mg morphine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

********** Why is stadol out of favor for use in some OB settings?

A

Due to a 75% incidence of transient sinusoidal fetal heart pattern (considered benign)
can cause narcotic withdrawl in narcotic addicts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Sedatives for Vaginal OB labor (3)

A

Phenothiazines
Benzodiazepines
Butyrophenones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Examples of Phenothiazines for sedatives

A

Thorazine

phenergan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Examples of Benzodiazapines for sedatives

A

Versed

Valium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Examples of Butyrophenones for sedatives

A

Haldol

droperidol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Anticholinergics

A

Atropine
Scopolamine
Glycopyrrolate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What to remember about robinul (glycopyrrolate)

A

it does NOTcross the BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are 3 periphreal nerve blocks for L&D

A

field block
Pudendal nerve block
Paracervical Block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are complications of the paracervical block do to? and what are the complications?

A

-Do to large volumes
complications are
- LA toxicity
- Fetal bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

hat is the gold standard for INVASIVE intervention r/t labor pains

A

Epidural

33
Q

Advantages of epidural

A 
greatful pt
excellent anesthesia
may improve dysfunctional labor
Can be raised for a C-section
Minimizes risk of (maternal aspiration, and fetal depression)
increased SPo2
Lower VAS pain scores
Higher fetal scalp pH
34
Q

what type of solutions must be used for epidural and intrathecal spaces

A

preservative free

35
Q

Is there a better APGAR score from epidurals?

A

Nope no difference

36
Q

what causes the higher SPO2 levels with epidurals?

A

-lower RR when comfortable, (b/c high RR mover primarily dead space air)

37
Q

**********Epidural dosing rational (one of many

A
  • Find the space
  • Loading dose
  • —20ml of 1/8 (0.125)% bupivacaine + 100 mcg fentanyl.
  • — Give in divided doses
  • Infusion
  • — 50ml 1/16 (0.0625)% bupivacaine + 100mcg fentanyl
  • — infuse @ 10-15 ml/hr
38
Q

Complications of an epidural

A 
hypotension
total spinal
LA toxicity
Headache
Local site pain
39
Q

Epidural contraindications

A

Pt refusal
Coagulopathies (plt <100)
Infection at injection site
Uncorrected hypovolemia

40
Q

what is always a regional anesthesia contraindication

A

significant fetal distress

41
Q

what position for SAB ensures that all nerves get bathed with hyperbaric LA solution whan pt is placed in LUD prior to c-section

A

Right lateral decubitus

42
Q

ITA (intrathechal Anesthesia) morphine SE:

A

itching
N/V
urinary retention

43
Q

ITA doses of fent and morph WITH or WITHOUT any LA

A

25mcg fentanyl + 100-150 mcg morphine called astromorph/duramorph)
—–side note i know it says mcg for morphine that is per his slide not my typo

44
Q

ITA advantages

A

excellent analgesia
No sympathtic block
Ambulatory block

45
Q

SAB are possiable for devivery but not for what

A

Labor

46
Q

What is teh best combined tech for labor OB pain control

A

Perform ITA for Labor and also place an epidural cath for use later

47
Q

Beware of what, b/c you must be prepared for emergent intervention

A

VBACS (vaginal birth afetr c-section)

48
Q

Epidural analgesia for L&D advantages

A
  • awake pt
  • avoids risk of somulence
  • decreased hypoxia
  • decreased hypercarbia
  • decreased aspiration
  • continuous
  • ready for C/S
  • safe
49
Q

Epidural analgesia for L&D disadvantages

A
  • Maternal affects
  • fetal affects
  • ? prolonged labor (not according to McD)
  • ? increase in C/S rate
  • ? motor block (if too high conc given)
  • ? bed rest
50
Q

Indirect effects of epidural analgesia on hemodynamics

A
  • uteroplacental perfusion usually secondary to hypotension (preload)
  • oxytocin metabolism
  • circulatory reflex depression
51
Q

epidural tech issues to condsider

A
  • lateral vs sitting
  • LOR tech (air vs saline, glass vs plastic) ((LOR= loss of resistance)
  • catheter direction
  • How for to insert catheter (2-3 cm per McD) or 3-5 cm
52
Q

How do u know where you are at with an epidural?

A 
aspiration
-CSF
-Blood
Test dose
monitoring
53
Q

what are the doses for test doses with an epidural placement check?

A

3ml of 1.5% lidocaine w/ 1:200,000 epi (5mcg/ml)

54
Q

what will occur with a test dose of fentanyl if not in the correct space?

A

drop in HR

55
Q

S/S suggesting that it may be a SAB not an epidural

A

Signs

  • sensory block
  • Motor weakness
  • Hypotension

Symptoms

  • Warm sensation
  • Pain releif
  • Numbness
56
Q

What are pregnancy issues that can cause problems inassociation with epidural placement?

A
  • Epidural space volume changes
  • venous sinuses
  • physical size
  • positioning (ICV syndrome)
57
Q

ICV syndrome?

A

between epidural and intrathecal modes of delivery is … Intracerebroventricular (ICV)

58
Q

Common local agents

A

Bupivacaine
Lidocaine
2.3 chloroprocaine
(opiates are usually added)

59
Q

what are problems u may have to deal with from performing SAB

A
  • wet tap
  • blood in catheter
  • hypotension
  • high block
  • motor block
  • inadequate analgesia
60
Q

what type of anesthesia is seldom used for vaginal delivary and according to M&M is worse than regional

A

General

61
Q

Advantages of GETA withC/S

A

Speed of induction
reliability
control
avaoidence of hypotension

62
Q

Potential GETA problems

A 
Maternal aspiration
Airway difficulties
Awareness
Stress response
Increased blood loss
63
Q

Indications for GETA

A
  • Acute fetal distress
  • Hemodynamic instability
  • Cardiac disease
  • Coagulopathy
  • Sepsis
  • failed regional
64
Q

if the stomach is full (as we already learned they all are) what should we give prior to GETA

A

Metacloprimide 10 mg IV +
Randetidine 50 mg IV +
Na Citrate 30 ml PO (chill it, it is disgusting otherwise)

65
Q

Why should u make sure you fully denitrogenate prior to GETA

A

decrease apnea to hypoxia time

66
Q

With GETA prior to sux’s what should you pretreat with to prevent fasiculations, myalgia, gastric pressure increase?

A

NDNMBD (lol thats long) NDMB)

67
Q

Induction agents for GETA for labor?

A 
sodium thiopental
methohexitol
hetamine
etomidate
propofol
midazolam
68
Q

GETA concerns r/t HYPERventilation

A
  • decreased uterine blood flow
  • left shift of maternal O-HDC
  • decreased ability to deliver O2 to baby
69
Q

What is the most important factor r/t neonatal depression with a GETA?

A

time from induction to delivery

70
Q

3 major indications for C/S

A
  • labor unsafe for mother or fetus
  • Dystocia
  • immediate or emergent delivery is necessary
71
Q

GA is not routinely used for elective C/S it is typically reserved for what?

A

Obstretrical emergencies

72
Q

4 main indications for GA with labor

A
  • contraindications to regional
  • Failed regional block
  • fetal distress
  • patient refusal
73
Q

When time is limiting ________ ________ is sometimes necessary b/c it offers speed of induction, reliability, controllability, and avoidance of sympathectomy induced hypotension

A

general anesthesia

74
Q

preparation for GETA for labor

A
  • Airway elavuation
  • Aspiration prophylaxis
  • experienced personal and backup plans
  • fetal considertions
75
Q

How to conduct GETA with labor

A
  • basic prep
  • positioning and monitoring
  • induction (RSI with cricoid pressure) (intubate with 6.0-7.0 cuffed ETT)
    -Maintance
  • emergence (pt extubated awake with airway reflexes intact)
    (if pt unstabe OETT remains in place)
76
Q

The obese parturient is at greater risk for medical diseases r/t what systems

A
  • CV
  • Respiratory
  • Endocrine and metabolic
  • GI
77
Q

What are the 4 airway considerations wit the obese parturent?

A
  • limited neck flexion and mouth opening
  • narrowed view of pharyngeal opening
  • Higher incidense of failed intubation
  • proper positioning of the head and neck may facilitate ET intubation
78
Q

What may position facilatates endotracheal intubation for the paturient

A

elevation of shoulder
flexion of cervical spine
extension of atlanto-occipital joint

Principles II- Josh (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions