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SUM'20 - Advanced Principles > Week 4 OB Complications & VBAC - Exam 2 > Flashcards

Week 4 OB Complications & VBAC - Exam 2 Flashcards

1
Q

A multivariate analysis identified five independent risk factors for difficult face mask ventilation:

A

(1) age older than 55 years
(2) body mass index (BMI) greater than 26 kg/m2
(3) presence of a beard
(4) lack of teeth
(5) a history of snoring

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2
Q

Difficult tracheal intubation has been variously defined by

A

(1) the time taken to intubate
(2) the number of attempts
(3) the view at laryngoscopy
(4) the requirement for special equipment

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3
Q

when are the the majority of obstetric general anesthetics administered for emergency deliveries?

A

often during off-hours;

these anesthetic procedures may be conducted by inexperienced anesthesia providers with less proficiency in difficult airway management.

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4
Q

larynx visualization - various strategies can minimize this problem, the most important is

A

optimizing the pts position

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5
Q

Comprehensive airway evaluation, prophylactic administration of nonparticulate antacids, and use of regional anesthesia decrease

A

the risk of aspiration.

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6
Q

General anesthesia may be unavoidable occasionally; therefore, awake intubation may be indicated in women in whom

A

airway difficulties are anticipated.

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7
Q

At term gestation the pregnant woman who requires anesthesia should be regarded as having anincompetent

A

lower esophageal sphincter.

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8
Q

When does LES return to normal? post partum

A

48hrs

1-4 weeks for pyloric sphincter tone to return

chestnut p 35

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9
Q

what two “things” likely account for the slight decrease in PaO2and increase in shunting that are observed in asp pneumonitis?

A

Bronchospasm and disruption of surfactant

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10
Q

Mild to moderate headache, lasting 30 minutes to 7 days. Often bilateral, non pulsating, and not aggravated by physical activity

A

tension h/a

*often circumferential and constricting, can be associated with scalp tenderness, and are usually of mild to mod severity.

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11
Q

Recurrent moderate to severe headache, lasting 4 to 72 hours. Often unilateral, pulsating, and aggravated by physical activity. Associated with nausea, photophobia, and phonophobia

A

Migraine

*rare to manifest for the first time during pp period

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12
Q

examples of :
H2 antagonists

dopamine receptor antagonist

PPI:

matching category of drug

A

famotidine
ranitidine

metoclopramide

omeprazole

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13
Q

Hypertension and/or HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome Headache
often bilateral, pulsating, and aggravated by physical activity

A

Preeclampsia/eclampsia

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14
Q

Severe and diffuse headache with an acute or gradual onsetPossible focal neurologic deficits and seizures

A

Posterior reversible (leuko)encephalopathy syndrome (PRES)

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15
Q

Ischemic or hemorrhagic.Cerebral infarction/ischemia:new headache that is overshadowed by focal signs and/or disorders of consciousness.Subarachnoid hemorrhage: abrupt onset of an intense and incapacitating headache.Often unilateral accompanied by nausea, nuchal rigidity, and altered consciousness.

A

stroke

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16
Q

Headache usually without typical features Often overshadowed by focal neurologic signs and/or altered consciousness

A

Subdural hematoma

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17
Q

Late developing headache that is constant in nature Bilateral or unilateral location

A

Carotid artery dissection

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18
Q

Nonspecific headache that may have a postural component.Often accompanied by focal neurologic signs and seizures

A

Cerebral venous and sinus thrombosis

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19
Q

Progressive and often localized headacheOften worse in the morningAggravated by coughing/straining

A

brain tumor

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20
Q

Progressive non pulsating headacheAggravated by coughing/strainingAssociated with increased CSF pressure and normal CSF chemistry

A

Idiopathic intracranial hypertension (pseudotumor cerebri/benign intracranial hypertension)

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21
Q

No history of dural trauma Diffuse, dull headache worsening within 15 minutes of sitting or standing Associated with neck stiffness, nausea, tinnitus, and photophobiaCSF opening pressure < 60 mm H2O in the sitting position

A

Spontaneous intracranial hypotension

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22
Q

Frontal headacheOften an abrupt onset immediately after dural punctureSymptoms can worsen with upright posture

A

Pneumocephalus

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23
Q

Headache is most frequent symptomOften diffuseIntensity increases with timeAssociated with nausea, photophobia, phonophobia, general malaise, and fever

A

menigitis

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24
Q

Frontal headache with accompanying facial painDevelopment of headache coincides with nasal obstructionPurulent nasal discharge, anosmia, and fever

A

Sinusitis

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25
Q

Onset of headache within 24 hours of cessation of regular caffeine consumptionOften bilateral and pulsatingRelieved within 1 hour of ingestion of caffeine 100 mg

A

Caffeine withdrawal

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26
Q

Mild to moderate headache associated temporally with onset of breast-feeding or with breast engorgement

A

Lactation headache

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27
Q

the classic presentation of subarachnoid hemorrahage:

A

“worst headache of my life”

sudden onset of a severe h/a that is unlike any previous h/a

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28
Q

Mild to moderate headache associated with ondansetron intake

A

Ondansetron headache

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29
Q

Headache within 5 days of dural punctureWorsens within 15 minutes of sitting or standingAssociated with neck stiffness, tinnitus, photophobia, and nausea

A

Post–dural puncture headache

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30
Q

50% of strokes occur w/in the first

A

6 weeks postpartum

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31
Q

primary headaches are how many times more common than secondary headaches in first week pp?

A

20 times

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32
Q

Primary headaches:

A 
Migraine
Tension-type headache
Trigeminal autonomic cephalagias
Cluster headache
Other primary headaches
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33
Q

Secondary headaches:

A 
Headache attributed to:
Head and/or neck trauma
Cranial or cervical vascular disorder
Nonvascular intracranial disorder
A substance or its withdrawal
Infection
Disorder of homeostasis
Disorder of the cranial structures (e.g., eyes, ears, nose, sinuses, teeth, mouth)
Psychiatric disorder
Lesions of cranial neuralgias and other facial pain
Other headache disorders
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34
Q

Secondary headaches:

A 
Headache attributed to:
Head and/or neck trauma
Cranial or cervical vascular disorder
Nonvascular intracranial disorder
A substance or its withdrawal
Infection
Disorder of homeostasis
Disorder of the cranial structures (e.g., eyes, ears, nose, sinuses, teeth, mouth)
Psychiatric disorder
Lesions of cranial neuralgias and other facial pain
Other headache disorders
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35
Q

The hallmark of a PDPH is

A

this postural component.

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36
Q

Contraindications to the administration of an epidural blood patch are related to complications of placing a needle in the central neuraxis or the injection of blood into the epidural space; they include

A

(1) known coagulopathy (e.g., concurrent pharmacologic anticoagulation)
(2) local cutaneous infection or untreated systemic infection
(3) increased ICP caused by a space-occupying lesion
(4) patient refusal.

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37
Q

Transient bradycardia has been observed after administration of an epidural blood patch, and some anesthesia providers may choose to establish intravenous access

A

and monitor the electrocardiogram in selected patients.

  • also may give fluid bolus as well
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38
Q

Transient bradycardia has been observed after administration of an epidural blood patch, and some anesthesia providers may choose to establish intravenous access

A

and monitor the electrocardiogram in selected patients.

  • also may give fluid bolus as well
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39
Q

Frank breech—

A

lower extremities flexed at the hips and extended at the knees

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40
Q

Complete breech—

A

lower extremities flexed at both the hips and the knees

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41
Q

Incomplete breech—

A

one or both of the lower extremities extended at the hips

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42
Q

Incomplete breech—

A

one or both of the lower extremities extended at the hips

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43
Q

With chorioamnionitis, a combination _______ should cover most relevant pathogens and is the recommended primary antibiotic regimen.

A

ofampicillinandgentamicin

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44
Q

The most common source of postpartum infection is the

A

genital tract.

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45
Q

in parturients with active lesions HSV infection what is recommended?

A

cesarean delivery

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46
Q

traditionally _________ has been thought to be a risk factor for preterm birth

A

A history of cervical surgery,

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47
Q

Criteria for the diagnosis of preterm labor include

A

gestational age between 20 0/7 and 36 6/7 weeks’ gestation and

regular uterine contractions accompanied by a

change in cervical dilation, effacement, or both (or initial presentation with regular contractions and cervical dilation of 2 cm or more).

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48
Q

The ACOG has stated that evidence supports the use of tocolytic treatment WHAT MEDICATIONS are okay to use for short-term prolongation of pregnancy (up to 48 hours) to allow for antenatal maternal corticosteroid administration.

A
  • beta-adrenergic receptor agonist therapy,
  • calcium entry–blocking agents, or
  • NSAIDs
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49
Q

Betamethasone

nice to know

A

12 mg IM

Every 24 h × 2

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50
Q

Dexamethasone

nice to know

A

6 mg IM

Every 12 h × 4

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51
Q

Conventional wisdom holds that the preterm fetus is more vulnerable than the term fetus to the depressant effects of analgesic and anesthetic drugs, for the following reasons:

A

(1) less protein available for drug binding, leading to a reduction in protein-drug affinity
(2) higher levels of bilirubin, which may compete with the drug for protein binding
(3) greater drug access to the central nervous system (CNS) because of the presence of an incomplete blood-brain barrier
(4) decreased ability to metabolize and excrete drugs
(5) a higher incidence of acidosis during labor and delivery

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52
Q

The most significant update is introduction of clinical signs and symptoms that may be used in the absence of proteinuria as diagnostic criteria for preeclampsia

A

i.e., thrombocytopenia [platelet count < 100,000/μL – lead to DIC
renal insufficiency [serum creatinine > 1.1 mg/dL],
pulmonary edema, or
cerebral or visual symptoms

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53
Q

thrombocytopenia

A

[platelet count < 100,000/μL]

can lead to DIC

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54
Q

The hallmark of preeclampsia is an

A

abnormal placentation-implantation.

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55
Q

Magnesium sulfate is administered for

A

seizure prophylaxis.

Magnesium 4–6 g IV followed by 1–2 g/h IV as a continuous infusion (goal is to maintain serum concentrations of 2.0–3.5 mEq/L)

56
Q

Magnesium sulfate is the anticonvulsant of choice because

A

it is more effective and has a better safety profile than benzodiazepines, phenytoin, or lytic cocktails.

57
Q

The standard IV regimen is a loading of magnesium sulfate is

A

2 g every 15 minutes to a maximum of 6 g.

*If a patient develops seizures while receiving a magnesium infusion for seizure prophylaxis, administration of a 1- to 2-g bolus is recommended, after which a plasma magnesium level should be measured

58
Q

Factors associated with a lower rate of successful VBAC include

A
  • socioeconomic,
  • ethnic, and
  • medical factors.
59
Q

contraindications for VBAC: (5)

A
  1. previous classic or T-shaped incision or extensive trasnsfundal uterine surgery
  2. preveious uterine rupture
  3. medical or obstetric complication that precludes vaginal delivery
  4. Inability to perform emergency c/s delivery b/c of unavailable surgeon, anesthesia provider, sufficient staff, or facility
  5. two prior uterine scars and no vaginal deliveries
60
Q

ECV is most likely to be successful if

A
  • *(1) the presenting part has not entered the pelvis
    (2) amniotic fluid volume is normal
  • **(3) the fetal back is not positioned posteriorly
    (4) the patient is not obese
    (5) the patient is parous
  • *(6) the presentation is either frank breech or transverse
61
Q

leading cause of maternal mortality worldwide.

A

Peripartum hemorrhage remains a

62
Q

During cesarean delivery with neuraxial anesthesia, ECG changes have a reported frequency of 25% to 60%; in this setting, administration of droperidol, ondansetron are associated with…

oxytocin may be associated with….

A

prolongation of the QT interval,

oxytocin administration may be associated with ST-segment depression.

63
Q

The addition of sodium bicarbonate 1 mEq/10 mL to lidocaine 2% with epinephrine 1 : 200,000 will hasten the onset of anesthesia when a rapid conversion to surgical anesthesia is necessary.
This combination results in:

A

results in approximately 90 to 120 minutes of surgical anesthesia.

64
Q

Sodium bicarbonate cannot be added to what LA?

Why?

A

bupivacaine as it results in precipitation when the pH is raised.

65
Q

the most common indication for a cesarean hysterectomy.

A

Placenta accreta is

66
Q

occurs when the placenta covers the cervix.

A

Placenta previa

67
Q

Placenta previa occurs

A

when the placenta covers the cervix.

68
Q

The classic clinical sign of placenta previa is

A

painless vaginal bleeding during the second or third trimester.

the lack of abdominal pain and/or absence of abnormal uterine tone helps distinguish placenta previa from placental abruption

69
Q

Scenario -

mom comes in bleeding with hypotension. what’s your anesthetic plan?

A
  • ETT

- Etomidate (not propofol) ketamine

70
Q

Placenta accreta refers to

A

a placenta that is abnormally adherent to the myometrium but hasnotinvaded the myometrium.

71
Q

In placenta increta,

A

the placentahasinvaded the myometrium.

72
Q

Placenta percreta is

A

invasion through the serosa.

73
Q

placenta accreta, Elective cesarean delivery recommendation;

A

at 34–35 weeks’ gestation to avoid emergent delivery is recommended.

74
Q

Placental abruption is defined as

A

complete or partial separation of the placenta from the decidua basalis before delivery of the fetus.

75
Q

if patients with severe hypovolemic shock what rare thing CAN happen with intubation

A

intubation can be accomplished without an induction agent.

76
Q

what IV vasopressors are recommended for amniotic fluid embolism hypotension

A

dopamine
dobutamine
norepinephrine

77
Q

how do we guide fluid therapy during amniotic fluid embolus

what are we cautiously aware of

A

CVP

aware that Pulmonary edema may occu

78
Q

multimodal analgesia statement regarding magnesium administration

A

magnesium sulfate administration resulted in small reduction in postoperative pain scores and a substantial reduction in opioid use.

79
Q

what medication has been used in the treatment of acute and chronic pain in nonobestretic patients

A

alpha 2 adrenergic receptor agonists.

80
Q

are IV opioids better than PO opioids

A

no, evidence suggest IV is not superior to oral

81
Q

what are the advantages of po opioids

A

cost savings. facilitate early mobility and greater patient satisfaction .

82
Q

what is the goal of PCA

A

maximum analgesia with minimal side effects.

83
Q

what is the advantage of multimodal pharmacological and non pharmacological treatment for pain

A

optimal approach and should be offered whenever feasible and medically indicated.

84
Q

low dose IV nitro- when is this recommended

A

40mcg bolus- recommended to relax the uterus for placental removal when indicated.

85
Q

placental accreta- what must be immediately available.

A

PRBC’s should be immediately available

86
Q

patient with placental previa - hospitalized for some time before delivery should have

A

have at least one IV catheter maintained if bleeding is recurrent or imminent delivery is anticipated

87
Q

the supine hypotension syndrome is caused by

A

compression of the aorta and inferior vena cava

88
Q

how does supine hypotension syndrome manifest

A 
pallor
tachycardia
sweating
nausea
hypotension
dizziness
89
Q

current guidelines recommend that prophylactic antibiotics be administered within

A

60 minutes

90
Q

Per my notes…what is recommended for patient who aspirates

A

cpap or peep- NOT abx or steroids

91
Q

how do we distinguish placental previa vs. placental abruption

A

lack of abdominal pain and or absence of abnormal uterine tone is previa

92
Q

if patient has an abnormal placental attachment- what may occur if the placenta is removed forcefully

A

massive hemorrhage

93
Q

** scenario discussed in class**

You have a pregnant patient you’ve given sux to for c/s but on laryngoscopy you are not able to intubate. pt and baby are stable and you are able to bag/mask adequately.

what would you do?

A
  • wake patient to discuss awake/ fiberoptic (best option since they aren’t in distress)
94
Q

The most common postpartum headaches are (2)

A

Tension-type and migraine headaches

95
Q

________ is the most common indication for a cesarean hysterectomy.

A

Placenta accreta

96
Q

Treatment of magnesium toxicity

A

o D/C magnesium
o Intubation and ventilation
o IV calcium gluconate (calcium antagonizes effects of magnesium)

97
Q

leading causes of maternal death (associated with PIH)

A
  • Pulmonary edema/cerebral hemorrhages (
98
Q

________ ______ is associated with more rapid oxygen desaturation during apnea during the induction of general anesthesia.

A

Increasing BMI

99
Q

The administration of CPAP in patients breathing spontaneously or the administration of PEEP in patients undergoing mechanical ventilation restores

A

functional residual capacity,
reduces pulmonary shunting, and
reverses hypoxemia.

100
Q

The administration of corticosteroids for aspiration pneumonitis recommended?

A

no

101
Q

The most effective way to decrease the risk for aspiration is to?

A
  • Comprehensive airway evaluation,
  • prophylactic administration of nonparticulate antacids, and
  • use of regional anesthesia decrease the risk of aspiration.
102
Q

The mother undergoing elective cesarean delivery should fast from solid food. Preoperative antacid prophylaxis may include?

A

“Before surgical procedures (e.g., cesarean delivery and postpartum tubal ligation), consider timely administration of nonparticulate antacids, H2-receptor antagonist, and/or metoclopramide for aspiration prophylaxis.”

103
Q

Preoperative prophylaxis before emergency cesarean delivery under general anesthesia should include?

A

General anesthesia may be unavoidable occasionally, therefore, awake intubation may be indicated in women in whom airway difficulties are anticipated.

104
Q

The hallmark of aspiration pneumonitis is?

A

Bronchospasm and disruption of surfactant

likely account for the slight decrease in PaO2 and increase shunting that are observed. The anesthesia provider witnesses regurgitation of gastric contents into the hypopharynx. Patients who aspirate while breathing spontaneously have a brief period of breath-holding followed by tachypnea, tachycardia, and a slight respiratory acidosis.

105
Q

Is the oral intake of clear fluids allowed during labor?

A

No, a healthy patient undergoing elective C/S may drink modest amounts of clear liquids 2 hrs before induction of anesthesia. Patients with addition risk factors for aspiration may have further restrictions – determined case by case.

106
Q

Does eating during labor results in larger residual gastric volumes?

A

Yes. A reduction in gastric content acidity and volume is believed to decrease risk for damage to the respiratory epithelium if aspiration should occur. Fasting periods for solids 6-8 hrs is recommended.

107
Q
  1. A patients BP is 80/40, HR is 120, RR 26, and are getting prepped for an emergency C/S. What should you do?
    a. Spinal
    b. Epidural
    c. LMA
    d. ETT
A

ETT

108
Q
  1. BP is 80/40 so will you use etomidate or propofol?
A

Etomidate

109
Q

why do we avoid oral hypoglycemic agents during pregnancy?

A

can cause fetal hypoglycemia

110
Q

The three most common symptoms preceding an eclamptic attack:

A
  1. Headache, visual changes
  2. RUQ/epigastric pain
  3. Seizures; severe if not controlled with anticonvulsant therapy
111
Q

HIV test to rule out?

A

ELISA

presumptive dx

112
Q

hiv rule out test?

A

Western blot assay

positive results are then confirmed with

113
Q

AIDS DX CD4 count:

A

CD4 < = 200

N = 500-1500

114
Q

can include a flu-like illness within a month or two of exposure

Stage of HIV?

A

Stage 1

Seroconversion means the immune system is activated against the virus and antibodies can be detected in the blood

115
Q

the individual usually remains free of major disease, even without treatment

stage of hiv?

A

Stage 2

It can last 6-8 years, during which HIV levels in the blood slowly rise

116
Q

occurs when the immune system loses the fight against HIV

stage of HIV?

A

stage 3

Symptoms worsen and opportunistic infectious develop

117
Q

HIV - Four stages of infection:

A
  1. Flu-like (acute)
  2. Feeling fine (latent) – during latent phase virus replicates in lymph node
  3. Falling count
  4. Final crisis
118
Q

Physical examination findings for HIV:

A
  • Low grade fever, night sweat, weight loss
  • Facial seborrhea
  • Diffuse lymphadenopathy (like Mono)
  • Splenomegaly
  • Oral candidiasis “thrush”
  • Herpes zoster infection (reactiviation of shingles too)
119
Q

Clinical features of HIV

A
  • Asymptomatic
  • Persistent fevers and chill
  • Drenching night sweats
  • Fatigue, arthralgias (joint pain), myalgias (muscle pain)
  • Unintentional weight loss “HIV wasting syndrome”
  • Depression, apathy, as early signs of HIV-related encephalopathy
120
Q

most common complaint with HIV:

A

fever

  • BC should be drawn for bacteria, fungus, atypical mycobacterium (MAI) and CMV
121
Q

unique feature of Tuberculosis in HIV+

A

o Tuberculosis (-ve tuberculin test) – because there is no immune system to activate against antigen

122
Q

most common cause of hiv related blindness

A
  • Blindness

o CMV retinitis – “Cheese and ketchup lesion” MCC

123
Q

Therapy for HIV

A

Azidotheymidine (AZT) with CD4 < 500

o Reverse transcriptase inhibitor

With CD4 < 200 add pneumocystis prophylaxis
o Trimethoprim-sulphamethoxazole

124
Q

why should hiv pts (and close family) not received LIVE vaccines?

A

lacking immune system usually disease will overcome

125
Q

decreased FRC in pregnancy - more prone to

A

hypoxia

126
Q

Placental transfer

A
  • lipid soluble substances diffuses rapidly
127
Q

prevent DVT with

A

pneumatic compression stockings during C/S

128
Q

what do you give to stop premature contraction?

A

Beta 2 agonist

ritodrine is given to stop premature contraction

129
Q

Avoid what with ritodrine?

A

Atropine

can cause tachy and lead to pulmonary edema

130
Q

mag sulfate increases sensitivity to both depolarizing and non-depolarizing muscle relaxants therefore….

A

decrease the dose

131
Q

lidocaine (in high doses) causes uterine:

A

vasoconstriction

increased tone

132
Q

most commonly injured during abdominal hysterectomy

A

Femoral nerve is

133
Q

Common peroneal nerve injury during vaginal hysterectomy may lead to

A

foot drop

134
Q

most commonly injured during vaginal delivery

A

Lumbosacral nerve is

135
Q

most common cause of anesthesia-related maternal mortality

A

Airways complications are

SUM'20 - Advanced Principles (16 decks)

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