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26 Cards in this Set
- Front
- Back
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What are the indications for a C-Section?
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Previous C-section, breech presentation, dystocia, fetal distress, placental abruption or previa, genital herpes acute attack, amnionitis, HIV
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How does pregnancy impact patient sensitivity to locals?
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Sensitivity is enhanced via 2 mechanisms: hormaonal mediation, decreased volume in epidural space d/t venous engorgement; *Decrease dose by 30%
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What is cephalopelvic disproportion?
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Disparity between fetal head size & size of maternal pelvic outlet
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What are the criteria for a diagnosis of gestational diabetes melllitus?
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Random blood sugar >/=200mg/dL
Fasting glucose >/=126mg/dL 2 hr. GTT >/=200 |
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What risk factors are assoicated with gestational diabetes mellititus?
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Advanced maternal age, obesity, family hx DM, prior stillbirth, neonatal death, fetal macrosomia, diminished uteroplacental blood flow
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Discuss death from anesthesia r/t regional vs. general:
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Regional is usually d/t high level or LA toxicity;
General is usually d/t inability to intubate/ventilate & aspiration |
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What are the advantages of regional anesthesia?
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Less neonatal exposure to depressant drugs, decreased risk maternal aspiration, maternal awareness, option of using neuraxial opioids; (Discuss SAB vs. Epidural)
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How does one administer an SAB for C-section?
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Non-particulate antacid, prehydrate, small pencil point needle to obtain T4 level, SLUD, monitor VS Q 5min for surgical C-Section
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What are advantages of GA for c-section?
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Rapid & reliable onset, control over airway, possibly less hypotension than regional
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What is a common side effect of SAB for C-section?
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Hypotension
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How does one minimize/treat hypotension from regional?
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IVF before, SLUD, early admin of vasopressors, O2, emergent delivery prn
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Name 2 complications that are possible soon after admin of the SAB?
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High spinal
intravascular injection |
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What are the symptoms of an intravascular injection?
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agitation, SOB, thrashing of legs, ALOC, apnea, seizure (same thing as LA toxicity-circumoral numbness, tinnitus, metallic taste)
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How to treat LA toxicity d/t intravascular injection:
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Early recognition, prevent progression, maintain oxygenation, support circulation, treat cardiac arrest, assess fetus
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Whar are the symptoms of a high spinal?
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agitation, dyspnea, paralysis of legs, unconsciousness, apnea, bradycardia, loss of resp. reflexes, C8 numbness
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How should one treat a patient with numbness in the fingers & dyspnea?
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Give O2, support b/p, reassure pt, assist ventilations prn
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If a patient is severly SOB after an SAB what should one do?
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Ventilate, intubate, T-berg/SLUD to increase venous return, fluids & pressors
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What if regional anesthetic is inadequate?
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Can give sedation & analgesia (Ketamine, Nitrous); if re-do may run risk for high block
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What should the anesthetist do after delivery of the neonate?
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Administer uterotonics, address maternal c/o pain, N/V
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How should post-op discomfort be managed?
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intrathecal opioids, N/V or pruritus with nubain/narcan, *r/o hypotension
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Does the fetus of a gestational diabetic mother have any risk?
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Yes, for fetal hypoglycemia, d/t sustained fetal hyperinsulinemia; Neonatal hyperbilirubinemia is 2-5x higher
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Discuss PDPH
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Usually on POD one, from decreased ICP, S/S: severe dull, throbbing pain, postural in nature, n/v, photophobia, diplopia
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Are PDPH's benign and self-limiting?
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No, they can lead to cranial nerve palsies & subdural hematomas d/t loss of CSF = loss of support on brain structures = traction on blood vessels and cranial nerves
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How is PDPH treated?
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Bed rest, hydration, caffeine, analgesics, blood patch
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Discuss administration of an epidural blood patch:
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Lateral position, inject most caudal interspace, 15-20ml of blood, rest supine minimum 2 hours
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What are contraindications to epidural blood patch?
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Coagulopathy, bacteremia; *HIV is NOT a contraindication
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