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26 Cards in this Set

  • Front
  • Back
What are the indications for a C-Section?
Previous C-section, breech presentation, dystocia, fetal distress, placental abruption or previa, genital herpes acute attack, amnionitis, HIV
How does pregnancy impact patient sensitivity to locals?
Sensitivity is enhanced via 2 mechanisms: hormaonal mediation, decreased volume in epidural space d/t venous engorgement; *Decrease dose by 30%
What is cephalopelvic disproportion?
Disparity between fetal head size & size of maternal pelvic outlet
What are the criteria for a diagnosis of gestational diabetes melllitus?
Random blood sugar >/=200mg/dL
Fasting glucose >/=126mg/dL
2 hr. GTT >/=200
What risk factors are assoicated with gestational diabetes mellititus?
Advanced maternal age, obesity, family hx DM, prior stillbirth, neonatal death, fetal macrosomia, diminished uteroplacental blood flow
Discuss death from anesthesia r/t regional vs. general:
Regional is usually d/t high level or LA toxicity;
General is usually d/t inability to intubate/ventilate & aspiration
What are the advantages of regional anesthesia?
Less neonatal exposure to depressant drugs, decreased risk maternal aspiration, maternal awareness, option of using neuraxial opioids; (Discuss SAB vs. Epidural)
How does one administer an SAB for C-section?
Non-particulate antacid, prehydrate, small pencil point needle to obtain T4 level, SLUD, monitor VS Q 5min for surgical C-Section
What are advantages of GA for c-section?
Rapid & reliable onset, control over airway, possibly less hypotension than regional
What is a common side effect of SAB for C-section?
How does one minimize/treat hypotension from regional?
IVF before, SLUD, early admin of vasopressors, O2, emergent delivery prn
Name 2 complications that are possible soon after admin of the SAB?
High spinal
intravascular injection
What are the symptoms of an intravascular injection?
agitation, SOB, thrashing of legs, ALOC, apnea, seizure (same thing as LA toxicity-circumoral numbness, tinnitus, metallic taste)
How to treat LA toxicity d/t intravascular injection:
Early recognition, prevent progression, maintain oxygenation, support circulation, treat cardiac arrest, assess fetus
Whar are the symptoms of a high spinal?
agitation, dyspnea, paralysis of legs, unconsciousness, apnea, bradycardia, loss of resp. reflexes, C8 numbness
How should one treat a patient with numbness in the fingers & dyspnea?
Give O2, support b/p, reassure pt, assist ventilations prn
If a patient is severly SOB after an SAB what should one do?
Ventilate, intubate, T-berg/SLUD to increase venous return, fluids & pressors
What if regional anesthetic is inadequate?
Can give sedation & analgesia (Ketamine, Nitrous); if re-do may run risk for high block
What should the anesthetist do after delivery of the neonate?
Administer uterotonics, address maternal c/o pain, N/V
How should post-op discomfort be managed?
intrathecal opioids, N/V or pruritus with nubain/narcan, *r/o hypotension
Does the fetus of a gestational diabetic mother have any risk?
Yes, for fetal hypoglycemia, d/t sustained fetal hyperinsulinemia; Neonatal hyperbilirubinemia is 2-5x higher
Discuss PDPH
Usually on POD one, from decreased ICP, S/S: severe dull, throbbing pain, postural in nature, n/v, photophobia, diplopia
Are PDPH's benign and self-limiting?
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
How is PDPH treated?
Bed rest, hydration, caffeine, analgesics, blood patch
Discuss administration of an epidural blood patch:
Lateral position, inject most caudal interspace, 15-20ml of blood, rest supine minimum 2 hours
What are contraindications to epidural blood patch?
Coagulopathy, bacteremia; *HIV is NOT a contraindication