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98 Cards in this Set

  • Front
  • Back

Reasons not to get spinal anesthesia

1. Patient refusal


2. Infection at the site


3. Sepsis


4. severe coagulothapy


5. severe aortic or mitral stenosis


6. increased intracranial pressure


7. indeterminate neurologic dz

C sections usually done under

spinal anesthesia

What is the effect of baricity on a spinal

baricity refers to the ratio of an anesthetic solution's density to CSF. 1 = isobaric. Less than 1 = hypobaric, it will travel against gravity. Hyperbaric solutions ( baricity > 1) travel in the direction of gravity.

what is duramorph

duramorph is a preservative free form of morphine, it is isobaric

difficult airway algorithm for parturients

awake fiberoptic/awake glidescope, intubate, bmv, gum elastic bougie, external laryngeal manipulation to right, LMA/Combitube

typical dose of local for an epidural for c section
1. 20 ml of Lidocaine with epi 1:200,000
2. 100 mcg fentanyl
3. 2 ml of 8.4% NaHCO3

why is NaHCO3 added to epidurals?

increases pH and percent of lidocaine that is unionized. This results in a more profound block of sensory and motor nature. It also makes the onset of the block much faster.

how is a Combined Spinal Epidural performed?

place the epidural, pass the spinal needle thru till you get CSF leakage, inject spinal dose, remove spinal needle, pass epidural catheter like normal, remove toughy needle. Then you're done.

CSE stands for

Combined Spinal Epidural

Primary anesthetic solution for epidural infusion during labor is

0.2% ropivicaine with 2 mcg/ml fentanyl

what is a test dose, what do you look for?

a test dose of local anesthetic with epi. Look for signs of epinephrine infiltration. Or signs of a spinal

a parturient with multiple babies in her can only deliver vaginally if

both fetuses are in vertex position

anesthetic for cerclage

spinal anesthesia

What is breech presentation?
butt first

What does ECV stand for

external cephalic version

what is an external cephalic version?

process of trying to externally turn a breech presentation to a vertex presentation before a child is born. Usually done under ultra sound and FHR monitoring.

breech presentation requires

c-section

how long must you wait for spinal anesthesia after taking:
1. warfarin
2. NSAIDs or ASA
3. Lovenox
4. minidose hep
5. ticlid
6. plavix
7. abciximab or integrilin
1. 4 days or need normal pt and inr
2. not a threat to increased hematoma
3. 24 hrs
4. mini dose heparin (subq hep) is not a contraindication to neuraxial anesthesia.
5. 14 days
6. 7 days
7. 48 hours

Normal Fetal Heart Rate is


110-160 bpm

what is an amnioinfusion?

a method of thinning thick meconium in amniotic fluid. Sometimes used with oligohydroamnios to prevent umbilical cord compression.

what is oligohydroamnios?

having inadequate levels of amniotic fluid.

What is Magnesium Sulfate used for?

* Prevention and treatment of seizures in women with preeclampsia or eclampsia.
* Fetal neuroprotection before anticipated early preterm (less than 32 weeks of gestation) delivery.
* Short-term prolongation of pregnancy (up to 48 hours) to allow for the administration of antenatal corticosteroids in pregnant women between 24 weeks of gestation and 34 weeks of gestation who are at risk of preterm delivery within 7 days

What are the therapeutic levels of Magnesium Sulfate?

4.3-8.4 meq/dL

macrosomia

having a big baby. Usually marked as 8 lbs 13 oz (4kg) or 9 lbs 15 oz (4.5kg)

what percent of cardiac output is shunted to the pregnant uterus?

10%

Placenta previa

Placenta Previa is a condition where the placenta lies low in the uterus and partially or completely covers the cervix. The placenta may separate from the uterine wall as the cervix begins to dilate (open) during labor.

placenta accreta

occurs when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle. Placenta accreta is the most common accounting for approximately 75% of all cases.

placenta increta

occurs when the placenta attaches even deeper into the uterine wall and does penetrate into the uterine muscle. Placenta increta accounts for approximately 15% of all cases.

placenta percreta

the rarest and most severe form of placenta accreta, occurs when the placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder. Placenta percreta is the least common of the three conditions accounting for approximately 5% of all cases.

placental abruption

Placental abruption (abruptio placentae) is an uncommon yet serious complication of pregnancy.


The placenta is a structure that develops in the uterus during pregnancy to nourish the growing baby. If the placenta peels away from the inner wall of the uterus before delivery — either partially or completely — it's known as placental abruption. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother.

uterine rupture
A uterine rupture is a tear in the wall of the uterus, most often at the site of a previous c-section incision.

premature rupture of membranes

Premature rupture of membranes (PROM) refers to a patient who is beyond 37 weeks' gestation and has presented with rupture of membranes (ROM) prior to the onset of labor.

chorioamnionitis

bacterial infection of the chorion and amnion (fetal membranes). often caused by prolonged labor.

umbilical chord prolapse

when the umbilical chord passes thru the cervix ahead of the baby, can cause hypoxia and death. Detected by FHR showing brady (<120 bpm)

neuraxial anesthesia effects pulmonary function...

unless the phrenic nerve is blocked, Vt remains constant and VC decreases only slightly.

if pt is on warfarin, these must be normal before applying spinal anesthesia

Prothrombin time and INR

spinal catheters

no longer approved bc they cause cauda equina syndrome.

the ph of lidocaine with epinephrine is relatively to regular lidocaine

more acidic

Fetal bradycardia defined as

fhr < 120 bpm

how much does MAC decrease in pregnancy

40%

which has oxygenated blood, the umbilical artery or vein?

the umbilical vein


before any neuraxial technique is performed on an obstetric patient, what should be done

large fluid bolus to combat hypotension

hetastarch in what dose causes increased allergy risk?

>20 ml/kg

spinal or epidural: tends to err by producing a one sided block?

epidural

types of placenta previa

* Complete previa: the cervical opening is completely covered
* Partial previa: a portion of the cervix is covered by the placenta
* Marginal previa: extends just to the edge of the cervix

Dural Puncture epidural

a CSE without injection of medxn thru the spinal needle.

for a Dural Puncture Epidural or a CSE, how far does the spinal needle usually extend beyond the epidural needle?

10-15 mm

which is more effective and why?



IV or neuraxial opioids?

Neuraxial opioids are more effective at providing analgesia than IV opioids because they target both supraspinal and spinal opioid receptors.

At Memorial University Medical Center, how much narcotic is usually placed in a spinal?

0.2 mg of Duramorph and 20 mcg of Fentanyl

which local anesthetic is usually cited as the most teratogenic?

cocaine

are muscle relaxants teratogenic?

muscle relaxants are not

is ketamine teratogenic?

ketamine is not

are benzodiazepines teratogenic?

benzos are not

are opioids teratogenic?

no, opioids are not

most common causes of anesthesia related death in obstetrics

failed intubation, ventilation, oxygenation, or aspiration (AIRWAY MANAGEMENT)

the uterus receives how much blood flow per min when pregnant?

600-700 ml/min

which type of uterine displacement can alleviate hypotension in the supine position?

Left Uterine Displacement

amniotic fluid embolism happens most often during

placental separation or uterine rupture

which has less failure as a technique, epidural or spinal?

spinal has less

what is better for surgical pain treatment in the ob patient who is undergoing unrelated surgery?


Opioid or NSAID

opioids are better because they don't disrupt the 'prostaglandin milieu' of pregnancy

cervical cerclage

performed for an incompetent cervical os, the procedure involves placement of sutures around the the cervical os to keep it closed

two techniques of performing a cervical cerclage and the recommended anesthetic

laparascopic - GETA


vaginally- hyperbaric spinal anesthesia

when are cerclages supposed to be performed

between weeks 13-16

what happens to the uterus at week 20?

it becomes less of a pelvic organ and more of an abdominal one, which complicates the whole risk of aspiration thing

which is better, external cephalic version with or without anesthesia?

ECV is better performed with spinal anesthesia, it allows the abdominal muscles to relax, the mother is not in pain, and the doc can use more effort

where should ECV be performed?

in the OR, as induced labor, fetal compromise, uterine rupture and other complications can all ensue

in addition to tocolytics, what drug has been show to cause added uterine relaxation?

nitroglycerin in 50 mcg boluses with 45 seconds in between

when can the fetus feel pain?

20-30 weeks

why is an epidural preferred for vaginal delivery

it has more motor preservation

how much blood is used in an epidural blood patch

10-20 ml of autologous blood

greatest cause of post partum hemmhoragge

uterine atony

if a patient with a spinal for C/section begins desatting, loses handgrip or the ability to vocalize...

RSI should be performed

bicarbonate should be used with which local anesthetic, and avoided in which others

use bicarb with lidocaine, but not with longer acting LAs like bupivicaine or ropivicaine as they can cause precipitation.

a good reason why we don't redose spinals

more holes in dura is not good

good LA for use in emergent C/section with an epidural

quick onset drug like chloroprocaine

nausea in the ob patient during a c/section correlates strongly with...

hypotension! Tx with fluids, phenylephrine, and ephedrine

literature supports the use of how many vital capacity breaths to replace pre oxygenation in emergencies

4 Vital capacity breaths.... whatever

how does epinephrine benefit spinal anesthesia

prolongs the analgesia and indicates intravascular injection

peak effect of morphine in spine is

60-90 minutes

morphine can provide analgesia for how long

24 hours

how does chloroprocaine effect opioids?

it greatly reduces the duration of analgesia that opioids can provide.

2 most common causes of late term hemmhorrage

abruptio placenta and placenta previa

symptoms: painless vaginal bleeding, malpresentation of fetus, difficulty palpating the presenting part of the fetus

placenta previa

symptoms: painful vaginal bleeding, uterine tetany, fetal distress/death, coagulothapy

placenta abruption

up to this percent of blood loss shows no signs

15-20%

hb level indicating PRBC are needed

6 gm/dl

if the cardiac accelerator fibers are blocked, how do you treat bradycardia?

epinephrine in 10 mcg boluses

fibrinogen level requiring blood products

80-100 mg/dL

the suggested goal of antihypertensive therapies

systolic of 140-155 and a diastolic of 90-105

Transient Neurologic Syndrome caused by which LA

all but mostly Lidocaine

onset of TNS usually occurs

12-24 hours after surgery

TNS is the manifestation of

pain or numbness in the lower back, buttocks, or LE

TNS lasts

6 hours - 7 days

treatment for TNS

nsaids, opioids, heat, leg elevation

Cauda Equina syndrome presentation

pain in low back with motor and sensory defecits, also bowel and bladder loss of control.

cause of Cauda Equina syndrome

ischemic compression from hematoma or abcess, or neurotoxicity.

onset, recovery, and duration of cauda equina syndrome

variable

signs of epidural hematoma

lower back/buttock pain with sensory and motor defecits, as well as bladder and bowel dysfunction.