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NUNA 693 Obs/Regional > OB: Anesthetic Complications in OB > Flashcards

OB: Anesthetic Complications in OB Flashcards

1
Q

Anesthetic Complications in OB

A

Nausea and vomiting
Postdural puncture headache
Accidental intravascular injection
Accidental subarachnoid injection
Accidental subdural injection
EKG changes during regional anesthesia
CPR in the pregnant patient

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2
Q

Nausea and Vomiting

Regulated by the _______________________ zone and the ___________ center which are located in the area postrema and the medullary lateral reticular formation respectively.

A

chemoreceptor trigger
vomiting

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3
Q

Nausea and Vomiting

Nausea and vomiting may occur _____ or in _____ and are not uncommon in pregnancy.

A

separately or in combination

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4
Q

Nausea and Vomiting

Multiple causes have been implicated including:

A
  • HCG
  • Estrogen
  • Progesterone
  • Prostaglandins
  • Immune system dysregulation
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5
Q

Hyperemesis gravadarum - When vomiting is sufficiently severe to produce:

A
  • Weight loss
  • Dehydration
  • Acidosis from starvation
  • Alkalosis from loss hydrochloric acid vomitus
  • Hypokalemia
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6
Q

Intraoperative Nausea and Vomiting

_____ in incidence and presentation

A

Varies

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7
Q

Intraoperative Nausea and Vomiting

Incidence may be up to ____%

A

80

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8
Q

Intraoperative Nausea and Vomiting

Anesthetic causes of vomiting are ______________ and increased ___________ activity

A

hypotension
vagal

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9
Q

Intraoperative Nausea and Vomiting

Non-anesthetic causes include:

A

Surgical stimuli
Bleeding
Medications (uterotonic agents, antibiotics)
Motion at end of surgery

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10
Q

Intraoperative Nausea and Vomiting

Many of these elements occur ______

A

simultaneously

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11
Q

Nausea and Vomiting due to Hypotension

______ is among the most common sequelae associated with neuraxial analgesia

A

Hypotension

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12
Q

Nausea and Vomiting due to Hypotension

Centrally, hypotension may lead to _____ & _____ _____

A

cerebral and brainstem hypoperfusion

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13
Q

Nausea and Vomiting due to Hypotension

Peripherally, hypotension may cause ____ _____ with release of emetogenic substances from the intestine

A

gut ischemia

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14
Q

Nausea and Vomiting due to Hypotension

Strict maintenance of ______ _____ _____ can reduce the occurrence of emesis

A

intraoperative blood pressure

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15
Q

Oxytocin causes N/V due to hypotension from release of _____ _____ and _____ _____ _____

A

nitric oxide and atrial naturetic peptide

20% incidence of nausea, 10% incidence of vomiting after 5 u IVP

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16
Q

_____ ______ - (methergine) interacts with the dopaminergic and serotonergic receptors

A

ergot alkaloids

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17
Q

Hemabate causes nausea through the stimulation of _____ _____ of the ____ ____

A

smooth muscles
GI tract

10% incidence of nausea and vomiting after 250 mcg IM

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18
Q

N/V due to visceral pain pain from (3)

A

Exteriorization of uterus
Intraabdominal manipulation
Peritoneal traction

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19
Q

____ _____ > activation of vomiting center

A

Vagal fibers

20
Q

general anesthesia-related factors:

A
  • female
  • hx of motion sickness or postop N/V
  • nonsmoking status
  • use of periop opioids
21
Q

spinal anesthesia-related factors

A
  • block height of T5 or higher
  • hx of motion sickness
  • hypotension
  • omission of neuraxial opioids
22
Q

Prophylaxis and Treatment of Nausea and Vomiting

Metoclopramide (Reglan) - _____ mg IV given ____ surgery or _____ cord clamping

Side effects: dizziness, drowsiness, fatigue. Rarely _____ and _____ _____

Can be given postpartum to increase milk production

A

10
before
after
EPS and acute dystonia

23
Q

Prophylaxis and Treatment of Nausea and Vomiting

Ondansetron - ____ mg IV given after cord clamping.
Some studies show ______ risk of hypotension after spinal if Zofran given prior to block

Area for further future study: epidural Zofran?

A

4
decreased

24
Q

Prophylaxis and Treatment of Nausea and Vomiting

Dexamethasone ___-___ mg IV, timing unclear, _____ _____ used for c-section patients

A

4-8
not regularly

25
Q

Prophylaxis and Treatment of Nausea and Vomiting

Scopolamine - ____ mg transdermal patch after cord clamping. Can have ______ effects on breastfeeding

A

1.5
detrimental

26
Q

Alternative therapies

A

Accupressure?
Supplemental O2?

27
Q

Postpartum headache is the complaint of _____, _____ or _____ pain occurring during the first 6 weeks after delivery.

A

cephalic, neck, or shoulder

28
Q

Postdural Puncture headache

Loss of CSF from within the dura and arachnoid membrane
Approximately ____ mL of CSF is present at a time
Approximately ____ mL is produced and reabsorbed every day

A

150
500

29
Q

Postdural Puncture headache

_____ puncture > beveled spinal needle > ____ ____ spinal needle

A

Touhy
pencil point

30
Q

Postdural Puncture headache

Dural fibers run _____ to ______
Implication for needle orientation

A

cephalad to caudad

31
Q

PDPH: Clinical Appearance

  • Relieved by lying down
  • Returns on sitting up or standing
  • Fronto-occipital, may be associated with ____/_____ stiffness
  • _____phobia
  • Less common: double vision, temporary deafness
  • Onset is not usually immediate, may take ___-___ ____
A

neck/shoulder
Photo
1-2 days

32
Q

PDPH Treatment

Conservative –

A

bedrest, oral or IV fluids, OTC analgesics

33
Q

PDPH Treatment

Caffeine – _____ mg 90% of PDPH patients reported “significant improvement”

A

300

12oz RedBull contains 111 mg of caffeine
16oz can of Monster contains 160 mg of caffeine

34
Q

PDPH Treatment

______ ______ block

A

Sphenopalatine ganglion

35
Q

PDPH Treatment

Most effective (and invasive):

A

epidural blood patch

36
Q

Liberal hydration doesn’t increase ____ _____, but dehydration does decrease

A

CSF production

37
Q

_____ causes cerebral vasoconstriction

A

Caffeine

38
Q

ECG Changes are ____ during routine c-section

A

common

39
Q

Some correlation with ____ ____ and complaints of chest pain, pressure, nausea, vomiting or dyspnea

A

ECG changes

40
Q

Few ST changes during regional anesthesia for cesarean delivery in healthy women are caused by _____ ______

A

myocardial ischemia

41
Q

CPR in the pregnant Patient

Fetus does not tolerate decreases in maternal _____ or _____ ____ well

A

oxygenation or blood pressure

42
Q

CPR in the pregnant Patient

Mother has high O2 _____ and low O2 _____ (residual volume)

A

demand
reserves

43
Q

CPR in the pregnant Patient

Aortocaval compression – ____ _____ _____ is necessary to success

A

left uterine displacement

44
Q

CPR in the pregnant Patient

Tilt decreases the ____ of ______

A

force of compressions

45
Q

CPR in the pregnant Patient

Compressions should be _______ higher on the sternum

A

1-2 cm

46
Q

CPR in the pregnant Patient

If patient has a neuraxial block substantially larger doses of ______ may be needed

A

vasopressors

47
Q

CPR in the pregnant Patient

If a near-term parturient does not respond to resuscitative measures in 5 minutes emergent c-section is _______
_____ ______ to neonate
Relief of ______ compression for mom

A

recommended
Direct oxygenation
aortocaval

NUNA 693 Obs/Regional (13 decks)

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