1F - Obstetric Anesthesia

Question 1

What are hematologically increased in a pregnant woman?

Answer 1

plasma volume, blood cell volume, procoagulant factors

Question 2

Hgb and hematocrit during pregnancy is decreased or increased?

Answer 2

Decreased

Question 3

What ASA class is a pregnant patient?

Answer 3

Class 2 with mild systemic disease

Question 4

Serum cholinesterase activity in pregnant women is decreased by?

Answer 4

20%

Question 5

Total protein in preg woman is?

Answer 5

Increased

Question 6

plasma protein in preg woman is?

Answer 6

De

to below 6g/dL

Question 7

Free drugs in preg woman are?

Answer 7

In

Question 8

What are de in cardio in preg woman?

Answer 8

SVR, arterial bp

Question 9

what are in in cardio in preg woman?

Answer 9

HR, CO, SV

*inc in SVR greater than inc in CO

Question 10

Supine hypotension syndrome is caused by the occlusion of what greater vessel?

Answer 10

Superior vena cava

Question 11

What maneuver can help alleviate supine hypotension syndrome?

Answer 11

Left uterine displacement using a wedge under the hip and left lateral decubitus position

Question 12

The diaphragm during pregnancy is displaced where?

Answer 12

Cephalad

Question 13

what partial pressure is decreased in the blood during pregnancy?

Answer 13

CO2 pressure

Question 14

Due to inc metabolic rate and dec FRC, what is the preg woman presidposed to?

Answer 14

Hpoxemia

Question 15

Overall GI transit time during preg is?

Answer 15

Increased

*gastric emptying time is not prolonged

Question 16

What GI function is distorted and incompetent during pregnancy?

Answer 16

LES

Question 17

Before any surgical procedure, due to the changes in GI tract during pregnancy, what drugs are given?

Answer 17

H2 blockers and metoclopramide

Question 18

The preg patient requires more or less inhaled anesth?

Answer 18

Less

Question 19

What categories in ficks principle permits placental transfer of drugs?

Answer 19

Non ionized, lipid soluble and small molecular size (<500Da)

Question 20

What vasoconstrictor is used to prevent transfer of drugs to the fetus?

Answer 20

Epinephrine (vasoconstrictor)

Question 21

What drug if induction to to delivery exceeds 5-10 minutes, causes newborn depression?

Answer 21

Nitrous oxide (NO)

Question 22

Metabolic clearance of the fetus when compared to an adult is inc, dec, or same?

Answer 22

Same

Question 23

renal clearance of fetus when comparesd to an adult is inc, dec, or same?

Answer 23

inc

Question 24

The spinal cord segments involved in labor pains at the first stage of labor are?

Answer 24

T10 to L1

Question 25

Spinal cord segments involved in the second stage labor pains?

Answer 25

S2 to S4

Question 26

Most commonly administered for labor analgesia?

Answer 26

Opioids

Question 27

what is the go to drug for analgesia?

Answer 27

Meperidine IV effects in 5-10 mins IM peaks in 40-50 mins

Question 28

what type on obstetric analgesia has lower incidence of nausea and vomiting and dysphoria?

Answer 28

Antagonist-agonist - nalbuphine, butorphanol safer then meperidine - ceiling effect on ventilatory depression

Question 29

Synthetic opioids upon repeated doses can cause what fetal complication?

Answer 29

neonatal depression *fentanyl

Question 30

Which potent analgesic causes amnesia?

Answer 30

Ketamine

Question 31

What stage of labor does regional anesth prolong?

Answer 31

None

Question 32

What epidural anesth are called walking epidural by sparing of motor skills?

Answer 32

Ropivacaine and Bupivacaine

Question 33

What form of regional anseth is used for imminent deliveries or multiparous deliveries?

Answer 33

Spinal anesth fentanyl + bupicavaine

Question 34

Repeated spinal anesth can cause what problem to the patient?

Answer 34

postdural puncture headache

Question 35

the painting wall sites of defence requires giving medications in what order of spaces?

Answer 35

Spinal then epidural

Question 36

If patients have aortic stenosis what form of analgesic should be given?>

Answer 36

Opioid only

Question 37

What is the ideal analgesic technique for labor?

Answer 37

Combined spinal and epidural anesth *opioid only or opioid + bupivacaine

Question 38

If central neuraxial anesthetic technique is contraindicated, what is the alternative?

Answer 38

Paravertebral lumbar sympathetic block

Question 39

What nerve block is used for forceps delivery and episiotomy?

Answer 39

Pudendal nerve block

Question 40

What is the most often used is the most often used inhalational anesthesia?

Answer 40

Nitrous oxide

Question 41

What is the most common complication of neuraxial anesth?

Answer 41

Hypotension

Question 42

Interval of monitoring in patients receiving neuraxial anesth?

Answer 42

Every 2-3 mins for first 20 mins

Question 43

Drug and method used for neuraxial anesth?

Answer 43

Morphine either epidural or intracthecal

Question 44

What dermatome is blocked for surgery of the preg woman?

Answer 44

T4

Question 45

What form of anesth is most commonly used in CS delivery?

Answer 45

Spinal anesth

Question 46

In addition to bupivacaine used in spinal anesth for CS delivery, what is added to increase rapidity of the blockade, and reduce symptoms such as nausea and vomiting and shivering?

Answer 46

Opioids

Question 47

What is the main disadvantage of lumbar epidural anesth?

Answer 47

Slow onset

Question 48

Bupivacaine is associated with greater risk of what complication?

Answer 48

LAST (local anesth systemic toxicity)

Question 49

What combination drug for lumbar epidural anesth poses less risk of LAST compared to bupivacaine?

Answer 49

Ropivacaine + fentanyl

Question 50

What is used when there is absolute or relative contraindications for neuraxial anesth?

Answer 50

general anesth

Question 51

What evaluation is important before undergoing general anesth?

Answer 51

preoperative airway evaluation

Question 52

What is the leading cause of maternal death related to anesth?

Answer 52

inability to intubate or ventilate

Question 53

What preventive measure to hypoxia is done before induction of general anesth?

Answer 53

denitrogenization for 3-5 minutes or 4 deep breaths of 100% oxygen

Question 54

what muscle relaxant is used to facilitate intubation?

Answer 54

Succinylcholine

Question 55

Which form of anesth is more related to anesth related maternal deaths, general or neuraxial?

Answer 55

General anesth

Question 56

Treatment for hypotension syndrome caused by anesth?

Answer 56

Vasopressin, epinephrine, Left uterine displacement, co load etc

Question 57

Treatment for convulsions occurring in LAST?

Answer 57

benzodiazepines

Question 58

Treatment for ventricular arrhythmias in LAST?

Answer 58

Amiodarone

Question 59

If unresponsive to lipid emulsion, what is the treatment?

Answer 59

Cardiopulmonary bypass

Question 60

withdrawal of what hormone causes post puncture headache?

Answer 60

estrogen

Question 61

Most commonly abused substance?

Answer 61

Tobacco