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Advanced Principles A (Spring 2025) Cooper > Anesthesia for Operative Delivery (Extra)) > Flashcards

Anesthesia for Operative Delivery (Extra)) Flashcards

(45 cards)

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1
Q

What is operative vaginal delivery?

A

Forceps or vacuum assisted delivery

Less use these days partly due to medico-legal concerns, shortens 2nd stage of labor

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2
Q

What are some factors contributing to operative vaginal delivery?

A
  • Non reassuring FHR
  • Maternal Exhaustion
  • Arrested Descent
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3
Q

What are the four T’s associated with maternal hemorrhage?

A
  • Tone
  • Trauma
  • Tissue (retained products)
  • Thrombin (coagulation status)
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4
Q

True or False: Maternal mortality is 10 times greater with cesarean delivery compared to vaginal delivery.

A

True:

Failed intubation
Inadequate ventilation
Pulm. Aspiration

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5
Q

What is the type of skin incision based on?

A

How rapidly the fetus must be delivered

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6
Q

Differentiate which skin incision is being described:

Lower incidence of uterine rupture
Higher likelihood of umbilical hernia
Less painful
Faster access
Cut from umbilicus to pubic symphasis

A

Lower incidence of uterine rupture: Low Transverse
Higher likelihood of umbilical hernia: Low Vertical/Midline
Less painful: Low Transverse
Faster access: Low Vertical/Midline
Cut from umbilicus to pubic symphasis: Low Vertical/Midline

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7
Q

What type of uterine incision is most common for cesarean deliveries?

Benefits of this?

A

Low Transverse

This incision has less risk of bladder injury and uterine rupture in future pregnancies.

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8
Q

True or False:
There is a high risk of uterine rupture with a low vertical incision.

A

False:

There is a higher risk than low transverse, but still a low risk in general.

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9
Q

What is the risk of uterine rupture with a classical incision?

A

Approximately 10%

TOLAC is contraindicated with classical incisions due to this high risk.

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10
Q

Comapred to the other 2 uterine incisions, the classical incision puts the patient at a higher risk of these 2 complications:

A
  1. Abdominal adhesions
  2. Uterine rupture
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11
Q

Describe the step-by-step process of how to handle a maternal hemorrhage:

A

Call for Help/ Blood Products
- IV Fluids, Albumin, Warm products
2nd Large bore IV & Airway
Check uterine tone
- Pitocin
- Consider Methergine/Hemabate
TXA (1g over 5 min)
Coags and Calcium

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12
Q

What can the OB do to aide with Maternal hemorrhage?

A
  1. Compression/B Lynch suture
  2. Hysterectomy
  3. Uterine artery ligation
  4. Bakri Balloon
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13
Q

What complications from previous c-sections can affect future pregnancies?

A
  • Placenta Previa
  • Placenta accreta, increta, percreta
  • Uterine rupture
  • Hemorrhage

Known issue = GETA

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14
Q

What classifies a “high-risk” pregnancy?

A
  1. Multiparity, Multiple C-sections
  2. Classical incision
  3. Anemia
  4. Abnormal placental implantations (previas)
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15
Q

What should we have readily available in the OR in preparation for an emergent situation?

A
  • Pressors
  • Succs/Prop
  • Blood tubing
  • Blood in blood bank
  • LMA, Bougie, Video laryngoscope
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16
Q

Pre-op meds we may need to give for c-sections:

A
  1. Pepcid 20 mg
  2. Reglan 10mg (monitor for EPS)
  3. Bicitra 30 mls
  4. ABX (Ancef, Azithromycin –> very high risk of nausea)
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17
Q

What are the advantages of neuraxial anesthesia?

A
  • Mother awake
  • Early bonding
  • Presence of support person
  • Use of opioids

Examples include morphine and fentanyl.

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18
Q

What are the disadvantages of neuraxial anesthesia?

A
  • Maternal discomfort
  • Nausea
  • Hypotension
  • Shoulder pain/ chest pressure

Nausea is not uncommon during a C-section, and hypotension can occur due to sympathetic blockade.

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19
Q

What is the bezhold-jarisch reflex? How does it present?

Study These Flashcards
A

Mechanoreceptors in the wall of the LV respond to a “low stretch”

  1. Vasodilation
  2. Hypotension
  3. Bradycardia
20
Q

What is the purpose of administering Ondansetron (Zofran) before spinal anesthesia?

Study These Flashcards
A

Prevents nausea and hypotension by inhibiting the activation of the Bezold-Jarisch reflex.

5-HT3 antagonism

21
Q

What is the preferred position to prevent hypotension during cesarean delivery?

Study These Flashcards
A

Slight head up position (10 degrees)

Left Uterine displacement

This helps prevent aortocaval compression.

22
Q

What local anesthetic is commonly used in spinal anesthesia?

Study These Flashcards
A

Hyperbaric lidocaine 5%

It carries a risk of transient neurologic syndrome (TNS).

23
Q

Fill in the blank: The most common dosage for Morphine in spinal anesthesia is _______.

Study These Flashcards
A

100-150 mcg

This dosage can provide postoperative analgesia.

24
Q

What is the risk associated with the use of Bupivacaine in epidurals?

Study These Flashcards
A

Cardiac toxicity

This risk is a concern with higher concentrations.

25
What adjunct can be added to local anesthetics to speed up onset time?
Sodium Bicarbonate ## Footnote This helps to increase the non-ionized state of local anesthetics.
26
What is a Combined Spinal Epidural (CSE)?
A rapid block associated with SAB with the option to use an epidural catheter ## Footnote This allows for sequential dosing if necessary.
27
What should be monitored before and after SAB placement?
FHT and maternal BP ## Footnote Monitoring is crucial for maternal and fetal safety.
28
What is the typical duration for postoperative analgesia with Morphine in spinal anesthesia?
12-24 hours ## Footnote This duration can vary depending on dosage and individual patient factors.
29
What is the purpose of administering 15 ml to extend an epidural?
To make adequate for surgery ## Footnote This dosage is crucial for ensuring effective anesthesia during surgical procedures.
30
What is the Allis test used for?
To assess level before incision ## Footnote This test helps in determining the appropriate anesthetic level prior to surgery.
31
What does Combined Spinal Epidural (CSE) refer to?
A rapid block associated with SAB and an option to use an epidural catheter ## Footnote CSE provides both immediate and prolonged pain relief.
32
What are the indications for General Endotracheal Tube Anesthesia (GETA)?
* Fetal distress * Sustained fetal bradycardia * Maternal hemorrhage with hypovolemia * Neuraxial anesthetic not possible * Coagulopathy/thrombocytopenia * Infection * Patient refusal * Failed block/patient not tolerating ## Footnote These situations necessitate GETA to ensure the safety of both mother and fetus.
33
List the benefits of GETA.
* Rapid onset * Secured airway * Hemodynamic stability ## Footnote These benefits make GETA an effective choice in certain emergency situations.
34
What are the disadvantages of GETA?
* Increased maternal mortality * Difficulty with airway management * Failed oxygenation/ventilation * Risk of aspiration * Mother not awake during delivery * No 'support person' in the OR * Potential anesthesia recall * Neonatal respiratory & CNS depression * 1-minute APGAR scores lower with GETA ## Footnote These risks highlight the need for careful consideration before choosing GETA.
35
What is the initial step in the GETA induction sequence?
Preoxygenate and monitor ## Footnote This step is crucial for ensuring adequate oxygen supply before intubation.
36
What is the purpose of cricoid pressure during GETA induction?
To prevent aspiration ## Footnote Cricoid pressure is an essential technique used during rapid sequence induction.
37
What medication is often used for intubation in GETA?
Succinylcholine 1-1.5 mg/kg ## Footnote This neuromuscular blocker is commonly used for rapid intubation.
38
What should be documented during the GETA procedure?
* Uterine incision time * Delivery time ## Footnote Accurate documentation is critical for medical records and future care.
39
What is the recommended volatile agent concentration after delivery of the fetus?
0.5-0.75 MAC ## Footnote This concentration helps maintain anesthesia while allowing for uterine tone restoration.
40
What should be administered after delivery to reduce the risk of recall?
Benzodiazepines ## Footnote Administering benzodiazepines post-delivery helps mitigate anesthesia recall.
41
What is the role of magnesium infusion in GETA?
Potentiates neuromuscular blockade ## Footnote Magnesium can enhance the effects of neuromuscular blockers during anesthesia.
42
What are the treatments for uterine atony?
* Pitocin/Oxytocin * Methergine/Methylergonovine * Hemabate/Carboprost ## Footnote These medications are critical for managing uterine atony and ensuring uterine contraction.
43
What is the typical concentration for Pitocin used for uterine contractions?
10 units/mL ## Footnote This concentration is commonly used to stimulate uterine contractions post-delivery.
44
True or False: GETA allows the mother to be awake during delivery.
False ## Footnote GETA typically results in the mother being unconscious during the procedure.
45
Fill in the blank: The initial medication for pain control postoperatively is _______.
Opioids ## Footnote Opioids are a primary choice for managing postoperative pain effectively.

Advanced Principles A (Spring 2025) Cooper (14 decks)

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