Anesthesia For Operative Delivery pt2 Flashcards
What surgical sensations are normal even with a spinal anesthetic?
pushing, pulling, tugging, & pressure
Which two drugs need to be stocked and ready to go in the OB operating room?
Propofol & Succinylcholine
Be ready to RSI.
(VL, bougie, LMA)
What three medications are given to prevent (or diminish consequences) aspiration in parturients?
- Famotidine 20mg IV
- Metoclopramide 10mg IV
- Na⁺ Citrate (Bicitra) 30mLs PO
What type of drug is famotidine (pepcid)?
H2 receptor antagonist that decreases gastric acid production.
What is the onset & peak of famotidine?
Onset: 30 min
Peak: 60 - 90 min
How does metoclopramide (reglan) work?
- ↓ stomach volume via increased motility.
- increased LES tone
- ↓ N/V
Dopamine D2 antagonist
When should metoclopramide be administered?
15-30 min prior to anesthesia start
What type of drug is Bicitra?
Non-particulate antacid that decreases gastric acidity to > 6 pH for one hour
When should Bicitra be administered?
within 20-30 min before going to the OR.
What antibiotic given to parturients should be administered slowly due to risk of N/V?
Azithromycin
What monitoring equipment is necessary before spinal placement?
At minimum:
- FHT
- Mom’s BP
- Pulse oximetry
EKG not usually required
Why is versed “discouraged” but not contraindicated?
- Crosses placenta & sedates baby
- Amnestic effects interfering with bonding
Is oxygen necessary for an elective c-section?
- Not necessarily (but is typically done).
- 0.35-0.4 FiO2 doesnt improve fetal oxygenation
- 1.0 FiO2 is ideal for GETA preoxygenation
What is an ideal spinal dose of morphine?
100 - 150mcg
What is an ideal spinal dose of Fentanyl?
10-25 mcg
What is an ideal dose of epidural morphine?
3mg
What are some disadvantages to C-section with neuraxial anesthesia?
- pressure sensations are uncomfortable/anxiety
- Diaphragm stimulated
- HoTN
- N/V
What causes referred shoulder/chest pain during a c-section with neuraxial anesthesia?
Uterus being pulled out
How is the diaphragm stimulated during a c-section?
Irrigation can stimulate the diaphragm & cause N/V, cold, pain sensations.
What reflex can be activated during a c-section?
Bezold Jarisch Reflex: low stretch in LV wall leading to bradycardia
What are the triad of symptoms associated with the Bezold-Jarisch Reflex?
- Vasodilation
- Hypotension
- Bradycardia
What causes the Bezold-Jarisch reflex?
Mechanoreceptors sensing low stretch in the LV due to low preload.
Which drug can be administered to prevent the bezold-jarisch reflex associated with a spinal block?
Ondansetron 4mg IV
Antagonizes 5HT-3 receptors & prevents activation of BJR.
What position should a patient be in after a spinal block?
Slight (10°) head up
Bed can also be tilted left for slight LUD.
