Anesthesia For Operative Delivery pt3

Question 1

Do spinally administered opioids increase or decrease PONV occurrence?

Answer 1

Both.

Can decrease occurrence due to decreased sensations that trigger PONV.

Question 2

What is the dose of Fentanyl for SAB?

Answer 2

10 - 25mcg

Question 3

Is early or late respiratory depression seen with fentanyl?

Answer 3

early: lipophilic = rapid onset, shorter acting

Question 4

What is the typical dose of morphine (astramorph, duramorph) for SAB?

Answer 4

100 - 200 mcg

Question 5

What is the onset and duration for morphine administered spinally?

Answer 5

Onset: 30 - 60 min
Duration: 12 - 24 hrs

hydrophilic = slower onset

Question 6

Will respiratory depression be seen earlier or later with morphine administered via SAB?

Answer 6

Later (6-18 hrs after)

Question 7

How is the pruritus associated with SAB morphine treated?

Answer 7

• Nalbuphine(nubaine) or Butorphanol(stadol)
• Naloxone or Naltrexone

Question 8

What is an “epi wash”?

Answer 8

coating the syringe with epinephrine and squirting out before drawing up drugs

Question 9

What is the purpose of epinephrine added to spinal anesthesia dose?

Answer 9

• Can prolong block by 15% or more via vasoconstriction
• 0.1-0.2mg (100-200mcg)

Question 10

What dose of Precedex is utilized in spinals?

Answer 10

5-10 mcg

Question 11

What is the purpose of Precedex as a spinal additive?

Answer 11

• Prolongs sensory & motor blockade
• Post-op pain control
• Minimizes shivering

Question 12

What are the main adverse effects associated with spinally administered dexmedetomidine?

Answer 12

Bradycardia & Hypotension

Question 13

Epidural medication doses are approximately _____ times that of spinal doses.

Answer 13

5 - 10x greater than spinal doses

Question 14

Are spinals or epidurals better for C-sections?

Answer 14

Spinals (more reliable and dense)

epidurals have a gradual onset and can be less dense or “patchy”

Question 15

IV anesthetics such as ______ or ______ are commonly used as adjuncts to epidurals for patients undergoing unplanned c-section.

Answer 15

ketamine ; precedex

Question 16

2% Lidocaine is just as fast as chloroprocaine when what additive is added to it?

Answer 16

Na⁺ Bicarbonate

Question 17

What dose of 1% Lidocaine is utilized for epidural blocks for c-sections?

Answer 17

Trick Question. Concentrations less than 2% Lidocaine are inadequate for c-section anesthetics.

Question 18

What metabolizes chloroprocaine?

Answer 18

Pseudocholinesterases

Question 19

What drug can decrease the efficacy of epidural morphine? Why?

Answer 19

2-Chloroprocaine

• Antagonizes μ and κ opioid receptors

Question 20

Which concentration of bupivacaine IS NOT utilized in epidurals?

Answer 20

0.75%

(Only for spinals)

Question 21

What concentration of bupivacaine is used for epidurals (for surgical anesthesia)?

Answer 21

0.5%

for dense block for surgical anesthesia (C-sx)

Question 22

What concentration of ropivacaine is common for epidurals (for surgical anesthesia)?

Answer 22

0.5%

Question 23

Compare the cardiac toxicity profiles of ropivacaine & bupivacaine?

Answer 23

Ropivacaine is less cardiotoxic than bupivacaine

Question 24

Between fentanyl and morphine, which opioid administered neuraxially provides for a more dense block?

Answer 24

Fentanyl

Question 25

What dose of dexmedetomidine is typically used in epidurals (for surgical anesthesia)?

Answer 25

4-5 mcg/mL of precedex Ex. 20mL + 80 - 100mcg Precedex

Question 26

How does Na⁺ bicarb helps speed up onset?

Answer 26

Shifts local anesthetic to more **non-ionized state**. very useful speeding up "dose up" from epidural to avoid GETA.

Question 27

Your patient has an epidural in place and is being converted from a normal labor to a c-section. The epidural is unilateral, how can this be fixed?

Answer 27

Replaced the catheter if possible

Question 28

Your patient has an epidural in place and is being converted from a normal labor to a c-section. The epidural is patchy, how can this be fixed?

Answer 28

- Supplement w/ adjuncts (ex. 50mcg Fentanyl can be used for hotspots)

Question 29

How much local anesthetic will you typically use to "dose up" an epidural for a c-section (surgical anesthesia)?

Answer 29

10 - 15mls

Question 30

What is the Allis Test?

Answer 30

Pinch patient with clamps to assess quality of epidural anesthesia. - If the patient can't feel clamps then you're good for surgical incision.

Question 31

Why should your epidural dosing be less with a combined spinal epidural (CSE) ?

Answer 31

Hole through dura mater can result in medication going from epidural to intrathecal space.

Question 32

What are three reasons that one might have to convert to general anesthesia for a c-section?

Answer 32

- Fetal Distress (fetal bradycardia) - Maternal Hemorrhage w/ hypovolemia - Neuraxial Anesthetic not possible

Question 33

What are some reasons that neuraxial anesthesia may not be possible for c-section patients?

Answer 33

- Outright refusal - Infection - Coagulopathy / thrombocytopenia

Question 34

If an epidural is not dense enough what can be administered to help? What must be done if the block is not adequate?

Answer 34

* If not dense enough, may need additional IV anesthesia or inhaled N2O * If not adequate, may need to convert to GETA

Question 35

2% lidocaine used in epidurals generally provides ____ onset and a _____ duration of action?

Answer 35

2% lidocaine used in epidurals generally provides **rapid** onset and a **short** duration of action?

Question 36

Chloroprocaine is typically not used for neuraxial anesthesia because?

Answer 36

Chloroprocaine has a very short duration of action

Question 37

Bupivacaine used in an epidural generally has a ____ onset and a ____ duration of action?

Answer 37

Bupivacaine used in an epidural generally has a **intermediate** onset and a **long** duration of action?

Question 38

Ropivacaine used in an epidural generally has a ____ onset and a ____ duration of action?

Answer 38

Ropivacaine used in an epidural generally has a **intermediate** onset and a **long** duration of action?

Question 39

What is the epidural dose of fentanyl?

Answer 39

50-100mcg

Question 40

What dose of morphine is typically administered in an epidural?

Answer 40

1-3mg