Anesthesia For Operative Delivery pt4

Question 1

Does GETA increase or decrease maternal mortality?

Answer 1

Increase

Question 2

How does GETA affect apgar scores?

Answer 2

↓ Apgar scores (1min) associated with GETA

Question 3

Why is the risk of anesthesia recall high with GETA for C-sx delivery?

Answer 3

• ↓ MAC for delivery due to loss of uterine tone & concurrent bleeding
• avoided administration of versed

Question 4

What is the dose of succinylcholine?

Answer 4

1 - 1.5 mg/kg

Question 5

What induction agents are used for emergent c-sections?

Answer 5

• Propofol (or ketamine) + SCh
• versed once baby is out

Question 6

What size ETT is used for c-sections?

Answer 6

6 - 7 mm ETT (remember that airway is friable & edematous)

Question 7

What other tube is placed (other than ETT) for a GETA c-section?

Answer 7

orogastric tube (suction out the stomach)

Question 8

In regards to a c-section delivery, when is pitocin/oxytocin started?

Answer 8

AFTER delivery

Needs to be announced to whole room that its being started.

Question 9

Less VAA = _______ uterine tone.

Answer 9

increased (results in less bleeding)

volatiles decrease uterine tone

Question 10

What is MAC value decreased to after delivery of the baby?

Answer 10

0.5 - 0.75 MAC

just above MACawake

Question 11

Opioids & BZDs are given ____ delivery in order to decrease ____?

Answer 11

Opioids and BZDs are given After delivery to decrease risk of recall/pain and reduce risk of neonatal respiratory depression.

Question 12

What paralytic is used after Succinylcholine has worn off?

Answer 12

Trick question. Use VAA to drive muscle relaxation (anesthetic depth)

surgeon may request muscle relaxation

Question 13

Maternal hypocapnia results in what oxygenation change for the fetus?

Answer 13

Less O₂ delivery due to leftward oxyhemoglobin dissociation curve shift (Locked)

Question 14

Maternal hypercapnia results in bradycardia or tachycardia?

Answer 14

Tachycardia

Question 15

What would cause you to do a deep extubation on a parturient patient?

Answer 15

Trick Question. Extubate patient awake. Still considered a full stomach.

suction OGT prior to extubation

Question 16

What are the three drugs used to treat uterine atony?

Answer 16

• Pitocin
• Methergine (methylergonovine)
• Hemabate (Carboprost)

Question 17

What symptoms from a Pitocin drip would prompt you to slow the infusion?

Answer 17

Hypotension & flushing

Question 18

When is Pitocin started after delivery?
What dosage is used?

Answer 18

• After umbilical cord is cut
• 20u in NS bag (drip in slowly)

(usually comes in 10u/mL)

Question 19

What is the dose of Methergine (methylergonovine)?

Answer 19

0.2 mg IV/IM (200mcg)

Question 20

________ would cause one to be very careful using Methergine (methylergonovine).

Answer 20

Hypertension

methergine can further increase HTN

Question 21

What is the dose of Carboprost (Hemabate)?

Answer 21

250mcg IM

Question 22

What drug is given if a patient is still bleeding after Pitocin administration?

Answer 22

Carboprost (Hemabate)

Question 23

What medical condition would make you cautious in giving Hemabate?

Answer 23

Asthma

Hemabate is a prostaglandin and can exacerbate asthma

Question 24

What factors associated with C-sections result in N/V?

Answer 24

• Hypotension
• Surgical Stimulation
• Uterotonics

Question 25

How does hypotension result in N/V

Answer 25

- Cerebral hypoperfusion → medullary vomiting center stimulation - Gut ischemia → emetogenic substances released from intestines

Question 26

Why does surgical stimulation result in N/V?

Answer 26

Vagal Stimulation - Uterine exteriorization - Intra-abdominal manipulation - Peritoneal tract stimulation

Question 27

GETA for emergent c-section results in a very high risk for ______.

Answer 27

recall from periods of lower MAC

Question 28

What drug can be given to help prevent recall in emergent c-sections? When is this given?

Answer 28

2mg Midazolam **as soon as the baby is out**.

Question 29

Is it better to have block that is too high or too low?

Answer 29

too high *Can supplement w/ O₂ and pressors*

Question 30

What should anesthesia do if a block is excessively high? (loss of consciousness, loss of respiratory drive, refractory HoTN)

Answer 30

Convert to GETA

Question 31

Why is preoxygenation so important in the parturient patient?

Answer 31

Parturients have significantly decreased FRC to begin with

Question 32

How does the induction flow during GETA for delivery?

Answer 32

* Preoxygenate * RSI - tube * As soon as tube is in = Incision * Baby out *announce "tube is in"*

Question 33

Why should you check twitches after giving succinylcholine and before giving NMBD in parturients?

Answer 33

potential for pseudocholinesterase deficiency that leads to prolongation of SCh effects

Question 34

What peripheral block is useful for postoperative pain from cesarean section?

Answer 34

Transverse Abdominis Plane (TAP) Block

Question 35

Why are uterotonics associated with N/V?

Answer 35

* Oxytocin: r/t HoTN * Methergine: interacts with dopaminergic and serotonergic receptors * Hemabate: stimulates GI tract smooth muscle

Question 36

What severe complications can arise from a high spinal?

Answer 36

* LOC * loss of respiratory drive * refractory HoTN

Question 37

What technique may help increase spread if you have too low of a block?

Answer 37

lithotomy/frog leg position and cough

Question 38

If neuraxial block is too low, what can be done?

Answer 38

* supplement with ketamine, precedex, or N2O * if mom unable to tolerate, may need to convert to GETA