Complications in Obstetric Anesthesia Flashcards
(34 cards)
What is the most common cause of pospartum maternal palsy?
Cephalopelvic disproportion which results in lumbosacral trunk compression.
Are postpartum maternal palsies more common with or without anesthesia of any kind?
More frequent without anesthetic.
What are the 7 complications that can occur with neuraxial blocks?
- Epidural hematoma
- Epidural abscess.
- Chemical nerve injury
- Needle trauma
- Positioning injury
- Post Dural Puncture Headache (PDPH).
- High or total spinal anesthesia.
T/F: Epidural hematoma can only occur with placement of the catheter and not removal?
False; can occur both periods of time so must be coagulating normally for placement and removal.
What is lowest acceptable platelet count for epidural placement?
100,000
Which parturients are safe to receive neuraxial blocks?
No hx of bleeding. No si/sx of PIH.
And no anticoagulation
If a parturient has PIH what is the lowest acceptable platelet and coags?
Platelets >100k and normal PT/PTT
Wait for neuraxial block for how many hours if therapeutically anticoagulated?
Prophylactically anticoagulated?
24hrs
12 hrs
What are 4 si/sx of epidural hematoma?
- Bilat leg weakness
- Incontinence
- Absent rectal sphincter tone
- Back pain
What is tx if suspected or confirmed epidural hematoma?
- Stat CT or MRI.
2. Surgical decompression within 6 hrs
If an epidural abscess/infection is present, how many days before symptoms?
4-10 days for pain and loss of function to occur
What is tx for epidural abscess?
- ABX
2. Laminectomy within 6-12 hrs of symptoms
What are the 5 symptoms of epidural abscess?
- Sever back pain worse with flexion
- Local tenderness
- Fever/malaise/meningitis-like H/A and neck stiffness
- Lab changes- WBC/ESR increase, + blood cx
- Progression of si/sx over hours to days
How is the epidural space so resistant to toxicity?
- Very vascular
2. Intact membrane between it and the SA space.
What drugs have been known to cause chemical nerve injury?
Thiopental, ephedrine, oxytocin, atropine, zantac, KCl,
What are si/sx of TNS (Transient Neurological SYmptoms)?
Pain and dysethesia in buttocks, legs, calves following SAB
What is most common cause of TNS?
High dose Lidocaine spinals and associated with lithotomy positioning.
Where is the conus of the spinal cord located?
T12-L3
Why should regional blocks not be done on sleeping patients?
Risk of needle trauma because they are unable to react to pain
What are two common compression injuries parturients are susceptible to?
- Common peroneal nerve
2. Femoral/obturator nerve
What typically causes common peroneal nerve compression?
Lithotomy stirrups
What two nerve injuries can cause postpartum foot drop?
- Common peroneal nerve
2. Brow compression of lumbosacral trunk
What will patient have difficulty doing if femoral nerve neuropathy?
Difficulty climbing stairs.
Where would patient experience dec sensation if obturator neuropathy?
Upper inner thigh, and week hip adduction.
