Epidural Anesthesia & Analgesia Flashcards
What provides the most effective labor pain relief?
epidural
What are absolute contraindications to epidural anesthesia?
1) pt refusal
2) inability to cooperate
3) skin or soft tissue infection at site of needle placement
4) frank coagulopathy
5) untreated sepsis
6) maternal hemodynamic instability
What are the most common side effects of epidural anesthesia?
1) postdural puncture headache - occurs s/p accidental dural puncture
2) back pain
w/ local anesthetic:
3) hypotension (SBP <100mmHg) –> FHR decels common 10-20 mins after placement
4) urinary retention
5) leg numbness/weakness
6) bladder distension
7) maternal fever >100.4
What s/sx indicate accidental intrathecal placement –> toxicity?
- rapid spread of anesthesia to head
- profound hypotension
- respiratory depression
- loss of consciousness
What s/sx indicate accidental intravascular placement –> toxicity?
- tinnitus
- dizziness
- metallic taste in mouth
- disorientation
- seizures
- cardiac dysrhythmias
- cardiac arrest
How does an epidural work?
blocks impulses traveling in sensory and motor nerves in epidural space
What anesthetic medications are most commonly used in epidural anesthesia?
1) bupivacaine (Marcaine)
2) ropivacaine (Naropin)
can add morphine or fentanyl to potentiate effect and allow for smaller doses
What drug prolongs the duration of epidural anethesia?
epinephrine
true or false:
Epidurals are associated with an increased rate of C-sections.
false
true or false:
Epidural anesthesia is associated with operative vaginal delivery
true
What is the effect of epidural anesthesia on labor progression?
debatable!
What is the effect of epidural anesthesia on the fetus?
can cross into fetal circulation BUT adverse neonatal outcomes not identified as significant
