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Advanced Principles A (Spring 2024) > Labor Anesthesia & Analgesia Pt. 1 (Exam III) > Flashcards

Labor Anesthesia & Analgesia Pt. 1 (Exam III) Flashcards

1
Q

What does SROM stand for?

A

Spontaneous Rupture of Membranes

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2
Q

What does AROM stand for?

A

Artificial Rupture of Membranes

Also known as Amniotomy.

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3
Q

Is OA or OP preferred for delivery?

A

OA (Occiput Anterior)

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4
Q

How long will the first stage of labor last for a woman having her first baby?

A

If Primiparous, 8 - 12 hours typically.

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5
Q

How long will the first stage of labor last for a woman having already had a child before?

A

If Multiparous, 5 - 8 hours typically.

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6
Q

What are the two phases of the first stage of labor?

A
  • Latent Phase
  • Active Phase
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7
Q

What characterizes the Latent phase of labor?

A
  • Cervical Effacement
  • Minor (2-4cm) cervical dilation
  • Contractions q5-7 min w/ 30 sec duration
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8
Q

What characterizes the active phase of the first stage of labor?

A
  • Cervical dilation up to 10cm
  • Contractions q2-5min w/ 60sec duration
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9
Q

How long does the 2ⁿᵈ stage of labor last?

A

Typically 15 - 120 min

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10
Q

What characterizes the 2ⁿᵈ stage of labor?

A
  • Full (10cm) cervical dilation
  • Contractions q 2min w/ 60-90s duration
  • Fetal Descent
  • Ends with Delivery
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11
Q

What event characterizes the end of the 2ⁿᵈ stage of labor?

A

Fetal Delivery

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12
Q

The 2ⁿᵈ stage of labor is considered prolonged if it lasts more than….

A

3 - 4 hours

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13
Q

How long does the 3rd stage of labor last?

A

15 - 30 min

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14
Q

When does the 3rd stage of labor begin?

A

Begins after fetal delivery

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15
Q

The 3rd stage of labor is prolonged if it lasts more than ….

A

30 minutes

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16
Q

What marks the end of the 3rd stage of labor?

A

Delivery of the placenta

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17
Q

In what stage of labor is the highest risk of uterine atony and post-partum hemorrhage present?

A

4th stage

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18
Q

When does the 4th stage of labor occur?

A

1 hour post-partum

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19
Q

What causes pain via mechanoreceptor stimulation in the 1st stage of labor?

A

Stretching and distention of lower uterine segment and cervix

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20
Q

What causes the visceral pain associated with the 1st stage of labor?

A

C-fibers entering spinal cord at T10 - L1

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21
Q

What spinal levels are primarily affected during the latent phase of the 1st stage of labor?

A

T10 - T12

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22
Q

What spinal levels are primarily affected during the active phase of the 1st stage of labor?

A

T12 - L1

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23
Q

What type of pain becomes more predominant in the 2ⁿᵈ stage of labor?
What are the characteristics of this pain?

A

Somatic Pain
- Sharp, easily localized
- Caused by stretching & compression of pelvic/perineal structures

24
Q

What nerve fibers are responsible for the somatic pain characteristic of the 2ⁿᵈ stage of labor?

A

Aδ fibers of the pudendal nerve

25
Q

What spinal levels are relevant to the somatic pain associated with the 2ⁿᵈ stage of labor?

A

T12 - S4

26
Q

What inhaled anesthetic can a patient use to “self-anesthetize”?

A

N₂O

27
Q

What receptors does N₂O work on?

A
  • Inhibits: NMDA glutamate
  • Stimulates: dopaminergic, opioid, and αlpha
28
Q

How much does N₂O depress uterine contractility?

A

Trick question. It does not.

29
Q

Does N₂O causes neonatal depression?

A

No

30
Q

What nerve block is often used in conjunction with N₂O ?

A

Pudendal nerve block

31
Q

What are adverse effects associated with N₂O?

A

N/V, Dizziness, Paresthesias, Xerostomia

32
Q

Combination of N₂O and _______ can result in hypoxia, LOC changes, and loss of airway reflexes.

A

Opioids

33
Q

Volatile anesthetic agents will cause uterine smooth muscle ________ in a dose-dependent modality.

A

relaxation

34
Q

Preeclampsia and hypertension prevent this use of this drug.

A

Ketamine

35
Q

What is the obstetric dose of ketamine?

A

0.2 - 0.5 mg/kg

36
Q

What is the IV onset & duration of ketamine?

A

Onset: 30 seconds
Duration: 5-10 min

37
Q

What is the IM onset & duration of ketamine?

A

Onset: 2-8 min
Duration: 10 - 20 min

38
Q

What is the ketamine infusion loading dose and rate?

A

Loading: 0.2 mg/kg (over 30 min)
Infusion: 0.2 mg/kg/hr

39
Q

What are the neonatal consequences of benzodiazepines?

A
  • Neonatal respiratory depression
  • Neonatal hypotonicity
  • Neonatal impaired thermoregulation
40
Q

What is the IM dose of meperidine?

A

50 - 100mg IM q4hours

41
Q

What is the IV dose of Meperidine?

A

25 mg IV q2-4 hours

42
Q

What is the weight based dose of IV morphine?

A

0.05 - 0.1 mg/kg IV

43
Q

What is the weight based dosing of IM morphine?

A

0.1 - 0.2 mg/kg IM

44
Q

What is the active metabolite of morphine than can accumulate in the neonate?

A

Morphine-6-glucuronide

45
Q

What is the PCA dosing of remifentanil?

A

20 - 40mcg (lockout of 2-3 min)

46
Q

What is the IV/IM dose of butorphanol?

A

1-2mg IV/IM q3-4 hours

47
Q

What is the dose of nalbuphine?

A

5 - 20 mg IV/IM/SQ

48
Q

What opioid can result in significant fetal bradycardia?

A

Nalbuphine

49
Q

Why is toradol typically not used in labor?

A
  • Suppresses uterine contractions
  • Premature constriction of DA
  • Inhibits PLT aggregation
50
Q

What nerve block is typically provided by the OBGYN during the 1st stage of labor?

A

Paracervical Block

51
Q

What are the two fetal complications that can occur with paracervical block?

A

Fetal LAST (more severe)
Fetal Bradycardia (more common)

52
Q

What nerve block is an alternative to pharmacologic pain management in the 2ⁿᵈ stage of labor?

A

Pudendal nerve block

53
Q

What form of anesthesia covers both 1st and 2ⁿᵈ stage of labor?

A

Neuraxial

54
Q

Epidural veins are decompressed in what position?

A

Lateral lying

Harder to place.

55
Q

What is there an increase for cephalad spread of neuraxial LA in pregnant patients?

A

Due to apex of thoracic curvature shifting from T8 to T6.

Also from epidural vein engorgement.

56
Q

What are absolute contraindications to neuraxial anesthesia?

A
  • Refusal
  • Uncooperative patient
  • Uncontrolled hemorrhage w/ ↓volume
  • Epidural site infection
  • Bleeding issues/disorder
  • Anticoagulated
57
Q

What are the risks associated with epidural placement that is too early in labor?

A
  • ↑ risk for instrumented delivery
  • Prolonged 2ⁿᵈ stage of labor
  • Risk of ineffective epidural and need for replacement

Advanced Principles A (Spring 2024) (11 decks)

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