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AP III > OB (10/10) > Flashcards

OB (10/10) Flashcards

1
Q

complications of neuraxial analgesia

A
  1. inadequate
  2. unintentional dural puncture
  3. Respiratory depression
  4. intravascular injeciton
  5. high spinal
  6. extensive motor block
  7. prolonged block
  8. sensory changes
  9. back pain
  10. pelvic floor injury
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2
Q

epidural analgesia can prolong which stage of labor

A

2nd stage (pushing stage)

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3
Q

you performed a combined spinal epidural, you dosed the spinal when you placed but did not use the epidural. 1 hour later you come back to start the epidural, what is the first thing you do?

A

do another test dose

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4
Q

common dose of bupivicaine in epidural

A

0.0625-0.125 %

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5
Q

dose of bupivicaine in spinal

A

1.25-2.5 mg

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6
Q

dose of ropiv in epidural

A

0.08-0.2%

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7
Q

dose of ropiv in spinal

A

2.5-4.5 mg

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8
Q

dose of levobupiv in epidural

A

0.0625 - 0.125%

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9
Q

dose of levobupiv in spinal

A

2.5-4.5 mg

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10
Q

dose of lido in epidural

A

0.75-1%

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11
Q

dose of fentanyl in epidural

A

50-100 mcg

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12
Q

dose of fentanyl in spinal

A

15-25 mcg

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13
Q

dose of sufenta in epidural

A

5-10 mcg

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14
Q

dose of sufenta in spinal

A

1.5-5 mcg

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15
Q

dose of morphine in spinal

A

0.125-0.25 mg

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16
Q

common indications for C/S

A
  1. dystocia
  2. malpresentation
  3. non-reassuring fetus
  4. previous C/S
  5. maternal request
  6. OB discretion
  7. previa
  8. placental or uterine abruption
  9. active gential herpes
  10. multiple gestation
  11. prolapsed umbilical cord
  12. deteriorating maternal condition
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17
Q

TOLAC

A
  1. trial of labor after C-section
  2. someone trying to have vaginal delivery after C/S
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18
Q

VBAC

A

vaginal birth after C/S

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19
Q

ECV

A

external cephalic version (baby is breech)

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20
Q

C/S complications

A
  1. hemorrhage
  2. infections
  3. thromboemboli
  4. ureteral/bladder injury
  5. abdominal pain
  6. future uterine rupture
  7. death
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21
Q

_______________ C/S has a greater risk of maternal morbidity and severe maternal mortality rates

A

non-elective (emergent)

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22
Q

what are some ways a C/S can be prevented/avoided

A
  1. adequate labor epidural
  2. external cephalic version (rotating the bby)
  3. intrauterine resuscitation (optimize maternal position, O2, IVF/vasopressors, D/C pitocin, consider tocolytic)
  4. TLC from CRNA
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23
Q

T/F: well functioning labor epidural can still be used if have to convert to C/S

A

true

24
Q

mom has a CLE but is having to be converted to C/S, what should you do before dosing the CLE

A

check the level of your block

25
Q

aspiration prophylaxis for C/S

A
  1. bicitra/alka-seltzer (non particulate antacid)
  2. pepcid
  3. reglan
  4. prilosec (omeprazole)
26
Q

Abx for C/S

A
  1. 2 gms of ancef (<120 kg)
  2. 3 gm of ancef (> 120 kg)
27
Q

________________ is the preferred anesthesia for C/S

A

neuraxial

28
Q

what are the options for anesthesia during C/S

A
  1. labor epidural dosed for anesthetic block
  2. spinal block
  3. GA
29
Q

epidural doses of local anesthetics & opioids are _________x ____________ than spinal doses

A

5-10 higher

30
Q

T/F: there is more systemic absorption of local/opioids with epidural than spinal

A

true - d/t epidural spaces proximity to engorged venous plexus

31
Q

benefits of epidural for C/S

A
  1. already in place (was placed for labor epidural)
  2. slower onset –> less hotn
  3. more titration allowed for level, density, and duration
  4. quicker start to surgery
32
Q

what are the local anesthetics that are used in epidural during C/S

A
  1. 2% lido + 5 mcg/mL epi
  2. chloroprocaine 3%
  3. Bupiv 0.5%
  4. ropiv 0.5%
33
Q

what is the dose of 2% lidocaine + 5 mcg/mL of epi in epidural for C/S

A

300-500 mg

20 mL of this = 400 mg

34
Q

what is the duration of action of 2% lidocaine with 5 mcg/mL of epi used in epidural for C/S

A

75-100 min

35
Q

what is the dose of 3% chloroprocaine used in epidural for C/S

A

450-750 mg

in 20 mL = 600 mg

36
Q

what is the dose of 0.5% bupivicaine used in epidural for C/S

A

75-125 mg

37
Q

what is the dose of 0.5% ropiv used in epidural for C/S

A

75-125 mg

38
Q

what is the DOA of 3% chloroprocaine dose in epidural for C/S

A

40-50 min

**wears off fast!

39
Q

what is the DOA of 0.5% bupivicaine & 0.5% ropivicaine used in epidural for C/S

A

120-180

40
Q

what is the dose of fentanyl used in epidural for C/S

A

50-100 mcg

41
Q

what is the dose of sufenta used in epidural for C/S

A

10-20 mcg

42
Q

what is the dose of morphine used in epidural for C/ S

A

3-4 mg

43
Q

what is the dose of meperidine used in epidural for C/S

A

50-75 mg

44
Q

what is the DOA of fentanyl and sufenta in epidural for C/S

A

120 -240 min

45
Q

what is the DOA of morphine when dosed in epidural for C/S

A

720-1440 min

46
Q

what is the DOA of meperidine when dosed in epidural for C/S

A

240-720 min

47
Q

what other medications can you give when epidural is not sufficient for surgical pain during C/S

A
  1. N2O
  2. IV duramorph
  3. more LA
  4. propofol
  5. ketmaine
  6. precedex
  7. OK anesthesia (ondansetron and ketorolac)
  8. verbal reassurance

*if this still is not enough, you will have to convert to GA

48
Q

your pt is having to be sent back for emergency C/S, she has a CLE providing adequate analgesia to T10; what volume of anesthetic would be required to extend this level of block to the T4 level

A

10-20 mL of LA

49
Q

benefits of adding epi to LA

A
  1. minimizes systemic absorption
  2. increases density of sensory and motor block
  3. increases DOA of LA
50
Q

benefit of adding bicarb to LA

A

speeds onset and augments quality of block d/t more LA being in non-ionized state on injection

51
Q

common dose of bicarb added to LA

A

2 mEq

52
Q

baricity of LA = ______________/____________

A

density of LA / density of CSF

53
Q

LA movment within CSF is depdent on ____________ in relation to CSF at 37 C

A

specific gravity

54
Q

LA in dextrose = _______________baric

A

hyper

55
Q

LA in water = ____________baric

A

hypo

56
Q

LA in NS = ___________baric

A

iso

57
Q

spinal marcaine is always _____________baric

A

hyper (mixed in dextrose)

AP III (20 decks)

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