OB: Anesthetic Complications in OB Flashcards by Linsley Lloyd

Q

Anesthetic Complications in OB

A

Nausea and vomiting
Postdural puncture headache
Accidental intravascular injection
Accidental subarachnoid injection
Accidental subdural injection
EKG changes during regional anesthesia
CPR in the pregnant patient

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Q

Nausea and Vomiting

Regulated by the _______________________ zone and the ___________ center which are located in the area postrema and the medullary lateral reticular formation respectively.

A

chemoreceptor trigger
vomiting

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Q

Nausea and Vomiting

Nausea and vomiting may occur _____ or in _____ and are not uncommon in pregnancy.

A

separately or in combination

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Q

Nausea and Vomiting

Multiple causes have been implicated including:

A

HCG
Estrogen
Progesterone
Prostaglandins
Immune system dysregulation

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Q

Hyperemesis gravadarum - When vomiting is sufficiently severe to produce:

A

Weight loss
Dehydration
Acidosis from starvation
Alkalosis from loss hydrochloric acid vomitus
Hypokalemia

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Q

Intraoperative Nausea and Vomiting

_____ in incidence and presentation

A

Varies

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Q

Intraoperative Nausea and Vomiting

Incidence may be up to ____%

A

80

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Q

Intraoperative Nausea and Vomiting

Anesthetic causes of vomiting are ______________ and increased ___________ activity

A

hypotension
vagal

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Q

Intraoperative Nausea and Vomiting

Non-anesthetic causes include:

A

Surgical stimuli
Bleeding
Medications (uterotonic agents, antibiotics)
Motion at end of surgery

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Q

Intraoperative Nausea and Vomiting

Many of these elements occur ______

A

simultaneously

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Q

Nausea and Vomiting due to Hypotension

______ is among the most common sequelae associated with neuraxial analgesia

A

Hypotension

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Q

Nausea and Vomiting due to Hypotension

Centrally, hypotension may lead to _____ & _____ _____

A

cerebral and brainstem hypoperfusion

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Q

Nausea and Vomiting due to Hypotension

Peripherally, hypotension may cause ____ _____ with release of emetogenic substances from the intestine

A

gut ischemia

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Q

Nausea and Vomiting due to Hypotension

Strict maintenance of ______ _____ _____ can reduce the occurrence of emesis

A

intraoperative blood pressure

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Q

Oxytocin causes N/V due to hypotension from release of _____ _____ and _____ _____ _____

A

nitric oxide and atrial naturetic peptide

20% incidence of nausea, 10% incidence of vomiting after 5 u IVP

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Q

_____ ______ - (methergine) interacts with the dopaminergic and serotonergic receptors

A

ergot alkaloids

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Q

Hemabate causes nausea through the stimulation of _____ _____ of the ____ ____

A

smooth muscles
GI tract

10% incidence of nausea and vomiting after 250 mcg IM

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Q

N/V due to visceral pain pain from (3)

A

Exteriorization of uterus
Intraabdominal manipulation
Peritoneal traction

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Q

____ _____ > activation of vomiting center

Study These Flashcards

A

Vagal fibers

Q

general anesthesia-related factors:

Study These Flashcards

A

female
hx of motion sickness or postop N/V
nonsmoking status
use of periop opioids

Q

spinal anesthesia-related factors

Study These Flashcards

A

block height of T5 or higher
hx of motion sickness
hypotension
omission of neuraxial opioids

Q

Prophylaxis and Treatment of Nausea and Vomiting

Metoclopramide (Reglan) - _____ mg IV given ____ surgery or _____ cord clamping

Side effects: dizziness, drowsiness, fatigue. Rarely _____ and _____ _____

Can be given postpartum to increase milk production

Study These Flashcards

A

10
before
after
EPS and acute dystonia

Q

Prophylaxis and Treatment of Nausea and Vomiting

Ondansetron - ____ mg IV given after cord clamping.
Some studies show ______ risk of hypotension after spinal if Zofran given prior to block

Area for further future study: epidural Zofran?

Study These Flashcards

A

4
decreased

Q

Prophylaxis and Treatment of Nausea and Vomiting

Dexamethasone ___-___ mg IV, timing unclear, _____ _____ used for c-section patients

Study These Flashcards

A

4-8
not regularly

Prophylaxis and Treatment of Nausea and Vomiting Scopolamine - ____ mg transdermal patch after cord clamping. Can have ______ effects on breastfeeding

1.5 detrimental

Alternative therapies

Accupressure? Supplemental O2?

Postpartum headache is the complaint of _____, _____ or _____ pain occurring during the first 6 weeks after delivery.

cephalic, neck, or shoulder

Postdural Puncture headache Loss of CSF from within the dura and arachnoid membrane Approximately ____ mL of CSF is present at a time Approximately ____ mL is produced and reabsorbed every day

150 500

Postdural Puncture headache _____ puncture > beveled spinal needle > ____ ____ spinal needle

Touhy pencil point

Postdural Puncture headache Dural fibers run _____ to ______ Implication for needle orientation

cephalad to caudad

PDPH: Clinical Appearance - Relieved by lying down - Returns on sitting up or standing - Fronto-occipital, may be associated with ____/_____ stiffness - _____phobia - Less common: double vision, temporary deafness - Onset is not usually immediate, may take ___-___ ____

neck/shoulder Photo 1-2 days

PDPH Treatment Conservative –

bedrest, oral or IV fluids, OTC analgesics

PDPH Treatment Caffeine – _____ mg 90% of PDPH patients reported “significant improvement”

300 12oz RedBull contains 111 mg of caffeine 16oz can of Monster contains 160 mg of caffeine

PDPH Treatment ______ ______ block

Sphenopalatine ganglion

PDPH Treatment Most effective (and invasive):

epidural blood patch

Liberal hydration doesn’t increase ____ _____, but dehydration does decrease

CSF production

_____ causes cerebral vasoconstriction

Caffeine

ECG Changes are ____ during routine c-section

common

Some correlation with ____ ____ and complaints of chest pain, pressure, nausea, vomiting or dyspnea

ECG changes

Few ST changes during regional anesthesia for cesarean delivery in healthy women are caused by _____ ______

myocardial ischemia

CPR in the pregnant Patient Fetus does not tolerate decreases in maternal _____ or _____ ____ well

oxygenation or blood pressure

CPR in the pregnant Patient Mother has high O2 _____ and low O2 _____ (residual volume)

demand reserves

CPR in the pregnant Patient Aortocaval compression – ____ _____ _____ is necessary to success

left uterine displacement

CPR in the pregnant Patient Tilt decreases the ____ of ______

force of compressions

CPR in the pregnant Patient Compressions should be _______ higher on the sternum

1-2 cm

CPR in the pregnant Patient If patient has a neuraxial block substantially larger doses of ______ may be needed

vasopressors

CPR in the pregnant Patient If a near-term parturient does not respond to resuscitative measures in 5 minutes emergent c-section is _______ _____ ______ to neonate Relief of ______ compression for mom

recommended Direct oxygenation aortocaval